ABSTRACT
Oskar Nelzén, MD
Vascular Surgeon
Department of Thoracic and Vascular Surgery and Department of Medical and Health Sciences
Linköping, Ostergotlands Lan, Sweden
156 limbs with great saphenous vein(GSV) incompetence were included (Table 1).
Treatment was performed using Radiofrequency ablation or High Ligation and stripping. Duplex ultrasound(DUS) and strain-gauge plethysmography with selective superficial occlusion (SGP) were performed before and one-year after treatment. The time taken (sec) to reach 50% of the venous volume(T50) after 20 knee bends were evaluated. The procedure was repeated with individualized inflated cuff pressures to achieve superficial occlusion. Remaining reflux was defined as a difference in T50>5 sec between postoperative SGP with and without superficial occlusion. Venous Clinical Severity Score(VCSS) and Aberdeen Varicose Vein Questionnaire(AVVQ) were evaluated at the same occasions. VCSS and AVVQ in patients with remaining reflux were compared to those without reflux using ANCOVA with age and the respective preoperative baseline value as covariates. Logistic regression was used to identify the source of remaining reflux.
Results:
In all patients, mean(±SE) T50 increased from 8±0.7 to 20±0.9 sec(p < 0.001) one year after treatment. VCSS was reduced (8.1±0.3 vs. 3.3±0.2, p < 0.001) and AVVQ improved(24.8±1.0 vs. 7.8±0.6, p < 0.001). Of all 156 limbs, 87(56%) demonstrated remaining reflux one year after treatment. Patients with remaining reflux displayed a significant higher mean(±SE) VCSS(3.7±0.3 vs. 2.9±0.3, p=0.020). AVVQ were also higher in patients with remaining reflux (8.9±0.8 vs. 6.5±0.9, p=0.041). Logistic regression showed that higher preoperative C in CEAP, age, small saphenous vein incompetence and GSV reflux below the treated area were significant risk factors for remaining reflux(Table 2).
Conclusions:
A majority of treated limbs showed detectable reflux despite successful treatment of the incompetent GSV. Patients with remaining reflux also demonstrated significant higher VCSS and AVVQ scores. These findings need to be verified in future studies, but if they remain consistent this suggest that a more thorough treatment may be advisable.