The procedure of C. H. Mayo is adapted to cases in which it is desirable to remove longer segments of the veins.  It consists in the employment of special instruments known as “ring-enucleators” or “vein-strippers,” by means of which long portions of the vein are removed through comparatively small incisions.

An alternative procedure consists in avulsing segments of the vein by means of Babcock’s stylet, which consists of a flexible steel rod, 30 inches in length, with acorn-shaped terminals.  The instrument is passed along the lumen of the segment to be dealt with, and a ligature applied around the vein above the bulbous end of the stylet enables nearly the whole length of the great saphena vein to be dragged out in one piece.  These methods are not suitable when the veins are brittle, when there are pouches or calcareous deposits in their walls, or where there has been periphlebitis binding the coils together.

Mitchell of Belfast advises exposing the varices at numerous points by half-inch incisions, and, after clamping the vein between two pairs of forceps, cutting it across and twisting out the segments of the vein between adjacent incisions.  The edges of the incisions are sutured; and the limb is firmly bandaged from below upwards, and kept in an elevated position.  We have employed this method with satisfactory results.

The treatment of the complications of varix has already been considered.

ANGIOMA[4]

[4] In the description of angiomas we have followed the teaching of the late John Duncan.

Tumours of blood vessels may be divided, according to the nature of the vessels of which they are composed, into the capillary, the venous, and the arterial angiomas.

CAPILLARY ANGIOMA

The most common form of capillary angioma is the naevus or congenital telangiectasis.

#Naevus.#—­A naevus is a collection of dilated capillaries, the afferent arterioles and the efferent venules of which often share in the dilatation.  Little is known regarding the etiology of naevi beyond the fact that they are of congenital origin.  They often escape notice until the child is some days old, but attention is usually drawn to them within a fortnight of birth.  For practical purposes the most useful classification of naevi is into the cutaneous, the subcutaneous, and the mixed forms.

The cutaneous naevus, “mother’s mark,” or “port-wine stain,” consists of an aggregation of dilated capillaries in the substance of the skin.  On stretching the skin the vessels can be seen to form a fine network, or to run in leashes parallel to one another.  A dilated arteriole or a vein winding about among the capillaries may sometimes be detected.  These naevi occur on any part of the body, but they are most frequently met with on the face.  They may be multiple, and vary greatly in size, some being no bigger than a pin-head, while others cover large areas of the body.  In colour they present every tint from purple to brilliant red; in the majority there is a considerable dash of blue, especially in cold weather.