Stripping Of Long Saphenous Vein Research Articles

Comparative study on outcome of surgical management of varicose veins with and without great saphenous vein stripping

Background: Varicose veins of lower limb are multiple elongated dilated and tortuous veins. It is a progressive disease that worsens as the day passes. The treatment modalities available are conservative, surgical and endovenous therapies. It is accepted that surgical treatment is required for symptomatic varicose veins, to relieve symptoms and to prevent the long-term sequelae of eczema, lipodermatosclerosis and venous ulceration. Different surgical interventions may be used, but most preferred treatment applied is saphenofemoral flush ligation and ligation of incompetent perforators. Methods: This prospective comparative study was conducted on 60 patients in the department of general surgery, Mamata general hospital from July 2020 to June 2022. 60 patients were allocated into two groups of 30 patients each, who underwent flush ligation of saphenofemoral junction with stripping of long saphenous varicose vein and Trendelenburg surgery alone (flush ligation of sapheno femoral junction) respectively. Results: The hematoma formation in the thigh was seen in 23.33% of patients who underwent venous stripping whereas it was seen only in 3.33% who underwent Trendelenburg procedure alone. These wounds were examined in the postoperative period. Delayed wound healing was observed in 26.66% in patients with venous stripping and it was 10% with Trendelenburg procedure alone. There was no significant difference in postoperative ambulation, hospital stay and pain relief after 2 months. Conclusions: From this study with the observed variables, it is concluded that the Trendelenburg procedure with incompetent perforators ligation without venous stripping appears to be better than Trendelenburg procedure with incompetent perforators ligation with venous stripping.

A COMPARATIVE STUDY OF TRENDELENBURG OPERATION AND TRENDELENBURG OPERATION COMBINED WITH STRIPPING OF LONG SAPHENOUS VEIN IN THE TREATMENT OF PRIMARY VARICOSE VEINS OF LOWER LIMB

Aims And Objectives: To compare the effectiveness, incidence of complications and recurrence after Trendelenburg operation and Trendelenburg operation combined with stripping of the thigh segment of long saphenous vein in the treatment of primary varicose veins of lower limb. Study is based on analysis Material & Methods: of 100 cases of primary varicose veins of long saphenous vein with or without perforator incompetence who got treated by either simple ligation or ligation with stripping of long saphenous vein from at Department of General Surgery, Osmania General Hospital, Hyderabad Telangana. After surgery residual long Results: saphenous vein reux was present in 22% cases in the group in which ligation alone was done and residual thigh perforators were identied in 11% of cases whereas in the group which underwent ligation combined with stripping of the thigh segment of long saphenous vein residual reux was present in 6% cases and no residual thigh perforators were identied. The i Conclusion: ncidence of Residual long saphenous vein reex and residual perforator in the thigh is less after ligation and stripping of long saphenous vein compared to Ligation of Saphenofemoral junction alone. The incidence of Nerve palsy and bleeding and hematoma is also not more in the ligation + stripping group compared to ligation alone.

A clinical study on varicose veins of lower limb, surgical management and functional outcome at a tertiary care hospital of South India

Background: Varicose veins defined as dilated, tortuous, subcutaneous veins ≥3 mm in diameter, measured in the upright position with demonstrable reflux. Though the history of varicose veins dates prehistorically, the advances in diagnosis and new management modalities gained attention recently. The aim of the present study was to study the clinical profile, risk factors and their association, different types of surgical procedures employed and complications associated with varicose veins.Methods: A one year observational after ethical committee approval was conducted by department of general surgery at ACSR Medical College. Cases fulfilling the inclusion criteria were clinically examined and duplex ultrasound colour Doppler was performed for diagnosing the varicose veins and findings of site of incompetence was noted. All the cases were operated and followed up for six months period. The results were tabulated and analyzed in Microsoft Excel for any corrections.Results: Eighty cases with 66.25% males and 33.75% females with mean age of 40.24 years and majority (40%) were in 41 to 50 years group. 60% of cases had varices in right limb and long saphenous vein was involved in 52.5% of cases.85% had dilated veins, perforator incompetence was noted below the knee in 30% of cases. 41.25% of cases saphenofemoral flush ligation with stripping of long saphenous vein. Wound infection was the common postoperative complication.Conclusions: Operative line of management should be the first line of treatment even though conservative management relieves the symptoms but always requires a definitive management.

A randomized study comparing conventional surgery versus endovenous laser therapy for the treatment of primary varicose veins of the long saphenous vein

Introduction Traditionally, long saphenous vein (LSV) varicosis with saphenofemoral junction incompetence was treated with high ligation and stripping. Postoperatively patients have significant discomfort and bruising. Endovenous laser therapy (EVLT) was developed to offer patients who have varicose veins a less painful treatment alternative to stripping, with a faster return to work and normal activities. EVLT of the LSV has been proven to be safe, with long-term results comparable to traditional high ligation and stripping. Aim The aim of this work was to compare between two different modalities for the treatment of primary varicose veins disease of the LSV: standard ligation with stripping, and EVLT, with regard to the effectiveness, complications of each treatment modality, recovery and return to work. Patients and methods This randomized study was conducted upon 40 patients in Benha University Hospital, enrolled from April 2016 to December 2016. Twenty patients underwent high ligation and stripping of LSV, while 20 others underwent EVLT. Results Our study found no significant difference in success of obliterating the vein using either method; however, patients who underwent EVLT showed less early complications and faster recovery and earlier return to work. Conclusions EVLT in varicose veins of the LSV is a safe viable alternative to high ligation and stripping using surgery. It has the advantage over surgery of having no incisions, less initial serious complications and faster ambulation and return to work.

Comparison of ligation versus ligation with stripping of long Saphenous vein in varicose veins of lower limb

Comparison of ligation versus ligation with stripping of long Saphenous vein in varicose veins of lower limb

Technical Notes and Tips: Technique for Dealing with Incomplete Stripping of the Long Saphenous Vein

Stripping of the long saphenous vein from groin to the knee can sometimes be incomplete.1 If a long, strong ligature is used to attach the vein to the stripper it can be controlled at both wounds after passing the stripper. Tie the ligature onto a length of ribbon gauze and pull this down through the saphenous tunnel to exit at the knee wound. This gauze frequently brings the saphenous vein remnant with it (Fig. 1) providing a simple method for completing the strip. The gauze also evacuates haematoma from the tunnel and can be soaked in local anaesthetic with adrenaline. Figure 1 Use of ribbon gauze to remove saphenous vein remnant.

Ocena i wyniki leczenia izolowanej obwodowej niewydolności żyły odpiszczelowej - aspekt porównawczy metod operacyjnych

Ocena i wyniki leczenia izolowanej obwodowej niewydolności żyły odpiszczelowej - aspekt porównawczy metod operacyjnych

Radiofrequency Endovenous Obliteration versus Stripping of the Long Saphenous Vein in the Management of Primary Varicose Veins: 3-Year Outcome of a Randomized Study

We evaluated the 3-year outcome of a series of patients with primary varicose veins who were randomized to radiofrequency endovenous obliteration vs. stripping of the long saphenous vein (LSV). Twenty-eight patients were included in the study: 15 were randomized to the radiofrequency endovenous obliteration procedure and 13 to LSV stripping. At 3-year follow-up, five patients (33.3%) of the endovenous group had recurrent or residual varices and in three of them a reflux in the thigh veins was detected. None of the primarily occluded LSV segments was recanalized. In the stripping group, three patients (23.1%, p = 0.68) showed varicosities at clinical and duplex examinations. In one patient, a patent duplicate LSV trunk was detected. In the remaining two patients, no reflux in the thigh region was detected. According to the present results, radiofrequency endovenous obliteration of the LSV is associated with somewhat poorer short-term results compared with the stripping operation.

The Effect of Long Saphenous Vein Stripping on Deep Venous Reflux

Background. The addition of long saphenous vein (LSV) stripping to sapheno-femoral junction (SFJ) disconnection and multiple stab avulsions (MSAs) in the course of varicose vein (VV) surgery is associated with a significant reduction in recurrence, and a significant improvement in quality of life. It is hypothesised that these benefits relate, at least in part, to a favourable effect of stripping on deep venous reflux.Objective. To examine the effect of long saphenous vein (LSV) stripping on deep venous reflux (DVR).Methods. This was prospective study of 62 consecutive patients (77 limbs) CEAP class 2–6, undergoing SFJ disconnection and MSAs, with and without successful stripping of the LSV to the knee. A duplex ultrasound examination was performed pre-operatively and at a median (IQR) of 24 (23–25) months post-operatively. Completely stripped limbs were defined as those in whom complete stripping of the LSV to the knee was confirmed on post-operative duplex. Reflux ≥0.5 s. was considered pathological.Results. Pre-operatively, 32 (42%) limbs had deep venous reflux (DVR). Post-operative duplex at 24 months revealed that the LSV had been completely stripped in 29 (38%) limbs. In patients with pre-operative DVR, complete stripping was associated with a significant reduction in the prevalence of superficial femoral vein (SFV) (p<0.001) and popliteal vein (PV) (p=0.016), McNemar test) on post-operative duplex. By contrast, in patients without pre-operative DVR, incomplete stripping was associated the development of SFV (p=0.031) and PV (p=0.008) reflux.Conclusions. Complete LSV stripping abolishes DVR in a significant proportion of limbs, whereas failure to strip is frequently associated with the development of new DVR. These data support for routine stripping and suggest that the benefits of stripping may relate, at least in part, to a favourable impact on deep venous function.

Long saphenous vein stripping reduces local level of reactive oxygen metabolites in patients with varicose disease of the lower limbs.

Long saphenous vein (LSV) stripping is the most common surgical procedure in patients affected by varicose disease of the lower limbs. Reactive oxygen metabolites (ROM) generation plays a crucial role in chronic venous insufficiency (CVI). The aim of this study was to investigate whether ROM generation is increased in patients affected by varicose disease versus healthy controls and whether LSV stripping has a positive effect on the local production of ROM. The local production of ROM was assessed measuring hydroperoxides in the blood collected from the leg of 30 patients consecutively undergoing LSV stripping and 30 controls. In both the patient group and the control group, the test was repeated 30 days later. We found that ROM levels before surgery are higher in varicose vein patients than in controls ( p <.0001) and that ROM are significantly reduced 30 days after LSV stripping ( p <.0001). At that time point, no significant differences between patients and controls was found. We also found that sex and age do not affect ROM concentration in patients and controls, either before or after surgery. In conclusion, our data indicate that CVI is characterized by significant oxidative stress and that LSV stripping is able to normalize local production of ROM in patients with varicose disease of the lower limbs. We suggest that measurement of ROM might be useful to test the positive effects of LSV stripping in these patients.

Femoral and Genitofemoral Nerve Blocks Versus Spinal Anesthesia for Outpatients Undergoing Long Saphenous Vein Stripping Surgery

Long saphenous vein stripping (LSVS) surgery is often used to treat varicose veins.We tested the hypothesis that femoral nerve block (FNB) with genitofemoral nerve infiltration provides sufficient analgesia and superior recovery characteristics to spinal anesthesia for LSVS procedures in the ambulatory setting. Thirty-six patients were randomized to receive FNB with 30 mL of 3% alkalinized chloroprocaine, and 32 patients received spinal anesthesia with 65 mg of 5% hyperbaric lidocaine. Data collected included patient demographics, time required for induction of and recovery from anesthesia, postoperative anesthesia complications, and patient report of pain severity after the operation. During a follow-up call, a blinded observer noted the onset of any complications, the requirement for analgesics, and the patients' satisfaction with the anesthetic technique. Patients in the FNB group had significantly faster recovery (P < 0.01) and lower incidences of pain (P < 0.05) and complications (P < 0.05) than the patients in the spinal group. All patients who received FNB indicated that they would choose this type of anesthesia in the future, whereas five (15%) patients in the spinal group would refuse spinal anesthesia in the future (P < 0.01). We conclude that FNB is an excellent anesthetic choice for LSVS. (Anesth Analg 1997;84:749-52)

A Double-Blind Clinical Trial of the Efficacy and Tolerability of O-(β-Hydroxyethyl)-Rutosides and Compression Stockings in the Treatment of Leg Oedema and Symptoms following Surgery for Varicose Veins

Objective: To study the efficacy and tolerability of O-(β-hydroxyethyl)-rutosides (HR) and compression stockings in the treatment of leg oedema and symptoms after varicose vein surgery. Design: A prospective double-blind, randomized, Parallel, placebo-controlled trial. Setting: Surgical department of a regional hospital. Patients: Forty patients undergoing venous surgery for varices associated with superficial insufficiency. Interventions: Saphenofemoral ligation, stripping of the entire long saphenous vein and removal of varicosities via 0.5 cm incisions. HR was given at 2 g/day (or Placebo) for 6 weeks starting on the first postoperative day. Twenty patients were randomized to each group. Main outcome measures: Leg volumes were measured by an automatic electronic-optic volumeter, prior to operation and again after 6 weeks and 3 months. Leg symptoms were recorded on days 1 and 10, weeks 3 and 6, and at 3 months. Results: There was no difference in leg volume between the two groups during the first 6 weeks when stockings Were worn, but the increase in oedema of the distal leg in the subsequent 6 weeks was significantly less in the HR group. Symptoms disappeared rapidly 3 weeks Postoperatively in both groups. Conclusions: Stockings are effective in controlling postoperative leg oedema and symptoms. The addition of HR can prevent subsequent oedema after removal of the stockings.

Office Varicose Vein Surgery Under Local Anesthesia

Varicose veins of any size (except telangiectasia) and in any site of the lower limb (except the saphenofemoral junction) can be avulsed through multiple 0.5-mm (or larger) incisions under local infiltration anesthesia (Müller's technique). When necessary, high ligation, division, and stripping of the proximal long saphenous vein can also be performed under local anesthesia. It is thus possible to treat even the most complex varicose cases with outpatient office-based surgery.

Vein Valve Graft for Primary Femorosaphenous Incompetence

Primary femorosaphenous incompetence (FSI) is a rare cause of venous stasis and ulceration and is conventionally managed by ligation of the saphenofemoral junction with or without stripping of the long saphenous vein (LSV). The authors present here 9 patients with FSI documented by phlebography who were managed by the alternate procedure of vein valve graft from the basilic vein to the long saphenous system to restore competency of the femorosaphenous (FS) junction . This procedure has hitherto not been tried for primary varicosity of the LSV. There was cosmetic improvement in all patients. Chronic ulcers in 5 patients seen preoperatively remained healed during a follow-up period of one to five years. There was symptomatic improvement of heaviness of the limb in 5 of 6 patients . Phlebography at one year postoperatively showed competency of the FS junction in all 9 patients and graft patency in 8 of 9 patients. This procedure has the added advantage of preserving the LSV for future use in arterial bypass surgery and avoids complications like saphenous nerve injury and lymphatic disruption associated with stripping of the LSV.

Day-Case Surgery: A Viable Alternative for Surgical Treatment of Varicose Veins

One hundred and forty-eight patients (164 limbs) who had varicose vein surgery by the same consultant surgeon 3–10 years previously were reviewed; 61 patients had surgery as an in-patient and 87 as a day-case. The patients were reviewed to assess the efficacy and acceptability of day-case varicose vein surgery. There were no significant differences between the age and sex ratios of the patients. However, twice as many operations in the in-patient group included stripping of the long saphenous vein above the knee (χ2 = 4.2, P = 0.04). Fifteen in-patients had bilateral vein surgery as opposed to only one day-case patient. Fifteen patients suffered complications most of which were minor and were evenly distributed including wound infections (nine), reactionary haemorrhage/haematoma (four), deep vein thrombosis (one) and pulmonary embolus (one). The convalescent period before returning to work was similar in the two groups (U= 953, P= 0.28). The mean duration of stay for the in-patients was 3.9 ± 2.2 days. There was no significant difference in the period off work (day-case: 3.6 ± 2.0 weeks; in-patient: 4 ± 2.9 weeks), or in the length of follow-up (day-case: 6.01 ± 1.24 years; in-patient: 6.79 ± 1.71 years). In the period before review 11 patients in the in-patient group and 13 patients in the day-case group had further surgery or sclerotherapy for recurrent symptomatic varicose veins. At review five patients in the in-patient group and six patients in the day-case group had recurrent sapheno-femoral incompetence (χ2 = 0.1, P = 0.7). A total of 34 patients in both groups had recurrent varicose veins. Only four (4.6%) of the day-case patients expressed a preference for in-patient treatment if they were to have further surgery and 21 (34%) of the in-patient group would prefer day-case surgery. Day-case varicose vein surgery has not been shown to be inferior in terms of complications or recurrence rate. Patient acceptability is good and it is a viable alternative to in-patient treatment in suitable patients in areas with adequate district nurse facilities.

SUCTION DRAINAGE AFTER STRIPPING OF LONG SAPHENOUS VEIN

SUCTION DRAINAGE AFTER STRIPPING OF LONG SAPHENOUS VEIN