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Thomas T. Myers, M.D.
JAMA. 1957;163(2):87-92. doi:10.1001/jama.1957.02970370001001.
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• The principles here outlined for the surgical treatment of varicose veins in the lower extremity are based on 2,660 stripping operations done over a five-year period and on 510 secondary operations for persistent or recurrent varicosities. Stripping means the removal of the incompetent part of the venous system. A length of vein that is not too tortuous can be removed by passing a stripper through it either from a proximal to a distal incision or vice versa; it is also possible to pass the stripper in both directions, for instance, from the knee. Veins too tortuous to permit passage of the stripper must be removed by dissection or evulsion. If the great saphenous vein is involved it must be ligated flush with the femoral vein at their junction, and the dissection at the groin is exacting. All other veins coming into the femoral vein laterally and medially should be ligated and removed by direct dissection, and the medial and lateral superficial branches of the great saphenous system should be prepared for removal if they are large. The flash bleeding that follows stripping usually stops soon, and the broken smaller tributaries retract. If bleeding persists, packing of the channel and ligation or removal of the responsible tributaries may be necessary. Follow-up studies over a period of years have shown that excellent results, with a minimum of secondary operations, can be achieved by proper preparation of the patient, appropriate choice of anesthetics, and good after-care.


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