[The sapheno-femoral area: Anatomic study and concepts for the prevention of varicose recurrences]

The rate of varicose recurrences from the groin after stripping of the long saphenous vein is still high in case of ligation flush with the femoral vein. Is it due to a vascular neogenesis or to the development of pre-existing collaterals? Many authors highlighted the necessity of the femoral vein dissection, but the evaluation of the recurrence risk remains uncertain. 114 patients have been operated consecutively in 1988-1989 under local anesthesia, to perform 150 long saphenous vein strippings. At the same time as the sapheno-femoral junction ligation, a dissection of the front and lateral sides of the femoral vein was systematically carried out from 1 cm above down to 3 cm below the saphenous junction. 14 sub-fascial collaterals going directly to the junction lower angle (frequency rate = 9,3%), 41 internal tributaries of the femoral vein on the whole length of the junction (27,3%), 19 antero-internal (12,6%) and 14 antero-external (9,3%) tributaries of the superficial femoral vein below the junction, capable of draining a superficial area, were noticed in the 150 saphenofemoral areas. Several collaterals might exist on a same femoral vein. Only 86 (57,3%) sapheno-femoral junctions were "isolated", i.e. without deep collaterals. 90% of the antero-internal collaterals were located from 0 to 15 mm below the junction and their diameter was from 1,5 to 3 mm (in supine position, i.e. without any orthostatic reflux !) in 78,9% cases. All the antero-external collaterals were located from 10 to 30 mm below the junction, but they were nearly always equal or less than 1 mm wide.(ABSTRACT TRUNCATED AT 250 WORDS)