Open operation is recommended when the primary site of incompetence is in the long or short saphenous veins. The affected veins are removed and their associated incompetent perforators ligated or avulsed.
Prior to surgery, the affected veins must be marked since they will not be visible during operation with the patient recumbent. Low-dose subcutaneous heparin should be offered to any patient with a history of superficial or deep venous thrombosis, or with other risk factors for deep venous thrombosis.
Often, the long saphenous vein must be removed. It is exposed in the groin and it's tributaries ligated at the sapheno-femoral junction. An intraluminal stripper is passed and the vein removed.
Increasingly modern practice is to preserve the long saphenous vein when possible, unless extensively dilated because of it's possible use in coronary artery bypass grafting.
Individual varices below the knee may be avulsed through small skin incisions over the veins.
The legs are bandaged at the end of the procedure, and though practise varies bandages or compression stockings remain in place for 1-2 weeks. The patient is encouraged to exercise daily after the first 24 hours and to keep the limb elevated when sitting.
Recurrence after operation is most frequently caused by failure to ligate all the tributaries of the long saphenous vein in the groin.
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