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SURGICAL TREATMENT OF TRUNCAL VEINS Stephen F. Daugherty, MD, FACS, RVT, RPhS.

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Presentation on theme: "SURGICAL TREATMENT OF TRUNCAL VEINS Stephen F. Daugherty, MD, FACS, RVT, RPhS."— Presentation transcript:

1 SURGICAL TREATMENT OF TRUNCAL VEINS Stephen F. Daugherty, MD, FACS, RVT, RPhS

2 SAPHENOUS VEIN STRIPPING DESCRIBED 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.

3 “…many believe that the operation (saphenous vein stripping) is probably obsolete.” Bergan, John J. in Rutherford’s Vascular Surgery, 6th ed; 2005: p2258.

4 SURGICAL OPTIONS - Open Excision - Saphenous Vein Ligation - Ankle-to-Groin Saphenous Stripping - Segmental Saphenous Stripping All of the above often were combined with phlebectomy.

5 The Craft of Surgery, Philip Cooper, ed., 1965

6 PROBLEMS WITH VEIN LIGATION FREQUENT EARLY FAILURE DUE TO COLLATERAL INCOMPETENT VEINS NEOVASCULARIZATION DUE TO GROIN DISSECTION

7 Rutherford Vascular Surgery, 6th ed., 2005

8 PROBLEMS WITH ANKLE-TO-GROIN STRIPPING SAPHENOUS NERVE INJURY STRIPPING CALF OFTEN IS UNNECESSARY INTRAOPERATIVE BLEEDING HEMATOMA CAUSING PAIN

9 A Regional Atlas of the Human Body, Carmine Clemente, 1975

10 PROBLEMS WITH SMALL SAPHENOUS VEIN STRIPPING SURAL NERVE INJURY VARIABLE LOCATION OF TERMINATION OF SMALLL SAPHENOUS VEIN

11 A Regional Atlas of the Human Body, Carmine Clemente, 1975

12 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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19 WHEN TO CONSIDER OPEN SURGERY? LARGE, COMPLICATED VENOUS ANEURYSM NEAR THE SFJ HIGH LIGATION COMBINED WITH - PIN STRIPPING - ENDOVENOUS THERMAL ABLATION FOAM SCLEROTHERAPY VERY SUPERFICIAL LONG TRUNCAL VEIN


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