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.
  • After exposure of the blood vessel that is thought to be the saphenous vein, it should be carefully examined with the end of one’s finger or by pinching it be tween two fingers to make sure it is not a pulsating artery before dividing it between clamps. It does not seem possible that the femoral artery could be mistaken for the saphenous vein, but this accident has occurred too often; in a few instances the artery has even been stripped, with disastrous results. Another error has been interruption of the femoral vein instead of the saphenous vein. It also should be remembered that the long saphenous vein lies superficial to the deep fascia of Scarpa’s triangle, whereas the femoral artery and vein lie deep to it. Since the above mistakes may mean the loss of a limb, every precaution should be taken to avoid them.
  • The main saphenous vein trunk is doubly clamped and then divided after as¬≠surance that this is the long saphenous vein and not some other blood vessel. The dissection is carried proximally to interrupt and ligate the proximal branches. This greatly facilitates the exposure of the fossa ovalis through which the saphenous veins go to join the common femoral vein. As a rule, three or four branches will be found. The lateral one is sometimes moderately large and is the cephalad end of a lateral trunk, which should be stripped.

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  • The distal clamped ends of the main trunk (1) and the lateral trunk (2) are shown. Three other branches are visible (one in a hemostat) and should be divided.

The operative technique ligation and stripping of long saphenous vein


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