Open and endovenous surgery of varicose veins are excellent ways of treating varicosis. However, there are great differences in how the techniques are performed. No matter which procedure is carried out, certain standards should be observed. The state of the art of open venous surgery with radical crossectomy is well-known, but unfortunately is still not always performed correctly. The state of the art of endovenous surgery has not yet been sufficiently documented, but should be based on open surgery techniques. This work describes in detail what are (or should be) the standards of both methods today. A definition of recurrence applicable to both techniques is established.
Venous diseases are among the commonest clinical pictures in the western world. The guidelines of the German Society of Phlebology and NICE both recommend early treatment of the epifascial venous system, by operation or intervention, in order to counter the possible complications and sequelae of chronic venous insufficiency insofar as possible. These may include skin alterations, venous leg ulcer, deep vein thrombosis and pulmonary embolism [1,2]. According to careful estimates, over 350,000 interventions in the epifascial venous system are carried out in Germany each year. Approximately one third of the operations require hospitalisation, but the majority are ambulatory, and this proportion is tending to rise. Crossectomy and stripping of incompetent vein segments used to be the methods of choice for the treatment of varicose saphenous veins, however in recent years new, minimally invasive endovenous methods have gained ground. Despite all the innovations in treatment, stripping remains an important element in the treatment of varicose veins and-if carried out correctly-is preferable to endovenous procedures in some cases. In very superficially coursing saphenous veins in particular, an invaginating stripping procedure can produce a better cosmetic result. For more than 30 years, the Gold standard for Stripping Operations has included: • preoperative duplex ultrasound vein mapping and marking of the incision (especially important in operations on the small saphenous vein, since a wide variety of configurations of the confluence may be encountered), • crossectomy and stripping of the saphenous vein, with invagination from proximal to distal as far as the distal reflux source (maximum), • no stripping of the whole saphenous vein from the medial or lateral malleolus from distal to proximal, • flat ligation of the saphenofemoral junction (SFJ) with non-absorbable sutures and ligation of all the tributaries with confluence in the region of the SFJ (including those joining the femoral vein), • flat ligation is not always possible in crossectomy of the saphenopopliteal junction (SPJ), nor is it essential; however it is always desirable if possible.
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Journal of Phlebology and Lymphology
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