Comparative analysis of high ligation and foam sclerotherapy or spot stripping in treatment of great saphenous varicose veins_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZENG Yanzhang ,  YUAN Ping , JIANG Qing , PAN Yang

Department of Vascular and Thyroid Surgery, Guizhou Provincial People’s Hospital, Guiyang 550002, P. R. China;

Corresponding author：

YUAN Ping, Email: yuanpinggzsy@163.com

Keywords：

great saphenous varicose vein; high ligation and spot stripping; high ligation and foam sclerotherapy; curative effect

DOI：

10.7507/1007-9424.202305008

Video：

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Objective To compare the effect of high ligation and spot stripping (HLSS) and high ligation and foam sclerotherapy (HLFS) in the treatment of great saphenous varicose veins (GSVV). Methods A retrospective analysis was conducted on the clinical data of 385 patients with GSVV who received HLFS or HLSS treatment at Guizhou Provincial People’s Hospital from January 2018 to June 2022. The differences in surgical time, intraoperative bleeding, complications, and postoperative hospital stay between the two groups were compared. Results The surgical time, intraoperative bleeding, postoperative hospital stay, visual analog scale for pain, incidence of postoperative hematoma, skin sensory disorders, and infection in the HLFS group were less or lower than those in the HLSS group (P<0.05), but there was no statistically significant difference in recurrence rate between the two groups (P>0.05). Compared with preoperative indicators at the same group, the modified venous clinical severity score (VCSS) decreased and the chronic lower limb venous insufficiency questionnaire (CIVIQ) score increased (P<0.05). However, there was no statistically significant difference in the degree of improvement in VCSS and CIVIQ between the two groups at three months after surgery and before surgery (P>0.05). Conclusions HLFS has a definite therapeutic effect on GSVV, with smaller trauma, faster recovery after surgery, and lower incidence of postoperative complication compared to HLSS. It can be used as a surgical option for GSVV patients in clinical practice.

Citation： ZENG Yanzhang, YUAN Ping, JIANG Qing, PAN Yang. Comparative analysis of high ligation and foam sclerotherapy or spot stripping in treatment of great saphenous varicose veins. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 808-813. doi: 10.7507/1007-9424.202305008 Copy

1.	梅家才, 郑月宏. 原发性下肢浅静脉曲张诊治专家共识 (2021版). 血管与腔内血管外科杂志, 2021, 7(7): 762-772.
2.	Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
3.	Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
4.	Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res, 1996, 5(6): 539-554.
5.	常光其, 陈翠菊, 陈忠, 等. 慢性下肢静脉疾病诊断与治疗中国专家共识. 中国血管外科杂志 (电子版), 2014, 6(3): 143-151.
6.	廖懿, 赵纪春. 高位结扎加点式剥脱术治疗原发性大隐静脉曲张的最佳时机. 中国普外基础与临床杂志, 2016, 23(2): 198-200.
7.	张振, 亓明. 原发性下肢浅静脉曲张压力治疗的研究进展. 血管与腔内血管外科杂志, 2022, 8(1): 91-96.
8.	Hamann SAS, Giang J, De Maeseneer MGR, et al. Editor’s choice - five year results of great saphenous vein treatment: a meta-analysis. Eur J Vasc Endovasc Surg, 2017, 54(6): 760-770.
9.	Nesbitt C, Eifell RK, Coyne P, et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev, 2011, (10): CD005624. doi: 10.1002/14651858.CD005624.pub2.
10.	Biemans AA, Kockaert M, Akkersdijk GP, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg, 2013, 58(3): 727-734.
11.	Lawaetz M, Serup J, Lawaetz B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol, 2017, 36(3): 281-288.
12.	Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part Ⅰ. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord, 2023, 11(2): 231-261.
13.	廖传军, 张望德. 腔内射频消融术联合透光旋切术与传统高位结扎剥脱术联合透光旋切术治疗下肢静脉曲张的疗效对比分析. 中国普外基础与临床杂志, 2021, 28(5): 631-635.
14.	Coughlin PA, Berridge DC. Is there a continuing role for traditional surgery?. Phlebology, 2015, 30(2 Suppl): 29-35.
15.	Lynch NP, Clarke M, Fulton GJ. Surgical management of great saphenous vein varicose veins: a meta-analysis. Vascular, 2015, 23(3): 285-296.
16.	李大林, 张鲲, 颜京强, 等. 低分子肝素预防下肢静脉曲张术后深静脉血栓形成的效果. 中国普外基础与临床杂志, 2014, 21(12): 1552-1554.
17.	Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg, 2004, 40(4): 634-639.
18.	Blomgren L, Johansson G, Emanuelsson L, et al. Late follow-up of a randomized trial of routine duplex imaging before varicose vein surgery. Br J Surg, 2011, 98(8): 1112-1116.
19.	毛正发, 范昕, 王旭青. 不同术式治疗原发性大隐静脉曲张的临床效果比较. 现代医药卫生, 2016, 32(15): 2386-2388.
20.	Lam YL, Lawson JA, Toonder IM, et al. Eight-year follow-up of a randomized clinical trial comparing ultrasound-guided foam sclerotherapy with surgical stripping of the great saphenous vein. Br J Surg, 2018, 105(6): 692-698.
21.	Kong J, Liu Z, Fu G, et al. Outcomes of fluoroscopy-guided percutaneous high ligation of the great saphenous vein combined with foam sclerotherapy for symptomatic great saphenous veins. J Vasc Interv Radiol, 2022, 33(4): 445-450.
22.	王深明, 李晓强, 刘鹏. 硬化剂治疗下肢静脉曲张 (中国) 专家指导意见 (2016). 中国血管外科杂志 (电子版), 2017, 9(1): 11-14, 26.
23.	李祥祥, 胡俊顶. 大隐静脉高位结扎术联合不同浓度聚多卡醇硬化剂治疗下肢静脉曲张的效果. 贵州医科大学学报, 2022, 47(3): 368-372.
24.	张岚, 张柏根. 生活质量调查表在下肢慢性静脉功能不全术后随访中的应用. 中华普通外科杂志, 2004, 19(5): 272-273.
25.	Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation, 2014, 130(4): 333-346.

1. 梅家才, 郑月宏. 原发性下肢浅静脉曲张诊治专家共识 (2021版). 血管与腔内血管外科杂志, 2021, 7(7): 762-772.
2. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
3. Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
4. Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res, 1996, 5(6): 539-554.
5. 常光其, 陈翠菊, 陈忠, 等. 慢性下肢静脉疾病诊断与治疗中国专家共识. 中国血管外科杂志 (电子版), 2014, 6(3): 143-151.
6. 廖懿, 赵纪春. 高位结扎加点式剥脱术治疗原发性大隐静脉曲张的最佳时机. 中国普外基础与临床杂志, 2016, 23(2): 198-200.
7. 张振, 亓明. 原发性下肢浅静脉曲张压力治疗的研究进展. 血管与腔内血管外科杂志, 2022, 8(1): 91-96.
8. Hamann SAS, Giang J, De Maeseneer MGR, et al. Editor’s choice - five year results of great saphenous vein treatment: a meta-analysis. Eur J Vasc Endovasc Surg, 2017, 54(6): 760-770.
9. Nesbitt C, Eifell RK, Coyne P, et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev, 2011, (10): CD005624. doi: 10.1002/14651858.CD005624.pub2.
10. Biemans AA, Kockaert M, Akkersdijk GP, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg, 2013, 58(3): 727-734.
11. Lawaetz M, Serup J, Lawaetz B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol, 2017, 36(3): 281-288.
12. Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part Ⅰ. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord, 2023, 11(2): 231-261.
13. 廖传军, 张望德. 腔内射频消融术联合透光旋切术与传统高位结扎剥脱术联合透光旋切术治疗下肢静脉曲张的疗效对比分析. 中国普外基础与临床杂志, 2021, 28(5): 631-635.
14. Coughlin PA, Berridge DC. Is there a continuing role for traditional surgery?. Phlebology, 2015, 30(2 Suppl): 29-35.
15. Lynch NP, Clarke M, Fulton GJ. Surgical management of great saphenous vein varicose veins: a meta-analysis. Vascular, 2015, 23(3): 285-296.
16. 李大林, 张鲲, 颜京强, 等. 低分子肝素预防下肢静脉曲张术后深静脉血栓形成的效果. 中国普外基础与临床杂志, 2014, 21(12): 1552-1554.
17. Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg, 2004, 40(4): 634-639.
18. Blomgren L, Johansson G, Emanuelsson L, et al. Late follow-up of a randomized trial of routine duplex imaging before varicose vein surgery. Br J Surg, 2011, 98(8): 1112-1116.
19. 毛正发, 范昕, 王旭青. 不同术式治疗原发性大隐静脉曲张的临床效果比较. 现代医药卫生, 2016, 32(15): 2386-2388.
20. Lam YL, Lawson JA, Toonder IM, et al. Eight-year follow-up of a randomized clinical trial comparing ultrasound-guided foam sclerotherapy with surgical stripping of the great saphenous vein. Br J Surg, 2018, 105(6): 692-698.
21. Kong J, Liu Z, Fu G, et al. Outcomes of fluoroscopy-guided percutaneous high ligation of the great saphenous vein combined with foam sclerotherapy for symptomatic great saphenous veins. J Vasc Interv Radiol, 2022, 33(4): 445-450.
22. 王深明, 李晓强, 刘鹏. 硬化剂治疗下肢静脉曲张 (中国) 专家指导意见 (2016). 中国血管外科杂志 (电子版), 2017, 9(1): 11-14, 26.
23. 李祥祥, 胡俊顶. 大隐静脉高位结扎术联合不同浓度聚多卡醇硬化剂治疗下肢静脉曲张的效果. 贵州医科大学学报, 2022, 47(3): 368-372.
24. 张岚, 张柏根. 生活质量调查表在下肢慢性静脉功能不全术后随访中的应用. 中华普通外科杂志, 2004, 19(5): 272-273.
25. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation, 2014, 130(4): 333-346.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative analysis of high ligation and foam sclerotherapy or spot stripping in treatment of great saphenous varicose veins

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