High Ligation for Small Saphenous Vein Aneurysms at the Sapheno-popliteal Junction under Knee-joint Bending

Abstract

Flush ligation of the small saphenous vein (SSV) is only performed in a limited number of institutions because of the technical difficulty of the procedure and the risk of neuropathy and deep vein damage. In this report, we propose the concept of ligation under knee-joint bending as an approach to facilitate flush ligation of the SSV. We applied the technique in the treatment of aneurysms localized near the sapheno-popliteal junction (SPJ).

[Subjects] The surgical procedure was performed in six cases of varicose veins with an aneurysm localized near the SPJ. Diameter of the aneurysm was ≥20 mm in three cases, and the distance to SPJ was ≤5 mm in five.

[Surgery method] Following the induction of a combination of tumescent local anesthesia and intravenous anesthesia, a 7-mm incision was made in the popliteal fossae. The SSV was exposed, ligated, and dissected. Once the proximal end of the SSV was raised and several branches were cut off without further dissection, the knee joint was bent ≥45°. This technique raised the SSV approximately 15 mm, making flush ligation easier to perform.

[Results] The mean surgical time was 37 minutes. In all six cases, high-level ligation was completed proximal to the aneurysm. No complications, such as neuropathy, deep vein thrombosis, and pulmonary embolism, were reported following surgery.

[Conclusion] The ligation under knee-joint bending technique was simple and safe and can, therefore, be widely applied in the future.