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Background Neovascularisation at the sapheno-femoral junction (SFJ) ligation site in the groin may occur within one year after great saphenous vein (GSV) surgery. Several anatomical and prosthetic barrier techniques have been proposed to prevent this evolution. Objective A prospective study examined whether closing the cribriform fascia could reduce the incidence of postoperative neovascularisation in the groin. Patients and methods Patients with primary varicose veins and incompetence at the level of the SFJ were included. After SFJ ligation in 235 limbs of 193 patients an anatomical barrier was constructed by closing the cribriform fascia. Postoperative duplex scanning was performed after 2 and 12 months. Results were compared with historical control groups in which either a silicone patch saphenoplasty or no barrier technique had been performed. Results After one year, 10 limbs had developed recurrent thigh varicose veins and duplex scan showed neovascularisation at the SFJ ligation site in 15 of 223 re-examined limbs (6.7%). This was comparable to the group of 191 limbs with silicone patch saphenoplasty (5.2%) ( P =0.526) and superior to the group of 189 limbs without barrier (14.8%) ( P Conclusion Interposition of an anatomical barrier by closing the cribriform fascia after SFJ ligation reduced ultrasound detected neovascularisation at the SFJ after one year. In primary varicose vein operations application of an anatomical barrier technique (without prosthetic patch) is an alternative option to prevent postoperative neovascularisation.

During the last decade, endovascular abdominal aortic repair (EVAR) has emerged as the preferred treatment in a selected group of patients with suitable aortic anatomy for endografting. In order to both minimise its invasiveness and reduce complications related to groin dissections, Harrison and coworkers studied a fascial closure technique of the puncture site without the need to touch the femoral artery itself. In 1997, Diethrich was the first to describe closure of the cribriform fascia where it covers the common femoral artery access. Larzon and colleagues published the largest series so far and analysed 131 sutured fascial cases during EVAR. In their hands, complication rate was 13.7% (89%

Objectives: to investigate whether a silicone implant at the sapheno-femoral ligation site could prevent recurrent varicosities. Materials and methods: two non-randomised groups of patients were studied prospectively. In group A 173 patients and 212 limbs had sapheno-femoral ligation, while 172 patients and 210 limbs additionally had a piece (2×3 cm) of silicone sheet sutured to the saphenous stump to cover the anterior half of the common femoral vein. The implant was fixed in apposition to the deep vein by carefully closing the cribriform fascia. Colour duplex scanning was performed after 2 and 12 months. Results: in the no implant group neovascularisation was observed in 35 (17%) after 12 months, but only in 13 (6%) limbs treated with a silicone implant ( p Conclusions: interposition of a partition of silicone implant seems to lower the incidence of neovascularisation one year after saphenofemoral ligation. This technique may constitute an efficient method to prevent recurrence at the correctly ligated saphenous stump.