The fate of residual saphenous vein after partial removal or ligation.

Abstract

Duplex scanning was used to study residual greater and lesser saphenous vein segments in 14 limbs with previous partial distal greater saphenous vein removal, 19 limbs with partial proximal greater saphenous vein removal, 29 limbs with total greater saphenous vein removal, 10 limbs with high greater saphenous vein ligation, as well as 37 contralateral unoperated and 8 other normal limbs. Partial distal removal showed better preservation of residual greater saphenous vein than partial proximal removal, with greater preservation of "usable" length and greater average diameter. Compared to contralateral unoperated legs, partial distal removal, partial proximal removal, and total removal all showed a similar degree of compensatory lesser saphenous vein enlargement. High ligation showed no lesser saphenous vein enlargement but showed the best greater saphenous vein preservation, none had less than 85% preservation of potential length. Combining residual greater saphenous vein and lesser saphenous vein segments of usable caliber, 100% of high ligation, 93% of partial distal removal, and 74% of partial proximal removal had greater than 60 cm total length, and most total removal had greater than 40 cm usable residual lesser saphenous vein. Previous saphenous vein surgery should not categorically exclude patients as having no usable residual ipsilateral vein for bypass. Partial distal removal allows better preservation of length and caliber of residual greater saphenous vein than proximal harvest, with both showing equivalent lesser saphenous vein enlargement to those with total greater saphenous vein removal. High ligation, performed for early tributary varicosities, in patients with saphenofemoral but no perforator incompetence, gives excellent preservation of residual greater saphenous vein length and caliber. Sclerotherapy to tributary varicosities did not obliterate distal greater saphenous vein segments.