Reinterventions for primary varices.

Out of more than 6,000 patients operated for varices since 1949, in private practice, 281 had already been operated on once before. In 230 of these cases, the first operation performed elsewhere had been incorrect or incomplete: partial stripping, a badly performed excision of the saphenofemoral-junction, neglect of gross perforants, neglect of the saphena parva which was partly or wholly responsible for 96% of the recurrences. Moreover, a partial operation, even if correct, does not check the development of a disorder which is often bilateral (89%) and which often affects the four saphenous veins (59%). 51 had been operated by myself, hoping that they would not have to come back; 29 cases in which 2/3 of the long saphenous vein was stripped and with crossectomy of the short saphenous vein until 1964, and 22 cases of complete stripping after 1965. 49 short saphenae had been causal in the first group but we noted 14 popliteal recurrences in the second. A mistaken anatomical abnormality, sixteen perforants but more particularly 30 regrown internal saphenofemoral junctions were noted in these two groups. It is difficult to give reasons for them. Finally the post-operative phlebological follow-up is often irregular or neglected. Re-operations are difficult but, with the aid of a phlebographical control, they give good results, except for deteriorations of the deep tract necessitating certain static hygiene. The best guarantees of a satisfying and lasting result are a complete and correct initial treatment of the main varices, and regular phlebological check-up.

[Arterial complications of the treatment of varices]. / Les accidents artériels du traitement des varices.

Surgical accidents (wounding, the inept mutilation of the fork of the femoral artery) are serious only when they are not recognized, and are treated late. If they are treated immediately, or soon after their occurrence, by an able team, recovery is usually straight-forward and successful. However, if a sclerosant solution is injected by accident intra-arterially, it causes irreparable damage to the area concerned, even if diagnosis is immediate and a strongly active treatment administered. Examples are cited.

[Direct approach for bypass of the distal deep femoral artery. The supra mediocrural route]. / Abord direct pour pontage de l'artère fémorale profonde distale. La voie sus-médiocrurale

The medio-femoral route permits a simple, direct approach to the distal part of the profunda femoris artery outside Scarpas triangle, i.e. below the first perforating artery. The quadriceps femoris and sartorius muscles are separated. This segment may reach the lower part of the popliteal artery through various collaterals supplying the muscle and nerve arteries and, hence, the leg. In selected cases with severe ischemia and absent femoral pulse, a by-pass operation carried out at this level permitted one to obtain a satisfactory arterial blood supply to the leg and foot. Used in only three patients, with a follow-up of several months, we cannot yet draw final conclusions, but the quality of the early results is evidence for the interest of the method.