Invaginated axial stripping and stab avulsion (hook) phlebectomy: a definitive outpatient procedure for primary varicose veins

Abstract

The classical high ligation and ankle-to-groin intraluminal saphenous vein stripping requires hospitalization, general anaesthesia, long convalescence, loss of income, unacceptable scarring and possible permanent nerve injury. This report describes the technique of invaginated axial stripping in conjunction with tributary stab avulsion (hook) phlebectomy. Using femoral block anaesthesia with supplemented local infiltration, the varicose tributaries are avulsed, through multiple stab incisions only 1.5–3 mm long, with specially designed hooks. This is performed in an ambulatory (office) setting, making varicose vein surgery a minimally-invasive procedure. Two hundred and fifteen patients with 261 involved limbs were operated on during a two-year period. Postoperative pain and complications were minimal. All patients immediately resumed normal daily activities. Cosmesis was excellent. There have been no recurrences in up to 3 years follow up. This procedure adheres to strict haemodynamic principles. Elimination of hospitalization, reduced postoperative morbidity, immediate ambulation, minimal nerve damage, excellent cosmesis and finally, obvious cost efficiency should make this form of varicose vein surgery appealing to surgeons and patients alike by making the future surgical care for varicose veins available today.