Great saphenous varicose vein surgery without saphenofemoral junction disconnection

Abstract

Abstract Background The aim of this case–control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral junction (SFJ) disconnection. The duplex protocol included a reflux elimination test (RET) and assessment of the competence of the terminal valve of the femoral vein. Methods One hundred patients with chronic venous disease who had a positive RET result and an incompetent terminal valve were compared with 100 patients matched for age, sex, clinical class (Clinical Etiologic Anatomic Pathophysiologic (CEAP) class C2–C6) and disease duration, but who had a positive RET result and a competent terminal valve. All patients underwent ligation and proximal avulsion of the incompetent tributaries from the great saphenous vein trunk without SFJ disconnection. Clinical and duplex follow-up lasted for 3 years, and included Hobbs' clinical score. Results Of legs with a competent terminal valve, 100 per cent were rated as cured (Hobbs' class A or B) and 14·0 per cent developed recurrent varices. Patients with an incompetent terminal valve had significantly worse results: 29·0 per cent had Hobbs' class A or B and 82·0 per cent developed recurrence (P < 0·001). Conclusion Preoperative duplex assessment of the terminal valve could be used to identify patients suitable for varicose vein surgery without the need for SFJ disconnection.