Plication of the sapheno-femoral junction. An alternative to ligation and stripping?

Plication of the long saphenous vein at the saphenofemoral junction (SFJ) can be used as an alternative to flush ligation and stripping in patients with superficial venous incompetence. The aim of this technique is to reduce or abolish venous reflux at the SFJ without causing permanent alterations of the vein which might be used in future for peripheral arterial surgery or coronary artery bypass grafting. The selection of the ideal candidate for SFJ plication must be done on the basis of ambulatory venous pressure measurements, Doppler, and duplex scanning which indicate and quantify the superficial incompetence. To be effective plication of the SFJ has to reduce the calibre of the vein to 60-70% of the initial calibre for a length of 1-1.5 cm allowing the valve cusps to close when flow in the femoral vein is reversed (ie., by Valsalva manoeuvre). In a series of 8 patients evaluated 8 months after plication of the SFJ, venous reflux was significantly reduced (at Doppler and duplex examination and at ambulatory venous pressure measurements) and the improvement of haemodynamic data was associated with an improvement of symptoms. In conclusion, on the basis of these data the treatment of incompetence of the long saphenous vein by SFJ plication is an effective physiological alternative to flush ligation. However long term results must be evaluated before it can be definitively used.