Objective assessment of high ligation without stripping the long saphenous vein

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Abstract
Non-invasive methods of venous assessment were used to assess the procedure of high ligation plus multiple avulsion of varicosities for the treatment of varicose veins in 54 limbs. Duplex scanning before operation confirmed saphenofemoral incompetence and excluded short saphenous incompetence. After operation it revealed that in two limbs the saphenofemoral junction was still patent and incompetent. In the 52 limbs in which the junction had been ligated there was persistent reflux down the long saphenous vein in 24 cases. In only two limbs was this attributable to mid-thigh perforating veins. Photoplethysmography was also performed before and after operation and the venous refilling time measured. Improvement in refilling time produced by application of above knee tourniquets before operation was measured (predicted improvement) and the change in refilling time after operation was also recorded (observed improvement). There was a statistically significant correlation between observed improvement and predicted improvement in refilling times in the limbs with no reflux in the long saphenous vein after operation (Pearson's correlation coefficient, r = 0.6, P<0.001). There was no correlation between predicted and observed refilling times in the limbs with persisting reflux in the long saphenous vein after operation. In conclusion, this operation fails to control functionally significant reflux within the long saphenous vein in a high proportion of cases.