“Correct” crossektomy of the great or small saphenous vein

Summary

Recurrent varicose veins at the groin are mostly result due to a technical failure during the primary surgery with leaving a residual stump of the great saphenous vein. Therefore there should exist minimum requirements for a “correct” crossektomy of the great or small saphenous vein. A so called “flush ligation” with ligation of the great or small saphenous veins directly at their orifice to the deep vein is absolutely necessary. Furthermore an oversewing of the stump should prevent any contact of the endothelium with the surrounding tissue in order to prevent a so called neovascularization. Therefore an electrocoagulation of the endothelium should also be performed. Furthermore the fossa ovalis should be sutured to prevent reflux from the deep to the superficial venous system.

Keywords

Great saphenous vein - small saphenous vein - crossektomy - flush ligation

• Literatur

• 1 Mumme A, Hummel T, Burger P. et al. Die Krossektomie ist erforderlich! – Ergebnisse der Deutschen Leistenrezidivstudie. Phlebologie 2009; 38: 99-102.
• 2 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 Lymphat Disord 2013; 01 (04) 357-363.
• 3 Boersma D. et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2016; 23 (01) 199-211.
• 4 AVMF – S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE) 2. komplett überarbeitete Auflage, Stand: 15.10.2015.
• 5 Mühlberger D, Wallutis K, Wolf EM. et al. Postinterventionelle Kompressionstherapie – Eine Umfrage in Deutschland. Phlebologie 2017; 46: 292-296.
• 6 Frings N, Nelle A, Tran P. Reduction of neoreflux after correctly performed ligation of the saphenofemoral junction. A randomized trial. Eur J Vasc Endovasc Surg 2004; 28 (03) 246-252.
• 7 Papapostolou G, Altenkämper H, Bernheim C. Die LaVaCro Studie: Langzeitergebnisse der Varizenoperation mit Crossektomie und Stripping der V. saphena magna. Interimsergebnisse nach 1 Jahr. Phlebologie 2013; 42: 253-260.
• 8 Hach W, Mumme A, Hach-Wunderle V. (Hrsg). Venenchirurgie. 3 Auflage. Stuttgart: Schattauer Verlag; 2013