Surgical treatment (ligation or stripping) is preferred for GSV diameter equal to or greater than
SAPHENOFEMORAL LIGATION AND GREAT SAPHENOUS STRIPPING An oblique groin incision is made at the level of, and lateral to, the pubic tubercle, ideally above the groin crease. The GSV is identified and dissected to the SFJ, which should be clearly established before the vein is divided to avoid disastrous inadveent transection of the superficial femoral vein. The anatomy is often variable but six GSV tributaries may be encountered close to the SFJ: Laterally: * superficial inferior epigastric vein; * superficial circumflex iliac vein; Medially: * superficial external pudendal vein; * deep external pudendal vein; Distally: * anterior accessory saphenous vein; * posteriomedial thigh vein. Classically, these are ligated distal to their divisions. A flush SFJ ligation is then performed and the GSV retrogradely stripped to around the knee. Phlebectomy is performed as discussed above. Closure of the cribriform fascia, with sutures or synthetic patches over the ligated SFJ, does not reduce groin recurrence. Stripping to the lowest point of reflux may improve results, but at a cost of increased saphenous nerve complications and is not widely performed. More recently, some surgeons argue that surgical trauma and subsequent inflammation in the groin is associated with neovascularisation, which in turn may lead to recurrence. Fuhermore, others hypothesise that it is the loss of the normal groin tributaries that may be responsible for driving the process of neovascularisation. These concepts have led some to believe that ligation of the refluxing vein should be distal to the tributaries and that the junction itself should be left untouched. There is no clear clinical evidence to suppo these hypotheses. Ref: Bailey and love 27th edition Pgno : 981
2 cm
3 cm
4 cm
5 cm
Vascular surgery