Proximal superficial femoral vein interruption

Proximal superficial femoral vein interruption

A positive diagnosis of deep calf venous thrombosis is sufficient indication to perform interruption of the superficial femoral vein at its junction with the profunda femoris vein. If a patient has had a warning, nonlethal pulmonary embolus, it is a good rule that the femoral veins in both extremities be interrupted irrespective of whether there are positive signs of venous thrombosis in the extremities. It is believed that this is a better operation for the patient than interruption or clipping of the inferior vena cava. The operative procedure may be performed under local infiltration anesthesia or light general anesthesia.

      • This shows the operating table in slight reversed Trendelenburg position. It is important that the patient’s body be elevated 10 degrees to produce positive pres­sure in the femoral vein to prevent thrombi from being dislodged and sucked proximally to result in pulmonary embolism.
      • This shows the location of the incision for femoral vein interruptions. The in­cision should be made longitudinally directly over and parallel with the femoral ar­tery pulsations. It extends up to the groin crease for the superficial femoral vein interruption as shown in the left groin; for the common femoral it should extend proximal to the groin crease as seen in the right groin for a more proximal exposure which is necessary.
      • The superficial femoral artery and vein are isolated by opening the Scarpa’s fascia. The dissection should be commenced distally and worked proximally to prevent injury to the common femoral vein. At the same time the surgeon should look for the bulge in the superficial femoral vein which indicates accurately the location of the profunda femoris vein just proximal to it. The femoral vein should be carefully palpated to make sure it does not have a thrombus in it because, if it does, the interruption should be of the common femoral vein instead of the super­ficial femoral vein.

Note the proximal portion of the saphenous vein (1), which should not be injured. The superficial femoral artery (2), with a small sensory branch of the femoral nerve coursing along it, lies lateral to the common femoral (3) and the superficial femoral (4) veins. The profunda femoris vein (5) terminates at the junction of these two veins, just proximal to a bulge in the superficial femoral vein, the site of a venous valve. This is a constant anatomical landmark and is an aid in locating the profunda femoris vein.

Proximal superficial femoral vein interruption

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