Stripping and Ligation
The procedure requires a dissection below the groin crease to expose the area where the superficial Great Saphenous Vein (GSV) connects with the deep Common Femoral Vein (CFV) and then tying off (legating) all of the veins draining into the GSV. Then the junction GSV is divided and the connection with the Common Femoral vein is legated to prevent bleeding. The GSV is then again exposed by another dissection either below the knee level or at the ankle level and divided and the vein is legated at is exposed end. Then a flexible stripping cable is threaded up the vein where it is recovered at the groin level and the vein is tied to the cable, and then the cable is forcibly pulled out through the groin and the vein is “stripped” out of the leg. This is essential a blind technique and all of the other smaller veins connected to the Great Saphenous Vein are ripped off and bleed. Pressure is usually applied to stop the bleeding while other incisions are made to ligate additional superficial varicose veins that remained behind. The procedure requires general or spinal anesthesia, some blood loss, risks injury to the sensory nerve at the ankle and can lacerate small colorless lymphatics in the groin and cause swelling. The incisions are usually sutured or stapled close. It is an uncomfortable procedure with a significant prolonged recovery, especially if both legs at once. The reason endovenous ablation surgery has become so popular is that it does not require general or spinal anesthesia, there are not dissections and the no suturing and since the view is sealed by catheter laser or radiofrequency energy system it does not have to be stripped out of the body. More importantly the failure rate for stripping and ligation procedures is 40% at 10 years. Some of this is related to the fact that Great Saphenous Vein may have accessory or parallel branches which are not treated by this method, and some of this is because of the trauma from the stripping and the groin dissection is a stimulus for the body to form more varicose veins in the very area that they were removed. Sadly some of problems also result because varicose vein surgery is usually put at the bottom of the priority list and there is tremendous pressure placed on the busy general surgeon to get these cases done as fast as possible and not delay the Operating Room schedule.