Randomised Trial of Flush Saphenofemoral Ligation for Primary Great Saphenous Varicose Veins

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Abstract

Objectives

The aim of this study was to assess different techniques of saphenofemoral ligation in the treatment of primary varicose veins.

Methods

One hundred and eighty-two patients (210 legs) with primary saphenofemoral junction incompetence were randomised to standard saphenofemoral ligation (transfixion with an absorbable suture) (SSL) or flush saphenofemoral ligation (oversewing with 4/0 polypropylene) (FSL). All legs underwent additional great saphenous vein stripping and multiple phlebectomies. Patients underwent assessment preoperatively, and at 6 weeks, 1 year and 2 years postoperatively with clinical examination, duplex imaging and completion of the Aberdeen Varicose Vein Symptom Severity Score (AVVSSS).

Results

A total of 148 patients (172 legs) attended follow-up at 2 years postoperatively. Recurrent varicose veins were visible in 30 legs (33 per cent) in the SSL group and 26 legs (32 per cent) in the FSL group (P = 0.90). Neovascularisation was present in 20 groins (22 per cent) in the SSL group and 15 groins (19 per cent) in the FSL group (P = 0.57). Nine cases of neovascularisation in the SSL group and five in the FSL group directly resulted in clinical recurrence (P = 0.37).

Conclusions

Flush ligation of the saphenofemoral junction confers no advantage over standard ligation with respect to clinical recurrence and neovascularisation.

Registration number: ISRCTN20235689 (http://www.controlled-trials.com).

Keywords

Primary varicose veins
Saphenofemoral ligation
Great saphenous vein

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Re-Submitted as a randomised clinical trial to the European Journal of Vascular and Endovascular Surgery on 15th April 2008.