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Invagination stripping

The first photo shows the preoperative ultrasound marking of the saphenofemoral anastomosis.

Photo 1

This allows for precise localization of the place where great saphenous vein (GSV) joins femoral one, thus minimizing groin fold incision up to 6-8 mm (photo 2).

Photo 2

Third photo shows puncture site, (marked with a letter “П” and an arrow). Venipuncture site is always located at the zone of transition of a healthy vein into the pathological one. Puncture on the border of the pathological area allows to avoid the removal of the healthy part of the vein. This statement is especially relevant when working with the veins of the shin, where they are surrounded by sensitive nerves, and traumatize them is highly undesirable since that can negate all the benefits of minimally invasive surgery, causing sensory disturbances in the postoperative period. So the vein will be extracted through the “П” point.

Photo 3

Asepsis is fundamental for surgery: lower limb preparation is the same as with other methods of vein surgery (laser, RFA) (photo 4).

Photo 4

A 0.35″ guidewire, inserted up to saphenofemoral anastomosis under ultrasound guidance, allows for finding the vein in the groin fold. The guidewire is detected by ultrasound clearly, and with a help of a Varady hook the vein is being extracted performing a stripping (photos 5, 6, 7).

Photo 5
Photo 6
Photo 7

The fixed vein is being removed with a help of a strong thread, which first end is driven outside through the puncture on the shin, and the other is fixed in the groin with the part of the vein to be removed. Thanks to the tumescence, the removal of the vein with a thread is painless (the tumescent solution contains lidocaine). The vein is being invaginated similar to a stocking being took off. This minimizes trauma of a surrounding tissues, since vein is being folded back inside itself (photos 8, 9, 10).

Photo 8
Photo 9
Photo 10

Absence of hematomas on the leg is due to tumescent anesthesia containing adrenaline (photo 11).

Photo 11

The final result is shown on photos 12, 13, 14.

Photo 12
Photo 13
Photo 14
One month after surgery I
One month after surgery II