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Varicose Veins: Aspects on Diagnosis and Surgical Treatment
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs.

In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery.

In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years.

After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p<0.001).

Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL.

The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery.

A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2005. , p. 71
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 53
Keyword [en]
Surgery, Varicose veins, Venous insufficiency, Surgery, Duplex, Quality of life, Cost analysis
Keyword [sv]
Kirurgi
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-5855ISBN: 91-554-6290-1 (print)OAI: oai:DiVA.org:uu-5855DiVA, id: diva2:166652
Public defence
2005-09-07, Hörsalen, St Görans Sjukhus, St Görans plan 1, Stockholm, 09:00
Opponent
Supervisors
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved
List of papers
1. Recurrent varicose veins: incidence, risk factors and groin anatomy
Open this publication in new window or tab >>Recurrent varicose veins: incidence, risk factors and groin anatomy
Show others...
2004 In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, Vol. 27, no 3, p. 269-274Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-93231 (URN)
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved
2. Randomized clinical trial of routine preoperative duplex imaging before varicose vein surgery
Open this publication in new window or tab >>Randomized clinical trial of routine preoperative duplex imaging before varicose vein surgery
2005 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 6, p. 688-694Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Duplex imaging is used increasingly for preoperative evaluation of varicose veins, but its value in terms of the long-term results of surgery is not clear.

METHODS:

Patients with primary varicose veins were randomized to operation with or without preoperative duplex imaging. Reoperation rates, clinical and duplex findings were compared at 2 months and 2 years after surgery.

RESULTS:

Two hundred and ninety-three patients (343 legs) had varicose vein surgery after duplex imaging (group 1; 166 legs) or no imaging (group 2; 177 legs). In 44 legs (26.5 per cent), duplex examination suggested a different surgical procedure than had been considered on clinical grounds; the procedure was changed accordingly for 29 legs. At 2 months, incompetence was detected at the saphenofemoral or saphenopopliteal junction (or both) in 14 legs (8.8 per cent) in group 1 and in 44 legs (26.5 per cent) in group 2 (P < 0.001). At 2 years, two legs (1.4 per cent) had undergone or were awaiting reoperation in group 1, and 14 legs (9.5 per cent) in group 2 (P = 0.002). In the remainder, major incompetence was found in 19 legs (15.0 per cent) in group 1 and in 53 (41.1 per cent) in group 2 (P < 0.001).

CONCLUSION:

Routine preoperative duplex examination led to an improvement in results 2 years after surgery for patients with primary varicose veins.

Keyword
Adult, Aged, Comparative Study, Female, Humans, Male, Middle Aged, Preoperative Care/methods, Prospective Studies, Reoperation, Research Support; Non-U.S. Gov't, Ultrasonography; Doppler; Duplex/methods, Varicose Veins/physiopathology/*surgery/*ultrasonography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93232 (URN)10.1002/bjs.4983 (DOI)15810046 (PubMedID)
Available from: 2005-05-23 Created: 2005-05-23 Last updated: 2017-12-14Bibliographically approved
3. Quality of life after surgery for varicose veins and the impact of preoperative duplex - results based on a randomized trial
Open this publication in new window or tab >>Quality of life after surgery for varicose veins and the impact of preoperative duplex - results based on a randomized trial
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-93233 (URN)
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved
4. Randomized clinical trial of the cost consequences of preopera-tive duplex examination before varicose vein surgery in Sweden
Open this publication in new window or tab >>Randomized clinical trial of the cost consequences of preopera-tive duplex examination before varicose vein surgery in Sweden
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Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-93234 (URN)
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved
5. Changes in superficial and perforating vein reflux after varicose vein surgery
Open this publication in new window or tab >>Changes in superficial and perforating vein reflux after varicose vein surgery
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2005 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 42, no 2, p. 315-320Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

This prospective duplex study was conducted to study the effect of current surgical treatment for primary varicose veins on the development of venous insufficiency < or = 2 years after varicose vein surgery.

METHODS:

The patients were part of a randomized controlled study where surgery for primary varicose veins was planned from a clinical examination alone or with the addition of preoperative duplex scanning. Postoperative duplex scanning was done at 2 months and 2 years.

RESULTS:

Operations were done on 293 patients (343 legs), 74% of whom were women. The mean age was 47 years. In 126 legs, duplex scanning was done preoperatively, at 2 months and 2 years, and at 2 months and 2 years in 251 legs. Preoperative perforating vein incompetence (PVI) was present in 64 of 126 legs. Perforator ligation was not done on 42 of these; at 2 months, 23 of these legs (55%) had no PVI, and at 2 years, 25 legs (60%) had no PVI. Sixty-one legs had no PVI preoperatively, 5 (8%) had PVI at 2 months, and 11 (18%) had PVI at 2 years. In the group of 251 legs, reversal of PVI between 2 months and 2 years was found in 28 (41%) of 68 and was more common than new PVI, which occurred in 41 (22%) of 183 (P = .003). After 2 years, the number of legs without venous incompetence in which perforator surgery was not performed was 11 (26%) of 42 legs with preoperative PVI and 18 (30%) of 61 legs without preoperative PVI, (P = .713). After 2 years, new vessel formation was more common in the surgically obliterated saphenopopliteal junction (SPJ), 4 (40%) of 10, than in the saphenofemoral junction (SFJ), 17 (11%) of 151(P = .027), and new incompetence in a previously normal junction was more common in the SFJ, 11 (18%) of 63, than in the SPJ, 3 (1%) of 226 (P < .001). Reflux in the great saphenous vein (GSV) below the knee was abolished after stripping above the knee in 17 (34%) of 50 legs at 2 months and in 22 legs (44%) after 2 years.

CONCLUSIONS:

Varicose vein surgery induces changes in the remaining venous segments of the legs that continue for several months. In most patients, perforators and the GSV below the knee can be ignored at the primary surgery. A substantial number of recurrences in the SFJ and SPJ are unavoidable with present surgical knowledge because they stem from new vessel formation and progression of disease.

Keyword
Female, Humans, Male, Middle Aged, Postoperative Period, Prospective Studies, Randomized Controlled Trials, Recurrence, Research Support; Non-U.S. Gov't, Saphenous Vein/ultrasonography, Ultrasonography; Doppler; Duplex, Varicose Veins/*physiopathology/*surgery/ultrasonography, Venous Insufficiency/*prevention & control
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93235 (URN)10.1016/j.jvs.2005.03.043 (DOI)16102633 (PubMedID)
Available from: 2005-05-23 Created: 2005-05-23 Last updated: 2017-12-14Bibliographically approved

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