surgical treatment of truncal veins stephen f. daugherty, md, facs, rvt, rphs

SURGICAL TREATMENT OF TRUNCAL VEINS

Stephen F. Daugherty, MD, FACS, RVT, RPhS

SAPHENOUS VEIN STRIPPINGDESCRIBED IN 1905-1907 BY:

William Keller

Charles Mayo

Stephen Babcock

Rose, Sidney S. Historical Development of Varicose Vein Surgery in Varicose Veins and Telangiectasias, ed. Bergan and Goldman, Quality Medical Publishing; 1993: pp123-147.

“…many believe that the operation (saphenous vein stripping) is probably obsolete.”

Bergan, John J. in Rutherford’s Vascular Surgery, 6th ed; 2005: p2258.

SURGICAL OPTIONS

- Open Excision

- Saphenous Vein Ligation

- Ankle-to-Groin Saphenous Stripping

- Segmental Saphenous Stripping

All of the above often were combined with phlebectomy.

The Craft of Surgery, Philip Cooper, ed., 1965

PROBLEMS WITH VEIN LIGATION

FREQUENT EARLY FAILURE DUE TO COLLATERAL INCOMPETENT VEINS

NEOVASCULARIZATION DUE TO GROIN DISSECTION

Rutherford Vascular Surgery, 6th ed., 2005

PROBLEMS WITH ANKLE-TO-GROIN

STRIPPINGSAPHENOUS NERVE INJURY

STRIPPING CALF OFTEN IS UNNECESSARY

INTRAOPERATIVE BLEEDING

HEMATOMA CAUSING PAIN

A Regional Atlas of the Human Body, Carmine Clemente, 1975

PROBLEMS WITH SMALL SAPHENOUS VEIN

STRIPPINGSURAL NERVE INJURY

VARIABLE LOCATION OF TERMINATION OF SMALLL SAPHENOUS VEIN

A Regional Atlas of the Human Body, Carmine Clemente, 1975

IMPROVEMENTS IN SEGMENTAL

SAPHENOUS VEIN STRIPPING- STRIP KNEE-TO-GROIN ONLY

- ULTRASOUND IMAGING FOR PASSAGE OF STRIPPER AND HOOK RETRIEVAL OF LARGE TRIBUTARY VEINS FOR LIGATION AND DIVISION- OESCH PERFORATE-INVAGINATE (PIN) STRIPPING DESCRIBED IN 1993. Goren, G., Yellin, AE, JVS 1994; 20:970-977.

WHEN TO CONSIDEROPEN SURGERY?

LARGE, COMPLICATED VENOUS ANEURYSM NEAR THE SFJ

HIGH LIGATION COMBINED WITH- PIN STRIPPING- ENDOVENOUS THERMAL

ABLATIONFOAM SCLEROTHERAPY

VERY SUPERFICIAL LONG TRUNCAL VEIN