A Prospective Study of Incidence of Saphenous Nerve Injury after Total Great Saphenous Vein Stripping

Abstract

Conclusion: There is only a minor incidence of saphenous nerve damage after total stripping of the great saphenous vein (GSV). Summary: Even in the era of endovenous ablation, partial stripping of the GSV is still a treatment option for some patients with primary varicose veins. Even with GSV reflux above and below the knee, clinicians generally perform a partial stripping of the GSV, leaving the below knee segment in situ because of fear of saphenous nerve injury. There are, however, very little data on the incidence of saphenous nerve injury after total GSV. The authors sought to evaluate the incidence of saphenous nerve damage after total GSV stripping in patients treated for primary varicose veins. A preoperative and postoperative neurologic examination was performed independently by a neurologist, with a protocol supervised and approved by the Department of Neurology at the authors' hospital. Patients were also administered a standardized questionnaire asking whether they had experienced unpleasant or altered sensation in the leg or had discovered areas of numbness or decreased sensation after surgery. Total stripping of the GSV was performed in 69 limbs. Indication for the surgery was pain in 9%, fatigue of limbs in 77%, and cosmetic reasons in 14%. The overall incidence of postoperative sensory neurologic deficits was 6%, with the incidence falling to 3% after 3 months of follow-up, and 99% of patients reported a reduction in signs and symptoms of primary varicose veins. Comment: The study suggests it is reasonable to treat the GSV below the knee when total saphenous reflux is present. These surgical results parallel a similar study that used endovenous techniques to treat total GSV reflux. It appears that when GSV reflux is present above and below the knee, a complete treatment of the vein, whether by endovascular or open surgical techniques, results in a very low incidence of saphenous nerve injury. There should be a randomized trial to evaluate symptom reduction and saphenous nerve injury in patients with total GSV reflux treated with total vs above knee only saphenous stripping or endovenous ablation.