Surgery

Sapheno-Femoral Ligation & Stripping, Step Avulsion, & Endovenous Ablation

Why It’s Done (Indications)

To treat painful, swollen, or cosmetically distressing twisted veins in the legs, or to manage complications like skin discoloration, leg ulcers, and chronic swelling.

How to Prepare (Preparations)

• Doppler ultrasound scanning of the leg veins beforehand to map out problematic vessels.
• Avoid shaving your legs on the day of surgery to prevent skin irritation or infection.
• Fasting (no food or drink) for 6 hours before surgery.
• Pause blood-thinning medications as instructed by your doctor.

What Happens (Procedural Details)

Endovenous Ablation (Radiofrequency or Laser):

1. Anaesthesia & Ultrasound Mapping: Performed under monitored anaesthesia. Ultrasound is used to map the diseased main vein (usually the Great Saphenous Vein) on your skin.
2. Catheter Insertion: A needle is inserted into the vein near the knee or lower leg under real-time ultrasound guidance. A thin guide wire and a tiny catheter are passed up through the vein toward the groin.
3. Tumescent Anaesthesia: A fluid mixture of local anaesthetist and saline is injected around the vein along its entire length. This numbs the leg, protects surrounding tissues from heat, and compresses the vein tightly around the catheter.
4. Heat Closure: The catheter tip is activated, delivering controlled laser or radiofrequency heat energy as it is slowly withdrawn, causing the vein wall to collapse, seal shut, and eventually be absorbed by the body.
    

Sapheno-Femoral Ligation & Stripping and Step avulsion

1. Incision & Ligation: Under general or spinal anaesthesia, an incision (3–5 cm) is made in the groin crease. The surgeon locates where the main surface vein meets the deep vein system, ties off (ligates) the tributary branches, and cuts the connection.
2. Stripping: A flexible plastic wire (stripper) is passed down through the length of the main vein from the groin to a small cut just below the knee. The end of the vein is secured to the wire, and as the wire is pulled downward, the diseased vein is pulled inside-out and removed from the leg.
3. Tiny Punctures: Done in combination with ablation or stripping. The surgeon uses a tiny needle or micro-blade to make 1–2 mm punctures directly over bulging surface veins.
4. Extraction: A small surgical hook is inserted through the puncture to grasp the vein, gently pull it out, and remove it in small segments. No stitches are usually needed for these micro-punctures.
    

Recovery (Postoperative Care)

• Compression stockings must be worn continuously for 1 to 2 weeks post-procedure.
• Regular daily walking is encouraged immediately; long periods of standing or sitting should be avoided.
• Return to daily activities typically within a few days for ablation, or 1–2 weeks for open stripping.
   

Risks (Potential Complications)

• Bruising, tightness, and temporary numbness along the treated vein path.
• Thermal skin burns or nerve injury (rare).
• Deep vein thrombosis (DVT) or vein recurrence over time.