Indications

• Symptomatic veins
• Cosmesis
• Varicose ulceration
• Lipodermatosclerosis

Pre-operative workup

• Hand-held doppler - confirm superficial reflux
• Venous duplex imaging +/- junction marking - demonstrates incompetent perforators, deep veins
• Mark veins pre-operatively with indelible marker

Tributaries

• Superficial inferior epigastric
• Superficial circumflex iliac
• Superficial / deep external pudendal
• Lateral / anterior cutaneous vein of thigh 

Risk factors - any cause of obstruction: DVT, pregnancy, running, malignancy, smoker 

Trendelenburg operation

1. GA, supine
2. 1.5cm incision lateral and below pubic tubercle (site of SFJ) - 4cm in groin crease
3. Dissect tributaries of SFJ (superficial inferior epigastric, superficial circumflex iliac, deep/superficial external pudendal)
4. Ligate and divide tributarie
5. Ligate SFJ
6. Pass stripper down LSV to knee
7. Stab incision over stripper and deliver
8. Strip vein back to groin
9. Close incision
10. Avulse local varicosities in lower calf
11. Apply compression bandaging

Complications

• Haematoma
• Recurrence (up to 20%)
• Saphenous nerve injury - loss of sensation medial thigh

Short saphenous vein

Transverse skin crease incision Dissect down to SSVJ Tie off junction (avoid sural nerve lateral to SPJ)

 Other surgical options

1. Endovenous laser ablation
2. Ultrasound guided foam sclerotherapy (risk of thrombosis)