I. Anatomy of the saphenous vein
The saphenous vein is located inside the superficial fascia and outside the deep fascia (this phrase should be kept in mind), starting from the medial part of the venous network of the dorsalis pedis, along the medial side of the calf along with the saphenous nerve superiorly through the front of the medial ankle, around the posterior side of the medial femoral condyle, then along the medial side of the femur superiorly and gradually turning to the front, and finally injecting into the femoral vein through the saphenous vein fissure at 3-4 cm below the pubic symphysis.
There are generally five superficial veins converging into the saphenous vein close to the injection site, they are
1. superficial abdominal wall vein: drains superficial venous blood from the lower part of the abdominal wall.
2, the superficial spinococcygeal vein: to receive superficial venous blood from the lower abdominal wall and the upper and lateral parts of the femur
3, the external pubic vein: drains superficial venous blood from the vulva.
4, medial superficial femoral vein: superficial venous branches from the medial femur
5.Lateral superficial femoral vein: superficial venous branch from the lateral femur.
All the geniculate branches near the saphenous vein fissure are cut and ligated separately, otherwise they are prone to postoperative recurrence. There are various types of injection of these five branches into the saphenous vein, such as one vein alone or two to three of them combined and injected into the saphenous vein.
There are more venous valves in the saphenous vein, an average of 8, of which the most constant is the injection of the saphenous vein into the opening of the femoral vein. The venous valves are bivalve-shaped pouches, usually with two opposing valves, to ensure the centripetal flow of venous blood. The valves prevent blood from flowing backwards toward the terminal part. There are many traffic branches between the saphenous vein and the deep veins, most often in the lower 1/3 of the thigh and the upper and middle 1/3 of the calf. These branches have valves that guide the superficial venous blood into the deep veins.
Clinical problems of saphenous vein
1. The saphenous vein can be used as the access for resuscitation and rapid infusion of fluids for patients in shock.
2.The saphenous vein can be used as a graft for coronary artery bypass grafting.
3.High ligation and stripping of saphenous vein for varicose vein surgery.
Third, simple saphenous varicose vein
Simple superficial varicose veins of lower extremities refer to lesions limited to saphenous vein, small saphenous vein and its branches, and the majority of patients occur in saphenous vein, which is called saphenous varicose vein. The superficial veins are elongated, dilated, and flexed, and they occur mostly in people who are permanently engaged in standing work and physical labor. Simple superficial varicose veins of the lower extremities are usually mild and surgical treatment often provides good results.
Treatment
1.The treatment of saphenous varicose vein is based on high ligation and stripping.
2.If the saphenous vein is incompetent but the traffic branch and deep vein are normal, high ligation can be done to cut off the saphenous vein and its branches.
3.Incompetent saphenous vein valve and incompetent traffic branch valve, in addition to the above surgery, the abnormal traffic branch should be ligated and cut off respectively, or saphenous vein stripping.
4.If the small saphenous vein enters the N vein with reflux phenomenon, the entrance section can be ligated and excised, and the distal section can be stripped or injected with sclerosing agent.
5.Limited varicose veins with small scope, or only the traffic branch valve insufficiency, or part of the varicose veins left after surgery, or local recurrence after surgery, sclerotherapy is applicable.
6.The following cases are not suitable for injection or surgical therapy, but can be treated by wearing elastic stockings.
(1) Systemic diseases, such as active hepatitis, progressive tuberculosis, uncontrolled diabetes, severe heart or kidney disease, etc.
(2) Local diseases, such as arterial circulation disorders, deep venous obstruction, intrapelvic or intra-abdominal tumors, acute phlebitis, and calf ulcers complicated by cellulitis.
(3) Patients during pregnancy, over age, secondary to arteriovenous fistula, etc.
7.Injection therapy: 5% cod liver oil sodium acid, etc. Patients stand, so that the varicose vein is filled, in the scheduled injection site, with a needle beveled short injection needle into the blood vessels, then ask the patient to lie down, the affected limb slowly elevated, pay attention to fix the needle does not move, wait for the varicose vein in the blood completely driven out, with fingers tight pressure on the upper and lower end of the section of the vein, and then slowly inject sclerosing agent, followed by massage at the injection site with gauze, and then from the toes to the knee wrapped with then wrapped with an elastic bandage from the toe to the knee for 2~3 weeks. After the injection, the patient is instructed to walk as usual.
Prevention
1, this disease has a genetic tendency, generally in the 30 years of age onset, so in childhood and adolescence should be diligent exercise, enhance physical fitness, to help prevent.
2, obese people should lose weight, obesity is not the direct cause, but the excessive weight pressed on the legs may cause poor venous reflux in the legs, so that the venous dilatation aggravated.
3, long-term heavy physical labor and long-term standing work, it is best to wear elastic stockings cover.
4, women during menstruation and pregnancy and other special periods to give special care to the legs, more rest, to often massage the legs to help blood circulation, to avoid varicose veins.
5, quit smoking, because smoking can make the blood viscosity change, blood becomes sticky and easy to stagnate. Oral contraceptives also have a similar effect, should try to take less.
6, elevate the legs and wear elastic stockings: elevate the legs so that the body position changes to help the venous blood flow back. Elastic stockings should be chosen from socks with high elasticity (medical), and the legs should be raised and slowly put into them before getting out of bed each day. The pressure of the elastic socks can improve and prevent varicose veins in the lower limbs.
7, every day adhere to a certain time walking, walking can play the calf muscle “muscle pump” role, to prevent the pressure of blood backflow.
Normal saphenous vein Saphenous vein body projection Saphenous vein localization Saphenous vein travels within superficial fascia Normal blood flow to the venous valve Pathology of varicose veins Saphenous vein can be used as a graft for coronary artery bypass grafting.