surgical treatment of truncal veins stephen f. daugherty, md, facs, rvt, rphs
TRANSCRIPT
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SURGICAL TREATMENT OF TRUNCAL VEINS
Stephen F. Daugherty, MD, FACS, RVT, RPhS
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SAPHENOUS VEIN STRIPPINGDESCRIBED IN 1905-1907 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: pp123-147.
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“…many believe that the operation (saphenous vein stripping) is probably obsolete.”
Bergan, John J. in Rutherford’s Vascular Surgery, 6th ed; 2005: p2258.
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SURGICAL OPTIONS
- Open Excision
- Saphenous Vein Ligation
- Ankle-to-Groin Saphenous Stripping
- Segmental Saphenous Stripping
All of the above often were combined with phlebectomy.
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The Craft of Surgery, Philip Cooper, ed., 1965
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PROBLEMS WITH VEIN LIGATION
FREQUENT EARLY FAILURE DUE TO COLLATERAL INCOMPETENT VEINS
NEOVASCULARIZATION DUE TO GROIN DISSECTION
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Rutherford Vascular Surgery, 6th ed., 2005
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PROBLEMS WITH ANKLE-TO-GROIN
STRIPPINGSAPHENOUS NERVE INJURY
STRIPPING CALF OFTEN IS UNNECESSARY
INTRAOPERATIVE BLEEDING
HEMATOMA CAUSING PAIN
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A Regional Atlas of the Human Body, Carmine Clemente, 1975
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PROBLEMS WITH SMALL SAPHENOUS VEIN
STRIPPINGSURAL NERVE INJURY
VARIABLE LOCATION OF TERMINATION OF SMALLL SAPHENOUS VEIN
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A Regional Atlas of the Human Body, Carmine Clemente, 1975
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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 1993. Goren, G., Yellin, AE, JVS 1994; 20:970-977.
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WHEN TO CONSIDEROPEN SURGERY?
LARGE, COMPLICATED VENOUS ANEURYSM NEAR THE SFJ
HIGH LIGATION COMBINED WITH- PIN STRIPPING- ENDOVENOUS THERMAL
ABLATIONFOAM SCLEROTHERAPY
VERY SUPERFICIAL LONG TRUNCAL VEIN