What are the Saphenous Veins?

The great saphenous vein starts from the medial end of the dorsal vein arch, passes through the front of the medial malleolus, and travels along the medial edge of the calf with the saphenous nerve. It passes about 2 cm behind the medial condyle of the femur, enters the medial portion of the thigh, and is associated with the medial femoral cutaneous nerve. Yes, gradually upward, through the saphenous vein hole below the pubic tubercle, and merge into the femoral vein, the point of convergence is called the saphenous femoral point.

Chinese name: Great saphenous vein
Foreign name: great saphenous vein
Genus: Superficial veins, superficial abdominal veins, etc.

Indication: Insufficiency of great saphenous vein and branch valve
Contraindications: Aged and frail with heart and lung diseases
Surgical anesthesia: Spinal or epidural anesthesia

Great saphenous vein composition and distribution

There are five branches of the great saphenous vein: superficial circumflex vein, superficial abdominal vein, external vulvar vein, medial femoral vein, and lateral femoral vein. They merge into the great saphenous vein in various forms and are rich in anastomosis. When the saphenous varicose veins are ligated at a high position, each branch must be ligated and severed to prevent recurrence. There are 9 to 10 pairs of venous valves in the lumen of the great saphenous vein. The two flaps are usually opposite each other and have a bag shape, which can ensure the blood to return to the heart. In addition, the large saphenous vein and the small saphenous vein communicate with the deep vein. The perforating valve faces the deep vein, allowing blood from the superficial vein to flow into the deep vein. When the deep venous return is blocked, the perforating valve is not fully closed, and the deep venous blood flows back into the superficial vein, which can cause superficial varicose veins in the lower limbs.

Great saphenous vein atlas (4 photos)

Surgical treatment of great saphenous veins

Great saphenous vein indication

1. Superficial varicose veins of the lower limbs are obvious, accompanied by calf pain and swelling, pigmentation, and chronic recurrent ulcers.

2. Insufficiency of great saphenous vein and branch valve.

3. No previous history of deep vein thrombosis, and deep vein valve function is good.

Great saphenous vein contraindications

1. Those who are old and infirm, have diseases of important organs such as heart, lung, liver and kidney, and have poor surgical tolerance.

2. Those with deep vein obstruction.

3. Complicated with acute phlebitis or systemic purulent infection.

Great saphenous vein preparation

1. For those with ulcers in the lower extremities, the wounds are clean and the inflammation has been controlled after treatment.

2. Due to the wide scope of surgery and trauma, antibiotics were applied 24 hours before surgery.

3. Shave the pubic hair and prepare the skin of the affected limb.

4. Use gentian purple liquid to mark the location and running of varicose veins to facilitate surgery.

Great saphenous vein anesthesia

Spinal or epidural anesthesia.

Great saphenous vein surgery steps

1. Incision: On the inside of the femoral artery, make a longitudinal or oblique incision from the inguinal ligament to the inside. It is about 6cm long.

2. Separation of the great saphenous vein: Cut the skin and subcutaneous tissue, and cut the superficial fascia on the inside of the femoral artery to expose the oval fossa. The confluence of the great saphenous vein and femoral vein can be found. The major saphenous vein trunk was isolated with curved hemostats.

3. Cut off the great saphenous vein branch: Separate along the vein trunk to find branches such as shallow circumflex, shallow abdominal wall, shallow external vulva, lateral ventral and medial femoral veins, and ligate and cut them one by one. The position and number of these branches vary greatly, so the department should be exposed as much as possible during the operation, and each branch should be carefully searched until the great saphenous vein enters the femoral vein.

4. Ligation of the great saphenous vein: A thick silk thread is caused from behind the great saphenous vein, and the great saphenous vein is ligated at a distance of 0.5 to 1.0 cm from the femoral vein. Clamp two hemostatic forceps at the distal end of the ligature, cut the vein between the clamps, and apply a suture at the proximal end of the proximal forceps.

5. Inserting and advancing the saphenous vein stripper: Insert a hard or soft venous stripper downward from the distal end of the severed vein, and advance it along the vein. If resistance is encountered, it may have reached the tortuous part of the vein or the plane of the deep venous communication branch. After the external contact membrane of the skin reaches the cylindrical metal head of the stripper, make another small incision in the skin at the corresponding place, exposing the area The vein is ligated at the upper and lower ends of the stripper head, and the vein is cut between the two ligatures.

6. Withdrawing the vein: Pull the stripper evenly from the incision of the oval fossa, and withdraw while pressing to stop bleeding, and the entire large saphenous vein can come out. The great saphenous vein can also be pulled out from the lower incision in the same way.

7. Continue segmental resection: Continue to extract the varicose veins from the lower incision in the same way down to the ankle. After the varicose veins are peeled off, the large branches that still appear must be carefully separated and peeled off.

8. Removal of the incompetent branch of the valve: In the process of extracting the trunk or branch, if resistance is encountered and the skin is faint, it is often suggested that there is a thicker branch of the branch. Another small incision should be made. After the blood vessels are separated To be ligated and cut.

9. Suture: Suture the incisions and evenly bandage the entire lower limbs with elastic bandages or socks to prevent bleeding from the exfoliation site.

Varicose veins

Great saphenous vein considerations

1. The anatomy of the great saphenous vein root should be clear, and all branch veins must be cut and ligated to prevent recurrence.

2. If the local anesthesia is not clear or the patient is too obese, the medial malleolus or inferior knee can be used to cut the saphenous vein. After cutting off, insert the stripper into the proximal stump and push it up to the groin. The trunk of the great saphenous vein can be found.

3. At the confluence of the great saphenous vein and the femoral vein, there is a layer of sieve fascia between the two, which cannot be easily cut to avoid accidental injury to the femoral vein. Once the femoral vein is injured during the operation, the incision should be enlarged immediately to fully expose the site of the femoral vein injury, and 5-0 nylon thread is used for venous repair. If the femoral vein is completely cut off, a segment of the autogenous saphenous vein should be taken for an interpositional femoral vein transplantation.

4. If the varicose veins are tortuous and cannot be smoothly inserted into the stripper, it is not necessary to withdraw it once, but a small incision can be made to separate, ligate, and remove the varicose veins subcutaneously. Then extract the remaining great saphenous vein trunk.

5. If there is pigmentation, eczema or ulcers on the medial malleolus, it indicates that the valvular branch of the medial malleolus is dysfunctional, and the saphenous vein should be peeled off and the communication branch ligated at the medial malleolus.

Postoperative management of great saphenous vein

1. Starting from the foot, bandage the entire lower limb with an elastic bandage.

2. Lift the affected limb, and take the initiative to do plantar flexion and dorsiflexion of the foot, promote the venous return of the calf, and reduce deep vein thrombosis.

3. You can get out of bed for a short walk on the day after surgery.

4. After 10 to 14 days of suture removal, the elastic bandage may be discontinued after 4 to 6 weeks.