Closure of the cribriform fascia: an efficient anatomical barrier against postoperative neovascularisation at the saphenofemoral junction? A prospective study

Eur J Vasc Endovasc Surg. 2007 Sep;34(3):361-6. doi: 10.1016/j.ejvs.2007.03.020. Epub 2007 May 21.


Background: Neovascularisation at the sapheno-femoral junction (SFJ) ligation site in the groin may occur within one year after great saphenous vein (GSV) surgery. Several anatomical and prosthetic barrier techniques have been proposed to prevent this evolution.

Objective: A prospective study examined whether closing the cribriform fascia could reduce the incidence of postoperative neovascularisation in the groin.

Patients and methods: Patients with primary varicose veins and incompetence at the level of the SFJ were included. After SFJ ligation in 235 limbs of 193 patients an anatomical barrier was constructed by closing the cribriform fascia. Postoperative duplex scanning was performed after 2 and 12 months. Results were compared with historical control groups in which either a silicone patch saphenoplasty or no barrier technique had been performed.

Results: After one year, 10 limbs had developed recurrent thigh varicose veins and duplex scan showed neovascularisation at the SFJ ligation site in 15 of 223 re-examined limbs (6.7%). This was comparable to the group of 191 limbs with silicone patch saphenoplasty (5.2%) (P=0.526) and superior to the group of 189 limbs without barrier (14.8%) (P<0.01).

Conclusion: Interposition of an anatomical barrier by closing the cribriform fascia after SFJ ligation reduced ultrasound detected neovascularisation at the SFJ after one year. In primary varicose vein operations application of an anatomical barrier technique (without prosthetic patch) is an alternative option to prevent postoperative neovascularisation.

MeSH terms

  • Adult
  • Case-Control Studies
  • Fasciotomy*
  • Female
  • Femoral Vein / diagnostic imaging
  • Femoral Vein / surgery*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Ligation / adverse effects
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / diagnostic imaging
  • Neovascularization, Pathologic / epidemiology
  • Neovascularization, Pathologic / etiology
  • Neovascularization, Pathologic / prevention & control*
  • Prospective Studies
  • Saphenous Vein / diagnostic imaging
  • Saphenous Vein / surgery*
  • Secondary Prevention
  • Severity of Illness Index
  • Silicones / therapeutic use
  • Time Factors
  • Treatment Outcome
  • Ultrasonography
  • Varicose Veins / diagnostic imaging
  • Varicose Veins / surgery*
  • Vascular Surgical Procedures / adverse effects*
  • Vascular Surgical Procedures / methods


  • Silicones