37722 Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below

Name of the Procedure:

Ligation, Division, and Stripping of the Long (Greater) Saphenous Veins

Summary

In this procedure, the long (greater) saphenous veins are surgically tied off (ligated), divided, and removed (stripped) from the saphenofemoral junction to the knee or below. This is typically done to treat problematic veins that are not functioning properly.

Purpose

Medical Condition: Varicose veins or chronic venous insufficiency Goals: To relieve symptoms such as pain, swelling, and skin changes, and to prevent complications like venous ulcers.

Indications

Symptoms or Conditions:

• Painful or symptomatic varicose veins
• Swelling (edema)
• Skin changes or ulcers due to chronic venous insufficiency Patient Criteria:
• Ineffective response to conservative treatments (compression stockings, lifestyle changes)
• No contraindications for surgical intervention

Preparation

Pre-procedure Instructions:

• Fast for 6-8 hours before the procedure
• Avoid certain medications as advised by the doctor Diagnostic Tests:
• Duplex ultrasound to map the veins and assess functionality

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A small incision is made at the saphenofemoral junction and at the knee.
3. Ligation and Division: The saphenous vein is tied off and divided at the saphenofemoral junction.
4. Stripping: A special wire is inserted through the vein and used to strip it from the body.
5. Closure: Incisions are closed with sutures or surgical glue.

Tools/Equipment:

• Scalpel, surgical ligation tools, stripping wire, suturing materials

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technician

Risks and Complications

Common Risks:

• Minor bleeding, bruising, swelling Rare Risks:
• Deep vein thrombosis (DVT), nerve damage, infection Management:
• Antibiotics for infection, anticoagulants for DVT

Benefits

Expected Outcomes:

• Relief from symptoms like pain and swelling
• Improved vein function and appearance Timeline:
• Benefits typically noticed within a few weeks post-procedure

Recovery

Post-procedure Care:

• Compression stockings to support the treated leg
• Elevation of leg to reduce swelling
• Over-the-counter pain medication as needed Recovery Time:
• Generally, a few days to a week for initial recovery
• Avoid strenuous activities for 2-4 weeks Follow-up:
• Appointment in a week to check healing

Alternatives

Other Treatment Options:

• Conservative management with compression stockings
• Endovenous laser therapy (EVLT)
• Sclerotherapy Pros and Cons:
• Non-surgical options have fewer risks but may be less effective for severe cases.

Patient Experience

During the Procedure:

• Under anesthesia, so no pain during the procedure Post-procedure:
• Mild to moderate pain and discomfort managed with pain relief
• Bruising and swelling around incision sites
• Encouraged to walk to promote blood flow

Pain management includes over-the-counter pain relievers and prescribed medications if necessary. Comfort measures include elevating the legs and using ice packs to reduce swelling.