Great saphenous varicose vein surgery without saphenofemoral junction disconnection

Br J Surg. 2010 Jun;97(6):820-5. doi: 10.1002/bjs.7022.


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.

MeSH terms

  • Ambulatory Surgical Procedures
  • Case-Control Studies
  • Chronic Disease
  • Female
  • Femoral Vein / surgery*
  • Humans
  • Male
  • Middle Aged
  • Preoperative Care / methods
  • Recurrence
  • Saphenous Vein / surgery*
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex
  • Varicose Veins / diagnostic imaging
  • Varicose Veins / surgery*
  • Venous Insufficiency