A study of the mechanisms by which haemodynamic function improves following long saphenous vein-saving surgery

Objective: To study the mechanisms by which haemodynamic function improves following long saphenous vein-saving surgery. Design: Cohort study. Patients: Twenty patients, 14 women and six men, with primary varicose veins. Interventions: Varicose vein surgery by the long saphenous vein-saving technique. Main outcome measures: Preoperative investigation by physical examination, strain-gauge plethysmography, phlebography and measurements of the long saphenous vein diameter at four different locations using high-resolution, real-time ultrasound. Three months following vein-saving surgery, the patients were reassessed with physical examination, strain-gauge plethysmography and measurements of the long saphenous vein diameter. Results: AU patients but one showed excellent or good results following surgery. The preoperative diameter of the long saphenous vein was reduced by 40% at four different levels in the operated legs (p<0.01). The venous return time of the same legs increased 2.4 times (p<0.001). The decrease of the long saphenous vein diameter correlated positively with the increase in venous return time (t-50), (r=0.50, p=0.04). Conclusion: The results suggest that the development of incompetent perforators is an early major event in the formation of primary varicose veins. The results also suggest that the long saphenous vein valvular incompetence in varicose veins is attributable to venous wall dilatation rather than degeneration of the valves. The results support the hypothesis that the improvement in haemodynamic function following long saphenous vein-saving surgery is due, at least partly, to a reduction of the long saphenous vein diameter, which in turn tends to restore valvular competence.