The instrumental removal of the stem vein began with a kind of invagination of short vein segments by the American Keller in 1905.

In 1906, Charles Mayo succeeded in the first promising saphenous extirpation in Rochester with a ring-curette developed by him, with which he triggered the extraluminal stem vein.

In 1907, William Wayne Babcock was able to introduce the intravascular procedure with his stripper probe, which is still practiced today. However, the Mayo method, described in 1916 in Boston by John Homans with a combination of crossectomy, stripping and ulcer excision as radical surgery, remained the preferred method for many years.

The radical use of Vena Saphena and the associated complications, admittedly, led to a limited spread of the stripping method in Germany in the first half of the 20th century.

There were numerous opponents who were even carried away by exaggerated statements. Let us quote the royal fountain doctor Professor Winkler from 1917 (11):

„Babcock has indicated a method for cases where the dilated vein is rather straight, which surpasses everything that has been tried in this field in terms of crudeness. Before a patient gets involved in this graft, he should make his will“.

Dermatologists, in particular, have tried to achieve varicose veins or chronic venous insufficiency by intravascular occlusion of the saphenous septum and its lateral branches. Due to Linser’s success in Tübingen in the 1920s, when he first used sublimate and later high – percentage saline and sugar solutions, numerous surgeons left the surgical treatment.

Unfortunately, reports about recanalizations and critical opinions about the lack of long – term results of dermatologists became more frequent:

„Dermatologists always report on successes but rarely on long – term successes“. Moszkowicz complained in 1934. And Zeller suggested already in 1927,

„to combine „the well – founded bloody surgical therapy with the conservative method that is now so much in the process of being adopted“.

However, many years were to pass before the surgical therapy of the insufficient saphena was again accepted by the surgeons themselves.

In 1932, a survey showed that 11 out of 12 surgical university hospitals performed sclerotherapy! Just after the Second World War did an increasing differentiation begin between cases suitable for sclerotherapy and classical stem varicosis.

We  immediately experienced this period of departure and was able to dedicate ourself to questions about the Vena Saphena until Wolfgang Lahl´s  age – related retirement from clinical everyday life and also afterwards through cooperation with the organizer of the conference beginning today.

In the Sixties…

Unforgotten for me is the statement of the Nestor of German Vascular Surgery, Prof. Vollmar, at the Surgeons‘ Congress in 1969 that „the claim to sole representation of the sclerotherapy experts and leg wrappers as well as that of the exclusive strippers“.

Nonetheless, it was an expression of the still subliminal rivalry between surgeon and dermatologist for professional competence with regard to the clinical picture. Unfortunately, the longstanding disregard of many surgeons for the value of varicose vein disease has not helped us.

A great benefit was the introduction of duplex or color-coded Duplex sonography. Previously, we were always faced with the question of the indication for a phlebography, the decision for or against which could have legal consequences.

We do not like to say many words about the various procedures to tear poor Vena Saphena out of the tissue. Whether ante or retrograde stripping, whether CHIVA, cryo or trivex procedures, invaginating or PIN stripping according to Oesch, whether with or without bloodlessness etc., in the end all methods more or less injured the surrounding tissue and always contained the danger of damage to neighbouring structures. Therefore, we would like to touch on another area that is only given little attention in the publications of conventional varicose vein surgery.

Already in the seventies, Dr. Lahl was interested in lymphological questions, especially under the aspect of iatrogenic damage after arterial reconstructions or stripping procedures. The ventromedial lymph vessel bundle runs parallel to the Vena Saphena magna and is therefore directly endangered during stripping. The extent of a possible intraoperative injury was only poorly documented. At that time, lymphographies with the oily contrast medium lipoiodol were still allowed. Thus, we were able to perform postoperative examinations on selected patients, whose surprising results we also published. They showed how invasive the stripping procedure can be despite all caution and, on the other hand, they represent a not to be underestimated advantage of endovenous methods.

Lymphography after stripping – op:  lymph vessels destroyed

Dr. Lahl also point out the possible nerve damage. While an injury in the saphenous region can be observed relatively frequently and is usually tolerated by the patient, it can never be safely avoided in the course of the sural nerve and is extremely unpleasant for the patient in the long term.  We are not aware of any really reliable data on the frequency of suralis lesions.

A large repertoire of surgical instruments has been developed for the gentle handling of the saphenous tissue and the perivasal tissue. Almost every surgeon had his preferred instrument, often named after him.

Despite the optimization of surgical therapy, the use of sclerosing drugs by our dermatological colleagues was unbroken. With the introduction of ultrasound-supported sclerotherapy and the use of microfoam, new possibilities arose to include not only side branch varices but also an inefficient saphena in the therapy concept.

Later, surgeons and phlebologists developed the various endovenous techniques at the beginning of the 1990s. Hence, they followed the demand of a nestor of phlebology, Urs Brunner, who already three decades ago formulated the desired treatment of Saphena as follows:

„Today’s concept is conservative, reflux-oriented, aesthetic“.

It is easy to answer the question of what led to the rapid development of endovenous forms of therapy that today replace the stripping method (19).

– they avoid larger wound areas, haematomas and infections – there is a general trend towards minimally invasive surgery – the patients demand a rapid

Rehabilitation, preferably without inability to work as well as optimal cosmetic results

– suitable technologies have been developed and modern catheter techniques
also developed for phlebology

– also a preferably radical approach in the conventional varicose vein surgery
could not prevent the recurrence,
with the actual recurrence rate after operative remediation of stem varicose veins has not yet been clearly proven. The information on this varies between 7 and 60 per cent.

And so, through the use of the new procedures adapted to the findings, the Vena  Saphena  long path of suffering also seems to have come to an end, in which it can remain closed but without damage to the surrounding structures and for the benefit of its bearers in its traditional place.