Standard Stripping versus Long Saphenous Vein-Saving Surgery for Primary Varicose Veins: A Prospective,Randomized Study with the Patients as Their Own Controls

Abstract

Objective:

To compare the postoperative discomfort and long-term outcome following standard stripping and atter long saphenous vein-saving surgery.

Design:

Prospective, randomized case-control study with patients serving as their own controls.

Setting:

Department of Surgery, County Hospital, Varberg, Sweden.

Patients:

Eighteen patients with bilateral primary varicose veins.

Interventions:

The patients were randomized prospectively to stripping or long saphenous vein-saving surgery. The leg causing most discomfort was operated on first. The other leg was operated on using the alternative method.

Main outcome measures:

Postoperative discomfort was assessed after an interview with the patient. Long-term outcome was determined by clinical assessment and Plethysmographic venous return time.

Results:

After 4 years the legs subjected to long saphenous vein-saving surgery yielded equal clinical results and had as great a prolongation of the plethysmographic venous return time as legs operated on using standard stripping. More patients reported greater discomfort following stripping than after vein-saving surgery. The saved long saphenous vein in all legs operated on was patent, compressible, non-sclerotic and free of intraluminal echoes.

Conclusion:

The long-term results of long saphenous vein-saving surgery are as good as standard stripping, provided that incompetent perforators are throughly mapped preoperatively and ligated at surgery. Long saphenous vein-saving surgery causes less subjective postoperative discomfort than standard stripping. The saved long saphenous vein can probably be used for future arterial reconstruction.