What is the role of saphenectomy in the treatment of varicose veins and spider veins (telangiectasia)?

Updated: Feb 28, 2018
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Answer

Saphenectomy with saphenofemoral ligation is the old approach performed using an internal stripping tool and an invagination technique. This technique has been replaced by endovenous ablation techniques.

A 2- to 3-cm incision is made at the groin crease beginning at the femoral artery and extending medially. The saphenofemoral junction is exposed by dissection.

After ligation and division of the junction and all associated tributaries, the stripping instrument (usually a stiff but flexible length of wire or plastic) is passed into the greater saphenous vein at the groin and is threaded through the incompetent vein distally to the level of the upper calf, where it is brought out through a small incision (5 mm or less) approximately 1 cm from the tibial tuberosity at the knee.

An inverting head is attached to the stripper at the groin and is secured to the proximal end of the vein. The vessel is then inverted into itself, tearing away from each tributary and perforator as the stripper is pulled downward through the leg and out through the incision in the upper calf.

If desired, a long gauze or ligature may be secured to the stripper before invagination, allowing a hemostatic packing to be pulled into place after stripping is complete.


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