Das Schicksal der Restsaphena nach stadiengerechter Varizenoperation

Zusammenfassung

Das Konzept der stadiengerechten Varizenoperation wird damit begründet, dass belassene gesunde Venenanteile für ein späteres Transplantat erhalten bleiben. In der vorliegenden Studie wurde dies überprüft.

60 Extremitäten wurden 2–7 Jahre nach stadiengerechter Operation einer Stamminsuffizienz der V. saphena magna (VSM) phlebographisch nachuntersucht. In 14 Fällen war die verbliebene Restsaphena komplett verschlossen. In weiteren 37 Fällen war die Vene an ihrem proximalen Ende thrombosiert (n=17), zeigte postthrombotische Wandveränderungen (n=14) oder konnte nicht ausreichend dargestellt werden (n=6).

Liegt der distale Insuffizienzpunkt der V. saphena magna unterhalb des Kniegelenks, bleibt nach stadiengerechter Operation nur ein kurzes Venensegment, das potenziell als singuläres koronares Transplantat verwendbar ist.

Abstract

Partial resection of the greater saphenous vein is currently the standard procedure for early stage varicosis. The intact vein segment left in situ is thought to be suitable for a later bypass graft. A study was performed to reconsider this concept.

Forty-eight patients (60 legs) were examined between 2 and 7 years after partial stripping of the greater saphenous vein. Following clinical examination, X-ray opaque markers were placed over the scar where the left segment of the saphenous vein was ligated during the former operation. Phlebography was performed to visualize deep and superficial veins. Initial length of the vein segment was calculated from the marker to the ankle. Informed consent was obtained from all patients.

Of the 60 vein segments in situ, 9 were intact while 14 were obviously occluded in full length. Thirty-seven vein segments showed some form of pathologic changes that involved on average one-fourth of the total vein length. Of these, 17 showed partial thrombotic occlusion, 14 showed irregular wall contours consistent with previous thrombosis, and in 6 the proximal part of the vein was not adequately visible.

It is concluded that partial stripping of the saphenous vein can preserve a vein segment for later bypass grafts. However, graft length will be limited especially when stripping below the knee is necessary.