High ligation of sapheno-femoral junction and thermal ablation for lower limb primary varicosity in day hospital setting


COD: 2020_01_10_3026 Categorie: ,

Luciano Izzo, Federico Pugliese, Gorizio Pieretti, Sara Izzo, Paolo Izzo
With collaboration of : Gaetano Florio, Mauro Del Papa, Daniela Messineo

Ann Ital Chir, 2020 91, 1: 61-64

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AIM: The traditional surgical treatment for lower limb primary varicosity has been for a long time high ligation of
sapheno-femoral junction and stripping of great saphenous vein. Surgery, however, has been frustrated by postoperative
pains and discomfort and recurrences so that it has been challenged by minimally invasive endovenous techniques such
as laser treatment and radiofrequency ablation. The aim of the article is to assess the feasibility, in a day hospital setting,
of a combined approach to greater saphenous vein reflux: high ligation of sapheno-femoral junction and thermal
treatment of the great sapenous vein.
METHODS: A retrospective analysis on 95 patients treated with high ligation and thermal ablation at our institution
from January 2009 to July 2017 was performed, assessing duration of surgery, post-operative pain and analgesics requirements,
early complications and resumption of activities.
RESULTS: Two patients (2.74%), in the laser group experienced skin burns in the course of the GSV. Moderate ecchymosis,
by laser fibre-induced perforation of the vein wall, were observed in another two patients (2.74%). Four limbs
(5.48%) in the EVLT group developed transient paraesthesias. Analgesic requirement on POD 3 was nil for RFA group;
conversely half of the EVLT patients did take analgesics, either 2 or 3 tabs were required. On POD 7, the patients of
RFA group continued to not ask for any analgesics, but the same half of the patients in EVLT group still needed 1-2
tabs to carry out their normal activities smoothly. On POD 15, no patient did require analgesics.
Resumption of routine activities was earlier for RFA group patients than for those in the EVLT group. The RFA group
resumed their activities within 3 days, whereas EVLT group in 8-9 days. High ligation of the SFJ didn’t add too much
time or morbidities.
CONCLUSION: Catheter delivery of thermal energies for saphenous ablation, even when combined with high ligation of
saphenous femoral arc, demonstrated to be minimally invasive, easy to learn and easy to perform in day hospital setting,
with early return to normal activity. EVLT achieved similar results to RFA and both techniques were considered
equally effective and safe; the results we obtained were not statistically significant but RFA showed less pain, ecchymosis
and haematomas, as well as provided better short-term quality of life.