Treatments for Veins and Varicose Veins - Stripping of Veins
Since the 1890s - well over 100 years - the
standard treatment of veins was to tie the top of the Great Saphenous
Vein, where it joined the deeper vein - called the femoral vein. The
idea was that this would stop the blood from falling down the Great
Saphenous Vein - thus stopping the reflux and so all of the
complication that this caused.
This was started by a Doctor called Trendelenberg. He had checked the veins of dead people and had found that normal people had normal valves, but people who had suffered from varicose veins during life, showed defective valves when checked after death.
Unfortunately, as he couldn't see how the veins actually worked in life, he assumed that all of the valves gave way from the top - hence anything putting pressure on the top valve would help to cause varicose veins and vein problems. It was this theory that made generations of doctors and patients believe varicose veins were caused from:
- Being fat
- Pelvic tumours (stopping blood flow out of the leg)
- Constipation and straining
- Standing for long periods of time
all of which we now know are wrong.
His idea was that tying the top of the vein was like putting a top on a bottle - by stopping blood getting into the vein, it couldn't reflux down it.
However it soon became obvious that reflux could still occur after a successful tie, due to blood running into the incompetent vein from other veins - classically the "thigh perforator (see diagram above) although with Duplex Ultrasound, have found out that such a perforator is not necessary, as blood enters the vein from normal tributaries (branches feeding into the Great Saphenous Vein) in any case.
Research from The Whiteley Clinic from 2001 showed that the top valve is not the main problem in any case (see www.Pioneering-Veins-Surgery.co.uk). The valves fail from lower in the leg and work their way UP the leg - the reverse of what seems obvious. So many people with varicose veins actually have a normal valve at the Sapheno-Femoral Junction - meaning just a tie wouldn't do anything at all for them!!
So several decades ago surgeons decided that tying wasn't enough - and the vein would need to be stripped away.
Unfortunately, although this seems like a
good idea, the veins are part of the connective tissue of the body -
which means that they heal. Unlike organs which are gone once removed,
connective tissue grows back after it is damaged. If this wasn't the
case, you wouldn't heal after cutting yourself.
So when the vein was stripped away, the bruising and trauma of the operation actually stimulates the ends of the vein and the branches to grow back again.
Prize winning research by The Whiteley Clinic was the first time this was proven*. We showed that 23% of people grow their veins back within 1 year of stripping - and our latest research shows 76% grow their veins back 5 years after stripping!!
*Strip-track revascularization after stripping of the great saphenous vein A Munasinghe, C Smith, B Kianifard, BA Price, JM Holdstock, MS Whiteley British Journal of Surgery 2007 Vol 94; 7: 840-3
