2019 Volume 30 Issue 3 Pages 259-265
Background: As a standard treatment for the varicose vein of the great saphenous vein (GSV) type, endovenous ablation (EVA) is the main approach. However, as a background to this, in the Europe and the United States, neovascularization (Neo) after the high ligation (HL) of the sapheno-femoral junction (SFJ) at the time of GSV stripping has been emphasized as one of the reasons for the high recurrence rate. On the other hand, almost no similar mid- or long-term results of GSV stripping have been reported from Japan.
Patients and Methods: From September 2011 to March 2014 when EVA was not my surgical option, 413 consecutive legs underwent GSV stripping by the author using the same procedure and were contacted by phone five years later and investigated about recurrence (REVAS) and reoperation (REDO), and 270 legs of the legs of the 391 living cases (69%) underwent venous ultrasonography (VUS). HL of SFJ was performed by central flash ligation with pulling out tow of peripheral side branches containing accessory saphenous veins. In principle, GSV stripping was conducted by means of invagination method in range of the entire reflux region from the HL cut section to the confluent section of the side branch causing the side branch varices. The range of stripping was to the upper thigh in 3 legs, to the middle thigh in 3 legs, to the lower thigh in 7 legs, to the knee in 46 legs, to the upper calve in 83 legs, to the middle calve in 52 legs, and over the full length in 76 legs. Stab avulsion was performed as much as possible for side branch varices. On VUS, the SFJ’s stump of GSV, the presence of side branch remnants and their reflux, the presence or absence of Neo, and recurrent lesions in other sites were evaluated. REVAS was classified as follows: Level 1, symptomatic recurrent lesion for which surgery is indicated; Level 2, asymptomatic recurrent lesion possibly requiring future surgery; Level 3, asymptomatic recurrent lesion that are unlikely to require future surgery.
Results: Of 391 legs of patients who could be contacted, REDO was performed in 23 legs (6%), including 15 limbs immediately after this investigation, and symptomatic REVAS was observed in 29 legs (7%). In 270 legs examined by VUS, REVAS legion was diagnosed as follows: 29 legs with Level 1 legion; 40 legs with Level 2 lesion; and 27 legs with Level 3 lesion. Level 1 REVAS caused at the SFJ was limited to only 3 legs (1.1%) whereas Level 1 REVAS from incompetent perforating veins (IPVs) was seen in 14 legs (5%), and Level 1 solitary tributary varices were seen in 9 legs (3%).
Conclusion: In this study, REVAS from SFJ was considerably less than in past reports. Instead, it was shown that REVAS due to IPVs or solitary tributary varices was more important.
