Stump evolution after great saphenous vein stripping with high ligation

The aim of the present observational study is to show the evolution of great saphenous vein (GSV) stump in two different periods of follow up. From 2001 to 2009, 500 legs with GSV insufficiency and terminal valve reflux, operated on with stripping by invagination without crossectomy, were followed. Doppler were performed at 1 month (early) and then mid-term (2-year follow-up). The hemodynamic examination of residual stumps showed 4 different types: S1) draining and competent terminal valve; S2) thrombosis and fibrosis; S3) turbulence under Valsalva maneuver and normal antegrade flow at rest; S4) turbulence with reflux at rest: refluxing terminal valve. Early: the most common finding was S1 (64%), then S2 (18%), S3 (12%) and S4 (6%); S1-S3 patterns were considered as good evolution (94%), whereas S4 were considered recurrence. Mid-term phase: the most common finding was again S1 (67%), then S3 (15%), S4 (10%) and S2 (8%). S1 evolution: out of 319 legs in S1 group at early phase, 294 (92%) remained still in S1 at mid-term follow up; 25 (8%) worsen to S3. S2 evolution: out of 92 legs in S2 at early phase, 42 (46%) improved to S1, 40 (43%) did not change pattern across time and 10 legs (11%) worsen to S4. S3 evolution: almost the legs in S3 (51, 86%) remained unchanged at mid-term, whereas 8 (14%) worsen to S4. S4 evolution: all the patients in S4 class at early follow up were still in the same class at mid-term. The evolution of GSV stump can be classified in 4 different patterns, where only S4 should be considered failure.