Role of PTFE Patch Saphenoplasty in Reducing Neovascularization and Recurrence in Varicose Veins

Abstract

Varicose veins have a high recurrence rate following surgery. Besides poor surgical technique, majority of these recurrences are attributable to neovascularization after both primary and repeat surgery. Authors have studied the effectiveness of a polytetrafluoroethylene (PTFE) patch interposition between the ligated vein stump and the overlying soft tissue at saphenofemoral junction in decreasing recurrence of varicose veins after initial surgery. Study was conducted on 50 patients of varicose veins with saphenofemoral junction incompetence. Patients were randomly divided into two groups, group A and group B alternately. In group A, standard surgical procedure was done followed by PTFE patch application. In group B, same surgical procedure was applied as in group A, with the exception of PTFE patch application. Patients in both groups were given similar postoperative care. A full venous duplex ultrasound assessment was performed in all the patients postoperatively. Neovascularization was observed in five patients (20 %) of group B, while it was not seen in any of the patients in group A at 1-year follow-up. This difference in neovascularization across the two groups was found to be statistically significant with a p value of 0.0251. Hence, authors concluded that patch saphenoplasty helps in reducing recurrence in varicose veins by decreasing neovascularization at saphenofemoral junction.

A comparative study of characteristics of polytetrafluoroethylene fibers manufactured by various processes

“…Polytetrafluoroethylene (PTFE) is a polymer with superior chemical inertness, excellent thermal stability, low friction property and good biocompatibility . On the basis of these outstanding properties, PTFE fibers have been processed into fabrics or felts for further applications such as filtration, biomedical products and seawater desalination .…”

“…Polytetrafluoroethylene (PTFE) is a polymer with superior chemical inertness, excellent thermal stability, 1 low friction property 2,3 and good biocompatibility. [4][5][6] On the basis of these outstanding properties, PTFE fibers have been processed into fabrics or felts for further applications such as filtration, 7,8 biomedical products and seawater desalination. [9][10][11] However, because of the high melt viscosity (10 10 210 12 poise), 12 PTFE fibers cannot be manufactured by the conventional melt spinning technology.…”

Can vein patch interposition after sapheno-femoral ligation prevent postoperative neovascularization at the saphenofemoral junction?

“…5,[20][21][22][23][24][25] Vashist et al, reported in prospective randomized single blinded study, including patients with primary varicose veins, none of the 25 patients (0%) in the PTFE patch group developed neovascularization while 5 out of 25 patients (20 %) in the group in which patch was not applied showed the presence of neovascularization on ultrasonography at 1-year followup. 20 Also, Creton et al reported that recurrent varicofemoral junction (RVFJ) was 4.2% after re-do surgery with PTFE patch interposition for 170 limbs with (RVFJ) at follow-up (mean 4.9 years). 20,21 Also, Van Rij et al reported in randomized control study a highly significant decrease in neovascular recurrence at the S.F.J.…”

“…20 Also, Creton et al reported that recurrent varicofemoral junction (RVFJ) was 4.2% after re-do surgery with PTFE patch interposition for 170 limbs with (RVFJ) at follow-up (mean 4.9 years). 20,21 Also, Van Rij et al reported in randomized control study a highly significant decrease in neovascular recurrence at the S.F.J. when a polytetrafluoroethylene patch (PTFE patch, 3×3 cm) is interposed between the ligated vein stump and the overlying soft tissue for patients presented with primary varicose vein.…”

“…However, implantation of foreign material may lead to postoperative complications. 20 Therefore, systematic use of a prosthetic patch in the groin after SFJ ligation remains a questionable issue. 21 Efficient natural origin anatomical barrier (vein patch) might offer a valuable alternative.…”