From the Guidelines
Surgical ligation and stripping of the saphenous vein is a traditional procedure that has largely been replaced by less invasive techniques like endovenous laser treatment or radiofrequency ablation, which offer quicker recovery times and fewer complications, as evidenced by recent studies 1.
Overview of the Procedure
Surgical ligation and stripping of the saphenous vein is a traditional surgical procedure used to treat varicose veins by removing the damaged greater or lesser saphenous vein from the leg. The procedure involves making small incisions at the groin and ankle, tying off (ligating) the vein at its junction with the deep venous system, and then inserting a flexible wire or stripper through the vein.
Comparison with Other Treatments
Recent studies have shown that endovenous ablation, including radiofrequency ablation (RFA) and endovenous laser ablation (EVLA), have similar efficacy to surgical ligation and stripping, but with improved early quality of life and reduced hospital recovery 1.
Key Points to Consider
- The procedure is typically performed under general or spinal anesthesia and may require an overnight hospital stay.
- Recovery involves wearing compression stockings for several weeks, limiting physical activity initially, and gradually returning to normal activities over 2-4 weeks.
- While effective at eliminating varicose veins, the traditional approach has been largely replaced by less invasive techniques.
- Blood naturally reroutes through healthier veins after the damaged vein is removed, improving circulation and relieving symptoms like pain, swelling, and skin changes associated with venous insufficiency.
- Recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery, with fewer rates of bleeding, hematoma, and wound infection 1.
Current Recommendations
Given the current evidence, endovenous laser treatment or radiofrequency ablation are recommended over surgical ligation and stripping of the saphenous vein for the treatment of varicose veins, due to their quicker recovery times and fewer complications, as supported by the most recent study 1.
From the Research
Definition of Surgical Ligation and Stripping of Saphenous Vein
- Surgical ligation and stripping of the saphenous vein is a traditional open surgery method used to treat varicose veins 2.
- The procedure involves the ligation (tying off) of the sapheno-femoral or sapheno-popliteal junction, followed by the removal (stripping) of the affected vein 2.
- The goal of the procedure is to eliminate the refluxing vein and alleviate symptoms associated with varicose veins.
Techniques and Considerations
- The technique of exposure of the sapheno-femoral and sapheno-popliteal junctions is crucial to avoid complications 2.
- The use of different types of strippers and the requirement for stripping the small saphenous vein are also important considerations 2.
- The extent of dissection necessary in the popliteal fossa is another factor to be taken into account 2.
Comparison with Other Treatments
- Surgical ligation and stripping has been compared to other treatments such as endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy in various studies 3, 4, 5, 6.
- These studies have shown that surgical ligation and stripping is a effective treatment for varicose veins, but may be associated with more complications and a longer recovery time compared to other treatments 3, 4, 5, 6.
Complications and Outcomes
- Complications of surgical ligation and stripping can include wound infection, nerve injury, vascular injury, and venous thromboembolism 2.
- The frequency of these complications can be minimized with proper technique and patient selection 2.
- The outcomes of surgical ligation and stripping can be assessed using duplex ultrasound imaging and quality of life questionnaires 5, 6.