The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury

Kostas, Theodoros; Ioannou, Christos V.; Veligrantakis, Michalis; Pagonidis, Constantinos; Katsamouris, Asterios

doi:10.1016/j.jvs.2007.07.055

Cited by 24 publications

(24 citation statements)

References 25 publications

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“…The symptoms consistent with nerve injury after complet GSV stripping affected quality of life in only 2.3% at long term evaluation 14 . According to a recently published study, complet GSV stripping showed better nerve injury results (19% at one month) than the nerve injury results of restricted GSV stripping of another study (27% after surgery) 8,17 . In Flu's study, 99% of the patients who underwent complet GSV stripping upward resulted in reduction of the complaints of varicose veins with nerve injury rate of 3% at 3 month follow-up 18 .…”

Section: Discussionmentioning

confidence: 91%

“…Currently, the only way to decrease the need for further operation in varicose veins, is routine stripping 13 . GSV stripping in patients suffering from superficial venous insufficiency ensures clear improvements in the quality of life 8,9,14 . It also should not be forgotten that when the saphenous vein is already displaying varicoses and incompetency, it will be unstable to use it as a graft.…”

Section: Discussionmentioning

confidence: 99%

“…Paresthesia as a subjective sensory abnormality was described as pins and needles or a tingling sensation. Dysesthesia was defined as unpleasent distorted sensation from actual sensory stimulation 8,9 .…”

Section: Methodsmentioning

confidence: 99%

“…GSV stripping above the knee may reduce the risk of nerve injury, but it does not eliminate this risk. Restricted stripping of GSV to the knee level may be the reason of developing recurrence of varicose veins in the residual segment below the knee 4,8 .…”

Section: Introductionmentioning

confidence: 99%

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Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency?

Uncu

2009

Acta Cir. Bras.

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Purpose:The most preferred method for the treatment of primary varicose veins due to greater saphenous vein (GSV) insufficiency is saphenofemoral high ligation and thigh stripping of the GSV, and ambulatory phlebectomy. Stripping is usually ended at the knee level to prevent nerve injury in the calf. However, different surgical modalities may be used depending on the surgeon's choice and experience. Methods: We present the results of complete stripping of the GSV to the ankle and ambulatory phlebectomies performed by a single surgeon. Ninety-six patients (102 limbs) who underwent standardized surgical procedure were participated in this study. Median follow-up time was 3.4 years. Results: All complaints due to varicose veins were resolved in all extremities. Some temporary complications observed were resolved fully during follow-up. Permanent paresthesia which was the most important complication was found only in two patients (2%). No recurrence was observed. Conclusion: The risk of saphenous nerve injury in the calf should not to be considered a reason to avoid complete stripping of the GSV to the ankle. If it is applied carefully and with appropriate technique, complete stripping still seems to be a good treatment option. Key words: Varicose Veins. Phlebotomy. Saphenous Vein. Venous Insufficiency. RESUMOObjetivo: O método de escolha para o tratamento das varizes primárias devido a insuficiência da veia safena magna (VSM) é a ligagura safenofemoral e a fleboextração em coxa e a flebectomia ambulatorial. A fleboextração é geralmente feita ao nível do joelho para prevenir a lesão neurológica no tornozelo. Diferentes modalidades operatórias, no entanto, podem ser utilizadas dependendo da escolha e da experiência do cirurgião. Métodos: Apresentamos os resultados da fleboextração completa da VSM até o tornozelo e flebectomias ambulatoriais realizadas por um único cirurgião. Noventa e seis pacientes (102 membros) que foram submetidos a procedimento cirúrgico padrão participaram deste estudo. A mediana do tempo de seguimento foi 3,4 anos. Resultados: Todas as queixas devido a varizes foram resolvidas em todos os pacientes. Algumas complicações temporárias observadas foram resolvidas totalmente durante o tempo de seguimento. Parestesia permanente que foi a complicação mais grave ocorreu apenas em dois pacientes (2%). Não observamos recurrência. Conclusão: O risco da lesão do nervo safeno no tornozelo não deve ser considerada uma razão para evitar-se a fleboextração completa da VSM até o tornozelo. Se é aplicada cuidadosamente e com a técnica apropriada, fleboextração ainda parece ser uma boa opção de tratamento.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency?

Uncu

2009

Acta Cir. Bras.

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“…The patterns of the reflux map have been reported by Koyano, et al 3) Selective stripping, which preserves the competent segment of the saphenous vein, is recommended to avoid postoperative injury to the nerve which lies just beside the below-knee saphenous vein. 4) Some authors persist in total stripping that corrects venous incompetence below the knee; 5,6) others have said that even if reflux is detected in the below-knee saphenous vein, we can preserve the incompetent below-knee saphenous because it is often corrected by just above-knee stripping. 7,8) This was a controversial point of debate during the 25th meeting of the Japanese Society of Phlebology.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Residual Below-Knee Reflux and Incompetent Perforating Veins on Venous Function after Stripping Surgery

Sugiyama

Uchida²,

Miyade

et al. 2013

Annals of Vascular Diseases

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F or many years, the standard operation for varices of great saphenous veins (GSV) was the selective stripping, stab avulsion and sclerotherapy of the varicosities. 1) Rec ently, however, endovenous laser and radio-frequency ablation of GSV have become new standard techniques. In both techniques, the below-knee GSV is usually preserved in order to prevent nerve injury. As a result, reflux in the below-knee saphenous vein often persists after the operation.The aim of this study was to analyze the influence of persistent below-knee saphenous reflux and incompetent calf perforating veins on venous function after stripping. MaterIals and MethodsFrom September 2007 to October 2008, 939 limbs (627 patients) were treated at Hiroshima Teishin Hospital. During this period, 131 limbs (131 patients) with varicosities of one side of the GSV were analyzed for this study.The patients were interviewed before surgery, one month after the operation, and one year after the operation. The venous filling index (VFI: normal range is lower than 2.0 ml/sec) was measured by air plethysmography, and persistent below-knee saphenous reflux was evaluated by duplex scanning. Persistent reflux was diagnosed when the reflux time was over 0.5 seconds using Persisting incompetent great saphenous vein (GSV) below the knee and residual incompetent perforating veins (IPV) are often found after selective stripping of GSV from the groin to upper calf. The aim of this study is to evaluate the venous function when the calf GSVs or calf perforating veins are incompetent after stripping surgery. One hundred-thirty-one limbs were treated by stripping from the groin to upper calf with stab avulsion or sclerotherapy of varices. One month and twelve months after surgery, the patients were examined clinically to establish the extent of persisting varices by duplex ultrasonography and air-plethysmography. Venous filling index (VFI) was a little higher in those who had residual calf GSV reflux 12 months later; it was also higher in the group with incompetent perforating veins than the group without. The chief complaints were found to have improved in all groups. The findings suggest that removal of the saphenous vein below the knee is not necessary, but it is important to take care of the incompetent perforating veins. (*English Translation of Jpn J Phlebol 2011; 22: 239-244.)

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Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Carradice

Mekako

Mazari

et al. 2011

British Journal of Surgery

108

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The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury

Cited by 24 publications

References 25 publications

Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency?

Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency?

The Influence of Residual Below-Knee Reflux and Incompetent Perforating Veins on Venous Function after Stripping Surgery

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

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