Comparing excluded saphenous vein technique with great saphenous vein stripping after 3 years

BACKGROUND: In specific scenarios such as ampullated dilation of the saphenous vein at the "crosse," absence/incontinence of the suprasaphenous femoral valve, and anatomical anomalies at the crosse or a high outlet of the anterolateral saphenous vein to the "crosse," thermal ablation is not the preferred approach. Instead, the Excluded Saphenous Vein Technique (ESVT) is utilized, involving selective crossectomy rather than stripping. This study aims to compare the effectiveness of ESVT with stripping, both interventions involving selective crossectomy. METHODS: A preoperative clinical and instrumental screening phase categorized patients into two groups: the ESVT group (105/200 patients) underwent ESVT and selective crossectomy, while the Stripping group (95/200 patients) underwent stripping and selective crossectomy. The primary outcome was the recurrence rate, defined as total recanalization of the great saphenous vein and/or onset of new saphenous vein and/or new varicose veins. RESULTS: Follow-up occurred at 10-day, 30-day, 1-, 6-, and 36-month intervals using Duplex scan. Recurrence rates were 2.8% and 6.31% for ESVT and Stripping, respectively, with no significant difference between the two groups (ESVT vs. stripping: OR 0.43, 95% CI [0.06; 2.12], CONCLUSIONS: ESVT offers several advantages over stripping in the aforementioned cases, including performance under local anesthesia, absence of thigh bruises, earlier patient discharge, and cost-effectiveness. In Italy, approximately 70% of venous treatments involve stripping. However, based on our findings, ESVT stands as a viable alternative to stripping, exhibiting equal effectiveness and safety along with notable advantages.