Surgery of small saphenous vein – endoluminal or open surgical procedure

Abstract

There exists, hitherto, no unifying standard for the surgical or endovenous treatment of small saphenous vein incompetence. Thus, a direct comparability of these two treatment modalities has been, so far, restricted. Particularly, differing definitions of recurrent small saphenous vein incompetence impede this comparability. There is a lack of prospective randomised studies of long term results. On account of this scanty data, a basic recommendation for or against one treatment option or the other is currently not possible. However, in daily practice, there are significant advantages for both, the surgical as well as endovenous therapies, even without the corresponding comparative studies. The recurrence rates are high among both approaches. A complete removal of the pathologically altered vein is, nonetheless, undertaken during neither surgical nor endovenous therapy. The extent to which a complete removal of the sapheno-popliteal junction, with implementation of the crossectomy (or high ligation) principle, can contribute to the amelioration of outcomes should be clarified by future studies.

Key words

Small saphenous vein incompetence - sapheno-popliteal junction - crossectomy

• Literatur / References

• 1 Allegra C, Antignani PL, Carilizza A. Recurrent Varicose Veins Following Surgical Treatment: Our Experience with Five Years Follow-up. Eur J Vasc Endovasc Surg 2007; 33: 751-756
• 2 Boersma D, Kornmann Verena NN, Van Eekeren RRJP. et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. Journal of Endovascular Therapy 2016; 23: 199-211
• 3 Brittenden J, Cotton SC, Elders A. et al. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of Laser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial. Health Technol Assess 2015; 19: 142-342
• 4 Creton D. 125 reinterventions for recurrent popliteal varicose veins after excision of the short saphenous vein. Anatomical and physiological hypotheses of the mechanism of recurrence. J Mal Vasc 1999; 24: 30-37
• 5 Desmyttere J, Grard C, Stalnikiewicz G. et al. Endovenous laser ablation (980 mm) of the small saphenous vein in a series of 147 limbs with a 3-year follow-up. Eur J Vasc Enovasc Surg 2010; 41: 400-405
• 6 Dogancy S, Yildirim V, Demikilic U. Does puncture site affect the rate of nerve injuries following endovenous laser ablation of the small saphenous veins?. Eur J Vasc Endovasc Surg 2011; 41: 400-405
• 7 Engel AF, Davies G, Keeman JN. Preoperative Localisation of the Sapheopopliteal Junction with Duplex Scanning. Eur J Vasc Surg 1991; 5: 507-509
• 8 Feuerstein W. Zur Behandlung der Vena saphena parva Varizen. Phlebol 1993; 22: 230-235
• 9 Fischer R. Die chirurgische Behandlung der Varizen – Grundlagen und heutiger Stand, Schweiz. Rundschau Med. PRAXIS. 1990 79. Nr. 7
• 10 Fischer R, Vogel P. Die Resultate der Strippingoperation bei der Vena saphena parva. VASA 1987; 16: 349-351
• 11 Flessenkämper I, Hartmann M, Hartmann K. et al. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins. Br J Surg 2014; 95: 1232-1238
• 12 lessenkämper I, Hartmann M, Stenger D. et al. Endovenous laser ablation with an without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: intial results of a multicentre radomized controlles trial. Phlebology 2013; 28: 16-23
• 13 Flessenkämper I, Hartmann M, Hartmann K. et al. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatmant of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebologie 2016; 31: 23-33
• 14 Frings N, Glowacki P, Kohajda J. Major-Komplikationen am Gefäß- und Nervensystem in der Varicenchirurgie. Chirurg 2001; 72: 1032-1035
• 15 Geier B, Stücker M, Hummel T. et al. Residual Stumpfs associated with inguinal varicose vein recurrences: a multicenter study. Eur J Vasc Endovasc Surg 2008; 36: 207-210
• 16 Gloviczki P, Comerota AJ, Dalsing MC. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53: 2-48
• 17 Hach W, Mumme A. et al. Venenchirurgie. 3. Aufl.. Schattauer; Stuttgart: 2012
• 18 Hamann St AS, Giang J, De Maeseneer MGR. et al. Five Year Results of Great Saphenous Vein Treatment: A Meta-Analysis. Eur J Vasc Endovasc Surg 2017; 1-11
• 19 Hanzlick J. Recurrent varicosity of the lesser saphenous vein. A 5-year-follow-up. Zentralbl Chir 1999; 1241: 42-47
• 20 Hartmann M. Krossektomie heilt Krampfadern schnell. Ärztl Prax 1980; 73: 2349-2350
• 21 Hartmann M, Waldermann F, Weingard IEt al. Ist die Ischiadicusvarikosis eine Variante der Parvavarikosis. Phlebologie. 05/2001
• 22 Hartmann K, Klode J, Pfister R. et al. Recurrent varicose veins: Sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping. VASA 2006; 35: 21-26
• 23 Hartmann K, Stenger D, Hartmann M. et al. Endochirurgie versus offene Chirurgie der Varikose. Der Hautarzt 2017; 8: 603-613
• 24 Helmig L, Stelzer G. Häufigkeit der operative Behandlung der insuffizienten Vena saphena parva. VASA 1983; 12: 159-164
• 25 Huisman LC, Bruins RM, vn den Berg M. et al. Endovenous laser ablation oft he small saphenous vein: prospective analysis of 150 patients, a cohort study. Eur J Vasc Endovasc Surg 2009; 38: 199-202
• 26 Mildner A, Hilbe G. Parvarezidive nach subfascialer Ligatur – 5 Jahres Ergebnisse. Phlebologie 1997; 26: 35-39
• 27 Monahan TS, Belek K, Sarkar R. Results of radiofrequency ablation oft he small saphenous vein in the supine position. Vasc Endovascular Surg 2012; 46: 40-44
• 28 Mouton WG, Naef M, Mouton KT. et al. Nerve Injury and Small Saphenous Vein Surgery. Eur J Vasc Surg 2005; 30: 108
• 29 Nandhra S, El-sheikha J, Carradice D. et al. A randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. Journal of Vascular Surgery 03/2015; 741-746
• 30 Noppeney T, Eckstein HH, Niedermeier H. et al. Ergebnisse des Qualitätssicherungsprojektes Varizenchirurgie der Deutschen Gesellschaft für Gefäßchirurgie. Gefäßchirurgie 2005; 10: 121-128
• 31 Noppeney T, Nüllen H. Diagnostik und Therapie der Varikose. Springerverlag; 2010
• 32 Noppeney T, Storck M, Nüllen H. et al. Perioperative quality assesment of varicose vein surgery. Langenbecks Arch Surg 2016; 401: 375-380
• 33 O’Donnell Jr TFO, Iafrati MD. The small saphenous vein and other „neglected“ veins of the popliteal fossa: a review. Phlebology. 2007 22.
• 34 O’Hare JL, Vandenbroeck CP, Whitman B. et al. A prospective evaluatiom of the outcome after small saphenous varicose vein surgery with one-year follow-up. Journal of Vascular Surgery 09/2008; 669-673
• 35 Park JA, Park SW, Chang IS. et al. The 1470-nm bare-fiber diode laser ablation of the great saphenous vein and small saphenous vein at 1-year follow-up using 8–12 W and a mean linear endovenous energy density of 72 J/cm. J Vasc interv Radiol 2014; 25: 1795-1800
• 36 Peräla J, Autio R, Biancari F. et al. Radiofrequency endovenous oblitereation versus Stripping of the long saphenous vein in the management of primary varicose veins: 3-year-outcoume of randomized study. Ann Vasc Surg 2005; 19: 669-672
• 37 Pronk P, Gauw SA, Mooij MC. et al. Randomised controlled trail comparing saphenofemoral-ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anaestesia: one year results. Eur J Vasc Endovasc Surg 2010; 40: 649-656
• 38 Pukacki F, Zielinksi P, Checinski P. et al. Short saphenous vein incompetence as a cause of recurrent varicose veins. Wiad Lek 2003; 56: 28-33
• 39 Rabe E, Pannier F. Epidemiology of chronic venous disorders. In: Gloviciki P. (Hrsg) Handbook of venous disorders. Hodder Arnold, CRC Press; 2009: 105-110
• 40 Rashid HI, Ajeel A, Tyrrell MR. Persistent popliteal fossa reflux following saphenopopliteal disconnection. British Journal of Surgery 2002; 89: 748-751
• 41 Rass K, Frings N, Glowacki P. et al. Same Site recurrence is more frequent after endovenous laser ablation compared with High ligation and stripping of the great Saphenous vein: 5 Year results of a randomized clinical trial (RELACS Study). Eur J Vasc Endovasc Surg 2015; 50: 648-656
• 42 Roopram AD, Lind MY, Van Brussel JP. et al. Endovenous laser ablation versus conventional surgery in the treatment of small saphenous vein incompetence. J Vasc Surg: Venous Lym Dis 2013; 1: 357-363
• 43 Sam RC, Silverman SH, Bradbury AW. Nerve Injuries and Varicose Vein Surgery. Eur J Vasc Endovasc Surg 2004; 27: 113-120
• 44 Samuel N, Caradice D, Wallace T. et al. Saphenopopliteal ligation and stripping of small saphenous vein: does extended stripping provide better results?. Phlebology 2012; 27: 390-397
• 45 Samuel N, Carradice D, Wallace T. et al. Randomized Clinical Trial of Endovenous Laser Ablation Versus Conventional Surgery for Small Varicose Veins. Annals of Surgery 2013; 257: 419-426
• 46 Stenger D, Janthur E, Rafi L. Stripping-Operation heute. Vasomed 2011; 23: 06-13
• 47 Stenger D, Rafi L, Hauch T. et al. Chirurgie der Vena saphena parva-Varikose – Antworten bisher ungeklärter Fragen. Phlebologie. 05/2011
• 48 Stenger D, Hartmann M. Crossektomie und Stripping-OP der Klassiker. Hautarzt 2012; 63: 616-621
• 49 Subramonia S, Lees T. Radiofrequency ablation vs conventional surgery vor varicose veins a comparison of treatment costs in randomised trial. Eur J Vasc Endovasc Surg 2010; 39: 104-111
• 50 Tellings SS, Ceulen RPM, Sommer A. Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature. Phlebology 2011; 26: 179-184
• 51 Tong Y, Royle J. Recurrent varicose veins after short saphenous vein surgery: a duplex ultrasound study. Cardiovasc Surg 1996; 4: 364-367
• 52 Vin F, Chleir F. Ultrasonography of postoperatively recurrent varicose veins in the area of the short saphenous vein. Ann Chir 2001; 126: 320-324
• 53 Whiteley MS, Lewis G, Holdstock JM. et al. Minimally invasive technique for ligation and stripping of the small saphenous vein guided by intra-operaitve duplex ultrasound. Surgeon 2006; 4: 372-377
• 54 Winterborn RJ, Campbell WB, Heather BP. et al. The Management of Short Saphenous Varicose Veins: A Survey of the Members of the Vascular Surgical Society of Great Britain and Ireland. Eur J Vasc Endovasc Surg 2004; 28: 400-403
• 55 Winterborn RJ, Foy C, Heather BP. et al. Randomised trial of flush saphenofemoral ligation for primary great saphenous varicose veins. Eur J Vasc Endovasc Surg 2008; 36: 477-484