Safenectomy The Phlebology Clinic / Services / Venous surgery / Safenectomy Introduction Key information Description of treatment Laser vein sealing Miniflebectomy Introduction Safenectomy, often also called strippingis a surgical procedure involving the removal of the great saphenous vein. The very term 'saphena' has a fascinating etymology – it comes from the Arabic language, where 'as-safin' means 'hidden' or 'invisible'. The name "stripping"stripping,' in turn, comes from the English word 'to strip' and the concept of a 'stripper,' which is a special probe inserted into the lumen of the great saphenous vein, used to remove it in a rather forceful manner." In the past, when minimally invasive vein treatment methods were not yet so developed, saphenectomy was the primary method of treating advanced venous insufficiency caused by saphenous vein trunk insufficiency. For many years, there was a prevailing belief in phlebology and vascular surgery that the most common cause of 'varicose veins' on the legs was the insufficiency of this very vein. Now we know (to a large extent thanks to the research of the Klinika Flebologii team) that partial saphenous vein insufficiency is most often caused by various forms of pelvic venous insufficiency. The beginnings of surgical removal of the great saphenous vein date back to 1905, when William Wayne Babcock first used this surgical technique. The Babcock method involved making two incisions – one in the groin area and the other in the medial ankle area. Then, the previously mentioned 'stripper' was inserted into the vein and it was removed. Today, it is rare to see patients whose saphenous vein insufficiency reaches the level of the ankle. We now know that it was a mistake to remove the entire saphenous vein, especially since it was done 'blindly,' without controlling the position of the nerve running alongside it. Nowadays, we are moving away from the widespread use of saphenectomy due to potential tissue damage and the availability of less invasive alternatives. Currently, saphenectomy, including stripping, is used more selectively, in cases of significant dilation of the venous trunks. The stripping procedure is then limited to the insufficient segment of the great saphenous vein (usually to the upper quarter of the lower leg). Laser saphenectomy" - what is it? The development of laser techniques in the treatment of lower limb venous insufficiency has been gradual, with certain breakthrough moments. The first endovenous (or endoluminal or endovascular) lasers were used between 2000 and 2008. Their systems operated at wavelengths of 810, 940, and 980 nm. In these systems, the damaging role was mainly played by the absorption of light in the hemoglobin contained in red blood cells. Although they were effective, their use was associated with a much higher risk of complications and postoperative discomfort. A real breakthrough in endoluminal laser techniques occurred in 2008 with the introduction of lasers with a wavelength of 1470 nm, whose action is mainly based on absorption in the water contained within the vein wall. This change, combined with the introduction of radial (ring) and later dual-ring optical fibers, significantly increased the safety and comfort of endovenous procedures. In 2019, the 1940 nm laser was introduced, opening a new chapter in the development of this technology. What is the difference between the idea of removing the great saphenous vein trunk (classic saphenectomy) and its laser equivalent, i.e., closing the great saphenous vein trunk using endovenous thermal ablation (the so-called laser 'safenectomy')? The term 'laser saphenectomy' is a certain simplification, because it does not involve the surgical removal of the great saphenous vein, but rather its closure from the inside using energy at the tip of an optical fiber introduced into the insufficient part of the great saphenous vein. In classic saphenectomy, as mentioned above, the vein is physically removed from the body. 1 In contrast, in endovenous laser ablation (EVLA), a laser fiber is introduced into the vein, which emits thermal energy, causing the vein lumen to contract and close. The main differences between classic saphenectomy and 'laser saphenectomy' are: invasiveness: surgical saphenectomy is a more invasive method—it requires surgical incisions, whereas EVLA is a minimally invasive procedure performed through a small percutaneous skin puncture. anesthesia: both procedures can now be performed in tumescent local anesthesia, however, for many years, the stripping procedure was performed under general anesthesia or regional anesthesia (either spinal or epidural). Laser saphenectomy” is a term that refers to the precise and minimally invasive closure of the great saphenous vein using endovenous laser ablation (EVLA). recovery time: EVLA is associated with a shorter recovery time and significantly less postoperative pain. procedure precision: in the case of EVLA, the operator has full control over the treated venous trunk, as well as its tributaries and perforating veins. At the Phlebology Clinic, we prefer minimally invasive methods, such as endovenous laser treatment (the most effective method for closing incompetent venous trunks), due to their safety, efficacy, and postoperative comfort for the patient. Classical saphenectomy is only performed in justified (exceptional) cases. Parvektomy - How do they differ from saphenectomy? Parvektomia It is a surgical procedure for the removal of the small saphenous vein (Latin: vena saphena parva – a shorter vein than the great saphenous vein). The word "parvus" means "small". The small saphenous vein is located on the posterior side of the lower leg, in contrast to the great saphenous vein, which runs along the medial side of the leg. Both saphenectomy and parvektomy (venous stripping) can be performed Babcock method. Nowadays, however, only minimally invasive techniques should be used to exclude the small saphenous vein from circulation. The technical difference between saphenectomy and parvektomy lies in the location of the surgical incisions – in the case of parvektomy, incisions are made in the area of the popliteal fossa and the lateral ankle (or, in a modified version, in the middle of the lower leg). Comparison of the scope of stripping in the case of: (1) Removal of the great saphenous vein (limited saphenectomy) and (2) Removal of the small saphenous vein (low parvektomy). Parvektomy has been and still is less commonly used than saphenectomy, mainly for two reasons: incompetence of the small saphenous vein occurs less frequently than incompetence of the great saphenous vein. the parvektomy procedure is more difficult to perform due to the anatomical variability of the small saphenous vein and its close proximity to the sural nerve. What can be treated with saphenectomy? Modern indications for saphenectomy are much more limited than in the past. Currently, saphenectomy it is considered in the following clinical cases and situations: in advanced incompetence of the great saphenous vein (i.e., significant dilation), when other treatment methods, such as thermal laser ablation, thermal radiofrequency ablation, or vein glue, cannot be performed or have not yielded the expected results; in recurrent venous disease after other treatment methods, when it is necessary to remove a significantly dilated great saphenous vein or its segment; in the presence of incompetence of the great saphenous vein and large varicose veins of its tributaries, which can be removed during a single surgical procedure (so-called stripping combined with miniflebectomy). Mapping of varicose veins before saphenectomy (surgical removal of the great saphenous vein) at the Phlebology Clinic. Key information on the venous procedure Type of anaesthesia infiltrative and tumescent Duration of treatment 60-120 minutes Treatment main venous trunks Risk of complications larger than with endovenous methods Physical activity return to activity after 3-5 weeks Recovery for 14-21 days (the period of wearing post-operative stockings) Limitations of great saphenous vein stripping: Despite its long-established effectiveness, great saphenous vein stripping (surgical removal) has numerous limitations and disadvantages. Below are some of them: invasiveness: Saphenectomy involves making surgical incisions and the relatively traumatic removal of the vein, which can cause hematomas, pain, and leave scars. long recovery time: Return to full activity after classic stripping can take 3-10 weeks. relatively high risk of complications: Like any surgical procedure, stripping carries the risk of complications such as infection, hematoma, nerve damage, lymphatic vessel damage, or deep vein thrombosis. low effectiveness in treating perforator incompetence: Stripping is ineffective in treating incompetent perforator veins, which may be the cause of recurrent venous disease. unsatisfactory cosmetic result: Compared to endovenous procedures, stripping may leave visible scars and result in bruising and pigmentation, as well as permanent swelling due to lasting damage to the lymphatic vessels running along the great saphenous vein. High recurrence rate of venous disease: This is primarily due to the fact that removing the great saphenous vein has little to do with the causal treatment of venous disease (such treatment often worsened the patient's venous problem and led to incompetence of the posterior drainage, i.e., the additional posterior thigh saphenous vein and the small saphenous vein). the need for general or regional anesthesia: Still, relatively few surgeons are able to perform saphenectomy using tumescent (perivascular) anesthesia under ultrasound guidance. For these and many other reasons, at the Phlebology Clinic, we limit the use of stripping (saphenectomy) to cases where other treatment methods are not suitable. Price range Phlebology Venous surgery varicose vein surgery + venous stripping on one leg (as a half-day stay) From £10,000 Make an appointment Preparation for the saphenectomy procedure Preparing the patient for saphenectomy includes several key stages, as with any phlebological procedure: phlebological consultation with evaluation of veins using Doppler ultrasound: The ultrasound examination is crucial for properly planning the scope of the procedure. discontinuation of certain medications: The patient should inform the doctor about all medications they are taking, including herbal preparations and dietary supplements; anticoagulants may need to be discontinued several days before the procedure. laboratory tests: Pre-operative blood tests on an empty stomach are required, as with any surgical procedure. medical documentation: All available medical documentation related to the venous system and any other relevant conditions should be prepared. pre-operative instructions: A few days before the procedure, alcohol should be avoided, and on the day of the procedure, the patient should fast (do not eat or drink for 6 hours before the procedure). a typical anesthesiological consultation is usually not required before the procedure due to the use of tumescent anesthesia. hygiene: on the day of the procedure, the patient should take a shower and thoroughly wash the leg that will undergo the procedure. Did you know? Unlike saphenectomy, the laser procedure avoids extensive skin incisions and the associated long recovery period. Patients of the Phlebology Clinic appreciate not only the minimal invasiveness of this method but, most importantly, the ability to return to daily activities the very next day after the procedure. Tomasz Grzela, MD, PhD Description of the saphenectomy procedure: Modern saphenectomy, performed at the Phlebology Clinic, is carried out as follows: anesthesia: The procedure is usually performed under tumescent anesthesia, which involves injecting a large amount of anesthetic solution (known as Klein's solution) under the skin and around the vein to be removed. Tumescent anesthesia helps reduce pain and discomfort during the procedure, minimizes bleeding, and allows for precise execution of the surgical procedure. Klein's solution also aids in separating the vein from the surrounding tissues, making its removal easier. surgical incisions: A larger incision is made in the groin area (for the great saphenous vein). Additionally, smaller incisions or punctures may be made in the upper part of the calf or at the site of varicose veins (for simultaneous mini-phlebectomy). vein removal: Using a stripper, the vein is carefully removed from the subcutaneous tissue. surgical wound closure: The wound in the groin area is closed with sutures, special dressings, and a bandage. compression dressing: After the procedure, special adhesive bandages and a compression stocking (CCL2) are applied to the leg, which helps with wound healing and prevents complications. At the Phlebology Clinic, we make every effort to ensure that the procedure is as comfortable as possible for the patient, using modern anesthesia techniques and minimizing the invasiveness of the procedure. Post-operative care after saphenectomy (surgical removal of the great saphenous vein): Post-operative care after saphenectomy includes: dressing use: Dressings prescribed by the phlebologist should be kept clean and changed according to the doctor's instructions. compression stockings: The compression stocking should be worn during the day for the period recommended by the operating doctor (usually 3-6 weeks). physical activity: After the procedure, regular walks are recommended, along with avoiding prolonged standing and sitting. It's also advised to elevate the legs during rest periods. pain medication: In case of pain, over-the-counter painkillers can be used as recommended by the doctor. wound care in the groin area: The wound(s) should be kept clean, avoiding soaking. After the stitches are removed, healing ointments can be used to promote faster recovery. avoiding air travel: Long air travel is not recommended for 4-8 weeks after the saphenectomy procedure. the first follow-up visit after a surgical saphenectomy is usually scheduled 6-8 weeks after the procedure. Patient after saphenectomy. Mapping of varicose veins before foam sclerotherapy procedure. Contraindications for saphenectomy procedure Główne przeciwwskazania do zabiegu chirurgicznego usuwania żyły odpiszczelowej są: ciężkie choroby ogólnoustrojowe, które stanowią zbyt duże ryzyko dla Pacjenta (np. niewydolność serca czy zaawansowana niewydolność nerek); aktywna infekcja w miejscu planowanego zabiegu lub zakażenie ogólnoustrojowe; deep vein thrombosis pregnancy; zaburzenia krzepnięcia krwi; alergia na środki znieczulające; otyłość znacznego stopnia; niekontrolowana cukrzyca; niewydolność tętnicza kończyn dolnych uniemożliwiająca stosowanie kompresjoterapii. Complications of endovenous laser ablation Po safenektomii mogą wystąpić różne powikłania. Do najczęstszych należą: reakcja na znieczulenie (przejściowy obrzęk, zasinienia, uczucie niepokoju, kołatanie serca, reakcje alergiczne);krwiaki podskórne: jest to najczęstsze powikłanie; w przypadku większych krwiaków może być konieczna ich ewakuacja; infekcja rany: ryzyko infekcji jest niewielkie, ale w przypadku jej wystąpienia konieczne może być leczenie antiotykami; zakrzepica żył głębokich: jest to poważne, ale rzadkie powikłanie (do 1%), któremu można zapobiegać stosując profilaktykę przeciwzakrzepową i wczesne uruchomienie Pacjenta; przejściowe lub trwałe uszkodzenie nerwów: może powodować przejściowe lub, rzadziej, trwałe zaburzenia czucia w operowanej kończynie (nawet u 10-20% Pacjentów); blizny: po nacięciach chirurgicznych mogą pozostać blizny, które z czasem stają się mniej widoczne; ból i obrzęk: są to normalne dolegliwości po zabiegu, które zazwyczaj ustępują w ciągu kilku dni; nawrotowa choroba żylna: pomimo prawidłowo wykonanego zabiegu, istnieje ryzyko nawrotu żylaków w operowanej kończynie w przyszłości (w perspektywie 5-letniej dotyczy to aż 15-45% Pacjentów). At the Phlebology Clinic we make every effort to minimise the risk of complications and our specialists remain available to patients during the recovery period. If you experience any worrying symptoms, please contact our Registry immediately. Treatment methods 01 / Microsclerotherapy 02 / Foam sclerotherapy 03 / Laser vein sealing 04 / Varicose vein taping 05 / Miniflebectomy 06 / Venous embolisation Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment Make an appointment at the Phlebology Clinic Book an appointment
