Great saphenous varicose vein surgery without saphenofemoral junction disconnection

In this paper we present our endovascular LASER treatment of mixed shunts. This technique is built according the CHIVA's important principles: diastolic reflux is interrupts at its proximal origin by flush LASER obliteration while centripetal systolic reflux is preserved. In this way, the surgeon interrupts a recirculation pressure loop producing the ambulatory venous hypertension critical to the development of varicose vein symptoms. In this paper we explain how to better understand the intricate venous drainage pathophysiology of mixed shunt and the strategy to approach it using an office-based technique. With the correct strategy and the technological support it is possible to achieve a good functional and aesthetic result to prevent varicosity recurrence.

Section: Case Reportmentioning

confidence: 57%

“…Because after the digit compression of the leg varicose tributary (reflux elimination test) 4 the reflux in the GSV was still present, our strategy was to perform a laser fragmentation of the hydrostatic column below the re-entry of the Giacomini into the GSV, while maintaining the upper outflow point of the OBS.…”

Section: Case Reportmentioning

confidence: 99%

Endovascular laser treatment of mixed shunt

Cavallini

2017

“…1,3,6,7,12 Advances in duplex-Doppler ultrasonography have contributed to CVVI understanding, diagnosis, treatment and followup. 2,[8][9][13][14][15][16][17][18][19][20][22][23][24] International consensuses occurred to minimize confusion in past phlebologic literature. 1,5,10 Description of patient populations studied improved but studies of even more specific sample populations, based on gender for example, 25 should be promoted.…”

Section: Discussionmentioning

confidence: 99%

“…Determination of terminal valve patency is significant to design type of treatment. 23 Brazilian custom is to treat telangiectasias and small reticular veins with 75% dextrose liquid sclerosant. Modern tendency includes foam sclerotherapy with polydocanol for relatively larger veins.…”

Section: Discussionmentioning

confidence: 99%

Associations of anterior accessory or thigh posterior tributary and great saphenous reflux patterns in early stages of chronic venous valvular insufficiency

Engelhorn

Salles-Cunha³

et al. 2014

Varicose veins are a common disorder. Extensive ultrasound (US) mapping of lower extremity chronic venous valvular insufficiency includes the great saphenous vein (GSV), anterior accessory saphenous vein (AASV) and thigh posterior tributary to GSV such as the posterior accessory saphenous vein (PTSV, PASV).The aim of this study was to determine associations between GSV-AASV-PTSV (including PASV) reflux in a specific sample population of Southern Brazilian women, mostly euro descendents, with telangiectasias, reticular veins, varices and/or intermittent edema.US performed in 1016 extremities of 513 women, 43±18 (18-81) years old were included. Women with previous venous thrombosis, surgery, suspicion of pelvic congestion syndrome, and men were excluded. Small saphenous vein and related thigh veins were excluded from analysis. GSV-AASV-PTSV reflux patterns were analyzed; prevalence was compared using χ 2 statistics. Reflux prevalence in AASV and/or thigh PTSV was 5.8% (59/1016): 1.3% at PTSV (n=13) and 4.5% at AASV (n=46), significantly lower than GSV reflux: 72% (n=727) (P<0

“…74 In particular, it became clear that GSV reflux is not always associated to SFJ incompetence; 75 79 ). In this instance junction dissection and high ligation is useless 80 and even harmful, the source of reflux coming from a perforator or tributaries.…”

Section: The Duplex Adventmentioning

confidence: 99%

The sapheno femoral junction involvement in the treatment of varicose veins disease

Ricci¹

2017

Sapheno femoral junction (SFJ) incompetence has been considered the most important cause of chronic venous insufficiency in a high percent of cases since the beginning of history varicose veins treatment. As a consequence SFJ dissection, ligation and section has been practiced all along the last century, generally associated to great saphenous vein stripping, with the porpoise of stopping the effect of hydrostatic pressure considered the origin of varicose veins. Recurrence prevalence at the site of SFJ, even in correctly performed dissection suggests that this attitude may not be the ideal one. Moreover, with the introduction of catheter-based systems of endovenous heating of the great saphenous vein with radiofrequency or endovenous laser ablation, it was shown that venous ablation could be achieved without high ligation of the SFJ. Also foam sclerotherapy demonstrated good results, even if less effective, always leaving the SFJ untouched. Following this trend several methods have been suggested that spare the SFJ, so that this site have lost its strategical importance. In this review history of the SFJ involvement in the varicose vein strategy is analyzed with particular attention to the new generation methods, technology assisted, launched on the market.