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Once superficial veins become varicosed as a result of incompetent / refluxing valves, and thereby causing reflux, the only definitive way to manage things is by removing the incompetent vein either by traditional (open) or endovenous (minimally invasive) surgery.

Therefore, the surgical treatment of varicose veins is by removing or obliterating these superficial veins.

The traditional method was open surgery but newer techniques of minimally invasive endovenous surgery (Laser EVLT, or radiofrequency VNUS ablation techniques) have largely replaced open surgery now. Open surgery may still have a role to play in selected patients with recurrent varicose veins or if multiple tributaries of the main superficial vein require removal.

High Tie, Strip, and Avulsions

The traditional procedure for treatment of varicose veins was surgical ligation of sapheno-femoral ligation (or sapheno- popliteal junction) and stripping of the long saphenous vein (or short saphenous vein) with or without multiple stab avulsions of the tributaries of these main truncal veins. It required a general anaesthetic and took approximately 30 – 60 mins depending on the extent of surgery required, whether one or both legs are being treated.

Acceptability by the patients

Although the long term outcomes of open surgery were good, the requirement for general anaesthesia, longer procedure times, recovery from surgery, and incidence of (albeit small) wound complications meant that when the newer minimally invasive came to the fore, most patients appropriately chose the newer techniques over open surgery.

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