Venous Treatment - Invaginated Saphenectomy

This procedure refers to the surgical extraction of the great saphenous vein (GSV) and/or short saphenous vein (SSV). We use ultrasound to assess the integrity of the valves, and/or presence of thrombus (clots). The short saphenous vein begins in the back of the ankle and foot and extends up the back of the leg and calf between the skin and calf muscles before connecting with the deep popliteal vein at the knee. When the valves within the segment become incompetent, patients develop progressively worsening systems and complications including large and bulging varicosities, edema, leg pain, leg fatigue, ankle discoloration, dermatitis, cellulitis, thrombosis, and ulcerations. The procedure is performed by ligating and dividing the juncture of the short saphenous vein with the deep popliteal vein through a small incision behind the knee. With a special instrument, the SSV is canalized and then the vein is inverted and pulled out through a small 3 mm incision at the ankle. Corresponding varicose branches are removed using the stab avulsion technique. Once removed, these varicosities do not recur. This procedure is always performed in the office under local anesthetic of lidocaine with epinephrine. Patients are fully ambulatory after the procedure and even allowed to drive. Procedure time is approximately 30 minutes to an hour, depending on the number of branch varicosities. Post-operative pain is described as mild or non-existent by patients. limited duration side-effects include bruising and ankle swelling. Routine activities are not restricted and exercise is allowed after seven to ten days.

The great saphenous vein (GSV) originates over the medial surface of the ankle and runs upwards between the skin and muscles eventually terminating at the groin where it joins the deep common femoral vein (CFV). There are multiple short and long branches several of which also terminate at the juncture with the common femoral vein. In order to prevent recurrence and reduce the development of new varicosities, it is necessary to remove not only the diseased great saphenous vein but also the diseased long and short branches. This surgical technique is similar to that described above except that the great saphenous vein is divided and ligated at the groin through a small incision. It is turned inside out (invaginated) and pulled out through a 3 mm incision at or below the knee. All other varicose branches are removed using the stab avulsion technique. Relief of symptoms from incompetency of these veins is often described by patients as occurring immediately. Because the disease in this instance is usually more advanced, the procedure is typically performed as an outpatient procedure at a surgical center or hospital. However, in appropriate patients, we will perform the procedure in the office under a local anesthetic of lidocaine and epinephrine. In either case, normal activities are not restricted. Exercise is allowed after 7 days. Scarring is minimal to none. Side effects also include bruising and small hematomas and ankle edema which resolve within a short period of time. When performed in the office, there are no preprocedure requirements or restrictions, and patients are fully ambulatory after the procedure.