The effect of long saphenous vein stripping on deep venous reflux.
BACKGROUND
The addition of long saphenous vein (LSV) stripping to sapheno-femoral junction (SFJ) disconnection and multiple stab avulsions (MSAs) in the course of varicose vein (VV) surgery is associated with a significant reduction in recurrence, and a significant improvement in quality of life. It is hypothesised that these benefits relate, at least in part, to a favourable effect of stripping on deep venous reflux.


OBJECTIVE
To examine the effect of long saphenous vein (LSV) stripping on deep venous reflux (DVR).


METHODS
This was prospective study of 62 consecutive patients (77 limbs) CEAP class 2-6, undergoing SFJ disconnection and MSAs, with and without successful stripping of the LSV to the knee. A duplex ultrasound examination was performed pre-operatively and at a median (IQR) of 24 (23-25) months post-operatively. Completely stripped limbs were defined as those in whom complete stripping of the LSV to the knee was confirmed on post-operative duplex. Reflux >/=0.5 s. was considered pathological.


RESULTS
Pre-operatively, 32 (42%) limbs had deep venous reflux (DVR). Post-operative duplex at 24 months revealed that the LSV had been completely stripped in 29 (38%) limbs. In patients with pre-operative DVR, complete stripping was associated with a significant reduction in the prevalence of superficial femoral vein (SFV) (p<0.001) and popliteal vein (PV) (p=0.016), McNemar test) on post-operative duplex. By contrast, in patients without pre-operative DVR, incomplete stripping was associated the development of SFV (p=0.031) and PV (p=0.008) reflux.


CONCLUSIONS
Complete LSV stripping abolishes DVR in a significant proportion of limbs, whereas failure to strip is frequently associated with the development of new DVR. These data support for routine stripping and suggest that the benefits of stripping may relate, at least in part, to a favourable impact on deep venous function.
MacKenzie
R K
RK
Vascular Surgery Unit, Royal Infirmary, Edinburgh, UK.
Allan
P L
PL
Ruckley
C V
CV
Bradbury
A W
AW
D000368:Aged; D005121:Extremities / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013223:Statistics as Topic; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery