Varicose Vein Stripping Of The Great Saphenous Vein

Introduction

Varicose veins of the great saphenous vein are the longest superficial subcutaneous veins in the body. They start from the dorsal vein of the foot on the inner side of the dorsum of the foot, ascend on the inner side of the lower limbs, and reach the groin. Varicose veins of the lower limbs mostly occur on the inner side of the calf. In severe cases, they can extend upward to the inner side of the thigh, and even the whole lower limbs can see varicose veins in a tortuous mass. Varicose veins of the lower limbs of these patients mainly occur in the great saphenous vein and its branches, so it is called great saphenous varicose veins.

Causes of varicose veins of the great saphenous veins

Genetic factors

The characteristics of primary varicose veins are familial, and many patients' ancestors have varicose veins to varying degrees. Varicose veins caused by genetic factors account for the most patients, accounting for 70-80% of the total number of patients. They are not born with this disease, but due to genetic factors, the vein wall is weak or the function is poor, which can be induced when the burden on the lower limbs increases.

Occupational factors

People who have been engaged in standing, sitting, exercising or overloaded work for a long time.

Other factors

It is common for women to have uterine expansion during pregnancy, which blocks the return of blood from the lower limb veins.

Clinical symptoms of varicose veins of the great saphenous veins

Early symptoms are: leg soreness and discomfort after standing for a long time, easy fatigue and weakness; generally speaking, the symptoms are milder when getting up in the morning, and worsen at night after a busy day at work; some patients will have numbness and mild pain on the inside of the ankle; both calves have blue varicose vein masses similar to earthworms.

Late symptoms are: the legs are very sore and swollen after standing for a long time, and even affect work; both calves are covered with varicose vein masses; eczema and ulcers appear on the ankles, and ulcers appear on the ankles due to the development of varicose veins to the middle and late stages.

Surgical steps

1. Incision

On the inside of the femoral artery, make a longitudinal or oblique incision from the inguinal ligament downward to the inside. About 6cm long.

2. Separation of the great saphenous vein

Cut the skin and subcutaneous tissue, cut the superficial fascia on the inner side of the femoral artery, expose the oval fossa, and you can find the confluence of the great saphenous vein and the femoral vein. Use curved hemostatic forceps to separate the great saphenous vein trunk.

3. Cut off the branches of the great saphenous vein

Separate along the vein trunk, find the superficial iliac circumflex, superficial abdominal wall, superficial external pubic, lateral femoral and medial femoral veins, and ligate and cut them one by one. The location and number of these branches vary greatly, so the part should be exposed as much as possible during surgery, and each branch should be carefully found until the great saphenous vein enters the femoral vein.

4. Ligation of the great saphenous vein

Draw a thick silk thread from the back of the great saphenous vein, and ligate the great saphenous vein 0.5 to 1.0 cm away from the femoral vein. Clamp two hemostatic forceps at the distal end of the ligature, cut the vein between the forceps, and suture the proximal end of the proximal forceps.

5.Insert and push the great saphenous vein stripper.

Insert a hard or soft vein stripper downward from the distal end of the severed vein and push it downward along the vein. If resistance is encountered, it means that the venous tortuosity or the plane of the deep vein communication branch may have been reached. After the cylindrical metal head of the stripper touches the membrane outside the skin, another small incision is made on the skin at the corresponding location to expose the vein at that location. Ligate the blood vessels at the upper and lower ends of the stripper head, and cut the vein between the two ligatures.

6.Extract the vein.

Pull the stripper out from the oval fossa incision evenly with force, while pressing to stop bleeding, and the entire great saphenous vein can be pulled out. The great saphenous vein can also be pulled out from the lower incision in the same way.

7.Continue segmental resection.

Continue to extract the varicose vein segmentally from the lower incision in the same way downward until the ankle. After the main trunk of the varicose vein is stripped, the thick branches that are still visible should also be carefully separated and stripped.

8. Resection of the communicating branches with incompetent valves

During the process of extracting the trunk or branches, if resistance is encountered and the skin is concave at that location, it often indicates that there is a thicker communicating branch at that location. A small incision should be made to separate the blood vessels and then ligated and cut off.

9. Suturing

Suture each incision and evenly bandage the entire lower limb with an elastic bandage or elastic stockings to prevent bleeding at the stripping site.

Precautions

1. The anatomy of the root of the great saphenous vein should be clear, and all branch veins must be cut off and ligated to prevent recurrence.

2. If the local anesthesia is unclear or for obese patients, an incision can be made on the inner ankle or the inner side of the lower leg below the knee to separate the great saphenous vein. After cutting, insert the stripper into the proximal end and push it upward to the groin, so that the great saphenous vein trunk can be found.

3. At the confluence of the great saphenous vein and the femoral vein, there is a layer of cribriform fascia between the two, which cannot be easily cut to avoid accidentally injuring the femoral vein. Once the femoral vein is damaged during the operation, the incision should be enlarged immediately to fully expose the injured part of the femoral vein, and the vein repair should be performed with 5-0 nylon thread. If the femoral vein is completely cut, a section of autologous great saphenous vein should be taken for interposition of femoral vein graft.

4. If the varicose vein is obviously tortuous and the stripper cannot be smoothly inserted, it is not necessary to force it to be extracted at one time. More small incisions can be made to separate, ligate and remove the varicose vein group in sections under the skin. Then extract the remaining great saphenous vein trunk.

5. If there is pigmentation, eczema or ulcer on the medial malleolus, it indicates that the valve of the medial malleolus anastomosis branch is incomplete. The great saphenous vein should be stripped and the anastomosis branch should be ligated at the medial malleolus.

Postoperative treatment

1. Starting from the foot, the entire lower limb is bandaged with an elastic bandage.

2. The affected limb is raised, and the foot plantar flexion and dorsiflexion activities are actively performed to promote calf vein return and reduce deep vein thrombosis.

3. You can get out of bed and walk for a short time on the day of surgery.

4.Remove the stitches 10 to 14 days after surgery, and consider stopping the use of elastic bandages after 4 to 6 weeks.

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