Long-term effects of superficial femoral vein ligation: Thirteen-year follow-up

Abstract

This study examines the late clinical, hemodynamic, and anatomic results of superficial femoral vein ligation performed in 35 extremities that were followed an average of 13 1/2 years (range, 5 to 22 years). Indications for interruption were to prevent recurrent embolization from distal deep venous thrombosis (14 cases), to prevent emboli in patients with contraindication to anticoagulants (eight cases), to prevent distal reflux in selected patients undergoing iliofemoral thrombectomy (11 cases), and to control reflux in failed venous reconstruction (two cases). Ligation was effective in the prevention of pulmonary emboli as indicated by no significant clinical events and 15 negative postligation ventilation-perfusion scans. Long-term clinical follow-up showed normal (class 0) or near-normal (class 1) extremities in 83%. Fourteen percent developed mild to moderate symptoms of pain or swelling but without ulceration (class 2), and only one case (3%) had ulcerative sequelae (class 3). The only two findings that correlated with worse clinical outcome were the presence of an incompetent profunda femoris or an obstructed greater saphenous vein. Profunda femoris reflux was found in 60% (3/5) of patients with class 2 or 3 sequelae, which was significantly higher than the 14% (3/22) found in those patients with class 0 or 1 results (p < 0.05). Obstruction of the greater saphenous vein was found in 50% of those patients with class 2 or 3 results as opposed to 9% with class 0 or 1 results (p = 0.05). A large collateral vessel between the profunda femoris and the distal superficial femoral or popliteal vein was associated with poor long-term results.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…Several case reports support ligation of the femoral vein as a method of eliminating physiologically significant reflux of the femoral vein when the collateral pathways of both great saphenous and deep femoral veins are patent and competent. [374][375][376][377] Several techniques are used to fashion an incompetent valve into a competent valve. External banding refers to a synthetic sleeve placed around the circumference of a valve to reduce the vein circumference and to produce a competent valve.…”

“…363,[391][392][393][397][398][399] Among these are comparable studies performed independently by experienced venous reconstructive surgeons who report a consistent range of successful results with longterm follow-up at 1, 5, and 7 years. 363,376,378 Venous valve transposition requires that a competent valve, or one that can be made competent, be placed above the site where the incompetent venous systems are implanted into the axial vein. One example would be the presence of a competent valve in the proximal deep femoral vein, below which the incompetent femoral vein can be implanted to result in a then competent femoral venous system.…”

“…In the select cohort of patients who are amenable to this intervention, a 40% to 50% competency rate with similar freedom from ulcer recurrence has been reported in a number of case series reports at 5 years of follow-up (Table XI). 376,391,395,[399][400][401][402][403][404][405] Venous valve transplantation involves harvesting of a competent segment of vein that contains a competent valve from another extremity and implanting it into the femoral or popliteal position to provide a functioning valve in the affected extremity. Adjunctive use of endophlebectomy and the need for an arteriovenous fistula to increase flow through the reconstruction sites are additional considerations.…”

Relative importance of iliac vein obstruction in patients with post-thrombotic femoral vein occlusion

“…[16][17][18] Furthermore, excellent collateralization through the profunda femoris vein is the rule in femoral vein CTO lesions, whereas iliac vein collateralization is typically less efficient. [19][20][21] The profunda femoris vein is the embryologic axial vein, with the femoral vein replacing it in later development. The connection between the two at the popliteal vein level persists in adulthood as a putative collateral connection, explaining the rapid evolution of the alternative profunda pathway in case of femoral vein occlusion.…”

Technik und Morbidität der Entnahme der V. femoralis superficialis

“…Im Falle einer offenen V. profunda femoris wurde dies nur in 14 % der Fälle beschrieben [54]. Allerdings wurde über eine hohe Rate an venöser Stauung berichtet, wenn die V. femoralis communis mitbetroffen war Abb.…”