Best treatment for varicose vein is
|A||Ligation at saphenofemoral junction and stripping|
|D||Banding and ligation|
Stripping the greater saphenous vein
a. One of the classic treatments for varicose veins.
b. The vein should be stripped only in the regions where pathology occurs.
If the entire vein is involved, one incision is made anterior to the medial malleolus and another just below the inguinal crease. A stripper is inserted into the vein lumen at one site and run through the lumen to the other site.
i. High ligation of the vein is done at the saphenofemoral junction, including all tributaries.
ii. Reconnection of the saphenous to the femoral system via multiple tributaries near the saphenofemoral junction is thought to be the major cause of recurrent varices.
iii. Compressive bandages are applied to reduce hematoma formation, and compression stockings are worn for several weeks.
iv. Complications include ecchymosis, DVT, and saphenous nerve injury.
v. Stripping only the thigh portion is probably the most important aspect of the procedure
vi. Not stripping the calf eliminates much of the risk to the saphenous nerve because this nerve is closely associated with the saphenous vein from the knee to the ankle; this also allows the portion of the vein below the knee to be used for arterial bypass if needed in the future.
vii. Because the goal of stripping is to stop reflux down the involved venous segment, removal of a limited portion of the saphenous system is now widely accepted. Ligation alone, however, is associated with high rates of recanalization and is therefore not adequate therapy.