History of Varicose Vein Surgery – Part III

History of Surgery I | History of Surgery II | History of Surgery III

The methods of stripping Varicose Veins with strippers or Keller wire and open surgical approaches at the beginning of the 20th century were still very crude and not procedures that people looked forward to having. Some of the surgical procedures led to cosmetically undesirable outcomes.

Crossectomy  was introduced back in 1916. Crossectomy  has been considered the standard procedure  for varicose veins. It consists of making a small incision in the groin crease and the saphenofemoral junction is identified and divided between dips. All of the tributaries are identified and dissected back to their first branch before ligation. Ligation can be done in many ways.  There is not a technique that has been proven to be better than the other. Failure of varicose vein surgery and the development of recurrent varicose veins are most common at the level of the groin due to inadequate groin dissection.

Using endovenous electrosurgical devices for venous wall denaturation is not new as these methods have been used off and on over the past few decades (1970s to 1980s). Since 2000, more advanced method, Endovenous obliteration with radiofrequency (RF) device or laser, has been becoming a very popular method and the preferred methods of vein specialists and surgeons. The original idea behind using electrosurgical device was to shrink the veins as to make valves competent again, but the observed result of venous obliteration with RF lead to the new ablation method.  Endovenous Laser Ablation (EVLA) can be performed in the ambulatory setting under local anesthesia, and it allows for the ease of the catheter to pass through the vein without too much discomfort to the patient.  The catheters are able to obliterate veins from 2mm to 12mm. This technique is minimally invasive and yet provides results that are immediately visible and will last long term.

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