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 blood 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 pooling. Compared to traditional compression therapy or medication, this procedure offers a more direct solution to the underlying problem.
Saphenous vein stripping can be 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 modified minimally invasive techniques use catheters or image guidance to reduce tissue damage.
The mechanism involves removing veins that have lost valve function, rerouting blood to healthier peripheral veins. The surgery combines ligation of proximal vessels and segmental removal of damaged sections to ensure smooth blood return to the heart.
Primarily indicated 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 consider this surgery.
Eligibility criteria include ultrasound confirmation that major lesions are located in the main trunk of the great saphenous vein, overall patient health suitable for surgery, and failure of other non-invasive treatments.
The procedure is usually performed under general or spinal anesthesia, lasting approximately 1-2 hours. Surgeons make incisions in the groin and calf, using specialized instruments to gradually strip the vein from proximal to distal, ligating branch veins.
The minimally invasive version may utilize image guidance or laser assistance to reduce tissue damage. Postoperative care includes wearing elastic compression stockings for at least two weeks and regular follow-up examinations.
Compared to medication or compression therapy, surgery provides more immediate and lasting improvements, especially for structurally damaged veins with irreversible repair.
Possible short-term complications include:
Important Risk Warning: 0.5-1% of patients may experience postoperative metabolic edema or subcutaneous hematoma, which can be alleviated with ice packs and compression stockings. Rare cases may involve persistent symptoms due to residual vein tissue not being fully removed.
Preoperative assessment should exclude coagulation disorders or uncontrolled diabetes. Pregnant women, patients with severe cardiopulmonary diseases, or recent severe infections should avoid surgery. Anticoagulants such as aspirin should be discontinued three 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. Patients undergoing radiation or chemotherapy should evaluate the risks and timing of surgery accordingly.
Compared to laser or radiofrequency ablation, saphenous vein stripping has a lower recurrence rate but may involve a longer recovery period. The choice should be based on the overall condition of the patient.
Studies show that at one year post-operation, symptom improvement rates reach 85-90%, and ulcer closure rates exceed 95%. A 2019 Cochrane review indicated that, compared to non-surgical treatments, surgery significantly reduces pain and activity limitations.
Long-term follow-up (5-10 years) reveals that about 5-10% of patients may require secondary treatment due to other peripheral vein issues. The effectiveness is highly related to patient adherence to postoperative care instructions.
Non-invasive options include:
The 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 suitable approach.
Preoperative ultrasound examination of the veins is necessary to confirm lesion locations and assess overall health. Anticoagulants may need to be discontinued, and fasting for 12 hours before surgery is recommended. Patients should arrange for family 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, medical evaluation is advised.
When can daily activities resume 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 two weeks. Follow the personalized guidance provided by your physician based on recovery progress.
What are the success rates and long-term effects of saphenous vein stripping?The success rate is approximately 85-95%, effectively removing diseased veins and improving symptoms. Long-term follow-up shows that 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 wounds clean and following medical instructions for antibiotics can reduce risks.
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