[Pre- and postoperative contribution of Doppler ultrasonography in superficial venous surgery of the popliteal fossa].

Abstract

Aims of the study: Does preoperative Duplex Scan (DS) allow to determine anatomy of the ending of the short saphenous vein (SSV), gastrocnemius vein (GV) and reflux in popliteal vein (PV), SSV and GV. Postoperative DS was performed to detect deep vein thrombosis (DVT) and GV thrombosis.

Material and methods: From June 94 to November 95 one hundred and eighty lower limbs operated for SSV were included consecutively and prospectively. Mean age in these 154 patients was 52 yr (24-80) with a sex ratio 4F/1M. An anatomical classification was previously defined. Type A: separate termination of SSV and GV; Type B: common ostium of SSV and GV in the popliteal vein; Type C: common trunk of the SSV and GV; Type D: Others. Forty-eight limbs (26.10%) had ligation of GV: 21 (11.10%) for reflux and 27 (16%) for anatomical or surgical reasons. Ten type A with GV reflux (10/31 = 32%) were not treated. Eighty two patients (45%) received preventive low molecular weight heparin (LMWH) treatment including the 48 limbs whose GV were ligated.

Results: Anatomical correlation between DS and surgery findings were calculated. Positive predictive values of DS in the different types were: A, 77%; B, 68%; C, 90%; D, 79%. That gave a global predictive value of 80%. Two limited DVT were identified in group D by postoperative DS (2/10 = 1.1%). These two patients had complete recanalization of PV without reflux. In the group of limbs which had ligation of GV we identified 37.5% of GV thrombosis. In the group without ligation of GV we found 3% of GV thrombosis.

Conclusion: Duplex scanning appears to be the investigation of choice before surgery for superficial vein incompetence in the popliteal fossa. It is a reliable investigation to determine termination patterns of SSV and GV (80%). It brings to the surgeon essential information which helps in the management of surgical procedure and particularly to ligation of gastrocnemius veins. But at this time there is no consensus on this point. The occurrence of DVT after SSV surgery including GV ligation was very low. Two questions remain: is anticoagulation necessary in all patients or selective after surgery of the SSV? is Duplex Scan mandatory during postoperative monitoring? On the basis of this study, one recommendation can be made: A routine postoperative DS is necessary after ligation of the GV or when the dissection of the popliteal fossa has been extensive (Type D).