Effect of long saphenous vein stripping on deep venous reflux

Abstract

Conclusion: Stripping of the greater saphenous vein (GSV) abolishes deep venous reflux in a significant proportion of limbs. Continued GSV insufficiency may be associated with development of new deep venous reflux. Summary: The authors examined the effect of GSV stripping on known deep venous reflux and development of new deep venous reflux. The study included 62 consecutive patients who underwent saphenofemoral junction disconnection, multiple stab avulsions of varicosities, and who may or may not have undergone successful stripping of the GSV to the knee. Duplex ultrasound scanning was performed to detect venous reflux preoperatively and at a median of 24 months postoperatively. Completely stripped limbs were defined as those in which complete stripping of the GSV to the knee was confirmed on postoperative duplex scans. Duplex scanning–Detected reflux time greater than 0.5 seconds was considered abnormal. Preoperatively, 42% of limbs had deep venous reflux. Follow-up postoperative duplex scans indicated that the GSV had been completely stripped in only 38% of limbs. In patients with preoperative deep venous reflux, complete stripping was associated with a significant reduction in the prevalence of superficial femoral vein reflux (P < .001) and popliteal vein reflux (P < .016). In patients without preoperative deep venous reflux, incomplete stripping of the GSV was associated at follow-up with development of superficial femoral vein reflux (P < .031) and popliteal vein reflux (P < .008). Comment: The authors; data suggest that successful stripping of a refluxing GSV may improve reflux in the femoral and popliteal veins. Incomplete stripping may lead to development of new deep venous reflux in the femoral and popliteal veins. This study affirms the growing realization that deep venous reflux may derive from the presence of superficial venous reflux. The results suggest that patients with a combination of deep and superficial venous reflux may benefit from stripping of the refluxing GSV and, in fact, may be harmed by leaving a refluxing GSV in situ.