Flush ligation of the sapheno-femoral junction vs simple, distal ligation. A randomised, 10-year, follow-up. The safe study

The aim of this study was to compare, in a prospective, randomised study, flush ligation/section of the sapheno-femoral junction (SFJ) including collaterals dissection/ligation to simple, distal (3-5 from the SFJ) long saphenous vein (LSV) ligation/section considering, after 10 years, recurrence of reflux, occurrence of new varices, lenght of obstruction after ligation of the LSV and comparing time/costs. Methods: Surgery. Flush ligation/section or distal ligation/section were performed under general (34%) or spinal anesthesia (76%). All patients went home the same day. Endpoints were variations in AVP (ambulatory venous pressure), RT (refilling time), color duplex reflux, number of recurrent or new incompetent venous sites, time, costs, and lenght of the LSV. Results: 400 patients were included in each group; 369 (age 43.3; SD11) completed the study in the flush ligation group and 377 (43.5;12) in the distal ligation group. AVP was 55 mmHg in both groups at inclusion; at 10 years it was comparable (41 in flush vs 40 in distal ligation). RT was 14 sec vs 13 at inclusion (ns); at 10 years 19 vs 18 (normalised in comparison with initial value; ns between groups). At 10 years major incompetent sites were 5 in both, groups; also minor sites were comparable. The occluded venous segment was 6.5 cm in flush vs 1.4 cm in distal ligation (p<0.025). The average number of sclerotherapy sessions per each patient, needed to control varices, was in favour of distal ligation (12; range 3-20, vs 22; 6-32). Operating time in flush ligation was 29 minutes, average cost was 455(SD55)$US. Operating time in distal ligation was 21% shorter; cost was 28% lower. Conclusions: In this study we used a combination of duplex and AVP. Results indicate that distal LSV ligation achieves, on the control and recurrency of varicose veins results comparable to flush ligation. This is obtained in a shorter operating time, with lower cost. As varicose veins surgery is very common, saving operating time, costs and making procedures simpler is an important option.