Randomised Trial of Polytetrafluoroethylene Patch Insertion for Recurrent Great Saphenous Varicose Veins

Winterborn, Rebecca; Earnshaw, J. J.

doi:10.1016/j.ejvs.2007.03.019

Cited by 35 publications

(21 citation statements)

References 24 publications

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“…Neovascularization, that is, formation of new venous channels after surgical closure of refluxing SFJ, was considered to be the most significant cause of recurrent varicose veins, and the surgical procedure itself has been blamed to trigger neovascularization. [23][24][25] Attempts to prevent recurrences in the groin by inserting diverse sorts of barriers over the ligated SFJ were disappointing [26][27][28][29] ; mechanical barriers either moderately reduced reflux recurrence rate in the groin in some studies or were ineffective in others, but in all they did not preclude development of recurrent reflux. Some authors expressed the opinion that recurrent reflux in varicose vein disease was unavoidable, no matter how careful and painstaking the primary procedure might be, 28,30 and postulated that some unspecified hemodynamic factors might be responsible for recurrences.…”

Section: Tendency Of Varicose Veins To Recurmentioning

confidence: 99%

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity

Recek

2013

Int J Angiol

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Although flow in the arterial system constitutes essentially an uncomplicated pulsing streaming in one direction from the heart to the periphery, venous return from the lower extremity to the heart in upright position is directed against the gravitation force and displays a more complex pattern; this field of the venous circulation and pathophysiology continues to be an insufficiently understood sphere with controversial perceptions concerning pressure and flow interactions in three different parts of venous circulation in the lower extremity: in deep and superficial veins, and in communicating channels between them. Moreover, several hemodynamic phenomena of the venous circulation have not so far been unequivocally apprehended or precisely defined, which provides for misunderstanding and misinterpretations, and deforms results presented after surgical and nonsurgical treatment of varicose veins.In this article, proven evidences pertaining to the influence of calf pump activity on pressure and flow changes that affect venous return to the heart were gathered from the references. Special point of view was concentrated on the hemodynamic significance of ambulatory venous hypertension, and on confusing opinions concerning incompetent calf perforators and reflux recurrence. Effect of the Hydrostatic PressureDuring quiet standing with relaxed calf muscles, gravitation force induces hydrostatic hypertension in the veins of the Keywords ► venous hemodynamics ► calf perforators ► venous hypertension ► hemodynamic paradox AbstractCalf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of t...

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Section: Tendency Of Varicose Veins To Recurmentioning

confidence: 99%

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity

Recek

2013

Int J Angiol

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“…17 The use of a silicone patch was similarly examined in a non-randomized study and shown to reduce neovascularization and recurrent thigh varicosities when compared with a standard twolayer closure. 18 Complications occurred in 19.5% of limbs after redo surgery, of which half were lymphatic in nature.…”

Section: Closing the Groin Dissectionmentioning

confidence: 99%

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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“…A = femoral vein, B = SV stump [3] patches, PTFE patches, and overstitching the stump with more extensive ligation. The postoperative recurrence rate in these cases lies between 2.4 % and 65 % [33,34,35,36,37] (▶ Table 4).…”

Section: Saphenofemoral Junctionmentioning

confidence: 97%

Möglichkeiten zur Rezidivprophylaxe in der Varizenchirurgie

Frings¹,

Brümmer²,

Prinz³

et al. 2019

Phlebologie

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ZusammenfassungDie hohe Crossenrezidivquote in der Varizenchirurgie führt zur Verpflichtung, Maßnahmen zur Rezidivprophylaxe einzusetzen.Durch diverse Barrieretechniken an der Crosse lässt sich die Refluxquote auf Werte zwischen 1,5 und 3 % nach 2–5 Jahren bei einer Erstoperation reduzieren. Die einfachsten Techniken stellen die Elektrokoagulation des Crossenstumpfendothels mit Naht der Lamina cribrosa sowie die extensive Crossektomie mit Stumpfübernaht dar. Dennoch kann das Crossenrezidiv nicht völlig vermieden werden. Die Remodelling Hypothese zur Genese der Varikosis, welche mit chronisch inflammatorischen Prozessen einhergeht sowie die weiteren Faktoren, welche mit einem Crossenrezidiv assoziiert sind, spielen hier eine bedeutsame Rolle. Es sollten somit zusätzlich zu den Barrieretechniken auch nicht operative, antiinflammatorisch wirksame Maßnahmen in das Behandlungsspektrum aufgenommen werden: Venenbewusste Lebensführung mit Kompressionsstrümpfen, Vermeiden von langem Sitzen und Stehen, Ausdauerbewegungen und bei Übergewicht Reduzierung des viszeralen Fettgewebes. Studien zu dieser nicht operativen Form der Crossenrezidivprophylaxe fehlen jedoch.

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Randomised Trial of Polytetrafluoroethylene Patch Insertion for Recurrent Great Saphenous Varicose Veins

Abstract: In this study, insertion of a PTFE patch did not affect the rate of perioperative complications and it did not appear to contain neovascularisation.

Cited by 35 publications

References 24 publications

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity

Standard varicose vein surgery

Möglichkeiten zur Rezidivprophylaxe in der Varizenchirurgie

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