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Usually long saphenous vein insufficiency is the main cause of primary varicose vein. But in the cases of primary varicose vein with related symptoms such as ulceration, superficial thrombophlebitis, dermatitis and eczema, short saphenous vein insufficiency becomes one of the main causes of the varicosities.

The anatomical studies carried out by Edward (1937–1940) and Cotton (1961) on 200 veins removed, mainly from the lower limbs, of patients suffering with varicose veins revealed the following: 1) structural alterations in the valves were never found, whereas alteration in the nearly parietal tissue were costantly found. 2) the only valve which is costantly present is the preterminal valve (98.1% compared with 93.4% for the ostial valve).

New techniques have been proposals in the last years in the surgery of the varicose veins of the lower limbs. Some techniques of conservative type, as the external valvuloplasty of the sapheno-femoral junction, are set the objective of take care of the varicose veins, eliminating the long reflux, so that prevent the progressive parietal expansion of the long saphenous vein, that comes left in situ.

Previous studies suggest that it is desirable to strip the long saphenous vein to prevent recurrence of varices, but this may cause haematomas, skin bruising and pain. Inverting stripping has been suggested as an alternative method which may reduce the extent of these complications.

To prevent sensory impairment in the cutaneous distribution of the saphenous nerve (S.N.) caused by stripping of the long saphenous vein (L.S.V.).

This intervention consists of correcting reflux at the sapheno-femoral junction and in the internal saphenous vein below Hunter’s perforating vein. This operation is done in order to segment the long saphenous vein in an attempt to normalise the pressure in the superficial veins. This in turn favours a return of blood to the circulation by means of the deep venous system when this is competent and patent.

In 1976 and later, Cloutier 1 and then Cloutier & al. 2, 3 established that the long saphenous vein (LSV) could be efficiently sclerosed by injecting an iodine — sodium iodide solution at distance from the sapheno-femoral junction (SFJ) at two different points, described as «summation effect».

Considerable controversy exists over the need to strip the whole Long Saphenous Vein (LSV) during operation of the varicose veins. Some surgeons recommend that LSV should be stripped to just below the knee. Proponents of the stripping argue that stripping procedure have better immediate results and lower long-term recurrence rate.

Long saphenous vein-saving surgery is an interesting alternative to standard stripping for treatment of varicose veins1, 2,3,4,5. The most apparent advantages of using long saphenous vein-saving surgery the way we perform it at our institution are: the long saphenous vein is preserved for future arterial reconstruction4,5 and the operation creates less subjective postoperative discomfort5. The obvious drawback is the necessity of a thorough preoperative mapping of insufficient perforators.

40 patients with long saphenous vein reflux due to incompetence at the sapheno-femoral junction (SFJ) confirmed by duplex ultrasound scanning and PPG gave consent for inclusion in the study. Patients with post-phlebitic limbs, recurrent varicose veins or other venous pathology were excluded.

To evaluate few invasive operation procedure /limited stripping of long saphenous vein/ with additional sclerotherapy.

The search for the mechanisms of skin damage in venous disease has resulted in investigation of the blood. Moyses et al studied the limbs of normal subjects Their subjects sat on a bicycle saddle with the limbs dependent for a period of forty minutes without moving1. Blood samples were taken from the long saphenous vein at the ankle.

Saphenofemoral incompetence is a frequent clinical diagnosis in patients with large saphenous varicosities.

Nowadays the surgical methods tend to be less invasive, functionally and cosmetically effective, adequate, precise and radical as well. This should coexist with possibly low burdening anaesthesia, preferably local. Both, sparing operations and well tolerable anaesthesia diminish complication ratio and make the recovery period comfortable.

The authors have studied the simultaneous pressures within the long saphenous vein, the popliteal vein and the three fascial compartments of the leg by means of microcatheters. Values in normal subjects in various positions and during a Valsalva manoeuvre are reported.

To evaluate patency of calf part of LSV remaining after its “limited” stripping for using in the future cardiovascular surgery.

The question whether long saphenous vein saving surgery can offer as good long-term results as standard stripping for long saphenous vein insufficiency is still unanswered. The matter is of clinical importance since the availability of an autogenous vein is of utmost importance in any patient who is going to be subjected to peripheral arterial reconstruction or coronary by pass surgery. It is therefore obvious that unnecessary surgical removal of the long saphenous vein should be avoided.

The author describes a survey of 607 pre-operative mappings of varices by echo-Doppler: in only 48% of patients was stripping of the long saphenous vein justified; in 27% it was entirely normal and in 25% it was normal in parts.

To evaluate long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion.

In the majority of cases, primary varicose veins are due to incompetence of long saphenous vein, short saphenous vein and medial thigh or lower leg communicating veins.

Surgical excision of the long saphenous vein in the treatment of varicose veins was first practised by Madelung in 18841. Stripping was introduced by Babcock in 19072. Many surgeons now practise stripping limited to the thigh with reduction in the incidence of long saphenous nerve injury3.

to show the technique of injection under duplex guidance and evaluate the results of sclerotherapy in long saphenous vein recurrency.