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Treatment of Primary Venous Insufficiency by Endovenous Saphenous Vein Obliteration

Department of Surgery, University of Colorado Health Sciences Center, Denver, Colorado

Olivier Pichot, MD

Divisions of Vascular Medicine University of Grenoble, Grenoble, France

Carmine Sessa, MD

Divisions of Vascular Surgery, University of Grenoble, Grenoble, France

Sanja Schuller-Petrovic, MD, PhD

Hautklinik LKH, University of Graz, Graz, Austria

Lowell S. Kabnick, MD

Department of Surgery, Morristown Memorial Hospital, Morristown, New Jersey

John J. Bergan, MD

Department of Surgery, the University of California, San Diego, La Jolla, California

The objective of this paper is to evaluate treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Three hundred one limbs were treated in 206 women and 67 men with a mean CEAP Clinical Class of 2.4 ±0.9. Endovenous obliteration was combined with high ligation in 67 limbs (22%) and with stab avulsion phlebectomies in 181 (60%). Acute occlusion was achieved in 290 limbs (96%). Obliteration failures in 11 limbs were treated by saphenous stripping or managed expectantly. Paresthesias followed 15% of treatments confined to the thigh and upper leg and affected 30% of limbs when treatment extended to the ankle (p < 0.001). Eight potentially preventable thermal skin injuries occurred, five in particularly superficial venous segments, of which four were in men. At a mean follow-up of 4.9 months, 21 (7.2%) of successfully treated veins have partially or totally (n = two) recanalized, but only 11 (3.8% of 290) have Doppler-detectable reflux. Ninety-one patients have been followed up for 6 months to 1 year, showing significant improvement in CEAP class and progressive relief from clinical symptoms. At their latest visit, 94% rated themselves as being symptom-free or substantially improved. These midterm results with endovenous obliteration in the treatment of primary varicose veins suggest that it may be as effective as surgical stripping in eliminating greater saphenous vein reflux and delaying the appearance of new varicose veins. Simple procedural modifications, such as not treating to the ankle, prophylactic infiltration about superficially placed veins, and early duplex surveillance should diminish the complications observed in this early experience.

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