ABSTRACT
INTRODUCTION: Chronic venous disease (CVD) of the lower limbs is a very prevalent medical condition with important socioeconomic repercussions. Small saphenous vein (SSV) incompetence, although less frequent than great saphenous vein (GSV) incompetence, presents a more challenging treatment, with higher rates of complication and recurrence. OBJECTIVES: To determine the incidence and associated risk factors of varicose veins recurrence in patients submitted, for the first time and exclusively, to SSV surgery with 5 years of follow-up. METHODS: Retrospective analysis of all exclusively first-time SSV surgeries, at Angiology and Vascular Surgery Service of Hospital Beatriz Ângelo, between January 1st, 2013, and December 31st, 2014. In March 2019, the authors performed clinical and venous doppler ultrasound reassessment of all included patients. RESULTS: A total of 23 limbs were evaluated, 56.5% were female and the mean age was 51.8 years. All patients were symptomatic and underwent ligation of the saphenopopliteal junction (SPJ), 26.1% and 43.5% had total and partial SSV stripping, respectively. After venous doppler ultrasound at 5-year follow-up, we found that 21.7% did not present a correct SPJ ligation due to failure to identify its location, with a statistically significant association between SPJ ligation and varicose vein recurrence. In follow-up, we also diagnosed GSV incompetence in 21.7% for the first time, which is in agreement with the fact that this is a chronic disease. Finally, we found that all patients with symptomatic recurrence at 5-year follow-up had CVD, however, some asymptomatic patients also had ultrasound changes. CONCLUSION: Routine preoperative localization of the SPJ by doppler ultrasound guidance could have an impact in minimizing varicose vein recurrence. Imaging recurrence does not always translate into clinical recurrence. Because this is a chronic disease, patients should keep general care to prevent disease progression, even after surgery.
Subject(s)
Saphenous Vein , Varicose Veins , Female , Follow-Up Studies , Humans , Lower Extremity , Middle Aged , Recurrence , Retrospective Studies , Saphenous Vein/diagnostic imaging , Varicose Veins/diagnostic imagingABSTRACT
The authors report the clinical case of a 66 years old man who underwent, in November 2007, a cross-over femoro-femoral bypass, using a spiral protected 8 mms PTFE graft, to treat a disabling intermittent claudication of the left lower extremity. In April 2009, seventeen month later, he suffered a brutal kick injury in the suprapubic area, resulting in a local voluminous hematoma, including the scrotum, shock and left lower extremity ischemia. Angio-CT scans disclosed a complete fracture of the prosthesis. The patient underwent immediate surgical management, consisting in the local thrombectomy and reconstruction of the graft continuity, through an end-to-end anastomosis. He was discharged seven days later and one month later he was found asymptomatic and in good condition. Following an exhaustive revision of the literature, the authors conclude that this is the first report of such complication of a cross-over femoro-femoral bypass graft.
