Page 68 - Virtual Vascular Vol 4
P. 68

Surgery for Varicose Veins                                                                                              The SFJ is located in the groin crease, medial to the femoral pulse, and
                                                                                                                               approximately 2-3cm below to the pubic tubercle.




                                                                                                                               The wound is about 2cm long, and should be along the groin crease.
          Indications for treatment of varicose veins:

          -     worsening symptoms with significant impact on quality of life

          -     complications of varicose veins such as eczema, skin changes with

                hemosiderin pigmentation, lipodermatosclerosis, ulceration.                                                           Head end
          -     bleeding

          -     Superficial thrombophlebitis with thrombus very near to the

                saphenofemoral junction (SFJ), in fear of progression to femoral vein                                                                                                               Divided
                deep vein thrombosis                                                                                                    Saphenofemoral junction                                     superficial

                                                                                                                                                                                                    external
          SFJ ligation, strip of great saphenous vein (GSV) , and multiple avulsions                                                                                                                pudendal

          of varicosities (Trendelenburg operation) remain the gold standard of                                                    Divided superficial                                              vein

          treatment for patients with incompetent SFJ and GSV. Other treatment                                                     circumflex iliac vein
          options include radiofrequency ablation, laser ablation, or endovenous

          cyanoacrylate injection.                                                                                            Lateral                                                                                        Medial






                                                                                                                               Anterolateral

                                                                                                                               vein of the thigh







                                                                                                                                 Great (or long)
          Usually, there are 5 venous tributaries which join the GSV

          before the SFJ at the fossa ovalis. These 5 tributaries                                                                saphenous vein

          should all be ligated individually and divided at surgery to
          minimize the chance of recurrence.




          Can you name these tributaries?











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