The Long Saphenous System (Varicose veins)

The Long Saphenous System (Varicose veins)
  • The distribution and patterns of varicose veins of the lower extremity have been found to be of greater help than the diagnostic tests to determine the type of operative procedure necessary to eradicate them.

This shows the long saphenous vein (1) from the lower left thigh to its origin on the inner aspect of the foot. The main trunk is readily recognized and should be removed from the groin to a level distal to the internal malleolus where it branches (2). The large group of varices seen on the inner side of the calf (3) is present in many patients with varicose veins. The presence of them always indicates that there are incompetent communicating veins, usually one to three, coming out through the gastrocnemius and soleus muscles and the deep fascia to join the su­perficial veins. Unless they are ligated and divided beneath the deep fascia, the pa­tient will not be cured of his varicose veins. These vessels are not palpable, but large varices in this location will assure the surgeon of the presence of incompe­tent communicating veins at this location. Without these varicosities the com­municating veins will be present but competent and so will not need to be interrupted.

Another common site for an incompetent communicating vein is at the ankle level 8 to 10 cm. above the internal malleolus. This location is shown by a star-shaped group of varices posterior to the main trunk (4), sometimes visible but most frequently palpable. Their presence here is also confirmatory evidence of an in­competent communicating vein that should be ligated as it comes out through the deep fascia. The varices frequently seen coming up from the plantar aspect of the foot (5) should be ligated and divided.

  • This shows a slightly different pattern on the inner side of the lower leg and ankle. The main long saphenous vein trunk (1) is seen. The large varices (2) that lie on either side of it in the proximal lower leg indicate the presence of incompe­tent communicating veins coming out through the deep fascia at the posterior edge of the tibia. These vessels should be ligated and divided beneath the deep fascia for the best results. It is not uncommon to find incompetent communicating veins at sites (3) and (4) as well. They should be ligated and divided through small in­cisions as they come out through the deep fascia. In addition to removing the main saphenous trunk by stripping, the distal branch at (5) should also be removed down as far as the lateral side of the foot.
  • This shows a chronic venous stasis ulcer of years’ duration secondary to vari­cose veins of the long saphenous system and incompetent communicating veins, chiefly above, underneath and distal to the ulcer. The bluish discoloration of the surrounding skin is evidence of the chronicity of this lesion. It can be readily cured by healing the ulcer either with bed rest, elevation and 2 per cent boric acid solution dressings, or by keeping the patient ambulatory and using a Unna’s paste or Elastoplast type of boot.
  • This demonstrates the venous pattern in the ankle and ulcer area after the ulcer has been healed. However, a cure can be obtained only by a radical procedure to remove all superficial varices and ligate and divide the incompetent communicating veins.

The Long Saphenous System (Varicose veins)

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