Do anatomical aspects of great saphenous vein insufficiency determine the course of its operational treatment?

Abstract

Background. Great saphenous vein insufficiency is the most common type of chronic vein insufficiency, and the most common treatment option is crossectomy with short stripping of the great saphenous vein (GSV) trunk. In our work, we confront this option with the anatomical range of GSV insufficiency revealed in preoperative duplex examination.
Material and methods. In the presented publication, we analyze the anatomical range of great saphenous vein insufficiency in 157 patients (158 limbs) admitted to our ward for surgical treatment of the condition between 01.01.2005 and 10.01.2006.
Results. We obtained the following rates of anatomical variants of GSV insufficiency: 1. isolated saphenofemoral junction (SFJ) insufficiency - 1%; 2. insufficiency in SFJ and thigh segment of GSV - 61%; 3. insufficiency in SFJ and thigh segment of GSV, isolated second insufficient crural segment - 9%; 4. insufficiency in SFJ and proximal thigh segment - 15%; 5. sufficient SFJ, insufficient proximal thigh segment - 5%; 6. sufficient SFJ, insufficient whole thigh segment - 8%; 7. sufficient SFJ, insufficient distal thigh segment - 1%.
Conclusions. Our results confirm that short stripping of GSV is the treatment of choice in the majority of patients. On the other hand, we document a high rate of other anatomical variants of the condition. Using one routine procedure in all cases may consequently be an inadequate treatment. It also occurs that in 30% of cases, proper introduction of a stripper may be difficult.