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The Valve
The mythological valve is still ruling the phlebological world and if it had not yet been discovered 'the need' for the radical operation called High Ligation and Stripping would not have been created and integrity of the millions of patients with relatively healthy Saphena vein would be preserved.
HIGH LIGATION AND STRIPPING
If you contemplate treatment to your varicose veins you should be aware of certain facts. So called "stripping" is a notoriously unsuccessful operation. Failure of the operation is progressive and starts to be apparent between six months and ten years and sometimes earlier.
Practically all patients end up having a flair-up of different calibre new veins accompanied by patches of telangiectasia and spider veins. Some patients are left with atrocious veins long after the operating surgeon has retired or is dead. After you have seen the photographs of the patients who underwent high ligation and stripping you might wonder "is it worthwhile?" Would it be better to just wear surgical compression stockings?
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Residual scar after stripping, flare up of veins around the scar |
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Complication of High Ligation and Stripping. New veins coming from the groin |
All over the world, hundreds of thousands of operations of high ligation and stripping are performed annually on a single assumption that there is an incompetent valve at the sapheno-femoral junction.
You may not be aware that the operation which you might be offered of High Ligation and Stripping was invented about 100 years ago by a very well known American Surgeon W. Wayne Babcock, M.D. from Philadelphia. He not only described the operation but also invented the stripper which is shown below. It is amazing that this operation is still performed regardless of the very well known unsuccessful long and short term result.
Sclerotherapy injections were performed much earlier with a variety of strong chemicals. The results were equally disappointing.
How the decision is taken?
Nowadays we tend to believe in the merits of technological advancement. The words like "Laser", "Doppler" and "Ultrasound" impress people enormously and if they had such an examination they believe that they are on the right path.
The varicose vein sufferer in the first instance refers to the family Doctor who routinely refers patient for the Doppler examination of the veins or alternatively refers patient directly to the surgeon who bases his decision on the result of so called Doppler (Ultrasound) examination of the veins. Invariably in the majority of cases the report says that the valve at the sapheno-femoral junction is incompetent. That information is conveyed to the patient who then easily accepts the idea of the necessity of "ripping out the whole vein".
Is the valve really incompetent? Who knows? Their examination is made by Vascular Sonographers who are highly qualified specialists in their field. However Sonographers are not the Doctors and not Specialist Radiologists. They report what they see and that might be correct but might not be relevant to the clinical presentation. Generally the patient is very rarely seen by a Radiologist who accepts the report of the Sonographer and signs it.
The valve could be incompetent, could be partially incompetent, slightly incompetent, intermittently incompetent and still performing the job adequately. The report of incompetence by the Sonographer should not be the single determining factor for stripping the whole vein and regretfully that is what happens in most of the cases nowadays.
It is a very well known fact that the superficial vein called Saphena could be used later in life for bypasses in heart surgery. Once removed there is very little option left.
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Former stripping |
Varicose veins are a multi factorial disease and could be caused amongst others by incompetent valve at Sapheno-femoral Junction, incompetent perforating veins. Some of them are very well known by the names of Doctors who discovered them Dodd, Boyd and Cockett. Other very well known factors influencing development of varicose veins are heredity, pregnancy, standing occupation and injury.
The photographs showing futility of High Ligation and Stripping are shown below.
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Stripping 20 years ago |
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Stripping 10 years ago |
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High ligation and stripping 12 years ago |
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Stripping 3 years ago New veins coming from the groin |
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