In general, a saphenectomy is the procedure that has been traditionally practiced even since the beginnings of vascular surgery as treatment for most of the venous conditions in which the most frequent symptom is the formation of varicose veins in the legs.
This technique consists in the surgical excision of the great saphenous vein or the small saphenous vein. The former is a long vein that originates in the internal face of the ankle; it passes through the medial face of the leg, while lightly bordering the knee, to come towards the back of the thigh where it reaches the groin and curves inwardly, joining the femoral vein.
In all its trajectory, the great saphenous vein receives many branches or tributary veins and has some connections with the deep circulation of the leg; additionally, it is full of valves that guide the flow of the blood ever upwards (towards the heart). It is precisely these that are associated with the principle causes of varicose veins and that allow the dilation of the saphenous vein and consequently, of its tributaries (which are much smaller and put up less resistance).
It is due to this that a saphenectomy has become one of the fundamental bases of varicose vein treatment in the legs since the saphenous is the vein that becomes a varicose in approximately 80% of all instances.
A saphenectomy should be considered when:
- All varicose veins are large (bigger than 7mm in diameter) and are located in the internal face of the leg/thigh.
- It is evident that the saphenous vein is insufficient.
- The varicose veins are direct tributaries of the great saphenous vein.
- After a physical examination (performed by a surgeon, Doppler ultrasound o vein map) it is demonstrated that there is a backflow in the union of the saphenous and femoral veins.
- There are varicose present at groin level related with the great saphenous vein.
- Varicose veins or vein insufficiency where a minor saphenectomy would be indicated are present.
If you suffer from any of the above, it is recommended for you to consider a consultation with your doctor. During your initial appointment, the doctor will be able to determine if a saphenectomy is the adequate procedure for your particular circumstance and can give you more suggestions.
The technique of a saphenectomy is quite simple. Two incisions are made, one in the interior face of the ankle (it is a small incision; more or less around 8mm) and another at the level of the groin, in the interior face as well (more or less 15mm in length). At both sites, dissections of the saphenous vein are performed, joining both ends with an absorbable string. After this, a thin wire or plastic filament is passed through the whole vein, beginning at the ankle, until it emerges at the end of the groin.
At the end of the ankle, this filament has a small ball (which is attached to the saphenous vein) and it is removed by pulling it out through the incision at the groin, extracting the vein with it. All the tributaries of the saphenous vein that are in the way of the extractor rapidly stop bleeding because they collapse. After the procedure, you will have to wear a compression stocking or an elastic bandage for two weeks.
After The Procedure
During the first night after a saphenectomy, you will need to sleep with your legs up high. The next day, most doctors recommend for you to walk around 15 minutes, alternating with 2 hours of rest; you should increase your walking time around 5 minutes per day until the 4th day after the surgery. At this point, you can resume normal walking and can rest around 2 to 3 times a day. To make your recovery period much more comfortable, the doctor can prescribe some medication for you.
Your sutured incisions need to be washed twice a day. You must remember that you need to wear your compression stocking or elastic bandage for 2 weeks straight. Your stitches should be removed 7 days afterwards by your doctor, or if you must travel before this time, by a health specialist.
Make sure to ask your doctor concerning any risks you might have to face when undertaking this procedure. In order to keep the risks at a bare minimum, please make sure that you follow the doctor’s instructions at all times.