Selective retention of the great saphenous vein to prevent saphenous nerve injury during varicose vein surgery

G.-L. Jia, H.-L. Xi, X.-K. Wang, S. Feng, Z.-L. Tian

Vascular Surgery Department of Xuzhou Central Hospital of Jiangsu Province, Xuzhou, Jiangsu, China. surgeontzl@163.com

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• Angiology

OBJECTIVE: To explore the selective retention of the great saphenous vein trunk below the knee to prevent saphenous nerve injury during varicose vein surgery.

PATIENTS AND METHODS: This research was a single-center prospective randomized trial. From January 2009 to January 2012, 280 patients of varicose veins in the great saphenous vein were treated and divided into two groups of 140 cases each. In the observation group, the vascular trunk of the great saphenous vein was stripped to below the knee level whilst that in the control group, it was stripped to the ankle level. Patients in both groups were treated with a transilluminated powered phlebectomy (TIPP) and foam sclerotherapy. Primary end points were postoperative pain, saphenous nerve injury, quality of life and recurrence rate.

RESULTS: After one month follow-up: 5.71% of patients in the observation group had neurological symptoms, while 14.29% of patients had neurological symptoms in the control group. The saphenous nerve injury between the two groups was statistically significant. Postoperative follow-up of one year, 1.47% patients had symptoms of neurological disorders in the observation group, while 7.14% patients had symptoms of neurological disorders in the control group. The saphenous nerve injury between the two groups was statistically significant. Therefore,  selective retention of great saphenous vein below-knee can prevent saphenous nerve injury. The main outcome measures were postoperative pain, missing saphenous nerve, improvement of symptoms and the incidence of recurrence.
The follow-up after one month showed that the percentage of neurological symptoms in the observation group and the control group was 5.71% and 14.29% respectively, and the saphenous nerve injury showed a statistical difference. The follow-up after one year showed 1.47% of abnormal sensation in the observation group and 7.14% of dysesthesia or paresthesia in the control group in surgical limb according to subjects’ claims, and there existed a statistical difference in the saphenous nerve injury.

CONCLUSIONS: The selective retention of the great saphenous vein trunk below the knee can prevent the saphenous nerve injury.

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