Can the Main Trunk of Greater Saphenous Vein be Spared in Patients with Varicose Veins?

Abstract

Greater saphenous vein (GSV) is the first-choice venous conduit used for bypass grafting. However, GSV is more often varicosed than any other vein. The purpose of this study was to identify how often the main trunk of GSV could be spared during varicose vein oper ations. Two hundred fifty limbs from 187 consecutive patients with GSV reflux on contin uous-wave Doppler were subsequently examined with color flow duplex imaging. The main trunk of GSV was divided into saphenofemoral junction (SFJ), thigh, knee, and below-the-knee (BK) segments. Reflux and varicosities at all levels were noted. Limbs with previous venous surgery involving GSV were excluded from the study. Reflux throughout the length of GSV was the most common pattern (n=122, 49%). The prevalence of reflux at the SFJ was 78% (n=196); thigh segment, 84% (n=210); knee, 92% (n=229); and BK segment, 74% (n=186). Of the segments with reflux, vari cosities were found in 71% at the thigh, 77% at the knee, and 28% (P<0.0001) at the BK segment. Despite the presence of reflux, the entire length of GSV was free of varicosities in 46 (18%) limbs. Because the main trunk of GSV most often lies deeper than its tribu- taries, in 79 (32%) limbs it was not possible to clinically detect the presence of GSV vari cosities. Those varicosities that were clinically evident most often involved the tributaries of GSV (n=232, 93%) that pierce the superficial fascia and come closer to the skin. One hundred thirty-two incompetent perforating veins were found in 71 limbs, of which 27 were connected with the thigh segment, 5 with the knee segment, and the remaining 100 with the tributaries of the BK segment. No perforating vein was found to be connected with the BK GSV. The main GSV trunk at the BK level frequently had reflux, but it was rarely varicosed. Because this segment of GSV is not connected to perforating veins, and owing to its intimate anatomic relationship with the saphenous nerve, it may be spared if not varicosed. In about a fifth of the occasions, the entire length of GSV was free of vari cosities, and at least in high-risk patients for arterial disease this vein need not be excised.