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Introduction. Relapses is an important criterion that is used to determine the effectiveness of any treatments of varicose veins of the lower extremity (VVLE). However, only a few studies in the literature are devoted to the distant outcomes of endovenous laser coagulation (EVLC) using the 1470 nm laser.Aim. To identify anatomical variants of VVLE relapses after EVLC using the 1470 nm laser, study the frequency of relapses, and determine the factors affecting the risk of relapses.Materials and methods. A total of 358 EVLC with 78 sonographic recurrences were performed during a 5-year observation period. EVLC was performed using the 1470 nm laser system, and radial light guides with a 400-μm-diameter. At 1, 3, 6, 12, 24, 36, 48, 60 months after EVLC, a follow-up ultrasound examination was carried out. A visual detection of varicose vein was classified as a clinical recurrence. Patients without visually detected varicose tributaries and trunk, but with recanalized sections of the great saphenous vein (GSV) trunk, an incompetent GSV trunk in the lower leg, tributaries and perforators of the operated extremity were considered to be sonographic recurrences. Statistical analysis was performed with IBM SPSS 22 statistic software package (USA). The analysis of variance test (ANOVA) was used to determine the statistical significance of observed differences in mean value, and Pearson's chi-squared (χ2) test in Fisher's exact solution to determine frequencies. Differences were considered statistically significant at p < 0.005.Results. The main anatomical variants of sonographic recurrences included incompetent ostial tributaries (n = 20), segmental recanalization of femoral perforator GSV trunk (n = 21), perforators in the upper third leg (n = 10), perforators in the middle and lower third leg (n = 22).Discussion. Endovascular laser obliteration of the intact anterior accessory great saphenous vein (AAGSV) needs further studies. It is not recommended to ligate perforators with a diameter < 3.5 mm, while coagulation of perforators that have direct drainage to the great or small saphenous vein trunk with a high energy flow needs further studies.Conclusion. The most of sonographic VVLE recurrences occur within 1 to 4 years after endovascular laser treatment and are associated with the development of valve insufficiency in previously intact saphenous and/or perforator veins followed by segmental recanalization of the obliterated GSV trunk.

The great saphenous vein (GSV), which has a long superficial course through the lower limb, is deemed as an important conduit of choice in coronary revascularization procedures. It is also a popular site for venous cannulation particularly in emergencies. Upon routine dissection of an 83-year-old Caucasian female cadaver, a rare unilateral unusual course of the left GSV was observed. A distal inter-fascial position of the left GSV was noted in the foot, followed by the occurrence of a thick fascial canal in the leg within which the GSV was lodged. It can be postulated that the presence of the fascial canal may aid venous return and prevent excessive dilatation of the vein during incompetencies of the venous valves. Moreover, knowledge of such variations of the GSV and its related fascial envelope are especially relevant for pre-operative protocols in peripheral vascular surgery. [ABSTRACT FROM AUTHOR]

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Veins of the lower extremity can be categorized into three hierarchically ordered groups: the epifascial, the interfascial, and the deep ones. In the past, the interfascial veins, e.g., the great saphenous vein, were categorized as superficial veins. But nowadays, experts recommend regarding these veins as a separate group because of their unique topography and clinical relevance. In order to better understand the venous anatomy of the lower limbs, which is highly variable, one should also comprehend their embryological development. Venous embryogenesis in the lower limb consists of three stages. During the first stage the primitive fibular vein is the main vein of the extremity. During the second stage it is replaced by the axial vein and finally by the femoral vein. In some adult individuals this embryonic or fetal venous anatomy is still present. Unfortunately, current anatomical textbooks and atlases, as well as traditional cadaver dissections, are not very useful regarding these issues. Therefore, undergraduate teaching of anatomy can be challenging. New educational tools, such as ultrasonography, seem indispensable to teach the anatomy of these veins properly.

Veins of the lower extremity can be categorized into three hierarchically ordered groups: the epifascial, the interfascial, and the deep ones. In the past, the interfascial veins, e.g., the great saphenous vein, were categorized as superficial veins. But nowadays, experts recommend regarding these veins as a separate group because of their unique topography and clinical relevance. In order to better understand the venous anatomy of the lower limbs, which is highly variable, one should also comprehend their embryological development. Venous embryogenesis in the lower limb consists of three stages. During the first stage the primitive fibular vein is the main vein of the extremity. During the second stage it is replaced by the axial vein and finally by the femoral vein. In some adult individuals this embryonic or fetal venous anatomy is still present. Unfortunately, current anatomical textbooks and atlases, as well as traditional cadaver dissections, are not very useful regarding these issues. Therefore, undergraduate teaching of anatomy can be challenging. New educational tools, such as ultrasonography, seem indispensable to teach the anatomy of these veins properly. [ABSTRACT FROM AUTHOR]

This study evaluates the pain experienced by patients undergoing endovenous laser ablation (EVLA) of the great saphenous vein (GSV) when combined with an ultrasound-guided femoral nerve block (FNB). The aim was to assess the effectiveness of FNB in reducing pain during the procedure and its impact on patient comfort, procedure duration, and recovery time. A total of 50 patients diagnosed with varicose veins were enrolled. The results indicated that ultrasound-guided FNB significantly reduced intra-procedural pain levels compared to the control group, improving patient outcomes. [ABSTRACT FROM AUTHOR]

Venous disorders encompass a diverse range of manifestations and diseases, impacting a significant portion of the population. While life-threatening conditions are uncommon in non-thrombotic disorders, like telangiectasias or uncomplicated varicose veins (VVs), these conditions still have a substantial impact on affected individuals. Ensuring that patients are well informed about their venous disorder is a crucial step in their treatment journey. Providing them with valuable information regarding the disease's natural progression and available therapeutic options plays a pivotal role in optimizing their care. When patients are diagnosed with venous disorders, they often have numerous questions and concerns they want to discuss with their healthcare providers. Addressing these inquiries not only improves patients' knowledge and understanding but also influences their treatment compliance and overall outcomes. Therefore, it is of utmost importance to provide comprehensive explanations that address any doubts, uncertainties, and areas of confusion that patients may have. This report aims to present a concise, practical, and informative guide to venous disorders, focusing specifically on the common questions frequently raised by patients in everyday clinical practice. By serving as a valuable resource for healthcare professionals working in the field of venous diseases, this guide equips them with the necessary tools to effectively address patients' concerns and provide optimal care. By bridging the gap between patients' inquiries and medical expertise, this guide strives to enhance therapeutic outcomes and improve the overall management of venous disorders, ultimately empowering patients in their treatment journey. [ABSTRACT FROM AUTHOR]

Introduction: Saphenofemoral junction (SFJ) incompetence is the most commonly attributed etiological factor in varicose veins of lower limbs with a consequent increase in the caliber of the great saphenous vein (GSV). This study aimed to assess GSV diameter to determine its cutoff diameter value for predicting reflux at the SFJ, in cases of varicose veins. Methods: This hospital-based prospective study was conducted on 156 patients (245 diseased limbs) over a period of 2 years, involving patients referred from the outpatient department for evaluation of varicose veins or those being evaluated as a part of preoperative assessment. Results: The cutoff value of GSV diameter to detect SFJ incompetence was determined at 5.4 mm with best sensitivity of 74.3%, specificity of 78.5%, and accuracy of 75.1%. Conclusion: GSV diameter assessment is of immense clinical importance as it can help the treating physician to filter out the false-negative cases solely being diagnosed based on reflux at SFJ, especially those with an absence of obvious clinical signs.

Objective To evaluate the early clinical effect of the application of endoscopy in coronary artery bypass grafting to obtain the great saphenous vein. Methods A total of 262 patients with great saphenous vein obtained by endoscopy in Nanjing Drum Tower Hospital were used to observe the operation status and incidence of postoperative incision complications from June 2019 to October 2023. Results The time to obtain the great saphenous vein was (39.1±9.2) min, and the length was (30.8±7.6) cm. There was no obvious damage to the wall of the great saphenous vein after removal. Subcutaneous ecchymosis occurred in 13 patients, and it could be absorbed and healed by itself after an average of about 10 days. The pain of the leg incision was not obvious, and there was no incision infection, dehiscence or fat liquefaction. Conclusion Obtaining the great saphenous vein through endoscopy with little trauma can bring good early clinical results and improve patient satisfaction and quality of life.

Vascular leiomyosarcoma LMS. is an extremely rare subgroup of LMSs. Fewer than 50 cases of LMS originating from the great saphenous vein have been reported. In 43% of reported cases, LMS was misdiagnosed clinically. In our case, the patient was initially misdiagnosed as having a thrombosed aneurysm. This misdiagnosis could be due to the rarity of great saphenous vein LMS cases, for which a high index of suspicion is needed, and because no specific radiologic findings have been established for diagnosing LMSs. Masses presenting along the course of vessels should be suspected for malignancy, which can be helpful in performing definitive surgery and avoiding multiple surgeries.

Introduction: It has been previously proposed in numerous studies that chronic venous insufficiency (CVI) has similar pathogenesis to varicocele in males. Varicocele has been identified as the most common cause of infertility in men, accounting for 40% of cases. Aim: This study investigates whether varicocele screening should be conducted in patients with CVI and, if so, which patients should undergo such screening. Material and methods: The study included 102 adult male patients with venous insufficiency complaints who presented to the cardiovascular surgery clinic between January 2023 and June 2023. Data were prospectively collected through medical history interviews and Doppler ultrasound measurements performed by a single radiologist. The relationship between non-normally distributed measurement data of the two groups was evaluated using the Mann-Whitney U test, while the association between categorical variables was assessed using the χ² test. ROC analysis was employed for determining predictive value. A type 1 error level of α = 0.05 was adopted. Results: The mean left great saphenous vein (GSV) diameter of those with varicocele (6.6 ±2.3) was significantly larger compared to the mean left GSV diameter of those without varicocele (5.3 ±2.6) (p = 0.004). The area under the ROC curve for left GSV diameter was 67% (p = 0.005). When varicocele screening is performed in patients with a left GSV diameter of 5.35 cm and above, sensitivity is 71.4% and specificity is 61.2%. Conclusions: There is a significant association between left GSV diameter and varicocele (p = 0.004). Varicocele screening can be carried out with 71.4% sensitivity in adult male patients with a left GSV diameter of 5.35 cm and above. Both cardiovascular surgeons and radiologists can conduct varicocele screening by measuring pampiniform veins in patients with a left GSV diameter of 5.35 cm and above. This approach has the potential to reduce the incidence of varicocele and associated infertility. [ABSTRACT FROM AUTHOR]

This paper reports on the occurrence of thrombose of the left great saphenous vein (GSV) soon after being given the AstraZeneca vaccine and two recurrent events within three days after the suspension of the anticoagulant. A 53-year-old patient had superficial thrombophlebitis of the GSV in the left leg three days after taking the second dose of the AstraZeneca vaccine for COVID-19 and initiated treatment with rivaroxaban (XareltoTM) 15 mg twice a day, subsequently increasing to 20 mg. After 45 days, the patient contracted dengue and stopped taking the anticoagulant. Two days later, the patient had another thrombosis in the left GSV. The patient is currently in outpatient care with a prophylactic dose of 10mg/day of anticoagulant and undergoes evaluations at three-month intervals. The result of our study is a rare event.

Double‑blind/multicenter/randomized trial protocol. Eligibility criteria: age 18-70 yrs; C2-C5 leg varices secondary to the Great Saphenous Vein (GSV) incontinence; GSV size 6-10mm, at 10cm from the Saphenous-Femoral Junction (SFJ); ostial reflux lasting >0.5 sec at duplex ultrasound; negative reflux elimination test; acceptance of the GSV sparing treatment plus partial/total varicose veins removal. Exclusion criteria: non-isolated GSV reflux; district already treated; pregnancy/lactation; impaired walking ability; deep vein thrombosis/insufficiency; severe comorbidities. Participants recruited from 7 Italian tertiary referral centres. Interventions: crossotomy (no SFJ’s tributaries ligation) vs crossectomy. The study aimed to verify if GSV drainage through the SFJ’s tributaries reduces groin/peripheral recurrences. Primary endpoint: 1-year GSV reflux recurrence, positive to the Valsalva maneuver, originating from the SF. Participants equally randomized. Participants, care givers, and those assessing the outcomes blinded to group assignment.

Background: We sought to assess the safety and efficacy of endovenous thermal ablation (EVTA) in treating large great saphenous veins (GSV) > 12 mm in diameter. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 for comparative and noncomparative studies depicting EVTA in the treatment of GSV > 12 mm. Primary endpoints included GSV occlusion, technical success, deep vein thrombosis (DVT), and endovenous heat-induced thrombosis (EHIT). We conducted a comparative analysis between GSV > 12 mm and < 12 mm and a meta-regression analysis for two sets of studies, one including the whole dataset, containing treatment arms of comparative studies with GSV < 12 mm and one exclusively for GSV > 12 mm. Results: Seven studies, including 2564 GSV, depicting radiofrequency (RFA) and endovenous laser ablation (EVLA) were included. GSV > 12 mm occlusion, technical success, DVT, and EHIT estimates were 95.9% (95% CI: 93.6–97.8), 99.9% (95% CI: 98.9–100.0), 0.04% (95% CI: 0.0–3.4), and 1.6% (95% CI: 0.3–3.5). Meta-regression revealed a negative association between GSV diameter and occlusion for both the whole dataset (p < 0.01) and the > 12 mm groups (p = 0.04), GSV diameter and technical success for both groups (p < 0.01), (p = 0.016), and GSV diameter and EHIT only for the whole dataset (p = 0.02). The comparative analysis between GSV < 12 mm and GSV > 12 mm displayed an occlusion estimate of OR 1.79 (95% CI: 1.25–2.56) favoring small GSV. Conclusion: Whereas we have displayed excellent occlusion and technical success results for the EVTA of GSV > 12 mm, our analysis has illustrated the unfavorable impact of GSV diameter on occlusion, technical success, and EHIT outcomes regardless of the 12 mm threshold. Potential parameter or device adjustments in a diameter-oriented fashion could further enhance outcomes. [ABSTRACT FROM AUTHOR]

Abstract The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins.

Introduction: Can the tandem arrangement of operating theater setup to perform a surgical drill similar to military, together with safe reuse of single-use items combat the cost of consumables of endovenous laser ablation (EVLA)? Methods: Operation pathway of EVLA consisted of cleaning and draping of patient (step 1), access to the affected vein and infiltration of tumescent local anesthesia (step 2), endovenous ablation (step 3), ultrasound-guided microfoam sclerotherapy (step 4), and chemical sterilization of consumables (step 5). Dedicated theater lists for EVLA were arranged to treat several patients per session in a prearranged operating theater. When the step 5 is completed on the first patient, the step 1 on the next patient was performed using sterilized optical fiber (OF) as a cycle while minimizing patient changeover time. Number of patients treated with each session of OF and time taken for step 1 to step 4 was recorded and analyzed. Results: A total of 140 patients treated using eight OFs during December 2019 to December 2022. Average number of patients treated with a single OF and during a single session of fiber is 17.5 (9–23) and 4.2 (3–7), respectively. Average time taken for step 1 was 7.83 min, step 2 was 7.95 min, step 3 was 1.57 min, and step 4 was 6.36 min. All the procedures were performed using four chemically re-sterilized guidewires and introducer sheaths. Conclusion: Tandem arrangement of operating theater to perform EVLA procedure similar to military drill can optimize the utilization of OFs and consumables.

The use of total arterial myocardial revascularization in patients with multivessel lesions of the coronary arteries has a number of advantages, namely the duration of functioning or patency of the grafts. The level of total arterial myocardial revascularization implementation in developed and developing countries remains quite low. The aim. Based on the analysis of our own experience, to determine the influence of the technique of total arterial revascularization on the frequency of complications in the early postoperative period. Materials and methods. From February 22, 2016 to December 24, 2020, 390 consecutive patients were operated at the Ukrainian Children’s Cardiac Center. The patients were divided into two groups: participants of the group I underwent total arterial myocardial revascularization, and those includedin the group II underwent conventional coronary artery bypass grafting (CABG). The inclusion criteria were: ischemic heart disease, stable angina or exertional angina, multivascular coronary artery disease, absence of valvular pathology. Results. There was zero 30-day mortality in both groups. The frequency of postoperative bleeding was higher in group II and amounted to 1.6%. Surgical wound complications (infection) were also more common in the group II: 1.2% versus 0.69% (p=0.906) in the group I. Similarly, laboratory parameters such as the level of creatine kinase-MB were almost identical. Conclusions. Total arterial myocardial revascularization is a safe method with good immediate results. The frequency of complications in total arterial myocardial revascularizationdoes not differ from that in conventional CABG. For a wider application of the total arterial myocardial revascularization,it is necessary to continue toconduct studies of the remote postoperative period.

Abstract Background Donor–recipient diameter discrepancy can be problematic when using an autologous great saphenous vein graft for internal jugular vein reconstruction. A triple-paneled method of saphenous vein grafting is one solution. Case presentation A 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. An 8-cm segment of the right internal jugular vein was resected. For reconstruction, a 30-cm segment of the great saphenous vein was harvested and divided into three pieces of equal length. After opening each piece longitudinally, they were sutured together in a side-by-side fashion to create a cylinder that was used to reconstruct the internal jugular vein defect. The graft was patent 10 months after the surgery. Conclusion The triple-paneled method is feasible for autologous great saphenous vein graft reconstruction of the internal jugular vein.

A 63-year-old man with a history of bipolar and schizoaffective disorder was admitted to the psychiatry unit. His comorbidities included active smoking, hypertension, diabetes, hyperlipidemia, coronary artery disease after coronary artery bypass grafting, and peripheral arterial disease. During the admission, the patient began to complain of right foot pain at rest. Angiography revealed occlusion of a previously placed right superficial femoral artery and popliteal stents, severe common femoral and distal popliteal stenosis with only a patent posterior tibial (PT) artery runoff. Serial venoplasty was performed and revealed an inadequately sized, ipsilateral great saphenous vein, followed by a delayed femoral–PT in situ saphenous vein bypass. Angiography at 32 months demonstrated a patent femoral–PT great saphenous vein bypass.

The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins. [ABSTRACT FROM AUTHOR]

Introduction: One of the parts of the coronary artery bypass grafting (CABG) or off-pump coronary artery bypass grafting (OPCAB) process is the collection of vascular material, which is then employed as a coronary aortic bypass due to the large number of coronary vessels necessitating an aorto-coronary bypass. An invasive surgical operation called saphenous vein harvest, also known as the great saphenous vein (GSV), has the potential to cause surgical site infection (SSI). There are currently 2 methods for harvesting GSV: the conventional method open vein harvest (OVH) and the endoscopic, minimally invasive method endoscopic vein harvest (EVH). The clinical issue is whether the GSV harvest approach can influence the patient's lower limb arteriovenous systems and help to lessen postoperative problems. Aim of the research: To analyse the healing of a surgical incision on the lower limb and the effect of GSV harvest methods on the arteriovenous system. Material and methods: In the study period May-September 2022, 60 patients with ischaemic heart disease, who were scheduled for surgical heart revascularization, were included. Clinical information was collected from 60 patients who met the inclusion criteria and were split into 2 groups at random. Results and conclusions: The arteriovenous system of the lower extremities was unaffected by either the OVH or EVH methods utilized to harvest GSV. The OVH approach resulted in a higher rate of SSI in patients with an elevated risk of SSI based on the BHIS scale, particularly in individuals with atherosclerosis of the lower limbs. [ABSTRACT FROM AUTHOR]

Venous aneurysms are uncommon and can involve the entire venous system and occur at any age. The presence of these aneurysmal formations at the level of the saphenous vein junction is rarely reported, given the small number of cases described in the literature. We report the case of a 41-year-old patient with an aneurysm in the saphenofemoral junction of the right great saphenous vein, discovered incidentally during a consultation for varicose veins of the right lower limb., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2024 The authors.)

Background: Peripheral arterial disease is a significant health care burden globally. Treatment options for limb salvage include open surgical bypass or endovascular revascularization. One of the vital prerequisite for successful infrainguinal bypass is the availability of good conduit. Not all patients have good quality great saphenous vein of adequate length to facilitate bypass. In these scenarios, splicing of available autologous veins and synthetic graft with vein cuff are alternate options. Aim: To compare the outcomes of infrainguinal bypass done for patients with chronic limb threatening ischemia in two groups In Group I, non spliced GSV was the conduit used. In Group II, either spliced vein graft or synthetic graft with vein cuff was used. Materials and Methods: This is a retrospective study done in a tertiary care centre over a period of 40 months. Ipsilateral Great Saphenous Vein (GSV) was our preferred conduit. In the absence of good calibre GSV, splicing of available autologous veins were done. Only when autologous veins were not available synthetic graft was used with distal vein cuff. Results: A total of 52 patients have undergone bypass during the study period of which 15 patients (28.8%) did not have good calibre GSV. Splicing of autologous veins were done for 10 patients (19.2 %) and synthetic graft with vein cuff was used for 5 patients (9.6%). One year graft patency in group I was 81% and in group II was 66.6%. Limbs were salvaged in 86% of patients in either groups. The mortality rate was 8.1% and 6.6% in groups I & II respectively. Conclusion: When good caliber GSV is not available, splicing of available autologous veins provide comparable patency and should be preferred over synthetic graft. Synthetic graft provides acceptable limb salvage rate when used with an adjunctive procedure like vein cuff for tibial bypasses and should be used when autologous veins are not available or when the patient carries a high risk for major surgery.

The assessment of the saphenofemoral junction (SFJ) is important in the diagnosis and treatment of venous reflux of the great saphenous vein (GSV). In the clinical practice of venous medicine, the SFJ is used to represent the region at which the saphenous arch connects with the common femoral vein (CFV). A number of notable variations of the SFJ have been documented, and rare variable courses of the GSV have been described recently. Our case study reports two unusual GSV terminations. In both cases, the SFJ was located below the confluence of the profunda femoris vein (PFV) with the femoral vein (FV). Case 1 showed the SFJ was formed by the GSV and FV; whereas case 2 showed the PFV was joined by the GSV after a transposition with the FV. Anatomical variations of the SFJ are rare; however, they are increasingly diagnosed with the use of duplex ultrasound. The identification of SFJ variants warrants a safe endovenous procedure and prevents surgical complications.

Background: The great saphenous vein (GSV) is the most commonly used conduit for coronary arterial bypass graft. However, the status of the GSV, including metabolic dysfunction such as diabetes mellitus (DM) complication, is strongly associated with vein graft failure (VGF). To date, the molecular mechanism underlying VGF remains elusive. Detailed characterization of the cellular components and corresponding expression regulation in GSVs would be of great importance for clinical decision making to reduce VGF. Methods: To this end, we performed single-cell RNA sequencing to delineate cellular heterogeneity in three human GSV samples. Results: Scrutinization of cellular composition and expression revealed cell diversity in human GSVs, particularly endothelial cells (ECs). Our results unraveled that functional adaptation drove great expression differences between venous ECs and valvular ECs. For instance, cell surface receptor ACKR1 demarcated venous Ecs, whereas ACRK3/ACKR4 were exclusively expressed by valvular ECs. Differential gene expression analysis suggested that genes highly expressed in venous ECs were mainly involved in vasculature development and regulation of leukocyte adhesion, whereas valvular ECs have more pronounced expression of genes participating in extracellular matrix organization, ossification and platelet degranulation. Of note, pseudo-time trajectory analysis provided in silico evidence indicating that venous ECs, valvular ECs and lymphatic vessels were developmentally connected. Further, valvular ECs might be an importance source for lymphatic vessel differentiation in adults. Additionally, we found a venous EC subset highly expressing IL6, which might be associated with undesirable prognosis. Meanwhile, we identified a population of ANGPTL7+ fibroblasts (FBs), which may be profibrotic and involved in insulin resistance in human GSVs. Additionally, our data suggest that immune cells only accounted for a small fraction, most of which were macrophages. By assessing the intertwined remodeling in metabolic dysfunction that potentially increases the gene expression regulatory network in mural cells and leukocytes, we found that transcription factor KLF9 likely operated a proinflammatory program, inducing the transcription of metallothionein proteins in two mural cell subsets and proinflammatory immune cells. Lastly, cellular communication analysis revealed that proinflammatory signaling, including TRAIL, PVR, CSF and GDF, were uniquely activated in patients with metabolic dysfunction. Conclusions: Our results identified critical cell-specific responses and cellular interactions in GSVs. Beyond serving as a repertoire, this work illustrates multifactorial likelihood of VGF. [ABSTRACT FROM AUTHOR]

Teng-Yue Zhao,* Ji-Qiang Bu,* Jian-Jun Gu, Yu Liu, Wen-Li Zhang, Zi-Ying Chen Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zi-Ying ChenDepartment of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of ChinaTel +86 15803210520Fax +86 3116188269Email chenzy_de@163.comObjective: This study aimed to examine the short-term effect of the no-touch technique on the patency rate of a great saphenous vein (GSV) bridge used during off-pump coronary artery bypass grafting (OPCABG).Methods: Between June 2018 and September 2020, 140 patients undergoing OPCABG, with grafts obtained from the GSV using the “no-touch” technique or the left internal mammary artery (LIMA), were enrolled in this study. The early clinical results and short-term patency rate of the OPCABG were evaluated at a three-month follow-up by comparing the patency rate of the LIMA bridge and the GSV bridge obtained by the no-touch technique. This study also analyzed the impacts of the postoperative complications of the lower limbs and the distribution area of diseased vessels on the patency rate of a GSV bridge obtained by the no-touch technique at an early stage.Results: No perioperative death or adverse cardiovascular or cerebrovascular events occurred in the 140 patients undergoing OPCABG. The difference in the early patency rate between the GSV bridge obtained by the no-touch technique and the LIMA bridge was not statistically significant (95.9% vs 97.1%, p = 0.501). There was no significant difference in the patency rate between an end-to-side anastomosed venous bridge and a LIMA bridge (95.0% [248/261] vs 97.1% [136/140], p = 0.314). The overall patency rate of a no-touch vein bridge in the right coronary artery region was lower than it was in the left coronary artery region (93.8% [165/176] vs 97.9% [183/187], p = 0.049).Conclusion: The no-touch technique may improve the early patency rate of a GSV bridge, and its effect is similar to that of a LIMA bridge.Keywords: off-pump coronary artery bypass grafting, no-touch technique, great saphenous vein, left internal mammary artery

Background Great saphenous vein (GSV) incompetence is involved in most cases of varicose disease. Standard preinterventional assessment is required to decide the treatment modalities. GSV diameter was measured at saphenofemoral junction, proximal thigh, distal thigh, knee, proximal leg, and distal leg. Analysis was done to find at which diameter size the reflux is expected to occur. Patient and methods The study involved 100 limbs from outpatient vascular clinic. GSV diameter was measured at the saphenofemoral junction, the proximal thigh, the distal thigh, below the knee, and mid-leg and correlated with reflux. Results Reflux in the sapheno-femoral junction (SFJ) (group I) occurred at 7.16±2.30 mm, proximal thigh (group II) at 6.60±1.89 mm, distal thigh (group III a) at 6.12±1.63 mm, knee (group III b) at 5.78±1.60 mm, proximal leg (group IV) at 4.61.24 mm, and mid leg (group V) at 3.59±1.16 mm. Conclusion Measurement at six sites revealed higher sensitivity and specificity to predict reflux. GSV diameter correlates with reflux.

Data on the efficacy of non-reversed and reversed great saphenous vein bypass (NRGSV and RGSV) techniques are lacking. The aim of the study was to compare the outcomes of patients undergoing open infrainguinal revascularisation using NRGSV and RGSV from a multi-institutional database. The Vascular Quality Initiative database was queried for patients undergoing infrainguinal bypasses using NRGSV and RGSV for symptomatic occlusive disease from January 2003 to February 2021. The primary outcome measures included primary and secondary patency at discharge and one year. Secondary outcomes were re-interventions at discharge and one year. Cox proportional hazards models were used to evaluate the impact of graft configuration on outcomes of interest. Of 7 123 patients, 4 662 and 2 461 patients underwent RGSV and NRGSV, respectively. At one year, the rates of primary patency (78% vs. 78%; p =.83), secondary patency (90% vs. 89%; p =.26), and re-intervention (16% vs. 16%; p =.95) were similar between the RGSV and NRGSV cohorts, respectively. Subgroup analysis based on outflow bypass target and indication for revascularisation did not show differences in primary and secondary outcomes between the two groups. Multivariable analysis confirmed that RGSV (NRGSV as the reference) configuration was not independently associated with increased risk of primary patency loss (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.91 – 1.13; p =.80), secondary patency loss (HR 0.94; 95% CI 0.81 – 1.10; p =.44), and re-intervention (HR 1.03; 95% CI 0.91 – 1.16; p =.67) at follow up. The study shows that RGSV and NRGSV grafting techniques have comparable peri-operative and one year primary and secondary patency and re-intervention rates. This effect persisted when stratified by outflow targets and indication for revascularisation. Therefore, optimal selection of vein grafting technique should be guided by the patient's anatomy, vein conduit availability, and surgeon's experience. [ABSTRACT FROM AUTHOR]

Background: Vena saphena magna (VSM) – one of the two superficial venous collectors of the lower limb, the longest vein of the human body, is often accompanied by parallel veins, of which clinical significance may be different. The objective of the study was to investigate the individual anatomical variability of the VSM, on macroscopic aspect, in cadavers, of which variability is important for the vascular surgeon and / or for the cardiac surgeon. Material and methods: This study was conducted on 22 formolized lower limbs using classical dissection methods. The observed anatomical variants were recorded and photographed. Results: The dorsal venous arch of the foot, the origin of the VSM, was double in 2 cases (9.1%), and it was absent in one case (4.55%), thus two dorsal metatarsal veins continued proximally with two medial marginal veins. In the leg, VSM was double in one case (4.55%), and in other 14 cases (63.63%) it was accompanied by accessory saphenous veins. In the thigh, it was double in 3 cases (13.6%), and in 10 cases (45.5%) it was accompanied by accessory saphenous veins. The saphenofemoral junction was located at 4.23±0.64 cm distance from the pubic tubercle; at 12.25±1.1 cm away from the anterior superior iliac spine and at 4.3±0.65 cm below the middle of the inguinal ligament. Conclusions. The anatomical variability of the VSM includes its duplicity and/or presence of the accessory saphenous veins. The dorsal venous arch may be double or absent. The saphenofemoral junction is relatively fixed in relation to the neighboring bone landmarks.

Introduction. The accumulated factual material about the topography of the great saphenous vein is extremely contradictory. Therefore, an individual approach is necessary to study the age-related anatomical variability of the large saphenous vein in human fetuses. The objective of the study was to determine the peculiarities of the saphenous vein topography in human fetuses of 4-10 months. Materials and methods. Studies of the variant anatomy of the great saphenous vein (GSV) were carried out on specimens of the lower limbs of 80 human fetuses of 81.0-375.0 mm parietal-coccygeal length using macro-microscopic dissection, vascular injection, surface staining of prepared vessels and nerves, radiography and morphometry. Results. GSV is a continuation of the medial marginal vein, which is directed upwards in the subcutaneous tissue along the anterior edge of the inner ankle in the studied human fetuses. On the lower leg, the GSV runs along the medial edge of the tibia and receives superficial veins from the anterior medial surface of the lower leg. The GSV bends around the back of the medial epicondyle of the femur in the knee area, is located outside the sartorial muscle, and passes to the anteromedial surface of the thigh. The GSV returns inward through the perforated fascia. In the saphenous opening area, it bends around the lower corner of the falciform margin of the saphenous opening, and it flows into the femoral vein (FV) from the anteromedial side. The anterior accessory saphenous vein flows into the femoral part of the GSV in 45% of cases. The posterior accessory saphenous vein is formed from the saphenous veins of the medial and posterior surfaces of the thigh. Conclusions. The anatomical variability of the great saphenous vein has been determined in human fetuses. The anterior accessory saphenous vein was detected in 71.3% of the studied fetuses, while the posterior accessory saphenous vein was found in 38.1% of cases. The great saphenous vein is characterized by the predominance of the transitional vein type (55.6% of cases) over the main (33.8% of cases) and loose (10.6%o cases) ones. The main type prevails over the loose type in the ratio of 3.2:1. The coincidence of the type of formation of a great saphenous vein on the right and left lower extremities was observed in 61.3% of fetuses. Significant gender differences in the typology of the great saphenous vein in human fetuses were not found.

Abstract Background Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass grafting surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose other conduit materials to revascularize the LAD. The purpose of this study was to explore the differences in different conduit materials used for LAD in terms of parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography. Methods We retrospectively collected the data of 410 patients who underwent isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the LAD revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA) group (n = 333), a right IMA (RIMA) group (n = 34) and a great saphenous vein (SVG) group (n = 43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates. Results Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume (MGF) (37.15 ± 23.29 vs 29.71 ± 20.94 ml/min, P = 0.036), however, had a lower value of pulse index (PI) (2.07 ± 0.62 vs 2.65 ± 1.01, P0.05). Compared with the RIMA-LAD group, the SVG-LAD group just had a lower value of PI (2.07 ± 0.62 vs 2.56 ± 0.96, P = 0.029). However, there was no significant difference between the two groups in terms of MGF and DF (P>0.05). Compared with the LIMA-LAD group, the RIMA-LAD group had a slightly lower value of DF (70.76 ± 11.87 vs 74.06 ± 7.09, P = 0.018), while there was no difference in terms of MGF and PI between the two groups (P>0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), that of RIMA-LAD group was 97.06% (33/34), and that of SVG-LAD group was 100%. There was no difference among the three groups in patency rate (P = 0.405). Conclusions SVG-LAD has a higher intraoperative MGF and a lower value of the PI than both LIMA-LAD and RIMA-LAD. RIMA has a higher preoperative blood flow and a lower value of the PI than LIMA; however, there were no significant difference between RIMA grafted to LAD and LIMA grafted to LAD in terms of MGF, PI and DF. In situ skeletonized RIMA did not increase blood flow compared to pedicled LIMA.

ObjectivesThe effects of body mass index (BMI) on the outcome of high ligation and stripping (HLS) in an ambulatory center remain unclear. This study aims to investigate the outcomes of HLS in an ambulatory center based on BMI in the Chinese population.DesignThis was a prospective cohort study with mid-term follow-up.Materials and Methods170 eligible patients were included in the study and the data of Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, Venous Clinical Severity Score (VCSS), Visual Analogue Score (VAS), Aberdeen Varicose Veins Questionnaire (AVVQ), Quality of Recovery (QoR-15), and postoperative complications at predetermined time points were collected.ResultsA total of 170 patients (236 limbs) with a mean age of 53.87 ± 9.96 years (range, 24–80 years) and a mean BMI of 23.86 ± 2.96 kg/m2 were included. Of the group, 50.6% were women, and 66 patients received bilateral procedures. Through curve fitting, a BMI less than 28 and a BMI of 28 or higher were found to have a negative [−0.1 (−0.3, 0.1) 0.296] and positive [0.7 (0.2, 1.2) 0.006] relationship trend, respectively, with the improvement of VCSS at 6 weeks after surgery. Through smooth curve fitting, BMI was shown to have a negative relationship trend on the improvement of VCSS at 6 months after surgery. After multivariable risk adjustment for potential confounding factors, BMI was not found to be associated with the improvement of VCSS and AVVQ at 6 weeks after surgery, as well as the improvement of AVVQ at 6 months after surgery (all p-values >0.05). Six months after surgery, BMI was shown to have a negative relationship trend on the improvement of VCSS, and obese patients showed lower VCSS improvement than patients of normal BMI [−1.3 (−1.9, −0.7)

Objective: To determine the sex prevalence of lower limb varicose networks fed by reflux of the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein singularly or in combination., Methods: We scanned by the means of the same color Doppler ultrasound protocol 3000 lower limbs in 1500 consecutive patients, affected by symptomatic chronic venous insufficiency from 2013 to 2023. Limbs with normal venous function, incomplete scans, or that were affected by post-thrombotic syndrome, pelvic reflux, isolated perforator reflux, venous malformation, phlebolymphedema and Clinical, Etiological, Anatomical, Pathophysiological clinical class C5 and C6 were excluded from the final analysis., Results: Overall, 1072 patients-252 (23.5%) males and 820 (76.5%) females (P < .0001) matched for age (P = .692)-were included in the study for a total of 1956 limbs affected by primary chronic venous insufficiency, clinical class C2 to C4. The main finding was the significant prevalence of varicose networks fed by reflux of the AASV alone (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.06; P = .001) or combined with GSV (OR, 1.84; 95% CI, 1.34-2.52; P = .0002) in females. In contrast, GSV insufficiency alone was significantly prevalent in males (OR, 0.54; 95% CI, 0.43-0.68; P < .0001). No significant sex differences regarding SSV reflux were detected. Moreover, we considered the presence of competent terminal valve (TV+) at the level of the saphenofemoral junction, which resulted more significantly present in female (OR, 1.57; 95% CI, 1.12-2.19; P = .0083); to the contrary incompetent terminal valve (TV-) was more common in males (OR, 0.64; 95% CI, 0.46-0.89; P = .0083). Finally, considering reflux in the AASV territory in the presence of a TV+, a strong prevalence in females was detected (OR, 2.28; 95% CI, 1.48-3.52; P = .0002), whereas males developed reflux along the GSV when a concomitant TV- was present (OR, 0.62; 95% CI, 0.41-0.94; P = .0244)., Conclusions: The analysis of the lower limb varicose networks highlights that reflux along the AASV alone, in presence of a TV+ at the junction or coupled with GSV insufficiency, is more prevalent in females. In contrast, GSV resulted the main trunk feeding varicose veins in males, in particular when a TV- was detected. Our findings suggest that females could be more prone to developing varicose veins with an ascending mechanism, whereas in males the descending one seems to be more common., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the correlation between optimal placement depth (OPD) and physical measurement parameters in preterm infants receiving placement of peripherally inserted central catheter (PICC) through the great saphenous vein (GSV), and to establish a predictive formula for OPD during the placement of PICC through the GSV., Methods: A retrospective analysis was performed for the preterm infants who received the placement of PICC through the GSV in the Neonatal Intensive Care Unit of the Third Xiangya Hospital of Central South University from December 2022 to February 2024. According to the site of puncture [GSV of the knee joint (KJ) or the ankle joint (AJ)], they were divided into a GSV-KJ placement group ( n =38) and a GSV-AJ placement group ( n =33). The infants were measured in terms of body weight (BW), body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference at the time of placement. The Pearson correlation analysis was used to investigate the correlation between the above variables and OPD. A predictive formula was established for OPD in the placement of PICC via the GSV in preterm infants, and the predicted residual between the predicted depth and the ideal OPD was compared between the conventional predictive formula and the new predictive formula., Results: The Pearson correlation analysis showed that PICC OPD was significantly positively correlated with BW, body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference in both the GSV-KJ placement group and GSV-AJ placement group ( P <0.05), with the highest degree of correlation between OPD and BW. The univariate linear regression analysis showed a linear relationship between PICC OPD and BW in both groups. The predictive formulas for OPD were as follows: GSV-KJ PICC OPD (cm) = 13.1 + 2.7 × BW (kg) and GSV-AJ PICC OPD (cm) = 13.4 + 6.0 × BW (kg), and the new predictive formulas had a significantly lower predicted residual than the conventional predictive formula ( P <0.05)., Conclusions: OPD for PICC through the GSV is positively correlated with BW, and the prediction results of the new predictive formula based on BW are closer to the ideal OPD.

Background: Donor–recipient diameter discrepancy can be problematic when using an autologous great saphenous vein graft for internal jugular vein reconstruction. A triple-paneled method of saphenous vein grafting is one solution. Case presentation: A 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. An 8-cm segment of the right internal jugular vein was resected. For reconstruction, a 30-cm segment of the great saphenous vein was harvested and divided into three pieces of equal length. After opening each piece longitudinally, they were sutured together in a side-by-side fashion to create a cylinder that was used to reconstruct the internal jugular vein defect. The graft was patent 10 months after the surgery. Conclusion: The triple-paneled method is feasible for autologous great saphenous vein graft reconstruction of the internal jugular vein. [ABSTRACT FROM AUTHOR]

Background: Stanford type A aortic dissection (STAAD) is often associated with coronary artery problems requiring coronary artery bypass grafting (CABG). However, the prognosis of different proximal graft locations remains unclear.Methods: From May 2015 to April 2020, 62 patients with acute STAAD who underwent aortic surgery concomitant with CABG were enrolled in our study. Aortic bypass was defined as connecting the proximal end of the vein bridge to the artificial aorta (SVG-AO); non-aortic bypass was defined as connecting the proximal end of the vein bridge to a non-aorta vessel, including left subclavian artery, left common carotid artery, and right brachiocephalic artery (non-SVG-AO). We compared early- and mid-term results between patients in the above two groups. Early results included death and bleeding, and mid-term results graft patency, aortic-related events, and bleeding. Grafts were evaluated by post-operative coronary computed tomography angiography. According to the Fitzgibbon classification, grade A (graft stenosis

BACKGROUND: Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and minimally invasive techniques used in the treatment of saphenous veins insufficiency. We compare a 1,470-nm EVLA and RFA in the treatment of patients with insufficiency of the great or small saphenous vein. MATERIAL AND METHODS: Six hundred and twenty-six consecutive patients presenting to our department with insufficiency of the great or small saphenous vein and treated between January 2017 and January 2020 were included in the study. The randomly selected 301 patients (group 1) received 1,470-nm EVLA and the other 325 patients (group 2) received RAF. Patients were assessed on the second day after the procedure, two and six months after procedure and then semiannually (not included in the study). Major and minor complications were recorded as well as VCSS. RESULTS: There was no difference between groups as to inclusion criteria as age, diameter of GSV and SSV, predominance of extremity and diameter of the treated vein. Also, clinical stages of CVI in both groups were similar and without statistical significance. VCSS was similar, however at 6 months after the procedure the inter-group difference in VCSS became clinically significant. In terms of the comparison of procedural pain and pain relief on the first postoperative day, the statistical level of difference was less than 0.05. The operative time was shorter in patients from group 1 with statistical significance, but the quantity of tumescent solution and length of GSV was also statistically lower than in group 2. Minor complications in EVLA and RFA were ecchymosis which occurred in 23.6 % of patients in group 1 and 33.8 % of patients from the RFA group, and local puncture inguinal hematoma with spontaneous resolution in 2 weeks, which occurred in 1% of patients in both groups. The frequency of all minor complications was similar in both groups. One months after the procedure, one patient from EVLA group was admitted to the hospital with signs of pulmonary embolism and thrombosis of VFC. The return to normal daily activity was similar in both groups, it took place on the next day after the procedure. The return to work took place earlier in RFA patients (Tab. 5, Fig. 2, Ref. 19). [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the efficacy of external valvuloplasty with silicone stents in the management of isolated terminal or preterminal valve dysfunction at the saphenofemoral junction based on comparisons between pre- and postoperative findings on Doppler ultrasound of the lower limbs. Patients and methods: This study included a total of 16 female patients (mean age 44.1±7.6 years; range, 32 to 58 years) who underwent valvuloplasty with the Dacron®-reinforced silicone cuff (Venocuff II™ Venous Valve Exostent) for the treatment of focal superficial venous insufficiency between April 2014 and September 2018. Postoperative color Doppler ultrasonography (CDUS) findings at three to six months were retrospectively compared to preoperative CDUS findings to analyze the efficacy of the surgical technique. Preoperative measurements of the diameter (in mm) of the great saphenous vein and reflux time at the saphenofemoral junction were compared to postoperative measurements. Valvular incompetence was graded 0 to 4 based on the reflux time. All assessments were performed with a 7.5 MHz superficial vascular probe on an CDUS scanner. Clinical improvement was assessed based on the revised Venous Clinical Severity Score (VCSS). Results: The grade of great saphenous vein reflux was significantly lower after surgery compared to the reflux grade measured before surgery. A statistically significant decrease was detected in the mean diameter of the great saphenous vein (p [Turk J Vasc Surg 2020; 29(3.000): 152-8]

Background: Radiofrequency ablation is an established minimal invasive treatment modality of varicose veins. This technique involves accessing the great saphenous vein (GSV) through which radiofrequency ablation catheter is inserted. Some established puncture techniques like in-plane and out-plane techniques are also not devoid of limitations. Aims and Objectives: To know the applicability of “Geometry based cannulation technique” in terms of mean cannulation attempts and percentage of successful cannulation. Materials and Methods: We are doing “Geometry based cannulation technique” for the cannulation of GSV. For cannulation 18G needle of length 3 cm attached with 10 ml syringe (cannulating needle) partly filled with normal saline is used. Doppler ultrasonography is done with Siemen's Acuson P300 machine with linear probe of frequency 7.5–12 MHz. The depth from the skin to the upper part of vein is measured in cm and is termed as distance “A.” The tip of the cannulating needle is positioned on the middle of the probe and gently pressed down the skin to form the shadow in the Doppler. The needle is readjusted such that the shadow corresponds to the GSV. Then, the needle is moved distally to A distance. Then the needle is made rotated 45° and skin is punctured to the length (distance B) calculated from the Pythagoras theorem as square root of 2A2. Then the angle is decreased to about 30° and further 2–3 mm advancement of the cannulating needle is done such that it lies inside the target GSV. Results: From 459 cannulations in the time frame of August 2013–December 2018, we found that mean cannulation attempts were 1.4 (standard deviation 0.72, 1–3 attempts). In 429 GSVs (95.5%), there were successful cannulations, whereas in 20 GSVs (4.5%), there was failure in cannulation. The cannulation of GSV has higher success if the diameter of GSV is more than 5 mm and the depth is less than 10mm. Conclusion: “Geometry based cannulation technique” for cannulation of GSV is a novel technique and can be used with high success.

Background: Varicose vein disease is one of the most common health problems faced by vascular surgeons worldwide affecting up to 23% of adult population. The majority of patients with primary varicose veins have great saphenous vein (GSV) insufficiency. Objective: To determine the feasibility and safety of flush Endovenous laser ablation (EVLA) of the patients with Great saphenous vein (GSV) up to the saphenofemoral junction. Patients and Methods: A prospective study was conducted in Vascular Surgery Department, Faculty of Medicine, at Zagazig University at period from January 2021 to June 2021 including 18 cases. All patients were subjected to detailed history taking, Clinical examination, the clinical severity of venous disease was established using CEAP [Clinical, etiological, anatomical & pathological] and VCSS, the effect of disease specific quality of life was determined using the CIVIQ, Laboratory Investigations and duplex ultrasonography performed for all patients. Results: The operative time, it ranged from 20 minutes to 40 minutes, with a mean of 30 minutes. Regarding hospital stay, all patients were discharged at the same day of the intervention. Return to normal activity ranged from 7 to 9 days, with a mean of 7.33 +/- 1.46. as regard complications; only Ecchymosis in 2 limbs (7%), Temporary numbness at leg in 3 limbs (11%) and Incomplete occlusion in one patient (4 %).Conclusions: That using of high wavelength (1470nm) with modified fiber tip with tumescent solution have a crucial role in achieving best results and minimizing the adverse effects. This allow a homogenous destruction of the vein wall exclusively. [ABSTRACT FROM AUTHOR]

Great saphenous vein aneurysms (GSVA) represent a rare yet clinically significant condition, often misdiagnosed due to their infrequent presentation and resemblance to more common inguinal pathologies. This case series examines five instances of GSVA, emphasizing the diagnostic challenges, surgical interventions, and postoperative outcomes. Patients presented with varying symptoms, including groin masses and lower extremity pain, which were initially misattributed to other conditions. Imaging techniques, primarily venous duplex ultrasound, played a crucial role in identifying the aneurysms and guiding surgical planning. Surgical treatment, including aneurysm excision and ligation, was performed in all cases, with most patients experiencing uncomplicated postoperative courses. However, the risk of recurrence and thromboembolic events, such as pulmonary embolism, remains a concern, particularly in cases involving more proximal aneurysms near the deep venous system. Despite the success of surgical intervention, there is no consensus on the management of asymptomatic GSVA, nor are there standardized treatment guidelines. This case series highlights the need for heightened awareness among clinicians regarding GSVA, the importance of accurate diagnosis, and the consideration of prompt surgical treatment to prevent severe complications. Further research is needed to establish clear guidelines for managing both symptomatic and asymptomatic GSVA, particularly in relation to thromboembolic risk., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Geisinger Medical Center IRB issued approval 2022-0413. Your protocol was reviewed on 05/06/2022 and it was determined that your research protocol meets the criteria for EXEMPTION as defined in the U. S. Department of Health and Human Services Regulations for the Protection of Human Subjects [(45 CFR 46.104)]. You may now begin your research. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gidaya et al.)

Background The technique of harvesting the great saphenous vein for bypass procedures may affect the results of the procedure. We describe a simple modification of the vein harvesting technique, which consists of leaving the saphenofemoral junction intact after completion of the proximal anastomosis. This modification allows blood to flow into the vein as soon as the proximal anastomosis is completed, thereby shortening the vein warm ischemia time and allowing the vein to distend with blood rather than saline, under physiologic pressure. This modification aims at improved vein integrity during harvesting and therefore improved graft patency. Patients and methods In this study, 30 patients were subjected to a femoral distal bypass using our modified technique. In this technique, we create a loop with the great saphenous vein being left in continuity at the saphenofemoral junction and the distal end anastomosed to the common femoral artery at the take-off of the bypass graft. The saphenofemoral junction is then ligated and cut after exposure of the distal target arterial exposure and preparation. Results A total of 30 consecutive patients, comprising 16 males and 14 females, were subjected to the technique. Among them, diabetics were 92%, hypertensive 81%, hypercholesteremic 67%, and 60% smokers. Their mean age was 55 years. No adverse effects were observed as a result of using this modification, neither in the form of infection or bleeding nor the increased incidence of cardiac or central complications. A review of the results of 30 consecutive bypass operations performed with the distal anastomosis located at the distal tibial arteries (ankle level) or dorsalis pedis artery using this modified technique showed that the primary 30-day patency rate was 93.1%, at 6 months was 90%, and at 1 year was 87%. Graft patency was documented using a color-flow Duplex scan. Conclusion The use of this modification provides nonpressurized saphenous vein dilation and adequate visualization of bleeding tributaries bleeding under vision, thus adequately controlling them before tunneling, hence minimizing postoperative hematoma with the concomitant possibility of infection.

Background Great saphenous vein (GSV) incompetence is involved in most cases of varicose disease. Standard preinterventional assessment is required to decide the treatment modalities. GSV diameter was measured at saphenofemoral junction, proximal thigh, distal thigh, knee, proximal leg, and distal leg. Analysis was done to find at which diameter size the reflux is expected to occur. Patient and methods The study involved 100 limbs from outpatient vascular clinic. GSV diameter was measured at the saphenofemoral junction, the proximal thigh, the distal thigh, below the knee, and mid-leg and correlated with reflux. Results Reflux in the sapheno-femoral junction (SFJ) (group I) occurred at 7.16±2.30 mm, proximal thigh (group II) at 6.60±1.89 mm, distal thigh (group III a) at 6.12±1.63 mm, knee (group III b) at 5.78±1.60 mm, proximal leg (group IV) at 4.61.24 mm, and mid leg (group V) at 3.59±1.16 mm. Conclusion Measurement at six sites revealed higher sensitivity and specificity to predict reflux. GSV diameter correlates with reflux. [ABSTRACT FROM AUTHOR]

Purpose: Extended pancreatectomy for locally advanced pancreatobiliary malignancy often involves combined major arterial resection (AR) and reconstruction (ARc). By limiting candidate inflow for ARc after combined resection of the celiac arterial system over a long distance, we evaluated whether great saphenous vein graft (GSVG) is an alternative conduit for obtaining non-anatomical arterial inflow. Methods: ARc with GSVG conduit was undertaken prior to resection. GSVG was harvested and anastomosed end-to-side with the reconstructing artery and then mostly passed via the retroperitoneal para-inferior vena cava route. Side-to-end anastomosis of GSVG inflow was established with the right common iliac artery or abdominal aorta. Results: Among 468 consecutive pancreatobiliary surgeries, ARc with GSVG was undertaken in seven cases. Primary cancers were in the pancreas in six patients and distal bile duct in one. Radical surgery was performed with pancreaticoduodenectomy in six patients and total pancreatectomy in one. Hepatic artery (HA) was concomitantly resected and reconstructed by GSVG in six patients or by the jejunal artery in one patient. Median operative time and intraoperative blood loss were 763 min and 350 ml, respectively. Serum level of AST, ALT, and LDH in patients with HA reconstruction by GSVG peaked by the second postoperative day and promptly normalized. Postoperative morbidity (CD ≥ III) was encountered in one patient. No surgical mortality was observed. Postoperative serum liver enzymes promptly decreased in ARc patients with GSVG to HA. Conclusion: Arterial reconstruction with GSVG prior to resection was performed securely and might help to reduce postoperative liver dysfunction. [ABSTRACT FROM AUTHOR]

Background: Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass grafting surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose other conduit materials to revascularize the LAD. The purpose of this study was to explore the differences in different conduit materials used for LAD in terms of parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography.Methods: We retrospectively collected the data of 410 patients who underwent isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the LAD revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA) group (n = 333), a right IMA (RIMA) group (n = 34) and a great saphenous vein (SVG) group (n = 43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates.Results: Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume (MGF) (37.15 ± 23.29 vs 29.71 ± 20.94 ml/min, P = 0.036), however, had a lower value of pulse index (PI) (2.07 ± 0.62 vs 2.65 ± 1.01, P<0.001). There was no significant difference between the two groups in terms of DF (P>0.05). Compared with the RIMA-LAD group, the SVG-LAD group just had a lower value of PI (2.07 ± 0.62 vs 2.56 ± 0.96, P = 0.029). However, there was no significant difference between the two groups in terms of MGF and DF (P>0.05). Compared with the LIMA-LAD group, the RIMA-LAD group had a slightly lower value of DF (70.76 ± 11.87 vs 74.06 ± 7.09, P = 0.018), while there was no difference in terms of MGF and PI between the two groups (P>0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), that of RIMA-LAD group was 97.06% (33/34), and that of SVG-LAD group was 100%. There was no difference among the three groups in patency rate (P = 0.405).Conclusions: SVG-LAD has a higher intraoperative MGF and a lower value of the PI than both LIMA-LAD and RIMA-LAD. RIMA has a higher preoperative blood flow and a lower value of the PI than LIMA; however, there were no significant difference between RIMA grafted to LAD and LIMA grafted to LAD in terms of MGF, PI and DF. In situ skeletonized RIMA did not increase blood flow compared to pedicled LIMA. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The aim of the research was to compare the influence of the endovenous laser coagulation (EVLC) on the pulmonary system with the performing of the Troyanov–Trendelenburg operation and without it. MATERIAL AND METHODS. We performed 108 endovenous laser coagulation for 16 patients without great saphenous vein trunk dressing and for 92 patients with dressing. The Russian portable laser device «Diolan» was used for the endovenous laser coagulation, wavelength of 980 nm, capacity of 16–20 watts. An intraoperative transesophageal echocardiography was carried to 12 patients to visualize heart chambers in the moment of the laser exposure. RESULTS. The patients without Troyanov–Trendelenburg operation had massive inflow of gas bubbles and detritus into pulmonary system during the endovenous laser coagulation. CONCLUSION. The obtained results showed the qualitative and quantitative differences in the character of the substrate entering the heart and the pulmonary system.