Congrès SFP décembre 2014

Great saphenous vein surgery without high ligation of the saphenofemoral junction

P. CASONI, M. LEFEBVREVILARDEBO, F. VILLA, P. CORONA

Parme – Italy

Objective
The aim of this study was to evaluate whether great saphenous vein (GSV) surgery without high ligation
of the saphenofemoral junction (SFJ) is benefi cial in terms of varicose vein recurrence.
Methods
This was a prospective randomized trial set in a private practice. From December 2000 to May 2004,
120 patients were enrolled. Patients were randomly allocated preoperatively to two groups undergoing
GSV surgery with (group A, n = 60) or without (group B, n = 60) high ligation of the SFJ.

In four patients
(two in each group), both limbs were operated on. Inclusion criteria were primary varicose veins with SFJ
incompetence resulting in GSV refl ux. Exclusion criteria were age <18 years, inability to give informed
consent, associated small saphenous vein incompetence, and prior GSV surgery. Mean follow-up was
8 years and was complete in all but one patient (99.2%). The primary end point was varicose vein
recurrence, defi ned as treated lower limbs with new thigh varices at clinical evaluation (CEAP ≥2) or
venous refl ux at the thigh or groin level, as assessed by duplex ultrasound imaging.
Results
The follow-up included 123 limbs. The combined clinical and ultrasound-determined recurrence rate was
24.4% (30 of 123): 32.2% (20 of 62) in group A vs 16.4% (10 of 61) in group B (P = .045). Postoperatively,
recurrence of even minimal varices was observed in 24 limbs (19.5%): 18 of 62 (29.0%) in group A vs
six of 61 (9.8%) in group B (P = .014). The ultrasound-detected recurrence rate was 22% (27 of 123):
32.2% (20 of 62) in group A vs 11.4% (7 of 61) in group B (P = .010). The average time to recurrence was
3.5 ± 1.2 years in group A and 4.1 ± 1.6 years in group B (P = .258).
Conclusions
GSV surgery without high ligation of the SFJ is associated with low rates of clinical and ultrasounddetermined
recurrence of varicose veins.

Casoni-Vilardebo-CHIRURGIE-D-EXERESE-DE-LA-GRANDE-VEINE-SAPHENE-SANS-CROSSECTOMIE