37700 Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions

Name of the Procedure:

Ligation and Division of Long Saphenous Vein at Saphenofemoral Junction, or Distal Interruptions
Common name(s): Vein Stripping, Saphenous Vein Ligation

Summary

Ligation and division of the long saphenous vein involve tying off and removing a portion of this vein near its connection with the femoral vein. This procedure helps alleviate symptoms caused by varicose veins.

Purpose

This surgical procedure aims to treat varicose veins, which are swollen, twisted veins that often occur in the legs. The goals of the procedure are:

• Reducing pain and discomfort.
• Improving the appearance of the leg.
• Preventing complications like ulcers or blood clots.

Indications

The procedure is indicated for:

• Varicose veins causing significant pain or discomfort.
• Venous insufficiency leading to skin changes or ulceration.
• Failed conservative treatments such as compression stockings and medications.
• Swelling and cramping in the legs.

Preparation

• Patients are typically advised to fast for about 6-8 hours prior to the procedure.
• Certain medications, especially blood thinners, may need to be adjusted or stopped as instructed by the physician.
• A physical examination and ultrasound of the veins are usually performed beforehand.

Procedure Description

1. The patient is placed under general or local anesthesia.
2. An incision is made at the groin to access the saphenofemoral junction.
3. The long saphenous vein is isolated, tied off (ligated), and then divided.
4. The divided vein is then removed or left to naturally be absorbed by the body.
5. Additional small incisions may be made along the leg to remove further varicose veins.
6. Incisions are stitched closed and bandaged.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon
• Surgical Nurse
• Anesthesiologist
• Supporting Medical Staff

Risks and Complications

• Common: Bruising, swelling, mild pain.
• Rare: Infection, deep vein thrombosis, nerve injury, bleeding, adverse reaction to anesthesia.

Benefits

• Relief from symptoms like pain and swelling.
• Improved leg appearance.
• Reduced risk of complications associated with untreated varicose veins. Benefits are often realized within a few weeks to months after the procedure.

Recovery

• Patients are typically able to go home the same day.
• Post-procedure care includes wearing compression stockings, keeping the leg elevated, and avoiding strenuous activities.
• Expected full recovery time is around 2 to 4 weeks.
• Follow-up appointments are often necessary to monitor healing and the effectiveness of the procedure.

Alternatives

• Sclerotherapy: Injecting a solution to collapse veins.
• Endovenous Laser Therapy (EVLT): Using laser energy to close off veins.
• Radiofrequency Ablation: Using radiofrequency energy to close veins.

Pros and cons:

• Non-surgical options are less invasive with shorter recovery times but may be less effective for larger varicose veins.
• Surgical options, like the described procedure, offer more comprehensive treatment but involve a longer recovery and increased risks.

Patient Experience

Patients may experience mild discomfort or pain during and after the procedure, managed with prescribed pain medication. Post-operative instructions focus on minimizing movement and promoting healing, with comfort measures like leg elevation and the use of compression stockings.