Surgery for Varicose Veins
Obsolete & traumatic:
The TRADITIONAL STRIPPING
To achieve the best therapeutic result, any treatment modality for varicose veins has to follow three major steps. Step 1. The method has to completely close/obliterate/stop leakage of blood originating at the level of the escape point/junction usually placed in the groin or behind the knee. Step 2. The method has to also stop (remove or close) the axial vein trunk (located in the inner aspect of the thigh or hind side of the calf) being the conduit enabling the downhill/reversed pattern of flow ("reflux"), originated at the level of the escape point, thus permitting large volumes of blood to spill/flood the branches/tributaries of the the axial vein causing them to distend/bulge. Step 3. The method lastly, should also take care of the distended and bulging tributaries either removing or closing them, if just possible, in the same session. (See drawing).
The over 100 years old traditional and by now outdated traumatic stripping is completely an American procedure unfortunately still practiced by some surgeons who have not kept up with times. Please do not misunderstand, from the results point of view, it is still a good procedure perfectly controlling Step 1, Step 2 as well as Step 3 needed for long lasting results. The procedure is outdated because it was excessive, very traumatic and also not cost efficient. Therefore, nowadays, in the era of minimally invasive (keyhole) procedures, its place is only in the medical/surgical history books.
The procedure took care of the refluxing incompetent junction, the escape point (in the groin or behind the knee) by ligating it through an open approach (Step 1). The old stripper consisted of a flexible wire was then threaded through the entire length of axial vein trunk from groin to ankle ( in case of involvement of the long saphenous vein ) or from behind the knee and ankle ( in case of short saphenous vein involvement) where - through a second skin opening- the stripper was removed. At this level a thumb size stripper head was attached and the vein tied to it. The wire was pulled upward traveling beneath the skin and towards the groin incision 0r behind the knee incision bringing with it - all bunched up - the entire length of the vein trunk (Step 2) . This thumb size stripper head traveling form the ankle to groin (or behind the knee) just under the skin, ripped the tissues apart and was the reason for the excessive trauma associated with the procedure (Fig. 7). Insult to injury, the varicose tributaries were removed (Step 3) through generous skin incisions which just enhanced the trauma and were responsible for ugly scars sometimes left for life (Fig. 8).
Since ultrasound examination arrived only in the seventies, up to that point, the whole procedure was done blindly thus the entire length of axial vein was removed. Today’s Doppler ultrasonography / duplex imaging permits to individually tailor the procedure and remove only the segment harboring the reversed pattern of flow existing in the axial vein.
While well performed the results were acceptable, this over-kill traditional and traumatic stripping surgery was cost inefficient as it had to be performed in a hospital setting under general or spinal/epidural anesthesia followed by weeks of convalescence and loss of income.