Randomised Trial of Flush Saphenofemoral Ligation for Primary Great Saphenous Varicose Veins

Winterborn, Rebecca; Foy, Chris; Heather, B. P.; Earnshaw, J. J.

doi:10.1016/j.ejvs.2008.06.022

Cited by 39 publications

(15 citation statements)

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“…Success rate was 97.2 % at a median follow up period of one year. Many papers have described particular problems in the management of varicose veins out of which neovascularization is a common problem and leading cause of poor outcome in surgically treated patients for recurrent varices [4]. Most common immediate complication noticed in this study was extravasation of foam during injection (4.1%), which is similar to other studies [5].…”

Section: Discussionsupporting

confidence: 86%

Outcome of ultrasound guided foam sclerotherapy (UGFS) treatment for varicose veins: A four years retrospective study at a tertiary care hospital in north India

et al. 2016

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Objective:The purpose of this study was to determine the outcome and rate of recurrence for varicose veins treated with ultrasound-guided foam sclerotherapy (UGFS). Methods: Data was collected from hospital records. Patients treated with UGFS for superficial venous insufficiency were included in the study. Total 361 legs in 241 patients, out of which 121 patients with unilateral limbs and 120 patients with bilateral limbs were found to be treated by this method. Results: Out of these 361 legs great saphenous vein (GSV) varicosity was found in 88 legs, short saphenous vein (SSV) in 76, GSV & SSV both in 63, others 134. 264 legs with primary varicosity while 97 were with recurrent. In 294 legs clinical CEAP was 2-3 while in 67 legs it was 4-6. Saphenofemoral junction (SFJ) incompetence was found 60 legs, saphenopopliteal junction (SPJ) incompetence in 68, only perforator's incompetence was in 56, SFJ with perforator's incompetence 61, SPJ with perforator's 29 and no incompetence was noted in 87 legs.Outcome at 6 months was 96.23% while treatment failure and recurrences were noted in 2.77 % of legs. Complications which were noted at 1 week were superficial skin necrosis in 3.04%, pain at injection sites in 15.23%, superficial thrombophlebitis in 16.62%, bruising in 12.18%, skin staining in 11.08%, superficial vein thrombosis (SVT) in 9.97% while no DVT was noted in any of the treated legs. Conclusion: On conclusion it was found that UGFS is a popular office based treatment modality, safe, effective, easy and improvement in venous signs and symptoms. Even on recurrence patients easily accepts retreatment with this method. Furthermore it is associated with lesser pain, anesthesia requirements; time off work and driving gives it additional advantages.

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Section: Discussionsupporting

confidence: 86%

Outcome of ultrasound guided foam sclerotherapy (UGFS) treatment for varicose veins: A four years retrospective study at a tertiary care hospital in north India

et al. 2016

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“…No difference was shown in rates of clinical recurrence or neovascularization at two years. 14 A further non-randomized study comparing standard SFJ ligation with resection of the great saphenous stump and oversewing also demonstrated no reduction of clinical recurrence or neovascularization. 15 Frings and co-workers’ 16 randomized study, however, did show a reduction at two years in groin neoreflux in the two groups where endothelial closure was undertaken.…”

Section: Sfj Ligationmentioning

confidence: 94%

Standard varicose vein surgery

Perkins

2009

Phlebology

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This article examines the practice of standard varicose vein surgery including sapheno-femoral and sapheno-popliteal ligation, perforator surgery and surgery for recurrent varicose veins. The technique of exposure of the sapheno-femoral junction and the sapheno-popliteal junction is outlined and advice given on avoidance of complications for both. The evidence regarding methods of closure over the ligated sapheno-femoral junction is examined as is the requirement for stripping and the use of different types of stripper. The requirement to strip the small saphenous vein and the extent of dissection necessary in the popliteal fossa is also examined. Complications of standard varicose vein surgery are outlined. The frequency of wound infection, nerve injury, vascular injury and venous thromboembolism are listed and strategies to avoid these complications are examined.

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“…Standard-high-Ligation (SHL) unterschied sich nicht von Flushhigh-Ligation (FHL) im Auftreten von Rezidiven (33 % versus 32 %; p = 0,9) und von Neovaskularisation (22 % versus 19 %; p = 0,57) [31]. die Ergebnisse bei Rezidiv, Reflux, Neovaskularisation und Seitenästen unterscheiden sich nicht [9].…”

Section: Ergebnisse Der Chirurgischen Behandlungunclassified

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

2020

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The results of studies on treatment of the great saphenous vein (GSV) with sapheno-femoral-junction (SFJ) insufficiency are unclear. Guidelines, however, recommend endovenous laser ablation (EVLA) and ultrasound-guided-foamsclerotherapy (UGFS) for symptomatic varicose large saphenous vein. There are numerous studies on GSV treatment but only a few randomized studies with a follow-up of two years and more. Meta-analyses in most instances included all studies and do not focus on studies with a follow-up of two years and longer. Methods A literature research in Pubmed used the keyword “great saphenous vein treatment”, “large saphenous vein treatment”, “varicose therapy” in conjunction with “randomized controlled trial”, “meta-analysis” and “systematic review”. Of 128 studies only 24 randomized controlled studies investigated the effect of High Ligation and Continuous Stripping (HL + CS), Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA), Liquid Sclerotherapy (LS), and Ultrasound-Guided-Foam-Sclerotherapy (UGFS) and a follow-up of two and more years. Study evaluation included “reflux”, “recurrence”, “therapy technique”, numbers of patients/legs treated, length of follow-up, and primary/secondary study endpoints. Results Most of these studies investigated surgical High Ligation and Continuous Stripping (HL + CS) with a follow-up of two years and more. This technique served a reference technique for other techniques in randomized controlled studies. However, there are major differences in techniques, mode of treatment, definitions, criteria for exclusion and inclusion, and study endpoints.The surgery study group included 1915 legs in 19 studies, the EVLA group 1047 legs in 12 studies and 240 legs in 3 studies with combined HL + EVLA treatment. RFA was used in 299 legs in 4 studies, UGFS in 661 legs in 5 studies, combined UGFS + HL in 39 legs and LS + HL in 92 legs in one study each.EVLA is associated with more reflux and recurrence when compared to HL + CS. RFA shows similar reflux and recurrence rates as surgery. In most studies UGFS and LS is followed by more reflux and recurrence when compared to surgery. Conclusion Due to heterogeneity of studies comparing study results of HL + CS, EVLA, RFA, LS and UGFS is not reliable. UIP or ECOP may form a commission to establish uniform, reliable and accepted study designs for varicose vein treatment to improve comparability of further randomized studies.

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Randomised Trial of Flush Saphenofemoral Ligation for Primary Great Saphenous Varicose Veins

Cited by 39 publications

References 23 publications

Outcome of ultrasound guided foam sclerotherapy (UGFS) treatment for varicose veins: A four years retrospective study at a tertiary care hospital in north India

Outcome of ultrasound guided foam sclerotherapy (UGFS) treatment for varicose veins: A four years retrospective study at a tertiary care hospital in north India

Standard varicose vein surgery

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

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