Stripping of Great Saphenous Vein

Burleva E.P.; Smirnov O.A.; Tyurin S.A.

doi:https://doi.org/10.17116/flebo201711276-82

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Abstract:

This literature review deals largely with the evolution of the views on the stripping of the great saphenous vein as a surgical procedure for the treatment of large varicose veins in the lower extremities. Various opinions, both positive and negative, as regards the advantages and disadvantages of this method for the open surgical intervention are discussed including its character and scope of applications with special reference to the effectiveness of elimination of pathological reflux on the one hand and the safety of this procedure on the other hand. The role of varicose vein stripping in modern phlebology is discussed taking into consideration the ever increasing contribution of endovasal technologies to the medical practice. The authors emphasize that the endovasal intervention could be the first-line treatment of the patients presenting with varicose veins. However, there are a number of clinical and technical limitations on the application of this method arising from the peculiar features of the anatomical structure of the main subcutaneous veins and related to the patient’s condition at which open surgery should be preferred over the endovasal procedures. The main approach to the treatment of varicose veins still remains the open surgical intervention, the «short» stripping technique being the best treatment option for the majority of the patients suffering from varicose veins. The paper contains data extracted from the Russian-language and foreign literature publications concerning the choice of the optimal extent of the great saphenous vein stripping and the fate of the residual segment of the GSV trunk at the calf level after partial stripping.

Keywords:

varicose veins

great saphenous vein

stripping

Authors:

Burleva E.P.

Kafedra obshcheĭ khirurgii GOU VPO "Ural'skaia gosudarstvennaia meditsinskaia akademiia", Ekaterinburg

Smirnov O.A.

«OLMED» Medical Center, Ekaterinburg, Russia

Tyurin S.A.

Municipal healthcare facility «City Clinical Hospital №40», Ekaterinburg, Russia

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References:

van den Bremer J, Moll FL. Historical overview of varicose vein surgery. J Vasc Surg. 2010;24(3):426-432.
Coughlin PA, Berridge DC. Is there a continuing role for traditional surgery? Phlebology. 2015;30(2 Suppl):29-35. https://doi.org/10.1177/0268355515589248
Saveliev VS, Kirienko AI, Zolotukhin IA, Seliverstov EI. Prospective observational study SPECTRUM: the registry of patients with chronic venous diseases. Flebologiya. 2012;6(1):4-9. (In Russ.).
Gloviczki P, Comerota AJ, Dalsing MC, Eklof Bo G, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Supplement):2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079
Moore HM, Lane TR, Thapar A, Franklin IJ, Davies AH. The European burden of primary varicose veins. Phlebology. 2013;28 Suppl 1:141-147. https://doi.org/10.1177/0268355512475118
Lim CS, Gohel MS, Shepherd AC, Davies AH. Secondary care treatment of patients with varicose veins in National Health Service England: at least how it appeared on a National Health Service website. Phlebology. 2010;25(4):184-189. https://doi.org/10.1258/phleb.2009.009035
de Medeiros ChAF. Cirurgia de varizes: história e evolução (Varicose vein surgery: history and evolution). J Vasc Bras. 2006;5(4):295-302. https://doi.org/10.1590/S1677-54492006000400009
Saveliev VS, Pokrovsky AV, Zatevakhin II, Kirienko AI. Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases. Flebologiya. 2013;7(2):4-47. (In Russ.).
Nicolaides A., Kakkos S., Eklof B., Perrin M., Nelzen O., Neglen P., Partsch H., Rybak Z. Management of chronic venous disorders of the lower limbs guidelines according to scientific evidence. Intern Angiology. 2014;33(2):87-208. PMID:24780922
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M. Management of Chronic Venous Disease. Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737. https://doi.org/10.1016/j.ejvs.2015.02.007
Rose SS. Historical development of varicose vein surgery. In: Bergan J.J., Goldman M.P., editors. Varicose veins and telangiectasias. Saint Louis: Quality Medical Publishing. 1993;123-147.
Muller R. Traitment des varices par le phlébectomie ambulatoire. Phlebologie. 1966;19:277-279.
Thomson H, Bergan JJ. Saphenous vein stripping and quality of outcome. Br J Surg. 1996;83(8):1027-1027. https://doi.org/10.1002/bjs.1800830802
Saveliev VS, Dumpe EP, Yablokov EG. Diseases of the trunk veins. M.: Medicine. 1972;390-394. (In Russ.).
Saveliev VS, Gologorsky VA, Kirienko AI. Phlebology. Guidelines for the medical doctors. M.: Medicine. 2001;454-484. (In Russ.).
Michaels JA, Brazier JE, Campbell WB, MacIntyre JB, Palfreyman SJ, Ratcliffe J. Randomized clinical trial comparing surgery with conservative treatment for uncomplicated varicose veins. Br J Surg. 2006;93(2):175-181. https://doi.org/10.1002/bjs.5264
Ratcliffe J, Brazier JE, Campbell WB, Palfreyman SJ, MacIntyre JB, Michaels JA. Cost-effectiveness analysis of surgery versus conservative treatment for uncomplicated varicose veins in a randomized clinical trial. Br J Surg. 2006;93(2):182-186. https://doi.org/10.1002/bjs.5263
Munn SR, Morton JB, Macbeth WAG, McLeish AR. To strip or not to strip the long saphenous vein? A varicose veins trial. Br J Surg. 1981;68(6):426-428. https://doi.org/10.1002/bjs.1800680621
Winterborn RJ, Foy S, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg. 2004;40(4):634-639.
Winterborn RJ, Earnshaw JJ. Crossectomy and great saphenous vein stripping. J Cardiovasc Surg. 2006;47(1):19-19. PMID:16434942
Vedensky AN. Varicose vein disease. M.: Medicine. 1983;200-208. (In Russ.).
Konstantinova GD. Practical course of the varicose vein disease treatment. М.: Profile. 2009;192.
Fullarton GM, Calvert MH. Intraluminal long saphenous vein stripping: a new technique minimizing perivenous tissue trauma. Br J Surg. 1987;74(4):255-255. https://doi.org/10.1002/bjs.1800740410
Kent PJ, Maughan J, Burniston M, Nicholas T, Parkin A, Robinson PJ. Perforation-invagination (PIN) stripping of the long saphenous vein reduces thigh haematoma formation in varicose vein surgery. Phlebology. 1999;14(2):43-47. https://doi.org/10.1177/026835559901400202
Scheltinga MR, Wijburg ER, Keulers BJ, de Kroon K.E. Conventional versus invaginated stripping of the great saphenous vein: a randomized, double-blind, controlled clinical trial. World J Surg. 2007;31(11):2236-2242. https://doi.org/10.1007/s00268-0 07-9211-3
Zolotukhin IA, Bogachev AN, Kuznetsov AN. Truncal phlebectomy with varicose vein disease. Flebologiya. 2007;1(1):8-14. (In Russ.).
Shekoyan SA, Churikov DA, Moskalenko EP, Bogachev VYu. Criteria of the injury of saphenectomy in the surgical treatment of the varicose vein disease. Flebologiya. 2010;4(2):53-124. (In Russ.).
Gavrilenko AV, Vahratyan PE, Shkatov VA, Gorin SM, Fateeva IE, Dutikova EF. Comparative evaluation of the surgical treatment methods with varicose vein disease. Angiologija i sosudistaja hirurgija. 2004;10(1):87. (In Russ.).
Konstantinovа GD, Gavrilenko AV, Donskaya ED, Vahratyan PE. Status of the great saphenous vein after intraoperative stem scleroobliteration with varicose vein disease. Angiologija i sosudistaja hirurgija. 2007;13(3):101-104. (In Russ.).
Holme JB, Skajaa K, Holme K. Incidence of lesions of the saphenous nerve after partial or complete stripping of the long saphenous vein. Acta Chir Scand. 1990;156(2):145-148. PMID: 2184634
Konstantinovа GD, Zubarev AP, Dradusov E.G. Phlebology. М.: Vidar-М. 2000;1-160. (In Russ.).
Koyano K, Sakaguchi S. Selective stripping operation based on Doppler ultrasonic findings for primary varicose veins of the lower extremities. Surgery. 1988;103(6):615-619.
Lees TA, Beard JD, Ridler BMF, Szymansksa TA. Survey of the current management of varicose veins by members of the Vascular Surgical Society. Ann R Surg Engl. 1999;81(6):407-417.
Lesko VA, Yanushko VA, Efimovich L.L. Types of varicose vein disease and graded approach of the surgical treatment. Angiologija i sosudistaja hirurgija. 2002;8(2):102-106. (In Russ.).
Rutherford RB, Sawyer JD, Jones DN. The fate of residual saphenous vein after partial removal or ligation. J Vasc Surg. 1990;12(4):422-428. PMID: 2214038
Fligelstone L, Carolan G, Pugh N, Shandall A, Lane I. An assessment of the long saphenous vein for potential use as a vascular conduit after varicose vein surgery. J Vasc Surg. 1993;18(5):836-840. https://doi.org/10.1016/0741-5214(93)90339-N
Serazhitdinov AS, Vladimirsky VV, Fedin AA, Shleikov DA, Makarov AV, Baryshnikov AA, Gasnikov AV, Chekorsky FV, Chernousov VV, Borlakov MM. Short stripping — reasonable tactic of treatment of varicose vein disease or the tribute to fashion. Flebologiya. 2010;4(2):53-124. (In Russ.).
Makarova NP, Chukin SA. Evaluation of the veinkeeping operations in the treatment of patients with varicose vein disease of the lower extremities. Flebologiya. 2010;4(2):53-124. (In Russ.).
MacKenzie RK, Paisley A, Allan PL, Lee AJ, Ruckley CV, Bradbury AW. The effect of long saphenous vein stripping on quality of life. J Vasc Surg. 2002;35(6):1197-1203. https://doi.org/10.1067/mva.2002.121985
Staver EV, Potapov MP, Muravjev A.V. An improvement in the approaches to treatment of the chronic vein diseases. Flebologiya. 2010;4(2):53-124. (In Russ.).
Sukovatykh BS, Belikov LN, Rodionov OA, Sukovatykh MB. Efficacy of the different methods of venectomy. Flebologiya. 2010;4(2):53-124. (In Russ.).
Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg. 1999;29(4):589-592.
Labropoulos N, Belcaro G, Giannoukas AD, Delis K, Mansour AM, Kang S, Nicolaides AN, Baker WH. Can the main trunk of greater saphenous vein be spared in patients with varicose veins? J Vasc Endovasc Surg. 1997;31(5):531-534.
Kostas TT, Ioannou ChV, Veligrantakis M, Pagonidis C. The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury. J Vasc Surg. 2007;46(6):1234-1241. https://doi.org/10.1016/j.jvs.2007.07.055
van Neer P, Kessels FG, Estourgie RJ, de Haan EF, Neumann MA,Veraart JS. Persistent reflux below the knee after stripping of the great saphenous vein. J Vasc Surg. 2009;50(4):831-834. https://doi.org/10.1016/j.jvs.2009.05.021
Sushkov SA, Skomoroschenko V.A. Recurrent of varicose veins after traditional surgery. Flebologiya. 2014;8(2):70-71. (In Russ.).
Sam RC, Silverman SH, Bradbury AW. Nerve injuries and varicose vein surgery. Eur J Vasc Endovasc Surg. 2004;27(2):113-120.
Wood JJ, Chant H, Laugharne M, Chant T, Mitchell DC. A prospective study of cutaneous nerve injury following long saphenous vein surgery. Eur J Vasc Endovasc Surg. 2005;30(6):654-658. https://doi.org/10.1016/j.ejvs.2005.06.009
Morrison C, Dasling MC. Signs and symptoms of saphenous nerve injury after greater saphenous vein stripping: prevalence, severity, and relevance for modern practice. J Vasc Surg. 2003;38(5):886-890. https://doi.org/10.1016/S0741
Sorrentino P, Renier M, Coppa F, Sarzo G, Morbin T, Scappin S, Baccaglini U, Ancona E. How to prevent saphenous nerve injury. A personal modified technique for stripping of the long saphenous vein. Minerva Chir. 2003;58(1):123-128. PMID:12692509
Papakostas JC, Douitsis E, Sarmas I, Avgos S, Kyritsis A, Matsagkas M. The impact of direction of great saphenous vein total stripping on saphenous nerve injury. Phlebology. 2014;29(1):52-57. https://doi.org/10.1258/phleb.2012.012061
Cicek MC, Cicek OF, Lafci G, Uzun A. Comparison of cutaneous nerve injury and vessel disruption complications following saphenous vein stripping using big or small olive heads. Pak J Med Sci. 2016;32(3):626-629. https://doi.org/10.12669/pjms.323.10017
Jaworucka-Kaczorowska A, Oszkinis G, Huber J, Wiertel-Krawczuk A, Gabor E, Kaczorowski P. Saphenous vein stripping surgical technique and frequency of saphenous nerve injury. Phlebology. 2015;30(3):210-216. https://doi.org/10.1177/02683555514539316
Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079-1087. https://doi.org/10.1002/bjs.7555.
Chernuha LM, Gooch AA, Bobrov SA. Endovasal laser obliteration, radiofrequency obliteration and routine phlebectomy in the treatment of varicose veins of the lower extremities. Phlebology. 2014;8(2):73-74. (In Russ.).
Shaidakov EV, Ilyukhin EA, Bulatov VL, Galchenko MI. Analysis of the effectiveness of radiofrequency obliteration with the diameter of the target vein: a multicenter retrospective longitudinal cohort study. Angiologija i sosudistaja hirurgija. 2014;20(1):87-94. (In Russ.).