Note 28 — Chapter XXIX · SURGICAL DISEASES OF THE HEART AND VASCULAR SYSTEM. (continued 2)

Extirpation of the Internal Saphenous.—Keller has quite recently suggested a new method of extirpating these varicose veins without extensive scarring. He exposes the vein at two points a considerable distance apart, and ties above and below after separating it from its surroundings. The vein is then cut below the proximal end, the upper end of the section to be removed split and a strong ligature tied to it, care being taken to include no more tissue in the ligature than will pass through the lumen of the vessel. Then from the lower end a wire loop or probe is passed upward, a ligature is threaded into its eye and the probe is then withdrawn, carrying the ligature, after which traction is made upon the latter, the edges of the vein being inverted into its own lumen, it being thus extirpated by being turned inside out and withdrawn from its sheath. With the internal saphenous, when a slight puckering is seen about midway between the incisions, indicating that the anterior branch of the vessel has been reached, a third incision is made, the branch is ligated and divided, and then the traction renewed until the vein is entirely pulled through the lower opening. Several cases thus treated have been very successful.