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Crossectomy and stripping have been the standard of care for primary great saphenous varicose veins since the high failure rates of sclerotherapy became apparent in the 1970s. As the specialty of venous surgery has evolved, a number of clinical trials have established the optimal methods of surgical treatment, and the clinical benefit of routine stripping. Long-term trials, however, have uncovered a high recurrence rate after varicose vein surgery that approaches 70% after 10 years. There is much debate about whether this is the result of the dilatation of existing tributaries in the groin or the growth of new veins as a result of angiogenesis that follows surgical treatment and healing (neovascularisation). The addition of barrier technology to current crossectomy has the potential to improve the results of surgery in the future. In the meanwhile, new techniques are evolving to obliterate the great saphenous vein, including endovenous laser, radiofrequency ablation and foam sclerotherapy. Randomised clinical trials are urgently required to compare these new treatments against standard surgery, and they will need to focus on whether the short-term gains in reduced convalescence and morbidity are balanced by durable long-term results.
KEY WORDS: Saphenous vein * Veins * Crossectomy * Stripping.
Disconnection of the incompetent saphenofemoral junction, with surgical stripping is the gold standard treatment for great saphenous varicose veins against which the results of all new methods of varicose vein treatment must be judged. As in many other branches of surgery, less invasive procedures and a move to (cheaper) day case or outpatient intervention have resulted in a re-assessment of current therapies. In the present review, standard surgery -crossectomy and stripping - has been placed in a historical context, and the outcomes re-analysed using contemporary data to define the strengths and weaknesses of the technique.
Historical aspects
Varicose veins were first described in the Ebers papyrus over 3 500 years ago. This ancient Egyptian work described 'serpentine windings' which were not to be operated on because the patients would be 'head to the ground'.1 This is the first description of what must have been a failed attempt at surgery to treat varicose veins, implying that the use of incisions lead to fatal haemorrhage.2 Hippocrates (Figure 1) took treatment one step further and whilst he did...