Saphenous vein stripping is a surgical procedure primarily used to treat severe varicose veins of the lower limbs. This operation involves removing damaged superficial great saphenous veins or deep veins to improve venous reflux and alleviate related symptoms. Suitable candidates typically include patients with skin ulcers, thrombophlebitis, or recurrent inflammation caused by varicose veins.
The main goal of the surgery is to restore venous circulation in the lower limbs and reduce pain, swelling, and pigmentation caused by blood stasis. Compared to traditional compression therapy or medication, this surgery offers a more direct solution to the underlying problem.
Saphenous vein stripping is divided into traditional open surgery and modern minimally invasive techniques. The traditional method requires large incisions in the groin and behind the knee to directly remove the affected veins; the improved minimally invasive techniques use catheters or image guidance to reduce tissue damage.
The mechanism involves removing veins that have lost valve function, redirecting blood flow to healthy peripheral veins. The procedure includes ligating proximal vessels and segmentally excising damaged sections to ensure smooth blood return to the heart.
Primarily applicable for symptoms such as severe varicose veins leading to skin ulcers, chronic inflammation, thrombophlebitis, or cases unresponsive to conservative treatments. Patients with chronic venous insufficiency and severe symptoms may also be considered for this surgery.
Criteria include: duplex ultrasound confirming main pathology in the great saphenous vein trunk, suitable overall health status for surgery, and failure of other non-invasive treatments.
The surgery is usually performed under general or spinal anesthesia, lasting approximately 1-2 hours. Surgeons make incisions in the groin and lower leg, using specialized instruments to gradually strip the vein from proximal to distal and ligate branch veins.
The minimally invasive version may use image guidance or laser assistance to reduce tissue damage. Postoperative care includes wearing elastic compression stockings for at least 2 weeks and regular follow-up examinations.
Compared to medication or compression therapy, surgery provides more immediate and lasting improvements, especially for structural venous damage that is irreversible.
Possible short-term complications include:
Important Risk Warning: 0.5-1% of patients may experience postoperative edema or subcutaneous hematoma, which can be alleviated with ice packs and compression stockings. Rare cases may involve symptoms recurring due to residual venous tissue not being fully removed.
Preoperative assessment should exclude coagulation disorders or uncontrolled diabetes. Pregnant women, patients with severe cardiopulmonary diseases, or recent serious infections should avoid surgery. Anticoagulants such as aspirin should be discontinued 3 months prior to surgery.
Contraindications include:
The surgery may need to be coordinated with anticoagulant therapy, adjusting doses of warfarin or novel oral anticoagulants before and after the procedure. For patients undergoing radiotherapy or chemotherapy, the risks and timing of surgery should be carefully evaluated.
Compared to laser or radiofrequency ablation, saphenous vein stripping has a lower recurrence rate but may require a longer recovery period. The choice depends on the overall condition of the patient.
Studies show that at 1 year post-operation, symptom improvement rates reach 85-90%, and ulcer closure rates exceed 95%. The 2019 Cochrane review indicates that surgery significantly reduces pain and activity limitations compared to non-surgical treatments.
Long-term follow-up (5-10 years) shows about 5-10% of patients may require secondary treatment due to other peripheral venous issues. The effectiveness is highly related to patient adherence to postoperative care instructions.
Non-invasive options include:
Advantages of alternative methods include lower invasiveness, but they may require multiple treatments and have less durable effects. Patients should evaluate symptom severity and quality of life needs with their physician to choose the most appropriate approach.
Preoperative duplex ultrasound is necessary to confirm the location of the lesions and assess overall health. Anticoagulants may need to be discontinued, and fasting for 12 hours before surgery is recommended. Patients should arrange for postoperative care or transportation in advance to ensure safety during recovery.
How is postoperative pain managed?Postoperative discomfort may include mild pain or swelling. Doctors may prescribe painkillers or recommend ice packs to reduce discomfort. Avoid excessive activity of the affected limb; wearing compression stockings can improve circulation and reduce swelling. If pain persists beyond 48 hours or is accompanied by fever, seek medical attention promptly.
When can daily activities be resumed after surgery?Generally, rest for 2-3 days, avoiding heavy lifting or prolonged standing. Walking and light activities can promote recovery, but strenuous exercise should wait at least 2 weeks. Follow the personalized guidance provided by your physician based on recovery progress.
What are the success rates and long-term outcomes of saphenous vein stripping?The success rate is approximately 85-95%, effectively removing diseased veins and improving symptoms. Long-term follow-up shows about 90% of patients experience symptom relief lasting over 10 years, provided they maintain healthy lifestyle habits such as regular exercise and avoiding prolonged sitting to reduce recurrence risk.
What complications may occur postoperatively and how can they be prevented?Potential complications include temporary bruising, skin numbness, or infection, with an incidence below 5%. Strict postoperative adherence to compression bandaging, regular dressing changes, and monitoring for redness or abnormal swelling are essential. Keeping the wound clean and following medical advice on antibiotics can reduce risks.
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