Partial Versus Total Stripping of the Great Saphenous Vein Evaluated by Strain-Gauge Plethysmography

Abstract

This study was undertaken in order to assess the necessity of stripping the great saphenous vein totally or partially in the treatment of varicose veins. Thirty-four patients with varicose veins with no previous treatment were allocated to one of the two following treatments: sapheno–femoral ligation and complete stripping from the groin to the ankle with ligature of incompetent perforators and avulsion of visible varicose veins (group I); and partial stripping from the groin to 5 cm below the line of the knee joint and otherwise treated as mentioned above (group II). All patients were examined clinically before and 3 months after surgery to assess their varicose veins and the sensitivity in the saphenous nerve area. They were all investigated by strain-gauge plethysmography, recording venous return-time (RT) and expelled volume (EV). The patients scored their subjective findings on visual analogue scales (VAS) assessing discomfort, swelling and visual appearance. The Plethysmographic results of the two groups showed that RT increased by 25.5 and 22.5 s, respectively, to 53.4 and 63.6 s (median values) (normal RT > 42 s). The increment of the two groups, is significant, but a comparison does not show any significant difference. The EV-values showed nonsignificant changes. Saphenous nerve damage was found in five of 15 patients in group I and in one of 19 in group II, but this difference is not statistically significant ( P < 0.10). The VAS scores showed a significant improvement in both groups, in terms of discomfort and visible appearance, but that they did not differ in these respects. We conclude that partial stripping does not lead to a different outcome from total stripping, and that partial stripping seems to be the preferable treatment of primary varicose veins.