Duplex-scanning represents major progress in diagnosis of venous insufficiency. It now permits also amelioration of sclerotherapy, by direct visual reference to the Doppler screen by which means we guide puncture of the vein and control the injection, whether the vein is deep or the location difficult. It permits us also to follow up the results rigorously. The video shows the injection technique by Doppler guidance. The authors report the initial results of a study of 72 consecutive cases.
1) An unknown or underestimated vein. During the 3 first quarters of the century, except some outstanding but confidential anatomical studies, the SSV has been reduced to a diagram that assimilates it to a Long but shortened SV Surgeons contented with this representation, often to their cost. Moreover the SSV has not retained the clinician's attention due to ignorance or diagnostic negligence. 2) A feared or disliked vein. Awareness appeared twenty years ago (Soc. Fr. de Phlébologie 1972-1973, etc.). The stress was put on the prevalence of the pathology of the short Saphenous vein, on the shortage of the therapeutics: unforeseen events, casualties and failures. 3) An investigation. New methods of vascular investigation are asserting themselves. The non-invasive ones are more open to everyone although less accurate than phlebography. They contribute towards a larger field of exploration of the SS network and create infatuation for the vein. False varices of SSV are detected, perforating and anastomotic veins are taken into account. 4) A spokesman of deep venous circulation? The SSV pathology is closely linked with the functioning of the femoropopliteal trunk and also with the gastrocnemial and solear muscular veins. The study of deep and superficial interferences initiates into a new pathology, that of the muscular veins.
Blind dissection of incompetent perforators is common practice for vein surgeons. Since many years some of them have been trying to do this endoscopically by means of the proctoscope or other endoscopes used for different purposes. At present however several surgeons are developing special instruments for this type of endoscopy. Lately some of these surgeons came together to work up their experiences and to study the probable future of the method. It permits the diagnosis and at the same time the treatment of incompetent perforators. It allows the healthy ones to be spared. All this can be done from a small incision distant to the site of the perforators where the skin often presents with trophic changes. However general or regional anesthesia as well as the bloodless limb technique are prerequisites. As any endoscopy also this one has its specific dangers and complications and therefore has to be learned and performed carefully.
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