title: Saphenopopliteal ligation and stripping of small saphenous vein: does extended stripping provide better results?
abstract: OBJECTIVE
  Saphenopopliteal ligation (SPL) for venous insufficiency is a challenging procedure, with mixed results being reported. The role of stripping of the small saphenous vein (SSV) is contentious. This prospective observational study aimed to assess the risks and benefits of this procedure.
  
  
  METHODS
  Fifty patients underwent SPL under general anaesthesia by a single surgeon in a tertiary referral vascular centre. The aim was to perform inversion stripping in each case, but in a proportion this was not possible. Patients were grouped into SPL with short segment excision ≤5 cm (n = 23) and SPL with extended stripping >5 cm (n = 27). Outcome measures included venous clinical severity scores (VCSS), quality of life (QoL), Aberdeen varicose vein questionnaire (AVVQ), patient satisfaction, recurrence and complication rates.
  
  
  RESULTS
  Intragroup analysis demonstrated statistically significant improvements in VCSS (P < 0.001), and QoL measures (generic and disease-specific AVVQ) (P < 0.050) with both treatments. Intergroup analysis demonstrated statistically significant superior VCSS scores at one year (P = 0.001), AVVQ at three months and one year (P < 0.05), and cosmetic satisfaction at one year (P = 0.011) in the SPL extended stripping group. There was no difference in clinical recurrence 1/23 (4.3%) versus 1/27 (3.7%) (P = 0.900) or complication rates (P > 0.050).
  
  
  CONCLUSIONS
  SPL with or without stripping is an effective procedure improving clinical severity and QoL in the short term. Early outcomes favour SPL with extended stripping to offer greater improvement in disease-specific QoL, venous severity and cosmesis. With this small sample, there is no evidence of increased complications following stripping, or increased short-term recurrence without it. Greater numbers and follow-up are required to make firm conclusions.
authors.affiliation: Academic Vascular Surgical Unit, Tower Block, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK. nehemiah.samuel@hey.nhs.uk
authors.forename: N
authors.initials: N
authors.lastname: Samuel
authors.forename: D
authors.initials: D
authors.lastname: Carradice
authors.forename: T
authors.initials: T
authors.lastname: Wallace
authors.forename: G E
authors.initials: GE
authors.lastname: Smith
authors.forename: F A K
authors.initials: FA
authors.lastname: Mazari
authors.forename: I
authors.initials: I
authors.lastname: Chetter
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012501:Saphenous Vein / Q000601:surgery*; D011795:Surveys and Questionnaires; D014689:Venous Insufficiency / Q000601:surgery*