| Abstract: |
Varicose veins represent everything n’Onl a cosmetic to a risk of venous leg ulcers. Predicting the risk of COlllpl ications has been difficult, not least due to less than satisfactory diagnostic procedures. Recent invistigations have pointed somel important new concepts: superficial venous inCOtllpetence nlay give rise to an ulcer, and such an ulcer may be prevented by varicose vein surgery.Clinical diagnosis is never sufficient in cases of sllspected chronic venous ineornpetence. The InininlUlTI requirenlentis the use of a hand-held Doppler. OnenIy, a lllore detailed ultrasonographic analysis is required.Recurrence rates as high as 65°;() have been reported following surgery for prinlary unconlpl icated varicose veins. In 1110St cases the recurrence have been I inked to inappropriate or inadequate surgery 111 the first instance. Traditionally, preoperative assessnlent of prinlary varicose veins has included a clinical exanlination. However, this has clearly been demonstrated to be unreliable, with high clinical uncertainty rates. Recently, clinical accuracy has inlproved with the adj uncti ve use of the continuous wave fOrIll hand-held Doppler.However, this 1110dality remains inaccurate due to the inability to confidently identify the vessel being insonated. Therefore a reduction in recurrence rate would represent a tnajor saving for national health service. This study evaluated the ill1portance of preoperative duplex scanning In all patients with primary uncomplicated varicose veins by Clssessing the radiological incidence of saphenofenloral (SF J), sapheno-popl iteal (SPJ), Th igh perforators and cal r perforators i ncornpetence. I n add ition, any significant anatomical variations that would have been inlpossible or difficult to detect clinically or with I-lHD and which lnight contribute to recurrences were also invistigaled.Clinical and Doppler assessnlent is unreliable. Use of the HHD probe in the preoperative assessment of patients with prilnary varicose veins was not accurate enough to plan surgery in this study. Duplex inlaging requires equipnlent and radiological expertise but provides accurate information, allowing the treatnlent of all sites of venous reflux and lTIUst not, however, deter us from attempt.ing to provide the highest standard of preoperative evaluation with prilnary venous disease. Finally, routine preoperative duplex iln~ging is required before all operations for pri1l1ary varicose veins.It is an essential prerequisite of any surgical procedure to have an accurate diagnosis prior to intervention. OUf study suggests that preoperative duplex assessment allows targetedrates are to be reduced to the nlinimum possible. Only diagnostic accuracy Inay assure a correct surgical approach, but the strategy oftreatlnent nlust be adapted to the single patient. Although, our study showed that, sparing the great saphenou vein is associated with a. relatively higher recurrence rate, stripping of the saphenolls vein is only required when there Clre visible, duplex scan confirtned varicose of the thigh saphenous itsel f and/or th igh perforCltors.Surgical treatlnent of varicose veins has l11ade progress in using fewer trauillatic techniques. Partial stripping of the greater saphenous vein pres eves the conlpetent venous segnlents and is related to a snlall persentage of local complications such as saphenolls nerve dcunage. Good results have been reported also with cOlnbined GSV high ligation and stab avulsion phlebectolny as it preserves LSV had excellent functional and coslnetic results.In cases of prinlary varicose veins ulcers, controversy exist regarding the role of saphenous vein surgery conlbined with postoperative c0111pression. In our study ablation of the superficial varicosities alone results in healing of the prinlary varicose vein ulcers without the need for cOlnpression.Our new insights into surgical 1l1anagelnent of prilnary varicose veins with duplex inlaging, That, duplex is 111andatory before every operation for varicose veins, every patient isspecial formula and The surgical operation must be tailored for each case Separately and 11luSt by duplex prelnapped. Stripping or the saphenous vein is lilllited to stenl vein disease and incOlnpetent thigh perforators.Accurate diagnosis and preoperative nlapping by duplex inlage enabled us to do ambulatory phlebect0111y, direct ligation of the perforators under local anaesthesia successfully with good cosmetic results and lower recurrence rate. In cases of calf perforators with unhealthy skin we did subfascial endocopic perforator surgery (SEPS) 111 4 cases with minimal con1plicatiol1s, less scar and 24 hours hospital stclY.
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