RECURRENCE OF VARICOSITIES FOLLOWING SURG ERY IN THE POPLITEAL FOSSA - ANATOMICAL DATA TO ULTRASONOGRAPHY AND SURGERY

The results of surgery of the short saphenous vein are less consistent than those of the long saphenous vein. The difference has been clarif ied by anatomo-physio-pathological studies which, as a complement to c linical examination, first used the different phlebography techniques and now benefit from pulsed colour echodoppler. They have shown that, in varicose veins considered to be of the short saphenous system, inco mpetence at its termination, with its anatomical variations, does not account fur all the findings. Thus, imaging and the findings at surger y, have revealed a genuine venous complex in the popliteal fossa situa ted in four areas: in the sapheno-aponeurotic area with a variable poi nt of termination of the short saphenous vein and important tributarie s along its convexity; in the area of the medial head of the gastocnem ius muscle with a voluminous trunk formed by the medial gastracnemial vein which may run towards the termination of the short saphenous vein or even drain into its concavity; in the deep plane of the popliteal vein, which is sometimes double; in the short saphenous network with i ts very variable vein in the popliteal fossa and the lateral gastrocne mial veins. In practice, this classification helps to identify congeni tal reduplications, abnormal of aberrant veins and to perform planned surgery aimed at preventing postoperative recurrences. This is so beca use the latter are due, albeit less frequently than at the sapheno-fem oral junction, to a ''new vein'' which is in fact simply a missed trib utary. Recurrences are mainly associated with: a duplication of the te rminal part of the vein which has been missed; a short saphenous stump fed by a trunk from the medical gastrocnemial veins which has a termi nation into the popliteal vein common with the short saphenous vein; i ncompetent large medial gastrocnemial veins draining separately; an in competent popliteal fossa perforator. The last two occur not uncommonl y together and it has also been noted that failure to strip the short saphenous trunk increases the likelihood of postoperative recurrences.