As mentioned in the previous article, if the varicose veins in the lower extremities are relatively large in scope, the degree of varicose is relatively heavy, and the symptoms that seriously affect the normal life of the patient such as edema, hyperpigmentation, dermatitis and eczema, and even skin ulcers are present, then minimally invasive stripping + electrocoagulation surgery is required. So how does this procedure treat varicose veins in the lower limbs? What are the differences compared with the traditional surgery? Let’s find out! Where is the saphenous vein? The saphenous vein is the longest and most superficial superficial vein in the lower extremity, starting at the dorsum of the foot, it travels up the inside of the leg and joins the femoral vein at the base of the thigh. As shown in the diagram, there are five major branches of the saphenous vein: the medial superficial femoral vein, the lateral superficial femoral vein, the external pubic vein, the superficial abdominal wall vein and the superficial circumflex iliac vein. Arterial blood from the heart flows to the lower extremities to deliver nutrients to tissue cells and to recycle metabolic waste into venous blood, which then flows back to the heart through the saphenous vein and the five branches of the lower extremities via the deep veins. How is a traditional high saphenous vein ligation and stripping done? If the saphenous vein is compared to the trunk of a building’s plumbing, then the five branch veins are the smaller pipes that branch off from the trunk, and they are one and the same, or what is anatomically called the “superficial venous system”. Traditionally, it is believed that only by intercepting all these problematic pipes can varicose veins in the lower extremities be prevented from occurring again. The traditional high saphenous vein ligation and stripping procedure involves ligating the saphenous vein and its five branches, and then stripping the entire saphenous vein trunk so that blood cannot flow back to the heart through this pathway, so that blood does not accumulate in the vein. As shown in Figure 1, the five major branches are far apart, and in order to ligate the saphenous vein and its five major branches, a large incision of 5 to 10 cm in the groin is required to complete the ligation. Some patients may ask: How can the blood return to the lower limbs after all the vessels are ligated? In fact, besides the superficial vein system, there is another deep vein system in the lower extremities of human body. After ligating the diseased superficial veins, the blood in the lower extremities can return to the heart through the deep veins. How is the minimally invasive stripping + electrocoagulation procedure done? The so-called modified minimally invasive stripping and electrocoagulation procedure is a modified procedure based on the traditional high ligation and stripping of the great saphenous vein. The direction of blood flow in the superficial abdominal wall vein and the superficial spinous iliac vein is from top to bottom, while the direction of the external pubic veins is more parallel, which means that these three veins do not flow back against gravity, so it is unlikely to cause varicose veins in the lower extremities. The modified minimally invasive stripping and electrocoagulation procedure preserves these three veins, strips only the main trunk of the saphenous vein, truncates the superficial medial femoral vein and the superficial lateral femoral vein, and “scald” the varicose superficial vein to death by electrocoagulation. This allows for a smaller incision in the groin, 1 cm is sufficient. Also, the number of incisions is significantly reduced to 2-3. Usually, there is one 1 cm incision in the groin and one in the inner ankle. Particularly severe varicose veins may require another incision on the medial side of the knee, through which the surgeon removes the severe varicose vascular mass. These incisions are simply closed with absorbable sutures and do not need to be removed. Many patients worry that the electrocoagulation needle will “burn” the blood vessels to death, and that it will not cause skin damage. Dr. Guo Hongjie explained that the homemade electrocoagulation needle is similar to the intravenous indwelling needle used for infusion, the core contains a cannula outside, the role of the cannula is to protect the skin to avoid burns. The core is slightly longer than the cannula, so that the tip of the needle is exposed. When the needle is punctured into the vein and the electrocoagulation needle is energized, the electricity is conducted directly to the tip to release heat, and the power and timing of the electrocoagulation is controlled so that the skin is not damaged. How is the minimally invasive peel + electrocoagulation procedure better than traditional surgery? First, the surgical incision is smaller than traditional surgery, which means less trauma and significantly lower risk of postoperative wound infection and lymphatic leakage; second, the incision is in a very concealed location, which can meet the patient’s aesthetic requirements; third, the superficial abdominal wall vein, superficial iliac vein and external pubic vein are preserved. This reduces the risk of femoral vein injury. Moreover, in case the patient develops deep vein thrombosis in the lower extremity for other reasons, preserving these three superficial veins means preserving a channel for blood flow back to the heart from the lower extremity; fourth, the patient has to be bedridden for 14 days after the traditional surgery before being discharged from the hospital. In contrast, after the modified minimally invasive stripping combined with electrocoagulation, the patient can be discharged on the same day, which greatly reduces the risk of deep vein thrombosis.