Prevention or reversal of deep venous insufficiency by aggressive treatment of superficial venous disease

Background: This study of patients who received either aggressive or less-aggressive treatment for superficial venous disease was undertaken to determine its effects on deep venous insufficiency (DVI). Methods: From 1998 to 2004, we treated 1,500 consecutive patients with superficial venous disease at our outpatient care center. A total of 100 patients were available for the study; the remaining patients were not available for the complete follow-up duplex scans 6 months after therapy, irrespective of the therapeutic results. Sixty-four patients underwent aggressive therapy, which included high ligation with partial selective perforation-invagination (PIN) axial stripping of the greater saphenous vein, ambulatory stab phlebectomy of the varicose veins, and transdermal treatment of the spider veins. Thirty-six patients underwent less-aggressive treatment. which included high ligation with selective partial PIN axial stripping of the greater saphenous vein and ambulatory phlebectomy of varicose vein clusters but no spider vein treatment. Results: Follow-up duplex scanning after aggressive treatment of superficial venous disease showed improvement or complete reversal of DVI in the majority of patients. This improvement was defined as a marked decrease in the size of the deep veins in 80% of patients and a decrease of the reflux closure time of the deep venous valves in 83% of patients. Only 28% of patients receiving less-aggressive treatment without transdermal laser therapy of the spider veins showed improvement in their reflux valve closure time; the remaining 72% were unchanged or deteriorated. Conclusions: Aggressive treatment Of Superficial venous disease can prevent or even eliminate deep vein insufficiency (DVI). (c) 2006 Excerpta Medica Inc. All rights reserved.