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.
      • This is inset (a) on the lower part of the thigh to demonstrate the method of removal of the tortuous varix. The incision crosses it at almost a right angle. If the incision is made directly over and parallel to the varix the skin edges may slough because the skin is so thin. As shown in the diagram, with a small rake retractor and with steady traction on the severed end of the vein it is possible, using sharp scissor dissection, to unravel and extract the varix subcutaneously halfway to the next incision. The remainder of it is removed in a similar manner through the ad­jacent incision. The complete removal of such varices is accomplished by use of multiple incisions.
      • This is inset (b) on the lower leg and shows the proximal ligated end of a com­municating vein as it emerges from the deep fascia. The other end, which is the varix, may be partially removed as shown in B, or stripped if it is not too tortuous. Sometimes simple ligation may be all that can be done. It is surprising how frequently these communicating veins are relatively small in caliber, yet are such an important factor in the etiology and persistence of lateral leg varices.
      • This shows some of the communicating vein sites on the lateral and dorsal aspect of the right ankle and foot and the short incisions made to interrupt them. The most lateral ones feed the distal end of the short saphenous vein and so should be interrupted. In addition, the long varix (1) should be stripped. As a rule, this is most readily done from the lower leg to the foot. It usually is a tributary of the long saphenous vein.
      • Similar communicating veins will frequently be found on the dorsum and inner side of the foot, feeding the distal end of the long saphenous vein. In addition to stripping the saphenous to just below the internal malleolus, it is worthwhile to continue down to the distal incision. The other incisions are used to interrupt the communicating veins where the varix ends abruptly.


      Phlebectomy and interruption of incompetent lateral leg and foot communicating veins for large tortuous varicoseveins



Leave a Reply