This describes high saphenous ligation & stripping of the long saphenous vein together with multiple avulsions.

Preoperative Preparation

Doppler studies are used to display valvular & perforator incompetence. Mark the varicosities with indelible pen.

Anaesthesia

General or spinal

Position

Supine with Tredelenburg tilt

Incision

First, a transverse groin crease over the sapheno- femoral junction.

Procedure

Ligate & divide all of these branches while approaching the sapheno-femoral junciton.

• After clearly identifying the junction, divide & perform a flush ligation of the long saphenous vein.
• If stripping is indicated, place a ligature around the long saphenous trunk & make a small venotomy below it to pass the vein stripper (flexible steel or disposable plastic).
• Gently manipulate the tip of the stripper through the lumen of the long saphous vein down to the level of knee joint.
• Make a stab incision over the palpable tip of the stripper & deliver it onto the surface.
• Strip the long saphenous vein from the groin to the knee with steady downward traction.
• After completion, multiple avulsions are performed of leg varicosities - separate stab incisions are made near the varicosities & avulsions are performed by traction & dissection.
• The short saphenous at the back of the popliteal fossa may also need ligation.

Closure

The groin incision can be closed with subcuticular suture & paper tapes to the stab incisions.

Postoperative Management

A compression bandage is applied to the leg for one week & early mobilsation.