title: Minimally invasive technique for ligation and stripping of the small saphenous vein guided by intra-operative duplex ultrasound.
abstract: BACKGROUND
  Small saphenous vein (SSV) disconnection and removal are challenging and considered by some authors to have too high a morbidity and failure rate to justify their routine use. Our audited results are at variance with these views.
  
  
  METHODS
  We describe a reliable, ultrasound guided, minimally invasive technique for ligation and stripping of the SSV with an incision usually <1 cm. From our total series, 50 random patients attended for ultrasound review. The sapheno-popliteal junction (SPJ), strip track and signs of recurrence were assessed and recorded.
  
  
  RESULTS
  Since 1999, 627 patients (679 limbs) have undergone surgery for ultrasound proven SSV reflux. Fifty-two limbs (50 patients) were ultrasound assessed post-operatively. Fifty-one had flush ligation of the SPJ with one showing a 'stump' <1 cm. All showed successful SSV removal. Three limbs had minor strip track revascularisation but none had obvious clinical recurrence. Of the whole series, 11/627 (1.8%) developed proven deep vein thrombosis (DVT). There were six superficial wound infections and one strip track abscess. Sural nerve neurapraxia occurred in 13/627 (2.1%); one showing no sign of recovery at four weeks post-operatively.
  
  
  CONCLUSIONS
  Ultrasound guided SSV is a safe, minimally invasive technique with high success and low recurrence and complication rates
authors.affiliation: The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, GU2 7RF, UK. info@thewhiteleyclinic.co.uk
authors.forename: M S
authors.initials: MS
authors.lastname: Whiteley
authors.forename: G
authors.initials: G
authors.lastname: Lewis
authors.forename: J M
authors.initials: JM
authors.lastname: Holdstock
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: C S
authors.initials: CS
authors.lastname: Harrisone
authors.forename: C L
authors.initials: CL
authors.lastname: McGuinness
authors.forename: B A
authors.initials: BA
authors.lastname: Price
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000098:blood supply; D007866:Leg / Q000098:blood supply; D008026:Ligation / Q000295:instrumentation; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery