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The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury.
J Vasc Surg. 2007 Dec; 46(6):1234-41.JV

Abstract

OBJECTIVE

To investigate the effect of stripping the below knee great saphenous vein (GSV) segment on varicose vein recurrence as well as any disability induced after saphenous nerve injury (SNI) during a 5-year period.

METHODS

One hundred and six limbs (86 patients, 64 female, mean age 46 years), that underwent GSV stripping, to the knee or ankle level, were prospectively followed up at 1 month and 5 years postoperatively with clinical examination and color duplex imaging (CDI), in order to evaluate SNI and the development of recurrence. The extent of GSV stripping complied with preoperative CDI in 84 limbs (79%) that were subjected to GSV stripping to the ankle and full abolishment of duplex-confirmed reflux. Furthermore, 19 limbs (18%) underwent stripping restricted to the below knee level since the distal GSV was competent. On the contrary, in three limbs (3%), the extent of stripping did not comply with preoperative CDI due to the absence of varicosities in the tibia, and stripping was restricted to the knee level, although they had reflux along the whole GSV length.

RESULTS

Overall recurrence was found in 24 out of 106 operated limbs (23%) after 5 years. Recurrence was found to be 20% (17/84) in the limbs with total GSV stripping and 32% (7/22) in the limbs with restricted GSV stripping (P > .05). However, the recurrence rate in the tibial area was significantly lower in limbs subjected to GSV stripping, which was in compliance with the preoperative CDI (9/103, 9%) compared with those that had undergone GSV stripping that was not in agreement with the preoperative CDI (3/3, 100%; P < .005). Neurological examination at 1 month postoperatively, revealed SNI in 17 limbs (16%). However, at the 5-year neurological reassessment, we found that seven out of these limbs (40%) were alleviated from SNI adverse symptoms presenting only deficits in sensation. In addition, no significance was found concerning SNI between limbs subjected to total and restricted GSV stripping (16/84 vs 1/22; P > .05).

CONCLUSIONS

Though SNI may occur after both restricted and total GSV stripping, this does not influence limb disability since any related symptoms seem to regress in almost half of the limbs 5 years postoperatively. Additionally, it seems that recurrence could be reduced in the tibial area if the level of GSV stripping complies with the extent of the ultrosonographically proven GSV reflux. Therefore, the extent of GSV stripping should not be guided by the intent of avoiding SNI.

Authors+Show Affiliations

Vascular Surgery Department, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

18155000

Citation

Kostas, Theodoros T., et al. "The Appropriate Length of Great Saphenous Vein Stripping Should Be Based On the Extent of Reflux and Not On the Intent to Avoid Saphenous Nerve Injury." Journal of Vascular Surgery, vol. 46, no. 6, 2007, pp. 1234-41.
Kostas TT, Ioannou CV, Veligrantakis M, et al. The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury. J Vasc Surg. 2007;46(6):1234-41.
Kostas, T. T., Ioannou, C. V., Veligrantakis, M., Pagonidis, C., & Katsamouris, A. N. (2007). The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury. Journal of Vascular Surgery, 46(6), 1234-41.
Kostas TT, et al. The Appropriate Length of Great Saphenous Vein Stripping Should Be Based On the Extent of Reflux and Not On the Intent to Avoid Saphenous Nerve Injury. J Vasc Surg. 2007;46(6):1234-41. PubMed PMID: 18155000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury. AU - Kostas,Theodoros T, AU - Ioannou,Christos V, AU - Veligrantakis,Michalis, AU - Pagonidis,Constantinos, AU - Katsamouris,Asterios N, PY - 2007/03/21/received PY - 2007/07/23/revised PY - 2007/07/26/accepted PY - 2007/12/25/pubmed PY - 2008/2/8/medline PY - 2007/12/25/entrez SP - 1234 EP - 41 JF - Journal of vascular surgery JO - J Vasc Surg VL - 46 IS - 6 N2 - OBJECTIVE: To investigate the effect of stripping the below knee great saphenous vein (GSV) segment on varicose vein recurrence as well as any disability induced after saphenous nerve injury (SNI) during a 5-year period. METHODS: One hundred and six limbs (86 patients, 64 female, mean age 46 years), that underwent GSV stripping, to the knee or ankle level, were prospectively followed up at 1 month and 5 years postoperatively with clinical examination and color duplex imaging (CDI), in order to evaluate SNI and the development of recurrence. The extent of GSV stripping complied with preoperative CDI in 84 limbs (79%) that were subjected to GSV stripping to the ankle and full abolishment of duplex-confirmed reflux. Furthermore, 19 limbs (18%) underwent stripping restricted to the below knee level since the distal GSV was competent. On the contrary, in three limbs (3%), the extent of stripping did not comply with preoperative CDI due to the absence of varicosities in the tibia, and stripping was restricted to the knee level, although they had reflux along the whole GSV length. RESULTS: Overall recurrence was found in 24 out of 106 operated limbs (23%) after 5 years. Recurrence was found to be 20% (17/84) in the limbs with total GSV stripping and 32% (7/22) in the limbs with restricted GSV stripping (P > .05). However, the recurrence rate in the tibial area was significantly lower in limbs subjected to GSV stripping, which was in compliance with the preoperative CDI (9/103, 9%) compared with those that had undergone GSV stripping that was not in agreement with the preoperative CDI (3/3, 100%; P < .005). Neurological examination at 1 month postoperatively, revealed SNI in 17 limbs (16%). However, at the 5-year neurological reassessment, we found that seven out of these limbs (40%) were alleviated from SNI adverse symptoms presenting only deficits in sensation. In addition, no significance was found concerning SNI between limbs subjected to total and restricted GSV stripping (16/84 vs 1/22; P > .05). CONCLUSIONS: Though SNI may occur after both restricted and total GSV stripping, this does not influence limb disability since any related symptoms seem to regress in almost half of the limbs 5 years postoperatively. Additionally, it seems that recurrence could be reduced in the tibial area if the level of GSV stripping complies with the extent of the ultrosonographically proven GSV reflux. Therefore, the extent of GSV stripping should not be guided by the intent of avoiding SNI. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/18155000/The_appropriate_length_of_great_saphenous_vein_stripping_should_be_based_on_the_extent_of_reflux_and_not_on_the_intent_to_avoid_saphenous_nerve_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(07)01282-7 DB - PRIME DP - Unbound Medicine ER -