CHOPIN

the relative simplicity and the good results obtained by the ligation of affectedveins have led to loss of enthusiasm for the unpredictablesclerosingtechniques. In some large medical centres the injection of sclerosing substancesas the major part of therapy is no longer carried out. Now even the well-tried techniquesof ligation are giving way to the comparativelyheroic proceduresof stripping of the entire length of the affectedvein by "pull through" methods from incisions at intervalsover the line of the vein. T. T. Myers and L. R. Smith' have stripped the long saphenous vein from the dorsum of the foot to the knee or to the groin in a large number of cases,and have combinedthis with the sclerosinginjection of remaining distal segments of veins. The.short saphenousvein was also treated by stripping out in a large group of patients. In the cases in which stripping was incomplete there was a recurrence rate of 19'3%; when the stripping was completethe recurrence rate was only 2%. The radical stripping operation was particularly satisfactoryin patientswith deep venous insufficiency. In a later paperMyers' statedthat stripping was used in all patients treated by surgical means for varicose veins at the Mayo Clinic since 1951. Latterly, the procedureshave been increasingly radical, and Myers suggeststhat all so-called recurrencesare really persistences attributable to insufficiency of the original operation. This is demonstratedby the finding that veins in which sclerosishas previously been performed are rarely completely solid and closed. Only stripping can prevent the reformationof the superficial venoussystem. Perforating veins are an important cause of recurrenceswhen incompetent,and they should be ligated. The varicosities will recur if the sapheno-femoral junction is not explored and if all venoustributariesin this areaare not ligated.