Varicose Vein Surgery
This describes high saphenous ligation & stripping of the long saphenous vein together with multiple avulsions.
Doppler studies are used to display valvular & perforator incompetence. Mark the varicosities with indelible pen.
General or spinal
Supine with Tredelenburg tilt
First, a transverse groin crease over the sapheno- femoral junction.
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.
The groin incision can be closed with subcuticular suture & paper tapes to the stab incisions.
A compression bandage is applied to the leg for one week & early mobilsation.