After the definite diagnosis was established according to the complete physical examination and non-invasive vascular study, A number of options are available for surgical treatment of varicose veins. No matter what kind of surgical method are considered, the objectives to treat the disease are the same. The tasks below must be completed by those treatments: (1) ablation of the hydrostatic forces of axial saphenous vein reflux and (2) removal of the hydrodynamic forces of perforator vein outflow. These objectives should be combined with extraction of the varicose vein clusters in as cosmetic fashion as possible.
Surgical Stripping of varicose veins
The traditional way to get rid of those varicose veins is surgical stripping of the saphenous veins with high ligation of the saphenofemoral or saphenopopliteal junction. The minor branches of varicosities can be dealt using multiple surgical excisions. Traditional stripping is effective and reliable in treatment of varicose veins. however, the wound pain, limb pain and frequent ecchymosis still remains to be its shortcomings.
There are basically 4 steps in performing the surgical stripping:
Incisions:
the incisions are made according to the preoperative vascular imaging. If the great saphenous vein reflux is to be treated, the incisions has to be placed over the inguinal area followed by dissection free of the saphenofemoral juction. The great saphenos vein and its branchs are to be explored followed by ligation and division. If the lessor saphenous vein reflux remains one of the problem, incision will be made over the near the popliteal fossa to explore the feomropopliteal junction. (the exact site of incision can be planned beforehand using the Doppler)
Introducing of strippers:
the metallic strippers is inserted via the venotomy either in the retrograde or antegrade fashion. (to insert the stripper in the antegrade fashion is easier) The device can be used using the so called "inversion technique" to reduce postoperative soft tissue trauma. At the ankle, the vein should be carefully and cleanly dissected to free it from surrounding nerve fibers. If this is not done, saphenous nerve injury will result, and the patient will experience numbness of the foot below the ankle.
Multiple excisions
Separate multiple excisions can be made to remove the varicose clusters directly. Especially those varicosity arising from the branches of saphenous vein. Surgeons can use the technique of stab avulsion to keep the wound as small as possible and remove the target vessels in a cosmetic fashion. Successive incisions are spaced as widely as possible. Varicosities are exteriorized by means of hooks or forceps . Particularly useful for this purpose are the specially designed vein hooks known by such names as the Varady dissector, the Muller hook, and the Oesch hook.
Stripping of Varicose vein
After the target varicosities are removed, the saphenous vein can be stripped gentally. The previously placed stripper is pulled distally to remove the saphenous vein. At the same time, effective compression along the stripping tract has to be done. The leg are bandaged over night and the patient can be discharged from the hospital.
There are some possible complication of traditional stripping, most are minor complications. Some patients do experience hematomas, pain, and extensive bruising. These three complications are linked; thus, every effort should be made to prevent oozing. The most feared complication of varicose vein surgery is venous thromboembolism, but the incidence of this complication is quite low (probably about 1%). The most frequent long term complication of stripping is the recurrence of varicosities.
Surgical Treatment of Vericose Veins
by Dr. Ko, Po-Jen
After the definite diagnosis was established according to the complete physical examination and non-invasive vascular study, A number of options are available for surgical treatment of varicose veins. No matter what kind of surgical method are considered, the objectives to treat the disease are the same. The tasks below must be completed by those treatments: (1) ablation of the hydrostatic forces of axial saphenous vein reflux and (2) removal of the hydrodynamic forces of perforator vein outflow. These objectives should be combined with extraction of the varicose vein clusters in as cosmetic fashion as possible.
Surgical Stripping of varicose veins
The traditional way to get rid of those varicose veins is surgical stripping of the saphenous veins with high ligation of the saphenofemoral or saphenopopliteal junction. The minor branches of varicosities can be dealt using multiple surgical excisions. Traditional stripping is effective and reliable in treatment of varicose veins. however, the wound pain, limb pain and frequent ecchymosis still remains to be its shortcomings.
There are basically 4 steps in performing the surgical stripping:
Incisions:
the incisions are made according to the preoperative vascular imaging. If the great saphenous vein reflux is to be treated, the incisions has to be placed over the inguinal area followed by dissection free of the saphenofemoral juction. The great saphenos vein and its branchs are to be explored followed by ligation and division. If the lessor saphenous vein reflux remains one of the problem, incision will be made over the near the popliteal fossa to explore the feomropopliteal junction. (the exact site of incision can be planned beforehand using the Doppler)
Introducing of strippers:
the metallic strippers is inserted via the venotomy either in the retrograde or antegrade fashion. (to insert the stripper in the antegrade fashion is easier) The device can be used using the so called "inversion technique" to reduce postoperative soft tissue trauma. At the ankle, the vein should be carefully and cleanly dissected to free it from surrounding nerve fibers. If this is not done, saphenous nerve injury will result, and the patient will experience numbness of the foot below the ankle.
Multiple excisions
Separate multiple excisions can be made to remove the varicose clusters directly. Especially those varicosity arising from the branches of saphenous vein. Surgeons can use the technique of stab avulsion to keep the wound as small as possible and remove the target vessels in a cosmetic fashion. Successive incisions are spaced as widely as possible. Varicosities are exteriorized by means of hooks or forceps . Particularly useful for this purpose are the specially designed vein hooks known by such names as the Varady dissector, the Muller hook, and the Oesch hook.
Stripping of Varicose vein
After the target varicosities are removed, the saphenous vein can be stripped gentally. The previously placed stripper is pulled distally to remove the saphenous vein. At the same time, effective compression along the stripping tract has to be done. The leg are bandaged over night and the patient can be discharged from the hospital.
There are some possible complication of traditional stripping, most are minor complications. Some patients do experience hematomas, pain, and extensive bruising. These three complications are linked; thus, every effort should be made to prevent oozing. The most feared complication of varicose vein surgery is venous thromboembolism, but the incidence of this complication is quite low (probably about 1%). The most frequent long term complication of stripping is the recurrence of varicosities.