[Does saphenous vein saving surgery have a role in the therapy of primary varices?]

Abstract

Venous grafts retrieved from long saphenous veins are the best conduits for vascular and coronary reconstructions. The demand for such grafts rise continuously with the development of vascular and coronary surgery. Surgeons were soon confronted with the problem whether the saphenous trunk in patients with varicose veins may be used for grafting or not. Saphenous vein saving surgery means intentional renouncement of removing the saphenous trunk during varicose vein surgery and saving it for a possible graft in the future. Opinions whether such procedures are substantiated differ widely and concern both the suitability of such grafts and the fact that lowering the radicality of varicose vein surgery increases the probability of varicose vein recurrence. The saphenous trunk in primary varicose veins is not diffusely degenerated, it usually shows only a few local bulges and is basically compatible for the use as a vascular or coronary artery conduit; it does not dilate aneurysmatically when transplanted into the arterial circulation. Crossectomy disconnects saphenofemoral junction, the most frequent source of reflux, abolishes even the most serious venous derangement and restores normal venous hemodynamics; stripping brings about no further immediate amelioration. Recurrence of varicose veins is more frequent when crossectomy alone is performed in comparison with crossectomy and stripping, but nor crossectomy combined with stripping is able to reliably prevent recurrence, because the distinct tendency to recur is a characteristic feature of varicose disease. Saphenous vein saving surgery can be efficiently supplemented by sclerotherapy during follow-up. The excellent hemodynamic improvement achieved immediately after crossectomy can be preserved for many years during follow-up by repeated applications of sclerotherapeutic agents. In this way necessary conditions for a rapid and mostly a definitive healing of varicose ulcers can be established. In addition, preservation of a possible graft for arterial reconstructions is relevant in elderly patients.