Surgical crossectomy and saphenic trunk sclerotherapy

Abstract

AIM: Here our proposal of a new approach to the incontinent saphenous-femoral junction (SFJ) based on the combination of surgery and sclerotherapy for treatment of incontinent varices. It is a two-step procedure with a surgical ligation and transection of SFJ followed by a sclerosis of saphenous trunk and extra-fascial tributaries.

MATERIALS AND METHODS: From January to December 2017, 95 patients (63 females and 32 males) with a mean age of 56.43 ± 6.07 years for a total of 121 limbs were treated with the SHSC approach.

Under local anesthesia, after surgical selective hemodynamic crossectomy and a retrograde cannulation of the saphenous trunk by means of 8-10 ch nelaton-like catheter, 0.5-1% polydocanol foam, obtained with Tessari’s technique, is injected into the vein. During injection, the catheter must be progressively withdrawn, so that the entire vein comes in contact with the foam.

RESULTS: 121 limbs have been treated with the above technique. A complete obliteration of the saphenous trunk was observed after 116 (95.86%) treatments in the immediate postoperative time. With regard to collateral veins sclerosis, 99 (81.81%) complete obliterations were observed. 28 (23.14%) collateral varices had to be refined by sclerotherapy.

DISCUSSION: SHSC associates the execution of a selective hemodynamic crossectomy with an intraoperative foam sclerotherapy for the treatment of the saphenous trunk and collateral varicose veins. SHSC, compared to classical US-guided foam sclerotherapy seems to be safer, with fewer risks of pulmonary and / or cerebral embolic complications. SHSC prevents blood wash out which could destabilize the consolidation of the saphenous trunk sclerosis.

CONCLUSIONS: SHSC can be considered an effective treatment of varicose veins, simple to perform, minimally invasive and well tolerated