A conflict in vascular surgery.

It is believed that many surgeons, by adopting 'stripping' as the routine surgical treatment of significant varicose veins may be sacrificing many major leg veins which could be potentially valuable arterial grafts. A protocol of surgery is suggested which replaces stripping by the stab-avulsion technique. Thus all varices are removed and distal incompetent perforators controlled. Freed from an inevitable 'high ligation', it enables selective ligation at proximal valves, only when they are incompetent. It is suggested that this protocol treats varices effectively whilst preserving undamaged veins. The results presented show a 3 year recurrence rate of about 10%, but evidence is offered that better results will be obtained, now that Doppler equipment is readily available.