1. Open surgery for Varicose veins
Ganesh Kuhan
Nottingham University Hospitals

2. Treatment of varicose veins
Endothermal ablation
Foam sclerotherapy
Open Surgery
Compression
Nice 2013
Current nice guidelines published in 2013 suggest that all patients should be offered endothermal ablation as a first line treatment. If they are not suitable for EVT then foam should be offered and as a 3 rd line procedure open surgery stands

3. Anatomy
Basic anatomy there are deep and sup venous system. Sup venous system has long and short saphenous sytstem as shown, sf junction, spj, lsv, ssv are shown

4. Tortuous dilated veins
Indications
Tortuous dilated veins
Large saphenovarix
? Extensive varicosities
? Failed endovenous procedures
Relative contra-indications
Previous DVT
Arterial insufficiency
Patient co morbidity
Morbid obesity
Indications as it stands for open surgery is patients not suitable for EVT, foam. These are few and far. Pts who have extensive varicosities, tortuao and dilated veins, large sapheno varix and faiiled EVT

5. Technique Conventional surgery under GA
ligation of the sapheno-femoral or sapheno-popliteal junctions
vein stripping and
multiple stab avulsions
The open proc needs GA, main junctions are sf, sp dissected ligated, LSV, ssv stripped and multiple stab avulsionbs

6. High tie

7. SPJ ligation

8. Stripping

9. Avulsions

10. Complications common: minor haemorrhage, thrombophlebitis, haematoma,
wound problems, severe pain
less common
sural/ saphenous nerves
rare
damage to deep veins, arteries, nerves, DVT

11. Is it a dinosaur?