Signs and symptoms of saphenous nerve injury after greater saphenous vein stripping: prevalence, severity, and relevance for modern practice.

PURPOSE: Saphenous nerve injury has long been recognized as a risk of greater saphenous vein stripping, and it has been suggested by some authors as a reason to avoid stripping below the knee. The rate of injury reported in the literature is extremely variable, with no study adequately addressing the effect of these injuries on patient quality of life. We undertook this study to measure the prevalence of these injuries and quantify their impact on quality of life.
METHODS: A cross-sectional study of patients who had undergone primary greater saphenous vein stripping to the ankle was performed. Patients who had undergone this procedure, performed in a downward manner by a single surgeon over a 12-year period, were contacted and asked to return for a follow-up examination. Subjects completed the Aberdeen Varicose Vein Symptom Severity Score as well as a questionnaire designed to identify symptoms of saphenous nerve injury and any effects on quality of life. They were then evaluated for saphenous nerve deficits with simple neurologic tests. Charts were reviewed to determine preoperative CEAP classification. Results were analyzed for statistically significant differences between groups.
RESULTS: Out of 111 patients (127 legs) who had undergone the procedure, 38 (34%) agreed to participate in the study. Three of these patients were ultimately excluded because of an inability to obtain a reliable neurologic examination of the legs, leaving 35 patients with a total of 45 legs operated. Participants did not differ from the potential study population in demographic data, follow-up interval, or preoperative CEAP classification. Median time since operation was 4.5 years (range, 8 months to 10.75 years). Overall, 40% of patients reported symptoms consistent with saphenous nerve injury at some time after operation, but these symptoms affected quality of life in only 6.7%. Symptoms persisted at evaluation in 17.8%, and only one patient (2.3%) reported any negative effect on quality of life at the time of examination. Saphenous nerve deficits were identified in 58% of patients. Patients with deficits had no statistically significant differences from those without deficits in terms of demographic data, follow-up interval, preoperative CEAP class, or Aberdeen score.
CONCLUSIONS: Signs and symptoms of saphenous nerve injury are common at long-term follow-up after greater saphenous vein stripping to the ankle. However, there appears to be little, if any, significant resultant morbidity. The risk of saphenous nerve injury should therefore not be considered a reason to avoid stripping of the greater saphenous vein to the ankle.