EFFICACY AND SAFETY OF CONCOMITANT SAPHENOFEMORAL JUNCTION LIGATION AND ULTRASOUND-GUIDED FOAM SCLEROTHERAPY VERSUS ULTRASOUND-GUIDED FOAM SCLEROTHERAPY ALONE FOR PRIMARY SFJ REFLUX: A PROSPECTIVE COMPARATIVE STUDY

Abstract

Background: Saphenofemoral junction (SFJ) reflux is one of the most important causes of chronic venous insufficiency and varicose vein disease. The use of ultrasound-guided foam sclerotherapy (UGFS) is a common treatment for superficial venous reflux, however, there is a possibility of recurrence if there is ongoing junctional incompetence. SFJ ligation with UGFS may be more effective at controlling reflux and achieving long-term clinical results. Objective: To compare the efficacy and safety of concomitant SFJ ligation plus UGFS with UGFS alone in patients with primary SFJ reflux. Study Design: A Prospective comparative study. Place and Duration of Study: From January 2023 to December 2024 at the Department of Vascular Surgery, MTI Lady Reading Hospital, Peshawar, Pakistan. Methodology: An enrollment of 120 patients with primary SFJ reflux and symptomatic varicose veins was completed after identifying these patients with duplex ultrasound. Group A (n=60) were treated with concomitant SFJ ligation and UGFS, and Group B (n=60) with UGFS alone. Clinical and duplex evaluations were done at 1, 6, and 12 months. The primary outcomes were abolition of reflux and recurrence. Secondary endpoints included the improvement in Venous Clinical Severity Score (VCSS), recovery after the procedure and procedure-related complications. Data was analyzed using SPSS version 24.0 and a p value of <0.05 was considered statistically significant. Results: The mean age of participants was 48.9 ± 8.2 years, and 72 (60.0%) were female. In Group A, 83.3% of the patients had achieved complete elimination of SFJ reflux at 12 months, whereas 70.0% of the patients in Group B had done so (p=0.048). Recurrence occurred in 4 (6.7%) patients in Group A and 11 (18.3%) patients in Group B (p=0.041). The VCSS score improved significantly in Group A compared to Group B (4.2 ± 1.1 compared to 3.1 ± 1.3 points; p=0.002). Postoperative pain scores were lower in Group A (2.1 ± 0.9 vs. 2.8 ± 1.0; p=0.006). Some minor complications were transient superficial phlebitis, hyperpigmentation and ecchymosis. There were no cases of deep venous thrombosis, pulmonary embolism or procedure-related mortality in either group. Conclusion: Concomitant SFJ ligation and UGFS demonstrated superior reflux abolition, lower recurrence rates, and greater clinical improvement compared with UGFS alone while maintaining a favorable safety profile. This combined therapy could be a good treatment for those with primary SFJ reflux, especially in a resource-limited setting. More multicenter trials with a longer duration of follow-up are needed to substantiate these results.