SURGICAL TREATMENT OF TRUNCAL VEINS Stephen F. Daugherty, MD, FACS, RVT, RPhS.

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Presentation transcript:

SURGICAL TREATMENT OF TRUNCAL VEINS Stephen F. Daugherty, MD, FACS, RVT, RPhS

SAPHENOUS VEIN STRIPPING DESCRIBED IN BY: William Keller Charles Mayo Stephen Babcock Rose, Sidney S. Historical Development of Varicose Vein Surgery in Varicose Veins and Telangiectasias, ed. Bergan and Goldman, Quality Medical Publishing; 1993: pp

“…many believe that the operation (saphenous vein stripping) is probably obsolete.” Bergan, John J. in Rutherford’s Vascular Surgery, 6th ed; 2005: p2258.

SURGICAL OPTIONS - Open Excision - Saphenous Vein Ligation - Ankle-to-Groin Saphenous Stripping - Segmental Saphenous Stripping All of the above often were combined with phlebectomy.

The Craft of Surgery, Philip Cooper, ed., 1965

PROBLEMS WITH VEIN LIGATION FREQUENT EARLY FAILURE DUE TO COLLATERAL INCOMPETENT VEINS NEOVASCULARIZATION DUE TO GROIN DISSECTION

Rutherford Vascular Surgery, 6th ed., 2005

PROBLEMS WITH ANKLE-TO-GROIN STRIPPING SAPHENOUS NERVE INJURY STRIPPING CALF OFTEN IS UNNECESSARY INTRAOPERATIVE BLEEDING HEMATOMA CAUSING PAIN

A Regional Atlas of the Human Body, Carmine Clemente, 1975

PROBLEMS WITH SMALL SAPHENOUS VEIN STRIPPING SURAL NERVE INJURY VARIABLE LOCATION OF TERMINATION OF SMALLL SAPHENOUS VEIN

A Regional Atlas of the Human Body, Carmine Clemente, 1975

IMPROVEMENTS IN SEGMENTAL SAPHENOUS VEIN STRIPPING - STRIP KNEE-TO-GROIN ONLY - ULTRASOUND IMAGING FOR PASSAGE OF STRIPPER AND HOOK RETRIEVAL OF LARGE TRIBUTARY VEINS FOR LIGATION AND DIVISION - OESCH PERFORATE-INVAGINATE (PIN) STRIPPING DESCRIBED IN Goren, G., Yellin, AE, JVS 1994; 20:

WHEN TO CONSIDER OPEN SURGERY? LARGE, COMPLICATED VENOUS ANEURYSM NEAR THE SFJ HIGH LIGATION COMBINED WITH - PIN STRIPPING - ENDOVENOUS THERMAL ABLATION FOAM SCLEROTHERAPY VERY SUPERFICIAL LONG TRUNCAL VEIN