Varicose vein surgery under anti-platelet therapy

Phlebologie ◽  
2008 ◽  
Vol 37 (06) ◽  
pp. 287-297 ◽  
Author(s):  
P.-M. Baier ◽  
Z. T. Miszczak
Keyword(s):  
Varicose Vein ◽  
Bleeding Time ◽  
Varicose Veins ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Review Of The Literature ◽  
Varicose Vein Surgery ◽  
Anti Platelet Therapy ◽  
Male Patients ◽  
Acute Atherothrombosis

Summary Background: Platelet function inhibitors (PFI) are used for prophylaxis of atherothrombosis. These drugs cause a prolongation of the bleeding time and should eventually be stopped before an elective operation. However, there is a risk that a perioperative pause of PFI lead to acute atherothrombosis. Objective: Our aim was to study whether a discontinuation of PFI therapy is necessary to avoid bleeding complications in patients undergoing varicose vein surgery. Methods: Selective review of the literature and retrospective analysis of clinical data of our own patients. Results: In the years 2002 to 2007 a total of 10 827 patients have been operated on varicose veins, 673 (6.2%) of these aged 32–86 years (67 ± 7.9) receiving permanent PFI therapy: 256 male patients (38.0%) and 417 female (62.0%), 39.1% categorized as ASA III patients: male 11.6%, female 27.5%. 38 patients who continued PFI therapy did not demonstrate haemorrhagic complications and none of those pausing anti-platelet medication experienced thromboembolic complications. The literature survey confirmed our finding that it is not necessary to suspend PFI medication for varicose vein surgery as the bleeding risk can be controlled for by technical means. Conclusion: Discontinuation of PFI therapy prior to interventions on varicose veins does not seem to be necessary, further studies are essential though.

Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽  
2007 ◽  
Vol 36 (03) ◽  
pp. 132-136
Author(s):  
M. W. de Haan ◽  
J. C. J. M. Veraart ◽  
H. A. M. Neumann ◽  
P. A. F. A. van Neer
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Varicose Vein Surgery ◽  
Proximal Point ◽  
Perforating Veins ◽  
Recurrent Varicose Veins ◽  
Below The Knee ◽  
Duplex Imaging ◽  
Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

Varicose Veins: optimum compression after surgery and sclerotherapy

1990 ◽  
Vol 76 (2) ◽  
pp. 101-104
Author(s):  
P. J. Shouler ◽  
P. C. Runchman
Keyword(s):  
Surgical Treatment ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Compression Stocking ◽  
Compression Stockings ◽  
Varicose Vein Surgery ◽  
High Compression ◽  
Graduated Compression Stockings ◽  
Non Surgical Treatment

SummaryGraduated compression stockings are used in both surgical and non-surgical treatment of varicose veins. In a trial of high versus low compression stockings (40mmHg vs 15mmHg at ankle) after varicose vein surgery, both were equally effective in controlling bruising and thrombophlebitis, but low compression stockings proved to be more comfortable.In a further trial after sclerotherapy, high compression stockings alone produced comparable results to Elastocrepe® bandages with stockings. It is concluded that after varicose vein surgery low compression stockings provide adequate support for the leg and that after sclerotherapy, bandaging is not required if a high compression stocking is used.

Day Case Varicose Vein Surgery: Patient Health Outcome

2001 ◽  
Vol 16 (4) ◽  
pp. 160-163
Author(s):  
K. J. Sweeney ◽  
T. Cheema ◽  
S. O'Keefe ◽  
S. Johnston ◽  
P. Burke ◽  
...  
Keyword(s):  
Physical Function ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Well Being ◽  
Health Perception ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Population Norms ◽  
Patient Health ◽  
The Impact

Background: The success of day case varicose vein surgery (DCWS) is traditionally denned clinically. However, the patient's perception of his or her own health prior to and following DCWS has not been established. This study prospectively measured the health status of patients with varicose veins, compared this with established population norms and assessed the impact of DCWS on both general health perception and varicose vein symptoms. Method: Fifty-three consecutive patients undergoing DCWS over a 9 month period were enrolled in this study. The SF-36 health assessment questionnaire and a vein-symptom-specific questionnaire were administered on the morning of surgery, 7 weeks postoperatively and 1 year following surgery. All patients in this study underwent a standard varicose vein operation and followed a standard protocol of postoperative management. Results: DCWS population health scores were lower than general population norms preoperatively. There was a significant improvement in the 7 week postoperative group in physical function and health perception (p<0.05). One year after surgery physical function, health perception, mental health and physical role were significantly improved from preoperative scores (p<0.05). Symptom-specific scores demonstrated a sustained trend towards improvement over the postoperative year. Conclusion: Varicose veins are associated with diminished well-being. Day case varicose vein surgery improves patient health perception and symptoms and is the treatment of choice for suitable patients with varicose veins.

Day-Case Surgery: A Viable Alternative for Surgical Treatment of Varicose Veins

1987 ◽  
Vol 2 (2) ◽  
pp. 103-108 ◽  
Author(s):  
D.C. Berridge ◽  
G.S. Makin
Keyword(s):  
Patient Group ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Viable Alternative ◽  
Patient Treatment ◽  
Case Group ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
Day Case Surgery ◽  
Case Surgery

One hundred and forty-eight patients (164 limbs) who had varicose vein surgery by the same consultant surgeon 3–10 years previously were reviewed; 61 patients had surgery as an in-patient and 87 as a day-case. The patients were reviewed to assess the efficacy and acceptability of day-case varicose vein surgery. There were no significant differences between the age and sex ratios of the patients. However, twice as many operations in the in-patient group included stripping of the long saphenous vein above the knee (χ2 = 4.2, P = 0.04). Fifteen in-patients had bilateral vein surgery as opposed to only one day-case patient. Fifteen patients suffered complications most of which were minor and were evenly distributed including wound infections (nine), reactionary haemorrhage/haematoma (four), deep vein thrombosis (one) and pulmonary embolus (one). The convalescent period before returning to work was similar in the two groups (U= 953, P= 0.28). The mean duration of stay for the in-patients was 3.9 ± 2.2 days. There was no significant difference in the period off work (day-case: 3.6 ± 2.0 weeks; in-patient: 4 ± 2.9 weeks), or in the length of follow-up (day-case: 6.01 ± 1.24 years; in-patient: 6.79 ± 1.71 years). In the period before review 11 patients in the in-patient group and 13 patients in the day-case group had further surgery or sclerotherapy for recurrent symptomatic varicose veins. At review five patients in the in-patient group and six patients in the day-case group had recurrent sapheno-femoral incompetence (χ2 = 0.1, P = 0.7). A total of 34 patients in both groups had recurrent varicose veins. Only four (4.6%) of the day-case patients expressed a preference for in-patient treatment if they were to have further surgery and 21 (34%) of the in-patient group would prefer day-case surgery. Day-case varicose vein surgery has not been shown to be inferior in terms of complications or recurrence rate. Patient acceptability is good and it is a viable alternative to in-patient treatment in suitable patients in areas with adequate district nurse facilities.

Varicose vein surgery in elderly patients: What needs to be considered?

Phlebologie ◽  
2017 ◽  
Vol 46 (04) ◽  
pp. 221-223
Author(s):  
A. Mumme ◽  
M. Dünnweber
Keyword(s):  
Varicose Vein ◽  
Geriatric Patients ◽  
Varicose Veins ◽  
Surgical Techniques ◽  
Anaesthetic Techniques ◽  
The Elderly ◽  
Laryngeal Tube ◽  
Ageing Population ◽  
Varicose Vein Surgery ◽  
Operative Trauma

SummaryThe need for invasive therapeutic measures in patients with varicose veins increases in an ageing population. Modern varicose vein surgery is particularly suitable for this age group, precisely because the stage of the disease is often advanced in geriatric patients. Gentle surgical techniques, such as invaginated stripping, cause the least possible operative trauma and are therefore especially suitable for the aged body. Less stressful anaesthetic techniques, such as tumescence, spinal anaesthesia or total intravenous anaesthesia with the use of a laryngeal tube, are likewise particularly well-suited for the treatment of geriatric patients with varicose veins.Special criteria regarding the ASA classification and anticoagulation must be applied when considering the perioperative risk in frequently multimorbid geriatric patients. Very few complications generally occur in patients at ASA stages 1 and 2 and under single anticoagulant therapy, and surgery is feasible even in elderly people. In the case of existing phenprocoumon treatment, bridging should be critically considered on a case-by-case basis. Perioperative prevention and management of hypothermia and special procedures to obtain postoperative convalescence should also be adapted to the particular needs of the elderly patient.

Standard varicose vein surgery

2009 ◽  
Vol 24 (1_suppl) ◽  
pp. 34-41 ◽  
Author(s):  
J M T Perkins
Keyword(s):  
Venous Thromboembolism ◽  
Wound Infection ◽  
Nerve Injury ◽  
Vascular Injury ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Popliteal Fossa ◽  
Varicose Vein Surgery ◽  
Different Types

This article examines the practice of standard varicose vein surgery including sapheno-femoral and sapheno-popliteal ligation, perforator surgery and surgery for recurrent varicose veins. The technique of exposure of the sapheno-femoral junction and the sapheno-popliteal junction is outlined and advice given on avoidance of complications for both. The evidence regarding methods of closure over the ligated sapheno-femoral junction is examined as is the requirement for stripping and the use of different types of stripper. The requirement to strip the small saphenous vein and the extent of dissection necessary in the popliteal fossa is also examined. Complications of standard varicose vein surgery are outlined. The frequency of wound infection, nerve injury, vascular injury and venous thromboembolism are listed and strategies to avoid these complications are examined.

Venoscopy in Varicose Vein Surgery: Initial Experience

1993 ◽  
Vol 8 (4) ◽  
pp. 145-150 ◽  
Author(s):  
W. S. Gradman ◽  
J. Segalowitz ◽  
W. Grundfest
Keyword(s):  
Los Angeles ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Medical Center ◽  
Preoperative Assessment ◽  
Initial Experience ◽  
Varicose Vein Surgery ◽  
Saphenous Veins ◽  
And Function ◽  
Deep Vein

Objective: To determine the number and function of valves and the location of perforators and tributaries in patients with varicose veins as a result of saphenofemoral or saphenopopliteal reflux. Design: Prospective endovascular evaluation of greater and lesser saphenous veins during varicose vein surgery. Setting: Cedars-Sinai Medical Center, Los Angeles, California, USA. Patients: Thirty-one limbs in 25 patients undergoing varicose vein surgery. Intervention: Patients underwent retrograde passage of a 2.3 mm angioscope from the junction of the saphenous and deep vein distally to the first competent valve. Main outcome measures: Based on intraoperative findings, the greater saphenous vein was preserved in eight out of 25 cases. Preoperative assessment of lesser saphenous reflux was incorrect in three out of six cases. Results: An incompetent subterminal valve was found in 16 out of 25 greater saphenous veins. In 13 out of 25 limbs, no other valves were seen to the knee. Four patients had competent thigh valves. Conclusions: Retrograde venoscopy may be of benefit in varicose vein surgery.

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