Page 69 - Virtual Vascular Vol 4
P. 69

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?











               Foot end
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