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

Abstract

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.