Saphenectomy: Procedure, Recovery, and Rehabilitation

The term "saphenous vein" refers to one of the main veins in the legs, which can be distinguished into the great saphenous vein and the small saphenous vein.

The great saphenous vein runs along the inner side of the leg, while the small saphenous vein is located at the back of the calf. Both are part of the superficial venous system and transport blood from the peripheral areas of the legs to the heart for oxygenation and recirculation.

“The saphenous veins are more frequently affected by venous insufficiency compared to veins in other parts of the body. Venous insufficiency affects about 30% of the global population and, in advanced cases, leads to the development of varicose veins, also known as varices, in the saphenous vein.

Varicose veins are nothing more than dilated, pathological veins that become tortuous, enlarged, and easily visible on the surface,” explains Dr. Resta.

Caused by the degeneration of vein wall tissue, varicose veins typically develop with advancing age, genetic predisposition, and among individuals who engage in activities requiring prolonged standing.

In such cases, the saphenous vein, when it loses its full structural functionality, presents:

• Blood pooling
• Dilation and visibility of superficial veins (varicose veins)
• Pain
• A sensation of heaviness
• Swelling
• Skin changes in more severe cases

Safenectomy involves the removal of the great saphenous vein and becomes necessary when the vein no longer functions properly.

The procedure consists of removing all or part of the saphenous vein, depending on the extent of the varicose veins and the condition of the vein. It is performed through small incisions along the leg, and a probe is then inserted to facilitate its removal.

“Generally, for this type of procedure, spinal anesthesia is used, which numbs the lower part of the body; the patient remains conscious but without feeling in their legs.

However, the doctor, after carefully evaluating the individual clinical case, will recommend the most appropriate sedation method based on the patient’s medical history and the expected duration of the procedure,” confirms the angiologist.

The duration of the procedure can vary depending on the extent of the varicose veins and the surgical technique used, but it typically lasts about an hour.

After safenectomy, the patient is generally monitored for a few hours and can usually be discharged on the same day as the procedure, unless complications arise.

“The primary consequence of the surgery is the appearance of a hematoma along the entire thigh and leg. In the immediate postoperative period, the patient might experience some pain and swelling in the operated leg,” warns the specialist. “During this phase, to prevent possible thrombophlebitis, anticoagulant therapy with heparin is prescribed.”

Recovery involves certain precautions that can facilitate healing and prevent potential issues. These general recommendations include:

• Wearing graduated compression stockings, which help reduce swelling and improve venous return. These should be worn throughout the day for the first few weeks, but always following the doctor's instructions.
• Keeping the legs elevated and unloaded during rest. Dr. Resta states: “It is helpful to keep the operated leg slightly elevated to facilitate blood circulation.”
• Avoiding direct exposure to sunlight, hot baths, and saunas, as heat can increase swelling and slow down tissue healing.

As with any surgical procedure, safenectomy also carries some risks and possible complications. Among the most common complications are:

• Pain and swelling, especially along the inner thigh where the saphenous vein was removed. These symptoms may persist for a few weeks. Pain can be managed, under medical advice, with anti-inflammatory drugs and pain relievers.
• Hematomas or bruising that may form as a result of the small incisions.
• Infections at the incision sites.
• Tingling or numbness.
• Bleeding.
• Deep vein thrombosis (DVT): “Although rare,” says the angiologist, “DVT can cause a pulmonary embolism, which is why it is crucial to wear compression stockings and follow the doctor’s instructions.”

Movement is crucial for recovery after a safenectomy. It is essential to avoid sitting for prolonged periods. The patient is encouraged to start walking just a few hours after the surgery, always under medical supervision and depending on their post-operative condition.

Walking is recommended because it stimulates blood circulation and helps prevent the formation of blood clots. Typically, patients are advised to begin with short walks, gradually increasing the intensity of physical activity based on their condition.

The post-operative check-up is a critical step in the recovery process following a safenectomy.

During the first post-operative visit, the surgeon will:

• Check the healing of the operated area, remove the stitches, and assess any persistent swelling or pain.
• Provide guidance on how to continue the recovery process.

“The final follow-up visit, approximately two months after the surgery,” explains Dr. Resta, “is performed using a diagnostic tool, the venous color Doppler ultrasound, which is used to evaluate:

• The complete reabsorption of hematomas.
• The condition of the remaining deep and superficial veins.”