Diseases of the Veins

The diseases of the veins have never attracted the surgical attention that arterial diseases have for a number of reasons. The apparent lack of interest in this branch of vascular surgery, despite the frequency of disorders, especially of the veins of the lower extremity, may in part be because the results of treatment of some of the common conditions involving them have for the most part been unsatisfactory.

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Inferior vena cava interruption and plication

Inferior vena cava interruption and plication
  • The inferior vena cava may also be exposed retroperitoneally with relative ease through a right paramedian right rectus muscle-retracting incision. The in­cision should extend from the pubis to 3 or 4 cm. above the umbilicus.
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The operative technique of ligation and stripping of the saphenous vein

This shows an intraluminal stripper that has been inserted into the vein at the ankle and passed proximally in it to the popliteal space.

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Thromboembolic disease – Proximal superficial femoral vein interruption

Thromboembolic disease – Proximal superficial femoral vein interruption
        • The femoral artery must be treated with great care to prevent injury to it. Under no conditions should it be retracted with a rubber tube or catheter around it because of the danger of fracturing its wall, with resulting thrombosis and occlusion. (See Introduction, Plate 12 A.)
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        The subfascial interruption of incompetent medial calf communicating veins

                • This shows the lower leg with a group of large varicosities in the pos­teromedial aspect of the calf and an intraluminal stripper in the long saphenous vein.
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                Postoperative care of extremities after radical operation for varicose veins of the lower extremity

                Postoperative care of extremities after radical operation for varicose veins of the lower extremity
                • This shows the location of the incisions, all of which have been closed with vertical mattress sutures of silk. The long saphenous vein has been removed from distal to the malleolus to the saphenofemoral junction. A lateral trunk was stripped to the small anterior low thigh incision. Through the oblique calf incision incompetent communicating veins were interrupted beneath the deep fascia, and through the two incisions at the ankle other communicating veins were interrupted at the point of their emergence through the deep fascia.
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                The operative technique ligation and stripping of long saphenous vein

                The operative technique ligation and stripping of long saphenous vein
                • This depicts exposure of the cephalad portion of the left long saphenous vein. To avoid inadvertently lacerating it, it is exposed most safely by scissor dissection with upward traction on the skin and the subcutaneous tissues with tooth forceps. The advantage of this method is that it does not retract the vein upward with the fatty tissue surrounding it. The dissection is accomplished most satisfactorily with curved Mayo type scissors.
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                Interruption of common femoral vein with thrombectomy

                Interruption of common femoral vein with thrombectomy
                • Interruption of the common femoral vein is indicated when a thrombus is found in it, or if a patient has had a minor pulmonary embolus, irrespective of whether there are signs of venous thrombosis in the lower extremities.
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                Phlebectomy and interruption of incompetent lateral leg and foot communicating veins for large tortuous varicoseveins

                Phlebectomy and interruption of incompetent lateral leg and foot communicating veins for large tortuous varicoseveins
                    • The lateral side of the right lower thigh and the lower leg are shown with large superficial varicose veins. They are so tortuous it is not possible to strip them; for that reason they must be excised through multiple, small, slightly oblique in­cisions. In addition, the location of two incompetent communicating veins should be noted at (1) and (2). These may be identified by the abrupt ending of the varices at these sites. It is important to interrupt them as they emerge from the deep fascia.
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                    The operative treatment of varicose veins of the lower extremity

                    The operative treatment of varicose veins of the lower extremity

                    The cure of varicose veins of the lower extremity can be accomplished by their surgical removal and the interruption of the incompetent communicating veins that are so important in the etiology. The percentage of cures depends on how rad­ical these surgical procedures are. The best results cannot be accomplished unless the surgeon has personally made a thorough examination of the extremities when the patient was first seen in his office. At this time a drawing of the varices should be made, tracing in the largest ones and noting the location of the incompetent communicating veins.

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