Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery

Abstract

Objectives: To investigate the possibility of the haemodynamic suppression of reflux in the greater saphenous vein (GSV) without any high ligation and/or stripping procedure. Design: Prospective study; single group of patients. Materials: forty patients affected by primary chronic venous insufficiency of all clinical classes, with demonstrated duplex incompetence both of the sapheno-femoral junction (SFJ) and the GSV trunk, with the re-entry perforator located on a GSV tributary. The re-entry point was defined as the perforator, whose finger compression of the superficial vein above its opening eliminates reflux in the GSV. Methods: Air-plethysmographic parameters as well as duplex scanning were performed both preoperatively, and 1 and 6 months later, respectively. Operation consisted in flush ligation and division from the GSV of the tributary containing the re-entry perforating vein. Results: Duplex investigation demonstrated both a forward flow and reflux disappearance in the GSV in 100% and 85% of the cases after 1 and 6 months, respectively. All air-plethysmographic parameters, with the exception of Ejection Fraction, improved significantly: Venous Volume changed from 150 ± 9 ml to 114 ± 7 ml (p<0.0001), Venous Filling Index from 4.9 ± 0.5 ml/s to 2.3 ± 0.2 ml/s (p<0.0001), and Residual Volume Fraction from 42 ± 3 ml to 30 ± 2 ml (p<0.0001). Conclusions: This study demonstrates that reflux in the GSV system is supported by a gradient of pressure between the anatomical point of reflux and the point of re-entry in the deep veins. Disconnection of the flow to the re-entry perforator without high ligation of the sapheno-femoral junction suppresses GSV reflux.