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Updated: May 12, 2025
The operation of Trendelenburg is especially appropriate to cases in which the trunk of the great saphena vein in the thigh is alone involved. It consists in exposing three or four inches of the vein in its upper part, applying a ligature at the upper and lower ends of the exposed portion, and, after tying all tributary branches, resecting this portion of the vein.
If the small saphena system also is involved, and if communicating branches are dilated, the veins fill up from below more rapidly. When the pressure over the saphenous opening is removed, the blood rapidly rushes into the varicose vessels from above; this is known as Trendelenburg's test. There are usually one or more bunches of enlarged and tortuous veins in the region of the knee.
The continuity of the artery may be restored by grafting into the gap left after excision of the sac a segment of the great saphena vein. Ligation of the Artery. The object of tying the artery is to diminish or to arrest the flow of blood through the aneurysm so that the blood coagulates both in the sac and in the feeding artery.
The 'superficial brachial vein', the 'cephalic' vein of the human subject, and the 'plat' vein of the farrier, may be resorted to in all lamenesses of the fore limb, and especially in all shoulder-wrenches, strains of the loins, and of the thigh and the leg, and muscular and ligamentous extensions of any part of the hind limbs; the 'vena saphena major', and the 'anterior tibial' vein may be punctured in such cases.
To effect this, after the bowels have been loosened by cooling clysters bleeding will be necessary. Therefore, open a vein in the arm, if she is not with child; the day after strike the saphena in both feet, fasten ligatures and cupping glasses to the arm, and rub the upper part. Purge gently with cassia, rhubarb, senna and myrobalan.
The instrument is passed along the lumen of the segment to be dealt with, and a ligature applied around the vein above the bulbous end of the stylet enables nearly the whole length of the great saphena vein to be dragged out in one piece.
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