Great saphenous vein stripping and nerve injury: the role of stripping direction

Although saphenous nerve (SN) injury represents a complication of great saphenous vein (GSV) stripping, little is know about the techniques to minimize the risk of nerve injury. This is still controversial if the stripping direction could be related to the incidence of nerve injury.

A prospective comparative study to compare upwards and downwards total GSV stripping during saphenectomy with regard to the occurrence of postoperative SN injury has been designed. Electroneurogram measurement and clinical identification of nerve injury have been performed 1 day before surgery, 1 week, 12 weeks and 1 year after surgery.

Although clinical evaluation of nerve injury was found to be similar among upwards and downwards stripping both at one and 12 weeks after surgery, ENG measurement showed a higher incidence of lesions after the downwards stripping both at one and 12 weeks after surgery. No clinical or ENG findings of nerve injury was found 1 year after surgery.

Upwards method is less traumatic than downwards total GSV stripping in terms of incidence of SN injury, as confirmed by electrophysiological nerve studies.