Thigh Saphenectomy is Not a Necessary Adjunct to High Ligation and Stab Avulsion Phlebectomy for Varicose Veins - Jinnah Hospital Experience.

Abstract

Venous ulcerations result from isolated superficial venous incompetence in upto 60% of cases. The principle behind the treatment of venous ulceration is to reduce venous hypertension and new therapeutic modalities have resulted in a paradigm shift in the approach to the management of varicose veins. High ligation of long saphenous vein with or without stab avulsion phlebectomy has become a commonly performed procedure for varicose veins. However, the need for concomitant stripping of thigh saphenous vein remains controversial. In the present study 26 patients with duplex scan — confirmed varicose veins underwent various surgical procedures: 21(80.7%) had high ligation and phlebectomy, 4(15.3%) had high tie, phlebectomy and thigh saphenectomy while 1(3.9%) had high tie alone. Leg ulcers in 10(38.4%) patients were dressed with a simple non — adherent dressing. Median age was 37 years and most common presenting feature was leg pain encountered in 19(73%) patients. All venous ulcers followed up in outpatient clinic healed at a median of ten weeks while two (7.9%) cases developed debilitating saphenous phlebitis in the immediate post-operative period. This study concludes that thigh saphenectomy is only required when patients are severely symptomatic of  advanced stasis changes.