Invasive Treatment
Open Venous Surgery. For patients in whom compression therapy does not resolve the varicose veins symptoms, open surgical treatment of venous abnormalities remains the standard of care and involves ligation, division, and stripping of the affected superficial vein. Surgical treatment of varicose veins can be performed under tumescent local anesthesia and aims to interrupt the reflux at the proximal and distal points of insufficiency and to remove any abnormal venous segments affected by incompetent valves.[16] In open surgical treatment for varicosities in the GSV, ligation and division occurs where the GSV conjoins with the common femoral vein, whereas varicosities in the SSV are ligated and divided about 3 to 5 cm below the saphenopopliteal junction to avoid damaging the sural, or short saphenous, nerve.[3,16] The abnormal venous segment is then resected, stripped, and pulled down through a small incision made below the knee for the GSV and in the popliteal crease for the SSV.[3,16]