Published online 4 April 2007 in Wiley InterScience (www.bjs.co.uk); DOI: 10.1002/bjs.5598
Paper accepted 19 February 2007
Presented to the Annual Meeting of the American College of Phlebology, San Francisco, USA, November 2005, and the Annual Meeting of the Venous Forum of the Royal Society of Medicine, London, UK, March 2005
MS Whiteley MS FRCS(Gen)
The Whiteley Clinic
Stirling House, Stirling Road
Guildford, Surrey GU2 7RF, UK
Email: [email protected]
Varicose veins that recur after standard high tie and strip are often associated with venous reflux in the thigh, as shown by duplex ultrasonography., The aim of this study was to look for evidence of revascularization in the strip track after great saphenous vein (GSV) stripping.
A consecutive series of patients with duplex-proven great saphenous varicose veins underwent saphenofemoral ligation with intraoperative confirmation of successful stripping. Duplex ultrasonography was performed 1 week and 1 year after surgery. The presence and extent of haematoma was noted, as was any venous reflux within the strip track.
At 1 year, four (6 per cent) of 70 patients had complete revascularization of the strip track and 12 (17 per cent) had partial revascularization, all with duplex-proven reflux. Partial revascularization was in the distal third of the track in six legs (9 per cent of the 70 patients), in the distal half in five (7 per cent) and was almost complete in one leg (1 per cent). All patients with revascularization had a significant strip track haematoma at 1 week after surgery.
Revascularization of the GSV strip track after stripping was found in 23 per cent of patients after 1 year; all of these had a postoperative haematoma in the track.
Aruna Munasinghe (Surgical Senior House Officer)
Craig Smith (The Whiteley Clinic Vascular Technologist)
Babak Kianifard (The Whiteley Clinic sponsored Research Fellow)
Barrie A. Price (Consultant Surgeon at The Whiteley Clinic)
Judy M. Holdstock(Chief Vascular Technologist at The Whiteley Clinic)
Mark S. Whiteley
Prize for Best Paper of the Meeting: South West Thames Vascular Group – Wimbledon, January 2005
British Journal of Surgery 2007 Vol 94; 7: 840-3
Since introducing endovenous surgery to the UK in March 1999, we initially met a lot of resistance with many established surgeons claiming that stripping was still a good option for varicose vein surgery.
This research proves that stripping veins is not a good operation. It was already known that stripping caused scars, was painful and usually resulted in 2 weeks off work. However, many surgeons felt that by removing the veins, they had cured the patient for good.
The Whiteley Clinic patients were all offered endovenous thermoablation from March 1999 onwards instead of stripping. Our long term research of these has shown that veins closed with Endovenous Thermoablation – when used using the settings and technique determined by The Whiteley Protocol® have a re-opening rate of <0.1% at one year.*
This justifies The Whiteley Protocol® approach to treating patients which hasn’t ever allowed stripping of varicose veins.
*Ten Year Results of Radiofrequency Ablation (VNUS Closure®) of the Great Saphenous and Anterior Accessory Saphenous Veins, in the Treatment of Varicose Veins
DC Taylor, AM Whiteley, TJ Fernandez-Hart, MS Whiteley Phlebology 2013; 28: p335
At the time of this study, almost all most varicose vein surgery in the UK was still tying and stripping the veins. At The Whiteley Clinic we had already been performing endovenous thermoablation for 6 years and had realised that the recurrence of varicose veins had dropped with the new technique.
So we studied a group of patients who are having high saphenous tie and stripping as part of another study, and followed them up with duplex ultrasound over 1 year.
Four patients (6%) grew a complete new great saphenous vein. More importantly these newly grown or “neo-vascular” veins did not develop valves – and so were instantly incompetent and were refluxing. Hence the body had reversed the operation and the varicose veins were back as before the operation.
In another 12 patients (17%) the great saphenous vein had partially grown back. Once again, no valves had formed and so these sections of vein that had partially grown back were also incompetent and showing recurrent reflux.
In total, 16 (23%) of patients who had varicose vein surgery by stripping the veins grew the same vein back again, in total or in part, within 1 year. All of these patients had recurrent venous reflux in these veins that had regrown, as none of the veins that regrew after stripping developed any valves.
This research was the first research to show that varicose veins can grow back again after stripping. For the first time, it proves that recurrent varicose veins after surgery was not due to ‘poor technique’ or ‘other vein opening up’ which had been claimed before, but was due to the trauma of the stripping itself.
The stripping procedure is an injury to the body. The subsequent re-growing of a new vein is the body’s way of trying to heal.
The fact that these new veins don’t develop valves means that stripping veins is doomed to failure.