[Ambulatory ligation of the sapheno-femoral junction. Complement of Dr. Muller's ambulatory phlebectomy technique].

The early diagnosis of incompetence of the sapheno-femoral junction is made possible by combined ultrasonography/Doppler. Thus when the great saphenous vein is not too dilated and is not the site of severe ectasia, ligation of the junction may be sufficient to deal with malfunction of the latter. This is an outpatient procedure. Following local anesthesia (lidocaine 0.25%), a 4 cm incision is made in the inguinal fold between the femoral artery and the tendon of gracilis muscle. Dissection of the great saphenous exposes a lake distal to the collaterals of the sapheno-femoral junction and--by traction--obtains maximal exposure of the junction. A wide Weck hemoclip is used to interrupt reflux in the incompetent junction. We ligate the pudendal veins entering the femoral vein separately. This procedure neutralizes a major perforator under local anesthesia by an out-patient technique free of morbidity. Varicose veins are removed subsequently using the technique of Dr. R. Müller.