The Short Saphenous System | Varicose veins

The Short Saphenous System | Varicose veins
    • This shows the posterolateral side of the left lower leg, with varices involving the short saphenous vein system and some of the frequently observed incompe­tent communicating veins. The short saphenous vein (1) is seen from its origin dis­tal to the external malleolus and extending proximally behind it, then a little lateral to the midline to terminate in the popliteal vein in the popliteal space beneath the deep fascia. It is important to remove this vein when it is varicosed. Usually the presence of varices on the outer side of the ankle, as shown, indicates that the vein is incompetent. Confirming evidence should be obtained by the Trendelenburg and Schwartz tests. The enlarged veins coming up from the lateral plantar surface of the foot (2) and some on the dorsum should be interrupted.

Another large varix is seen on the posterolateral side of the knee (3) that is best treated by multiple ligation and division through small incisions if the com­municating vein cannot be found. Note that lower down at (4) the varix abruptly ends. This invariably indicates the presence of an incompetent communicating vein at this site, which should be ligated and divided.

    • This shows the anterolateral side of the left lower leg and the dorsum of the foot. Note that a portion of the short saphenous vein (1) is shown. The veins (2), (3) and (4) are tributaries of the long saphenous vein and frequently can be removed by stripping. The communicating veins shown on the dorsum of the foot (5) and (6) if ligated and divided will help to cure the prominent varicosities on the dorsum. Additional incisions should be made at (7) and (8) when the varices end abruptly in order to ligate the communicating veins in these locations. It may be possible to strip the other varices extending proximally; if not, multiple interrup­tions through small incisions should be used.
    • This demonstrates the varices around the external malleolus, in this patient requiring stripping of the short saphenous vein (1), interruption of communicating veins at sites (2) and stripping of varices (3).

It should be pointed out that varices of the short saphenous system are much less common than of the long saphenous system. As a result, short saphenous varicosi­ties are frequently missed. It is believed this is because the examining surgeon does not turn the patient around so that he can examine the posterior aspect of the leg for the presence of such varicosities.

The Short Saphenous System | Varicose veins


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