Functional repair of the great saphenous vein by external valvuloplasty reduces the vein's diameter: 6-month results of a multicentre study

Dominic Mühlberger, Erich Brenner, Norbert Frings, Bruno Geier, Achim Mumme, Stefanie Reich-Schupke, Horst-Peter Steffen, Dietmar Stenger, Markus Stücker, Thomas Hummel, Dominic Mühlberger, Erich Brenner, Norbert Frings, Bruno Geier, Achim Mumme, Stefanie Reich-Schupke, Horst-Peter Steffen, Dietmar Stenger, Markus Stücker, Thomas Hummel

Abstract

Objectives: External valvuloplasty (eVP) is a reconstructive surgical method to repair the function of the terminal and preterminal valves. We evaluated the 6-month outcomes of eVP regarding the diameter of the great saphenous vein (GSV).

Methods: Patients from five vein centres were included in this observational study. Follow-up involved detailed duplex sonography of the GSV. The venous clinical severity score (VCSS) and the C class of the clinical, aetiologic, anatomic and pathophysiologic (CEAP) classification were recorded.

Results: We enrolled 210 patients, with a follow-up rate of 58%; eVP was sufficient in 95.24% of the patients. The GSV diameters decreased significantly from 4.4 mm (standard deviation (SD): 1.39) to 3.9 (SD: 1.12), 4 cm distal to the saphenofemoral junction (SFJ); from 3.7 mm (SD: 1.10) to 3.5 mm (SD: 1.02) at the mid-thigh; from 3.6 mm (SD: 1.14) to 3.3 mm (SD: 0.94) at the knee and from 3.1 mm (SD: 0.99) to 2.9 mm (SD: 0.78) at the mid-calf. VCSS decreased significantly from 4.76 (SD: 2.13) preoperatively to 1.77 (SD: 1.57) 6 months postoperatively.

Conclusions: GSV function can be restored by eVP; diameters over the total length of the GSV decreased significantly.

Keywords: Great saphenous vein; external valvuloplasty; reconstruction; saphenofemoral junction; varicose vein; venous reflux.

Conflict of interest statement

Declaration of conflicting interest: Markus Stücker received consulting fees from Bauerfeind AG.

Figures

Figure 1.
Figure 1.
Scheme of external valvuloplasty.

References

    1. Davies AH. The seriousness of chronic venous disease: a review of real-world evidence. Adv Ther 2019; 36: 5–12. DOI: 10.1007/s12325-019-0881-7.
    1. Wittens C, Davies AH, Bækgaard N, et al.. Editor's Choice - Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49: 678–737. DOI: 10.1016/j.ejvs.2015.02.007.
    1. Ruckley CV, Evans CJ, Allan PL, et al.. Chronic venous insufficiency: clinical and duplex correlations. The Edinburgh Vein Study of venous disorders in the general population. J Vasc Surg 2002; 36: 520–525. DOI: 10.1067/mva.2002.126547.
    1. Maurins U, Hoffmann BH, Lösch C, et al.. Distribution and prevalence of reflux in the superficial and deep venous system in the general population–results from the Bonn Vein Study, Germany. J Vasc Surg 2008; 48: 680–687. DOI: 10.1016/j.jvs.2008.04.029.
    1. Kim MJ, Park PJ, Koo BH, et al.. Association between venous reflux and diameter of great saphenous vein in lower thigh. J Vasc Surg Venous Lymphat Disord 2020; 8: 100–105. DOI: 10.1016/j.jvsv.2019.04.016.
    1. Hamel-Desnos CM, De Maeseneer M, Josnin M, et al.. Great saphenous vein diameters in phlebological practice in France: a report of the DIAGRAVES Study by the French Society of Phlebology. Eur J Vasc Endovasc Surg 2019; 58: 96–103. DOI: 10.1016/j.ejvs.2018.09.011.
    1. Mendoza E, Amsler F, Kalodiki E. Correlation between GSV diameter and varicose clinics. Phlebologie 2016; 45: 29–35. DOI: 10.12687/phleb2291-1-2016.
    1. Cappelli M, Molino Lova R, Ermini S, et al.. Hemodynamics of the sapheno-femoral junction. Patterns of reflux and their clinical implications. Int Angiol 2004; 23: 25–28.
    1. Tan MKH, Sutanto SA, Onida S, et al.. The relationship between vein diameters, clinical severity, and quality of life: a systematic review. Eur J Vasc Endovasc Surg 2019; 57: 851–857. DOI: 10.1016/j.ejvs.2019.01.024.
    1. Mitschang C, Mühlberger D, Goerge T. [Pros and cons of classic crossectomy with stripping compared to endoluminal treatment: competition or team play?]. Hautarzt 2020; 71: 6–11. DOI: 10.1007/s00105-019-04515-z.
    1. Onida S, Davies AH. CHIVA, ASVAL and related techniques–concepts and evidence. Phlebology 2015; 30: 42–45. DOI: 10.1177/0268355515591439.
    1. Lane RJ, Cuzzilla ML, Coroneos JC. The treatment of varicose veins with external stenting to the saphenofemoral junction. Vasc Endovascular Surg 2002; 36: 179–192. DOI: 10.1177/153857440203600304.
    1. Faccini FP, Ermini S, Franceschi C. CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results. J Vasc Bras 2019; 18: e20180099. DOI: 10.1590/1677-5449.009918.
    1. Mühlberger D, Brenner E, Brockhoff H, et al.. External valvuloplasty of the saphenofemoral junction in insufficient great saphenous veins - six weeks results of a prospective multicentre trial. Vasa 2020; 49: 411–417. DOI: 10.1024/0301-1526/a000874.
    1. Geier B, Voigt I, Marpe B, et al.. External valvuloplasty in the treatment of greater saphenous vein insufficiency: a five year follow up. Phlebology 2003; 18: 137–142.
    1. Camilli D, Platone A, Ruggeri M, et al.. Use of a novel device in reconstructive venous surgery: preliminary results. Int J Angiol 2020; 29: 245–249. DOI: 10.1055/s-0040-1715132.
    1. Joh JH, Lee KB, Yun WS, et al.. External banding valvuloplasty for incompetence of the great saphenous vein: 10-year results. Int J Angiol 2009; 18: 25–28. DOI: 10.1055/s-0031-1278318.
    1. Sarac A, Jahollari A, Talay S, et al.. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency. Clin Interv Aging 2014; 9: 575–579. DOI: 10.2147/cia.S60555.
    1. Lane RJ, Cuzzilla ML, Coroneos JC, et al.. Recurrence rates following external valvular stenting of the saphenofemoral junction: a comparison with simultaneous contralateral stripping of the great saphenous vein. Eur J Vasc Endovasc Surg 2007; 34: 595–603; discussion 604. DOI: 10.1016/j.ejvs.2007.06.021.
    1. Mumme A, Stücker M, Hummel T. Die extraluminale Valvuloplastie der Vena saphena magna. Gefäßchirurgie 2014: 637–642.
    1. Mühlberger D, Burkert B, Mumme A, et al.. External valvuloplasty. Phlebologie 2014; 43: 210–212. DOI: 10.12687/phleb2207-4-2014.
    1. Labropoulos N, Tiongson J, Pryor L, et al.. Definition of venous reflux in lower-extremity veins. J Vasc Surg 2003; 38: 793–798. DOI: 10.1016/s0741-5214(03)00424-5.
    1. Hach W, Mumme A, Hach-Wunderle V. Venenchirurgie . Stuttgart, Germany: Schattauer GmbH, 2013.
    1. Passman MA, McLafferty RB, Lentz MF, et al.. Validation of venous clinical severity score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg 2011; 54: 2S–9S. DOI: 10.1016/j.jvs.2011.05.117.
    1. Allegra C, Antignani PL, Bergan JJ, et al.. The “C” of CEAP: suggested definitions and refinements: an International Union of Phlebology conference of experts. J Vasc Surg 2003; 37: 129–131. DOI: 10.1067/mva.2003.47.
    1. Stücker M, Moritz R, Altmeyer P, et al.. New concept: different types of insufficiency of the saphenofemoral junction identified by duplex as a chance for a more differentiated therapy of the great saphenous vein. Phlebology 2013; 28: 268–274. DOI: 10.1177/0268355513476215.
    1. Zolotukhin IA, Seliverstov EI, Zakharova EA, et al.. Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease. Phlebology 2017; 32: 601–607. DOI: 10.1177/0268355516674415.
    1. Pittaluga P, Chastanet S, Locret T, et al.. The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein: a prospective study. Eur J Vasc Endovasc Surg 2010; 40: 122–128. DOI: 10.1016/j.ejvs.2010.03.031.
    1. Caggiati A, Rosi C, Heyn R, et al.. Age-related variations of varicose veins anatomy. J Vasc Surg 2006; 44: 1291–1295. DOI: 10.1016/j.jvs.2006.07.040.
    1. Perrin MR, Labropoulos N, Leon LR., Jr. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg 2006; 43: 327–334; discussion 334. DOI: 10.1016/j.jvs.2005.10.053.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する