Efficacy of varicose vein surgery with preservation of the great safenous vein

Abstract

OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001) and reduction in the diameter of the great saphenous vein (p <0.001). There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001). CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review

“…Seven studies observed the relationship between truncal venous diameter and CEAP classification, 9e12,19,20 while four described its relationship to VCSS. 9,20,22,23 CEAP classification Consistently, all studies reported a positive correlation between truncal venous diameters and CEAP clinical class. Studies showed that GSV diameters increased with clinical class.…”

“…In a very small cohort of 22 limbs, Barros et al also described a directly proportional relationship between these two parameters, but did not report specific statistical values. 22 Additionally, Mendoza et al were able to show significant correlations between every single component of the VCSS and GSV diameter at both the saphenofemoral junction and proximal thigh. 20…”

“…Nine were cross sectional studies, 9e12,19e21,23,25 one was a prospective cohort study, 25 and one was a pre-post study. 22 These studies recruited a total of 2,732 limbs presenting with a distribution of CVD severity (Table 1). Eight studies assessed only GSV diameters, 10,17e23 while three measured both GSV and SSV diameters.…”

“…Eight studies assessed only GSV diameters, 10,17e23 while three measured both GSV and SSV diameters. 9,11,12 Maximum diameters were recorded in five studies, 9,12,22,23,25 while the remaining six measured diameters at specific locations along the vein's length. 10,11,19e21,24 Four studies observed the relationship between truncal venous diameters and both HRQoL and clinical severity scores (n limbs ¼ 900), 9,23e25 while seven only reported on clinical severity (number of limbs ¼ 1,687).…”

Caracterização de pacientes com úlcera venosa assistidos em ambulatório de estomaterapia de hospital público

“…It revealed that surgeries were performed essentially in cases of isolated superficial venous insufficiency (53.1%) 8 . Surgical treatment, such as radical saphenectomy in patients with alterations in this vein, has an increasingly limited indication, considering its importance as a vascular substitute for several beds of the circulatory system 15 .…”