Publication

Abstract : Varicose veins, a common disease in surgical practice, has vexed surgeons for ages, due to its various problems. We hereby present a pilot study of 80 consecutive patients who underwent anatomical and haemodynamic evaluation at the time of Tren-delenberg procedure. Aim 1.To study the location of the saphenofemoral junction(SFJ) in relation to the pubic tubercle. 2.To locate variations in the pattern of tributaries around the SFJ 3.To analyse the haemodynamics of the SFJ Materials and methods 80 consecutive patients who underwent Trendelenberg procedure from August 2007 to August 2008 are presented. Radiological and clinical evaluation were done and patients were subjected to Trendelenberg procedure at which time position of the Sapheno-Femoral junction(SFJ) in relation to pubic tubercle was measured, also noting nature and number of tributaries. A demonstration of the severity of reflux was made and all the information was noted and computed. Results We found that in the Indian patient the position of the SFJ was higher and more medial than the Western counterpart. There were fewer tributaries in the Indian patient. The external pudendal artery was seen more commonly in the Indian patient and could act as a landmark for identification of the SFJ. Conclusion SFJ was seen at a much higher point contrary to the popular anatomy. High incision using the pubic tubercle as the reference point gives good exposure for flush ligation and identification of the tributaries at the SFJ thereby preventing inadequate primary surgery. In our study, there are between 4-5 tributaries at the SFJ and these need to be completely identified and disconnected. Deep external pudendal artery is seen as it goes laterally at the lower border of the cribriform facia and forms a good marker of the termination of GSV and presence of the SFJ.