Reasons to strip the long saphenous vein

Whether the long saphenous vein (LSV) should be stripped or not remains contentious. Varicography in patients with recurrent varicose veins frequently demonstrates an intact LSV. A series of 41 varicograms have been reviewed to find how often an unstripped LSV is associated with recurrence. Thirty-two patients, 22 female and 10 male, of mean age 49 years (33-78 years) were investigated. Forty-one limbs had previously had high saphenous ligation, yet still had clinical and ultrasound evidence of superficial venous reflux from a source above the knee. The mean interval between first and the last operations was 16 years (2-33 years). An intact LSV in some part of the thigh was present in 22/41 limbs (54%). Midthigh perforator incompetence (MTPI) via the unstripped LSV was present in 14/41 limbs (34%) and MTPI direct from femoral vein to a superficial varix occurred in 6/41 limbs (15%). The commonest problem is a residual communication at the groin found at operation in 80 p. cent of limbs. Accurate saphenofemoral ligation is crucial but we suggest that recurrence from MTPI via the intact LSV, and the possibility of recanalisation from the upper end of the intact LSV to the femoral vein are arguments for continued stripping.