Surgical Stripping: Surgical management includes high-ligation of the sapheno-femoral junction and stripping of the GSV from the groin to the knee. Until recently it has been the “Gold-Standard” of management of an incompetent GSV. This procedure requires a hospital admission and general anaesthesia.
Complications can include:
- surgical incision with scarring
- bruising and bleeding
- damage to the saphenous nerve around the knee
- lymphatic leak
- vascular damage from groin dissection
- deep vein thrombosis (DVT).
Whilst serious complications are uncommon and minimised with modern surgical techniques they have resulted in a move towards endovenous treatment options as they have numerous advantages.
Phlebectomy: is the segmental removal or avulsion of superficial varicose veins via small incisions. This can be done under general anaesthesia or local anaesthesia in either a hospital or ambulatory setting. Phlebectomy is a secondary procedure and should be done in conjunction with another modality/modalities that treat the underlying truncal reflux disease. It is used to interrupt and remove grossly dilated visible varicosities, reducing congealed blood/thrombosis that may cause complications with other treatments and may have a roll in decreasing disease recurrence.
Acute bleeding from varicose veins often requires surgical treatment and should be urgently referred to a Vascular or General Surgeon for assessment and management.