The operative treatment of varicose veins of the lower extremity

The operative treatment of varicose veins of the lower extremity

The cure of varicose veins of the lower extremity can be accomplished by their surgical removal and the interruption of the incompetent communicating veins that are so important in the etiology. The percentage of cures depends on how rad­ical these surgical procedures are. The best results cannot be accomplished unless the surgeon has personally made a thorough examination of the extremities when the patient was first seen in his office. At this time a drawing of the varices should be made, tracing in the largest ones and noting the location of the incompetent communicating veins. The reason for this is that the varices will be more promi­nent when the patient is ambulatory than they will be the morning of operation after the patient has been in bed overnight.

  • This shows the varicose veins and the location of the incompetent com­municating veins of the long saphenous system of the lower extremities being marked with a black waterproof ink brush-type pen. Various other means have been tried, but this method has been found the most satisfactory. The marking is done while the patient stands, just before anesthesia is commenced, with refer­ence to the drawing made in the office. It is recommended that the surgeon who is to perform the operative procedure be the individual to mark the veins. Special at­tention should be given to marking the course of the largest tortuous varices. The locations of the communicating veins to be interrupted are marked with X’s. In addition, other X marks are placed where multiple transverse incisions will be required to excise the large tortuous varices that cannot be stripped.
  • This is a posterior view of the lower legs. The X marks on the left calf demon­strate the location of the incompetent communicating veins; the ones at the ankle indicate the location of others. The ones on the right calf indicate that there are in­competent communicating veins in this region. In addition, the large tortuous varices are marked so that they can be excised through multiple transverse in­cisions to obtain the best results; they are too tortuous for stripping.
  • General anesthesia consisting of intravenous pentothal, a muscle relaxant and nitrous oxide administered through an endotracheal tube is the preferred method. Spinal anesthesia works well, but because of the high percentage of post­operative spinal headaches, it is not recommended. The patient is shown lying supine. The skin of the lower abdomen, groins, legs and feet is cleansed with ether, then with an alcohol solution of hexachlorophene, care being taken not to rub away the previously placed ink marks. The toes and part of the feet are cov­ered with rubber gloves. Sterile towels and sheets are used to drape the patient, leaving the groins and legs exposed.

The groin incision is made first about 1.5 cm. below and parallel with the groin crease. The location of the femoral artery pulsation is ascertained in order to make the incision so that at least three quarters of it lies medial to this artery and only one quarter lateral to it. This is because the saphenous vein courses slightly poste­rior to the femoral vessels after its takeoff; this makes for an easier and safer ex­posure of its proximal portion.

The operative treatment of varicose veins of the lower extremity

The operative treatment of varicose veins of the lower extremity


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