Vascular

Varicose Vein Surgery — High Tie, Strip and Avulsions

OPERATION: Varicose Vein Surgery — High Tie, Stripping and Multiple Avulsions of Long Saphenous Vein
ANAESTHETIC: General / spinal / local anaesthesia
POSITION: Supine, Trendelenburg. Groin and entire leg prepared. Varicosities marked pre-operatively with patient standing.

INDICATION:
Symptomatic varicose veins with [aching / swelling / itching / lipodermatosclerosis / venous eczema / venous ulcer]. Duplex USS: saphenofemoral junction incompetence with reflux in long saphenous vein. [Endothermal ablation not suitable / patient preference for open surgery per NICE guidelines].

PROCEDURE:
WHO Checklist performed.

HIGH TIE (SAPHENOFEMORAL JUNCTION LIGATION):
Transverse incision in the groin just medial to the femoral pulse. Saphenofemoral junction (SFJ) and all tributaries identified. Tributaries (superficial and deep pudendal, anterolateral thigh, superficial epigastric, superficial circumflex iliac veins) ligated and divided flush with the long saphenous vein. SFJ doubly ligated and divided flush with the common femoral vein. Long saphenous vein completely disconnected.

STRIPPING: