The operative technique of ligation and stripping of the saphenous vein

This shows an intraluminal stripper that has been inserted into the vein at the ankle and passed proximally in it to the popliteal space.

The tip of the stripper can be readily palpated at the level at which the short saphenous vein turns acutely to go deeper to join the popliteal vein, so that exposure of the proximal end of the vein is greatly facilitated through a properly placed small transverse incision. Care should be taken not to attempt to pass the stripper higher unless it stays relatively superficial, because sometimes the junction of these two veins is at an acute angle and the stripper may pass up into the popliteal vein.

Under these conditions the tip of the stripper is lost to palpation. It should be immediately withdrawn in order to place the incision at the correct level, since the location of the junction of the two veins does vary considerably. The exposure has been carried down to the deep fascia of the popliteal space. The proximal portion of the short saphenous vein is shown beneath it because, at this level, it is always subfascial.

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