Vein surgery in combination with sclerotherapy. Alternative to Babcock's operation for primary varicosis of the great saphenous vein Hach grade IV

摘要

abstract_textpBackground. Treatment of primary varicosis of the great saphenous vein (GSV) with reflux of the total GSV (down to the ankle or Hach grade 4) by the modified Babcock operation may lead to damage of the saphenous nerve. We combined high saphenofemoral ligation and partial stripping with sclerotherapy of incompetent veins and perforators of the lower leg./ppPopulation and method. A total of 129 legs were treated first by high ligation and partial stripping, 6 weeks postoperatively by sclerotherapy of the remaining incompetent parts of the GSV and incompetent perforators of the lower legs. Before surgery (A), 6 weeks after the operation (before sclerotherapy B) and 9 months after completion of sclerotherapy (C) the venous refilling time (T0) and venous ejection fraction (V0) were evaluated and Duplex scanning performed. The subjective intensity of 7 different complaints of the legs was assessed./ppResults. The T0 was highly significantly prolonged from 13.3 s +/- 3.8 to 27.0 s +/- 4.9 by the operation (B) and again highly significantly to 32.4 s +/- 7.6 at (C). At (C) six legs (4.7) had refluxes in the groin and in five lower legs (3.9) recurrent incompetent perforators. At (B) there were sensory neurologic deficits in four legs and at (C) in none. All seven assessed complaints improved significantly from point A to B as well as from B to C./ppConclusion. Sclerotherapy significantly improves hemodynamic parameters and subjective complaints compared to operative treatment alone and minimizes the risk of saphenous nerve injury./p/abstract_text