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A Journal on Phlebology
Acta Phlebologica 2014 December;15(3):137-41
The Lazarus Syndrome
Phlebological Unit of Siena Hospital, Department of General Surgery, University of Siena, Siena, Italy
AIM: In the last 10 years, endovascular procedures have taken over on saphenous stripping in rich countries. The recent literature is full of scientific papers that magnify the results of endovascular procedures, and guidelines in many countries attribute to them the role of a new golden standard in the treatment of varicose disease. But surely in the world there are still some surgeons who perform saphenous stripping in patients in which the indication is placed after preoperative ultrasound analysis. Therefore stripping is not dead and cannot yet be buried.
METHODS: In our experience the traditional ablative surgery in the treatment of patients with varicose veins of the lower limbs (CEAP 2-6) is always in the first place and continues to be performed in a percentage that approaches 70% compared to the total of phlebological interventions performed annually. Over the past 3 years on a total of 858 patients (554 F and 304 M) aged between 22 and 84 years, 590 patients (68.7%) underwent saphenectomy by stripping, often associated with multiple phlebectomies of the thigh and/or leg.
RESULTS: With the various techniques used there was neither mortality, nor infectious complications. We complain about a case of hematoma in the thigh in a subject operated by stripping in anticoagulant treatment, because of serious heart disease. No thrombotic complication, neither immediate nor at 3-month follow-up, has been documented.
CONCLUSION: Our current experience makes us conclude that surgery still represents for long-term efficacy the therapeutic strategy of reference, but it is undeniable that the endovascular procedures for their minimally invasiveness, fewer complications, reduced need for general anesthesia, quicker return to work and equivalent recurrence rates, are destined to become in the near future the gold standard for treatment of varicose disease. However, due to the heterogeneity of the diseases, it is not possible to perform only one type of operation for all varicose patients, and probably saphenous stripping will always have a role, though reduced over time.