Great saphenous vein transposition to the popliteal vein (the May-Husni procedure).

Abstract

A 55-year-oldmale long distance runner had been bothered by venous claudication for 8 years. He previously sustained a tibial plateau fracture complicated by a deep venous thrombosis. He was no longer able to compete in longdistance races because of severe swelling and pain from the knee down. Before his injury, he had completed thirteen 100-mile ultra-marathons. Venous ultrasound imaging demonstrated segmental occlusion and incompetence of the left femoral and popliteal veins. An ascending and descending venogram demonstrated the femoral, popiteal, and tibial veins to have partial occlusions and incompetence due to chronic deep venous thrombosis (A). The patient was a suitable candidate for transposition of the saphenous vein into the popliteal vein (May-Husni procedure) to alleviate venous outflow obstruction. The operation was conducted through a vertical incision at the distal thigh. The great saphenous vein (GSV) and proximal popliteal vein were exposed through the same incision. After heparinization, a thigh tourniquet was inflated to provide a bloodless field, the popliteal vein was opened longitudinally, some old recanalized thrombus was excised, and an end-to-side anastomosis was performed between the GSV and the popliteal vein (PV) using running 6-0 monofilament suture (B and C [CFV, Common femoral vein; DFV, deep femoral vein]). After an uneventful postoperative course, the patient was discharged fully anticoagulated. A computed tomography (CT) venogram at 14 months showed widely patent popliteal-saphenous anastomosis with preferential flow of contrast into the transposed GSV (Cover). The patient currently reports no symptoms of venous claudication.