Combined high ligation and stab avulsion for varicose veins in an outpatient setting

BACKGROUND. In recent years, the transition from radical surgery for the treatment of primary varicose veins has been modified from the previously described high ligation with complete stripping of the greater or lesser saphenous vein. OBJECTIVE. The purpose of the here within-described technique is to present a less invasive technique that incorporates sapheno-femoral ligation with hook avulsion of branch varicosities. METHODS. Sapheno-femoral ligation with hook avulsion of branch varicosities is carried out under local anesthesia utilizing the tumescent technique with dissection, ligation, and division of the greater saphenous vein and its tributaries. The hook avulsion procedure removes residual diseased venous segments. RESULTS. Patients treated by this combined ligation-hook avulsion approach achieve excellent functional and clinical results associated with a minimal side effect profile. CONCLUSIONS. Combined flush sapheno-femoral ligation of normal saphenous veins (<8 mm in diameter) and hook avulsion of branch tributaries produces excellent functional and cosmetic results with minimal morbidity.