Skip to main content
SpringerLink
Log in

Open Surgical Treatment of Superficial Reflux

  • Chapter
  • First Online:
Current Management of Venous Diseases

  • 1913 Accesses

Abstract

The incorporation of the various endovenous techniques in the treatment of the superficial vein incompetence has limited the space for the open techniques. According to the current guidelines, the thermal ablation techniques, and the nonthermal ablation techniques secondarily, have been proposed as the main treatment options. Nevertheless, open surgical procedures (high ligation with or without stripping and phlebectomies) still remain an equal alternative. Additionally, there are specific situations that the ablation techniques cannot be used. In these cases, the standard surgical treatments remain a prudent option. Similar to primary varicose vein disease, the role of traditional open surgery for the management of recurrent varicose veins has been significantly limited by the development of the endovenous techniques. However, in the unusual circumstances where the endovenous techniques are either unavailable or contraindicated, a re-exploration of the groin may be considered. In the current chapter, a detailed description of the open surgical technique used today and suggested treatment algorithms for the primary and recurrent superficial vein incompetence are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

ASVAL:

Ambulatory selective varices ablation under local anesthesia

CFV:

Common femoral vein

CHIVA:

Cure conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire

GSV:

Great saphenous vein

HL:

High ligation

SFJ:

Saphenofemoral junction

SPJ:

Saphenopopliteal junction

SSV:

Short saphenous vein

VVs:

Varicose veins

References

  1. van den Bremer J, Moll FL. Historical overview of varicose vein surgery. Ann Vasc Surg. 2010;24(3):426–32.

    Article  PubMed  Google Scholar 

  2. Trendelenburg F. Uber die unterbindung der vena faphena magna bei unterschendelzaricen. Berl Klin Chir. 1890;7:195.

    Google Scholar 

  3. Mayo C. The surgical treatment of varicose veins. Saint Paul Med J. 1904;6:695.

    Google Scholar 

  4. Babcock W. A new operation for the extirpation of varicose veins of the legs. NY Med J. 1907;86:153.

    Google Scholar 

  5. Homans J. The operative treatment of varicose veins and ulcers, based upon a classification of these lesions. Surg Gynecol Obstet. 1916;22:143–59.

    Google Scholar 

  6. Muller R. Treatment of varicose veins by ambulatory phlebectomy. Phlebologie. 1966;19(4):277–9.

    CAS  PubMed  Google Scholar 

  7. Wittens C, Davies AH, Baekgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor’s choice - Management of Chronic Venous Disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737.

    Article  CAS  PubMed  Google Scholar 

  8. Takase S, Pascarella L, Bergan JJ, Schmid-Schonbein GW. Hypertension-induced venous valve remodeling. J Vasc Surg. 2004;39(6):1329–34.

    Article  PubMed  Google Scholar 

  9. Fischer R, Chandler JG, De Maeseneer MG, Frings N, Lefebvre-Vilarbedo M, Earnshaw JJ, Bergan JJ, Duff C, Linde N. The unresolved problem of recurrent saphenofemoral reflux. J Am Coll Surg. 2002;195(1):80–94.

    Article  PubMed  Google Scholar 

  10. Munn SR, Morton JB, Macbeth WA, McLeish AR. To strip or not to strip the long saphenous vein? A varicose veins trial. Br J Surg. 1981;68(6):426–8.

    Article  CAS  PubMed  Google Scholar 

  11. Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, Nicolaides A, Smith PC. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document. Part II. Anatomy. Vasa. 2007;36(1):62–71.

    Article  CAS  PubMed  Google Scholar 

  12. Oesch A. Pin-stripping: a novel method of traumatic stripping. Phlebology. 1993;8:171–3.

    Article  Google Scholar 

  13. Belardi P, Lucertini G. Advantages of the lateral approach for re-exploration of the sapheno-femoral junction for recurrent varicose veins. Cardiovasc Surg. 1994;2(6):772–4.

    CAS  PubMed  Google Scholar 

  14. Bradbury AW, Stonebridge PA, Callam MJ, Walker AJ, Allan PL, Beggs I, Ruckley CV. Recurrent varicose veins: assessment of the saphenofemoral junction. Br J Surg. 1994;81(3):373–5.

    Article  CAS  PubMed  Google Scholar 

  15. Viani MP, Poggi RV, Pinto A, Andreani SM, Spagnoli C, Maruotti RA. Re-exploration of the saphenofemoral junction in the treatment of recurrent varicose veins. Int Surg. 1996;81(4):382–4.

    CAS  PubMed  Google Scholar 

  16. Biemans AA, van den Bos RR, Hollestein LM, Maessen-Visch MB, Vergouwe Y, Neumann HA, de Maeseneer MG, Nijsten T. The effect of single phlebectomies of a large varicose tributary on great saphenous vein reflux. J Vasc Surg Venous Lymphat Disord. 2014;2(2):179–87.

    Article  PubMed  Google Scholar 

  17. Gianesini S, Occhionorelli S, Menegatti E, Zuolo M, Tessari M, Spath P, Ascanelli S, Zamboni P. CHIVA strategy in chronic venous disease treatment: instructions for users. Phlebology. 2015;30(3):157–71.

    Article  CAS  PubMed  Google Scholar 

  18. Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2014;7:Cd005624.

    Google Scholar 

  19. Lazaris AM, Moulakakis K, Vasdekis S, Geroulakos G, Lattimer CR. Re: ‘Management of chronic venous disease. Clinical practice guidelines of the European Society for Vascular Surgery’. Eur J Vasc Endovasc Surg. 2016;51(4):609.

    Article  CAS  PubMed  Google Scholar 

  20. Perrin MR, Guex JJ, Ruckley CV, dePalma RG, Royle JP, Eklof B, Nicolini P, Jantet G. Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg. 2000;8(4):233–45.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 1, Rimini Str Haidari, Athens, 12462, Greece

    Andreas M. Lazaris MD, FACS, FEBVS & George Geroulakos FRCS, DIC, PhD

Authors
  1. Andreas M. Lazaris MD, FACS, FEBVS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Geroulakos FRCS, DIC, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas M. Lazaris MD, FACS, FEBVS .

Editor information

Editors and Affiliations

  1. Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Cassius Iyad Ochoa Chaar

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lazaris, A.M., Geroulakos, G. (2018). Open Surgical Treatment of Superficial Reflux. In: Chaar, C. (eds) Current Management of Venous Diseases . Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65226-9_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65225-2

  • Online ISBN: 978-3-319-65226-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation