Limitations of Subfascial Ligation for Refractory Chronic Venous Stasis Ulceration

Robison, Jacob G.; Elliott, Bruce M.; Kaplan, Adam J.

doi:10.1007/bf02000660

Cited by 17 publications

(7 citation statements)

References 27 publications

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“…If the perforator veins are incompetent, a subfascial ligation of these veins will abolish reflux. The long-term results with this procedure have been moderately successful [18]. A good result can be expected in most patients, but recurrent ulceration has occurred in about a quarter of these patients [1,11].…”

Section: Discussionmentioning

confidence: 96%

Management of varicose veins from chronic venous insufficiency

Chang

Stein

2011

Int J Angiol

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Chronic venous insufficiency is a progressive disease, which may require surgical intervention to prevent complications. This study was done to determine the usefulness of a high ligation with sclerotherapy to prevent the return of symptoms. Duplex scanning was used to locate incompetent veins. There was no evidence of incompetent perforating or deep veins in the 322 patients who had 483 high ligations of the greater saphenous vein. Multiple phlebectomies and limited vein stripping were done for large (>20 mm) varicose veins. The clinical, etiologic, anatomic and pathophysiologic (CEAP) score evaluated the severity of venous dysfunctions. Symptoms of leg aches, ankle edema, night cramps or ulceration were evaluated after 1-3 months, and then at 6-12 month intervals. Sclerotherapy of the saphenous vein, using a sodium tetradecyl sulfate solution from 0.1-3.0%, was done if there was no significant improvement of a non-healing ulcer or the recurrence of symptoms. Compression hose, 30-40 mm Hg, was prescribed unless contraindicated by arterial occlusive disease, acute deep vein thrombosis or severe congestive heart disease. After the high ligation, symptoms improved in 212 limbs, were unchanged in 187 limbs and became worse in 84 limbs. After sclerotherapy in 264 limbs, 237 limbs improved, 21 remained unchanged and six became worse. Patients who have varicose veins from superficial venous incompetence can achieve a good long-term outcome with the high ligation procedure. However, it is important to control venous reflux and the related symptoms with sclerotherapy as needed.

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Section: Discussionmentioning

confidence: 96%

Management of varicose veins from chronic venous insufficiency

Chang

Stein

2011

Int J Angiol

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“…This has been particularly true with ulcer patients who presented with post-thrombotic syndrome as their underlying factor. [31][32][33][34] Preliminary results with the use of sclerotherapy under ultrasound guidance are promising and this may one day supplant SEPS as the procedure of choice for local control of perforator incompetence.…”

Section: Endovenous Vein Obliterationmentioning

confidence: 99%

Varicose Vein Surgery

Ombrellino¹,

Kabnick²

2005

Semin intervent Radiol

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The treatment of superficial venous disease and chronic venous insufficiency continues to evolve, and the interest in venous disease has matched that in arterial disease in vascular medicine. A better understanding of venous anatomy and pathophysiology and the development of newer, more efficient diagnostic technology have allowed clinicians to utilize minimally invasive techniques in the treatment of varicose veins. These techniques have reduced recurrence and improved overall quality of life (postoperative pain and bruising) following these procedures. This article provides an overview of basic venous surgical anatomy and pathophysiology, along with several older and newer surgical options in the treatment of superficial venous disease. Advantages and disadvantages of each approach are briefly discussed so that the reader may gain better understanding of the options available in the treatment of chronic venous insufficiency.

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“…If the perforator veins become incompetent, a subfascial ligation of these veins will abolish reflux, but recurrent ulceration has occurred in some patients. 15…”

Section: Discussionmentioning

confidence: 99%

Management of Varicose Veins by High Ligation, Sclerotherapy and Duplex Scanning

Chang

Stein

2006

Journal for Vascular Ultrasound

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Background Venous duplex scanning helps in the management of patients after high ligation of the greater saphenous vein and spares it for future vascular reconstructions. Methods Duplex scanning was used to locate incompetent veins in these patients. The clinical, etiologic, anatomic, and pathophysiologic (i.e., CEAP) criteria classified the clinical severity of disease. High ligations of the greater saphenous vein at the saphenofemoral junction were performed in 1,021 limbs of 608 patients who only had chronic superficial venous insufficiency. Unless contraindicated, the use of 30–40 mmHg compression hose was prescribed. The progression of venous disease was determined by examination, history, and duplex scanning at 1- to 3-month and 6- to 12-month intervals. Ulceration, ankle edema, night cramps, stasis changes, cellulitis, varicose veins, and reflux were recorded. If there was a nonhealing ulcer, no significant improvement, or a recurrence of symptoms, then residual varicose veins were injected with a sodium tetradecyl sulfate solution to sclerose incompetent veins. At follow-up times, limbs were classified as improved, stable, or worse. Results After the high ligation, symptoms were improved in 449 limbs (44%), stable in 398 limbs (39%), and worse in 174 limbs (17%). After sclerotherapy of 572 limbs, 517 limbs (90%) improved. Ulcers occurred in 14 limbs. Edema occurred in 33 limbs, cellulitis developed in 15 limbs, and night cramps occurred in 12 limbs. If varicose veins persisted, they were managed by sclerotherapy, and 60% of the sclerotherapy-treated limbs were free of symptoms or varicosities at 8 years. Conclusion High ligation at the saphenofemoral junction is a valuable procedure in select patients to preserve the greater saphenous vein. Periodic venous duplex scanning is needed to properly manage these patients.

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Limitations of Subfascial Ligation for Refractory Chronic Venous Stasis Ulceration

Cited by 17 publications

References 27 publications

Management of varicose veins from chronic venous insufficiency

Management of varicose veins from chronic venous insufficiency

Varicose Vein Surgery

Management of Varicose Veins by High Ligation, Sclerotherapy and Duplex Scanning

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