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

Plication of the long saphenous vein at the sapheno-femoral junction (SFJ) is an interesting alternative to flush ligation and stripping in superficial venous incompetence. This technique abolishes venous reflux at the SFJ without altering the vein which may be useful for peripheral arterial surgery or coronary artery bypass grafting. The selection of the ideal candidate for plication must be done by ambulatory venous pressure measurements, Doppler and duplex scanning which indicate and quantify the superficial vein incompetence. The plication of the SFJ reduces the calibre of the vein to 60%-70% of its calibre for a length of 1.5 cm allowing the valve cusps to close when flow in the femoral vein is reversed (i.e. by Valsalva manoeuvre). In this series of ten patients, evaluated 6 months after plication of the SFJ, venous reflux was significantly reduced (at Doppler and duplex examination and ambulatory venous pressure measurements) and the improvement of haemodynamic data was associated with improvement of symptoms. In conclusion, considering these data, SFJ plication is an effective physiological alternative to flush ligation but long term results must be evaluated before using it for the treatment of incompetence of the long saphenous vein.