Trendelenburg operation for varicose veins
The Trendelenburg operation for varicose veins (varicosis) was developed by the surgeon Friedrich Trendelenburg during his time in Bonn. The operation consists of ligating the great saphenous vein on the thigh and removing a section a few centimeters long.
Initial description
Trendelenburg assumed that an important disease mechanism was insufficiency of the venous valves in the superficial leg veins, i.e. the great saphenous veins and the small saphenous veins ; therefore, on the wall of these two veins, the full hydrostatic pressure of the blood column in the large veins - the iliac vein and the vena cava - is applied up to the right heart. Therefore, with the Trendelenburg test, varicose veins that had previously been emptied by elevation filled up suddenly and retrograde, i.e. from above, when the leg was lowered: “A large amount of blood shoots into the saphena from above, and the old picture the taut Varicen is back ”.
That is why, wrote Trendelenburg, “the idea suggests, in an operative way, by permanent occlusion of the saphena at one point, to prevent the blood from flowing back from the iliac vein through the saphena into the varices and at the same time prevent the veins of the lower leg and foot from the abnormal To free the prints that weigh on them. Such a permanent closure can easily and without danger be achieved by double ligation and cutting of the vein between the ligatures, and after I have used this operation since 1880 in a large number of cases with the best results, I can do the same for all cases of Recommend lower leg varices with simultaneous expansion of the saphena. "
- Trendelenburg's publication 1891
title
Scheme drawing
In Trendelenburg's sketch, y means the smallest veins, x the so-called venae perforantes, through which the blood flows in healthy people from the superficial to the deep leg veins, for example the femoral vein , and A the ligament point during surgery.
Trendelenburg's following case also sheds light on the daily life of his time: “In one ... case I was able to monitor the success of the operation for 5 years. The varicose veins, which were enormously expanded before the operation, have remained less voluminous. The ulcer on the inner ankle, which had existed for 3 months and which had already healed when the bandage was changed 8 days after the operation, did not open again; the patient, now 44 years old, can stand by the washing tub all day without feeling any discomfort. "
Today's view
The operation, as described by Trendelenburg, is no longer performed today. But it was a step towards today's crossectomy . Says a retrospective in 1997 (translated from French): "Trendelenburg has the ligation of the Crosse introduced the great saphenous vein after he first examines the anatomy. He was the first to provide a theory and the proposed surgical solution. In his 1891 article he describes the venous valves, the connecting veins between the superficial and deep veins and the clinical examination methods. For therapy, he suggests ligating the cross of the saphena. The vein is exposed with the handle of the scalpel. Following Trendelenburg and his contemporaries, both pathophysiology and therapy have developed rapidly. "
See also
A second operation is named after Friedrich Trendelenburg: the Trendelenburg operation for pulmonary embolism .
Individual evidence
- ↑ a b F. Trendelenburg: About the ligation of the great saphenous vein in lower leg varices . In: Contributions to clinical surgery 1891; 7: 195-210
- ↑ HG Kluess, T. Noppeney and others: Guideline for the diagnosis and treatment of varicose veins . In: Phlebology 2004; 33: 211-212 http://www.schattauer.de/en/magazine/subject-areas/journals-az/phlebologie/contents/archive/manuscript/954.html
- ↑ M. Pocard: Des varices du moyen et de les couper: du papyrus Ebers d'à Trendelenburg . In: Annales de Chirurgie 1997; 51: 710-712
- ↑ http://www.whonamedit.com/synd.cfm/968.html
