Summary of Content.
1.Traditional surgical treatment
The traditional surgical treatment of saphenous varicose vein includes simple high ligation and high ligation stripping.
The efficiency of simple high ligation of the main trunk and main genus branches is 40%, with high short-term efficiency, poor long-term effect and high recurrence rate, and simple high ligation is currently considered undesirable.
High ligation and stripping of the saphenous vein trunk from the groin to the ankle has an efficiency of 94%. High ligation with stripping of the saphenous trunk is effective, but saphenous nerve damage is 58%, and 6.7% of patients will have quality of life compromised by saphenous nerve damage.
Dilatation of saphenous vein branches can be treated by point stripping under the expulsion band and percutaneous superficial vein continuous suture ligation.
2.Minimally invasive endovenous techniques for saphenous vein
1) Endoluminal radiofrequency ablation.
Intraluminal radiofrequency ablation treatment: a large number of studies have shown that radiofrequency ablation has the tendency to replace traditional saphenous vein stripping. Prospective studies have compared the therapeutic effects of radiofrequency ablation and high ligation stripping: clinical indicators and quality of life are better with radiofrequency ablation than high ligation stripping at 1 to 3 weeks, but there is no significant difference at 4 months.
2) Intracavitary laser treatment
Endovenous laser treatment of saphenous varicose veins: a minimally invasive treatment similar to radiofrequency ablation, it is important to determine the diseased segment of veins and its diameter with multispectral lethality before the procedure, which is not suitable for patients with severe saphenous varicose veins and predominantly branching varicose veins. Dilatation of the branches of the saphenous vein can be performed by spot stripping under a repellent band, or by electrocoagulation with a homemade puncture electrocoagulation device.
3.TriVex system of venous spinotomy
The TriVex system has a wide range of indications and is suitable for all cases of superficial varicose veins in which the deep veins are patent. The postoperative recovery is smooth, and the patient is out of bed the next day after surgery, with different degrees of subcutaneous bruising, which subsides in about 10 d. There is no deep vein thrombosis in the lower limbs and other complications. The study confirmed that TriVex system venous spinotomy for saphenous varicose veins is safe, effective and aesthetic. Prospective studies comparing venous spinotomy with conventional stripping have found small incisions and short operative times, with no significant differences in postoperative pain or bleeding. Advantages of this procedure: few and small incisions, only 3 mm in the calf, with cosmetic effect and unique advantages for women with limited limb varicose veins; short operative time; fast postoperative recovery, can be out of bed after 2 d and can be discharged in 5.9 d; aspiration excision of varicose veins under direct vision, complete surgery, not easy to miss, low recurrence rate, suitable for different types of varicose veins and those that have been treated with injections It is suitable for different types of varicose veins and varicose veins that have received injection treatment; avoid making incision in the area of skin lesions (such as ulcers, eczema, etc.), which can reduce the chance of non-healing incision or infection after surgery; the operation is simple and easy to master.
4.Lumpectomy of traffic branch ligation.
The lumpectomy of femoral-saphenous traffic vein is aimed at the treatment of lower 1/3 of thigh, or femoral-saphenous traffic vein of lower leg. This procedure is indicated for: simple saphenous varicose veins; those with calf ulcers; those with traffic branch valve insufficiency; and as a complementary procedure to deep vein annuloplasty or venous muscle collaterals in the treatment of deep vein valve insufficiency in the lower extremities. The operation is thorough in dealing with the traffic branch of deep and superficial veins, with small trauma and good recent efficacy, but the long-term efficacy needs further observation.
5.Other treatment methods
1) Percutaneous superficial vein continuous suture ligation
2) Sclerotherapy
Sclerotherapy takes more than 6 months to completely occlude the vein through thrombotic fibrosis, and the thrombus spreads to the deep vein through the traffic vein causing serious deep vein thrombosis, which seriously restricts the development of sclerotherapy, further improving the use of sclerosing substances such as foam, spring ring, and improving the injection method such as the application of angioscopic direct injection of sclerosing agent may be the direction of injection therapy in the future.
3) Peripheral blood stem cell transplantation.
Broadly speaking, stem cell transplantation for chronic lower limb ischemic diseases is the direct implantation of stem cell suspensions into ischemic tissues to promote arterial and venous angiogenesis to improve tissue ischemia. Stem cell transplantation is a relatively new medical technology that brings hope for the treatment of severe saphenous varicose veins and other chronic ischemic diseases of the lower extremities that cannot be solved by traditional surgery, and is a promising treatment method.
Summary.
Minimally invasive techniques for the treatment of saphenous varicose veins include endovascular radiofrequency ablation and laser therapy, and spinotomy of varicose veins, which have the common advantages of being less invasive, aesthetically pleasing, shorter operative time, less painful, shorter hospital stay, faster recovery and less costly, and are therefore effective methods for the treatment of saphenous varicose veins. The TriVex system (Smith & Nephew) has a wide range of indications compared to endovascular radiofrequency ablation and laser treatment, and can be used in all cases of superficial varicose veins where the deep veins are patent, and the more severe the varicose veins are, the better the results. The latter two are only indicated for trunk veins and very mild varicose veins. There is reason to believe that the TriVex system of minimally invasive rotational treatment will be very important in the future surgical treatment of saphenous varicose veins.