Residual stumps associated with inguinal varicose vein recurrences: a multicenter study.

PURPOSE: It is unclear whether a residual sapheno-femoral stump left in place after stripping of the great saphenous vein can contribute to the formation of late inguinal varicose vein recurrence. In order to obtain information about the time course of recurrence development, patients with histologically proven residual stumps were recruited and asked about the interval between the initial operation and the first clinical signs of varicose vein recurrence. METHODS: A multi-centre study involving 7 centres was conducted amongst patients undergoing redo-surgery for inguinal varicose vein recurrences. The sapheno-femoral stumps resected during the redo-surgery were classified histologically. Patients with a proven long residual sapheno-femoral stump were asked to describe the first signs of varicose vein recurrence with the help of a standardised questionnaire. From these data the symptom-free interval, consisting of the time frame between the initial operation and the first signs of recurrence, was determined. RESULTS: In 279 legs of 251 patients a long residual sapheno-femoral stump was present. Most patients had experienced a symptom-free interval after the initial operation with a mean duration of 7.4 S.D. 5.5 years. Recurrent varicose veins became apparent after a mean time interval of 6.3 S.D. 5.3 years and congestion symptoms occurred after a mean interval of 8.5 S.D. 5.7 years. CONCLUSIONS: In patients with symptomatic groin recurrences, a long residual sapheno-femoral stump was found in about two thirds of cases. The first clinical signs of varicose vein recurrence can be expected 7-8 years after the initial treatment at the earliest. Long term follow up is required reliably to asses the outcome of treatment for varicose veins.

[Surgery of the lateral accessory saphenous vein]. / Chirurgie der V. saphena accessoria lateralis.

Confusion exists regarding the right surgical strategy for therapy of isolated varicosis of the lateral accessorian saphenous vein (LASV) resulting from an incompetent valve at the crosse without concomitant reflux into the long saphenous vein (LSV). In a retrospective study 30 patients with isolated varicosis of the LASV were examined 3 years after surgical treatment. In this study the first segment of the LSV was removed after resection of the LASV. 64% of our patients were free of recurrence after 3 years. 25% had partial reflux from the Boyd perforans vein and only 9% of the patients had a complete reflux in the LSV. Based on our results it is justified not to remove the LSV in cases of isolated varicosis of the LASV.

[Tumescence local anesthesia in venous surgery]. / Die Tumeszenzlokalanästhesie in der Phlebochirurgie.

After the long standing application of the tumescent solution with percutaneous sticks the tumescent technique in combination with the Rofil Medro-pump represents at the moment a very elegant and innovative method of local anesthesia in the field of phlebosurgery. Since 1997 the tumescent technique has been used in our hospital for all major surgeries in the field of phlebosurgery. Even more difficult operations like inguinal relapse-varicosis or acute thrombophlebitis are successfully performed with this method. From our experience the advantages of this method are a reduced bleeding, less hematomas, an insignificant risk of thrombosis and embolism, an antibacterial effect, the hydrodissection and anodynia. Using very large volumes painless surgical treatment of complicated and extended findings is possible. Essential disadvantages (like a wet surgical field, which needs to get used to) hardly exist neither for the patient nor for the surgeon. Therefore, the tumescent technique represents a safe, comfortable and almost painless kind of local anesthesia of the skin and the subcutaneous fatty tissue.