The Anatomy – Varicose veins of the lower extremity

The Anatomy – Varicose veins of the lower extremity
  • The long, or greater, saphenous vein is shown from its origin on the dorsum of the foot to its termination where it joins the common femoral vein at the fossa ovalis. Note that there is a lateral and medial trunk to the main vein in the thigh; the medial vein even extends down the lower leg. Another important trunk is a posterior one in the lower leg that arises near the internal malleolus and terminates proximally with the main trunk at the knee level. In the majority of patients these blood vessels lie superficial to the deep fascia of the extremity, but in some the main trunk in the thigh may lie beneath it; in the lower leg they are always superfi­cial to the fascia. The location of the communicating veins is also shown. Note that they are found in the foot and thigh as well as the lower leg, where they are most numerous. This system of vessels connects the superficial veins with the posterior tibial, anterior tibial and peroneal veins, so their distribution follows the course of these deep veins. The interruption of them when they are incompetent is essential if varicose veins are to be cured.
  • The short, or smaller, saphenous vein is shown from its origin on the lateral side of the dorsum of the foot, coursing up the posterolateral side of the ankle and lower leg. It goes through the deep fascia, usually in the upper third of the lower leg to terminate in the popliteal vein, most commonly in the mid portion of the popliteal space. Note the osculations with the branches of the long saphenous sys­tem and the venous tributary connecting the cephalad end with the main sa­phenous vein trunk. The location of the communicating veins is shown in the foot and the lateral side of the lower leg.

The goal of the surgeon treating varicose veins by surgery should be to cure the condition by performing the proper and adequate surgical procedure at the operat­ing table, so that few if any postoperative injections of a sclerosing solution will be needed for residual veins. In order to attain the goal the surgical treatment should consist of (1) ligation and stripping of the long saphenous vein and any secondary trunks in the thigh and lower legs; (2) removal of the short saphenous vein, if in­competent, in a similar manner; (3) then, of great importance, interruption of all incompetent communicating veins by ligation and division; and (4) removal of all large tortuous varicosities that cannot be stripped through multiple short oblique and transverse incisions. The methods of performing these various procedures are demonstrated in the following illustrations and legends.

The Anatomy - Varicose veins of the lower extremity

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