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An assessment of the long saphenous vein for potential use as a vascular conduit after varicose vein surgery

1993; Elsevier BV; Volume: 18; Issue: 5 Linguagem: Inglês

10.1016/0741-5214(93)90339-n

1097-6809

Louis Fligelstone, Grace Carolan, Neil Pugh, A A Shandall, I F Lane,

Peripheral Artery Disease Management

Purpose: There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation.1McMullin GM Coleridge-Smith PD Scurr JH. Effect of ligation without stripping on the long saphenous vein.Br J Surg. 1990; 77: A697-A698Google Scholar Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous ligation with multiple stab phlebectomy. Methods: Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (LF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen.2Jakobsen BH. The value of different forms of treatment for varicose veins.Br J Surg. 1979; 66: 182-184Crossref PubMed Scopus (174) Google Scholar Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed. Results: Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 ± 0.1 mm (mean ± SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X2 = 0.465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (X2 = 2.916; p = 0.0877; NS). Conclusions: It is concluded that high saphenofemoral ligation combined with multiple “stab avulsions” preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results. (J VASC SURG 1993;18:836-40.)