Chirurgie des varices

Surgical strategy for primary varicose veins of the lower extremities depends on precise preoperative assessment, which is based on clinical and Doppler ultrasound examinations. This locates superficial varicosities, sites of reverse flow and provides information on the disease stage and on the deep venous network. The aim of surgery is to eradicate reflowing vessels and superficial varicosities with concomitant sparcing of normal saphenous vessels. High ligature and stripping is the basic approach for long and short saphenous vein incompetence. Concerns about nerve injuries and cosmetic reasons suggest the selection of minimal invasive procedures such as selective stripping and invagination techniques. These basic methods may be associated to Muller's varicectomies and perforator interruption. The essential role of high ligation has been demonstrated in prospective studies for incompetent long and short saphenous veins; conversely, stripping of the whole saphenous trunk remains controversial. It seems to improve the results when the long saphenous vein is enlarged and submitted to significant reverse flow. Post operative recurrence rate is reduced by preventing de novo formation of a saphenofemoral junction. Exactive surgical treatment should be proposed whenever possible and should be adapted to each clinical situation, in order to decrease recurrence and sequel rates.