The early morbidity of varicose vein surgery

1995 ◽  
Vol 81 (1) ◽  
pp. 42-46
Author(s):  
D C Mackay ◽  
D J Summerton ◽  
A J Walker
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Population Group ◽  
Postal Questionnaire ◽  
Varicose Vein Surgery ◽  
Long Saphenous Vein ◽  
Case Surgery ◽  
Post Operation ◽  
The Difference ◽  
Considerable Morbidity

AbstractThe early outcome and morbidity associated with varicose vein surgery were assessed at six months post operation by postal questionnaire. Most cases underwent sapheno-femoral ligation, above-knee stripping of the long saphenous vein and multiple stab avul sions. A 73.8% response rate resulted in 155 replies, and revealed a high incidence (65.8%) of perceived complications within the first two weeks after surgery. The commonest of these were bruising, pain and numbness. Over a third of patients consulted their general practitioner (GP) postoperatively. Half of these required further management or treatment and the rest, reassurance alone. At six months 79.4 % were satisfied with the outcome of their surgery, although some still claimed problems with residual veins, skin discoloration, numbness, and ankle or foot disco loration. Eleven percent were referred to hospital for further opinion, mostly because of perceived residual varicose veins. The difference between residual and recurrent varicose veins is discussed. No patient fe lt that the standard 2.5 day admission was too long, and 12.9% thought it too short. Day case surgery is not a popular option in this population group.Despite high satisfaction rates, there is a considerable morbidity attached to varicose vein surgery. We believe that good pre- and perioperative communication, augmented by a comprehensive information sheet, is important to prepare patients for those postoperative problems and thus reduces their perceived importance.

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.

Audit of varicose vein surgery: the patients' perspective

2005 ◽  
Vol 20 (4) ◽  
pp. 179-182 ◽  
Author(s):  
P S Sains ◽  
K M Reddy ◽  
H J S Jones ◽  
J K Derodra
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Surgical Patient ◽  
Varicose Vein Surgery ◽  
Patient Dissatisfaction ◽  
Modifiable Factors ◽  
Patients Perspective

Objectives: Varicose veins cause varying symptoms and post-surgical patient dissatisfaction is not uncommon. We aimed to identify patients' reasons for having surgery and sought to identify measures for improvement. Methods: A postal questionnaire was sent to patients. The patients' preoperative symptoms and postoperative satisfaction were enquired upon. Replies were cross-referenced to the operation notes. Results: Three hundred and thirty-five patients completed the questionnaire. The consultant carried out 73% of operations, with 27% being carried out by trainees. In all, 41% of patients were very satisfied with surgery, 39% were satisfied, 17% were dissatisfied and 4% were very dissatisfied. In those whose operation was carried out by a consultant, 18% were dissatisfied as compared with 31% of those operated on by a trainee. Conclusion: The vast majority of patients are satisfied with varicose vein surgery and there are modifiable factors such as grade of surgeon and supervision, which can influence the outcome and satisfaction.

The Influence of Effective Analgesia and General Anaesthesia on Patients' Acceptance of Day Case Varicose Vein Surgery

1993 ◽  
Vol 8 (1) ◽  
pp. 29-31 ◽  
Author(s):  
O. C. Onuma ◽  
P. E. Bearn ◽  
U. Khan ◽  
P. Mallucci ◽  
M. Adiseshiah
Keyword(s):  
General Anaesthesia ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Day Case ◽  
Varicose Vein Surgery ◽  
College Hospital ◽  
Day Case Surgery ◽  
Patient Interview ◽  
Case Surgery ◽  
Analgesia Requirement

Objective: To assess the efficacy of locoregional anaesthesia and non-opiate analgesia in controlling pain after varicose vein surgery. To examine patient attitudes to day case surgery for this condition. Design: Prospective single patient group study (22 consecutive patients). Setting: University College Hospital (Teaching Hospital). Intervention: Locoregional and general anaesthesia. Non-opiate analgesia. Surgical treatment for varicose Main outcome measures: Patient interview, pain scores, analgesia requirement. Result: Post operative Pain was absent in 36% during the first 24 hours. Oral analgesia was given to 36% as inpatients but only 18% after discharge. Before surgery, 95% would have preferred DCS but only 24% at six months. The after-effects of general anaesthesia was the main reason for this change in attitude. Conclusions: Patients would like day case surgery for varicose veins but anaesthesia and analgesia must be satisfactory.

Postoperative care after varicose vein surgery: patient-based questionnaire

2005 ◽  
Vol 20 (4) ◽  
pp. 190-192 ◽  
Author(s):  
T Tang ◽  
J R Boyle ◽  
M E Gaunt ◽  
K Varty
Keyword(s):  
Varicose Vein ◽  
Postoperative Care ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Walking Ability ◽  
Varicose Vein Surgery ◽  
Practical Advice ◽  
Pain Scores ◽  
Surgery Patient ◽  
The Mean

Objective: Practical advice given postoperatively to varicose vein patients remains subjective. They are encouraged to walk in their stockings or bandages as much as possible. The aim of this study was to investigate if this is a realistic request. Methods: A postal questionnaire was given to all patients undergoing varicose vein surgery from July 2003. The questionnaire referred to the following issues: pain scores, walking ability, stairs, driving, return to work, dressings and stockings. Results: A total of 93 patients replied, of which 55 (59%) were women and the mean age was 52 years (range 23–83). Of the patients who replied, 66 (71%) had a unilateral procedure and 13 (14%) had recurrent varicose veins. A total of 65 (70%) underwent a high tie, strip and avulsions, 16 (17%) underwent a short saphenous tie, nine (10%) underwent ligation of both saphenous systems and three (3%) underwent avulsions alone. Pain scores were low (3/10), resolving completely after nine days on average. Despite this, 89% of patients could only walk around the garden or block in the first week. After two weeks, normal activities were possible but most patients remained off work for three weeks. Stockings were a problem for 49 (53%) patients. Conclusions: Although we would like all our patients to mobilize early after varicose vein surgery, the traditional long walk is unrealistic. Support stockings cause difficulties in over half the patients. Postoperative care and advice for varicose vein surgery need re-thinking.

Recurrence following Varicose Vein Surgery

2002 ◽  
Vol 16 (3) ◽  
pp. 101-105 ◽  
Author(s):  
D. D. I. Wright ◽  
K. G. Rose ◽  
E. Young ◽  
C. N. McCollum
Keyword(s):  
Varicose Vein ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Consecutive Series ◽  
Varicose Vein Surgery ◽  
Recurrence Rates ◽  
Primary Surgery ◽  
Mean Time

Objective: To determine the site-specific rates of recurrence following varicose vein surgery. Design: Postal questionnaire followed up by telephone enquiries. Full clinical review, including continuous wave and duplex Doppler investigations were carried out for all patients with responses suggesting recurrence. Setting: Surgicare Manchester, an independent provider of specialist varicose vein treatments. All procedures were guided by Doppler ultrasound and performed by surgeons working to the same protocol. Subjects: A consecutive series of 250 operations on 246 Patients. Of these, 208 (85%) could be contacted for follow-up. Mean time to re-examination was 27 months. Results: Twelve patients returned spontaneously and 51 were recalled for examination based on questionnaire responses. Recurrences were divided into ‘site’, ‘perforator’ or ‘new site’ recurrence. Primary surgery to the sapheno-femoral junction (SFJ) had the lowest ‘site’ recurrence rate of 2.3% compared with 9.5% for SFJ re-operation. Primary surgery and re-operation of the sapheno-popliteal junction (SPJ) had higher recurrence rates of 8.3% and 7.8% respectively. New incompetence was detected in 5% and 2% of previously competent SFJ and SPJ respectively. Minor perforator incompetence was found in a further 14%. Conclusions: Varicose veins were progressive in some individuals, with new sites of incompetence appearing over time. However, ‘cure’ remains possible for most Patients and major recurrence can be reduced by Doppler diagnosis and precise surgery.

A Rare Complication of Varicose Vein Surgery

2000 ◽  
Vol 15 (1) ◽  
pp. 43-45
Author(s):  
J. Herman ◽  
M. Lovecek ◽  
M. Duda ◽  
I. Svach
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Rare Complication ◽  
Iliac Vein ◽  
University Hospital ◽  
Varicose Vein Surgery ◽  
The Czech Republic ◽  
Long Saphenous Vein ◽  
Internal Iliac ◽  
Primary Varicose Veins

Design: Case report. Setting: University Hospital in the Czech Republic. Patients: Patient undergoing surgery for primary varicose veins. Interventions: The patient underwent attempted long saphenous vein stripping by passing a flexible stripper from ankle to groin. The stripper fractured at its upper end and a fragment of stripper became lodged in the internal iliac vein in the pelvis. This was removed at laparotomy. The patient made an uncomplicated recovery. Conclusion: Major complications of varicose vein surgery are rare. This unusual problem was probably caused by material fatigue in the stripper, leading to fracture near the upper end of the stripper.

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.

Varicose vein surgery performed by a surgical care practitioner

2009 ◽  
Vol 24 (1) ◽  
pp. 43-45 ◽  
Author(s):  
N C Hickey ◽  
K Cooper
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Surgical Care ◽  
Training Programme ◽  
Varicose Vein Surgery ◽  
Long Saphenous Vein

A surgical care practitioner (SCP) completed a structured training programme to perform all aspects of varicose vein surgery including sapheno-femoral disconnection and long saphenous vein stripping. Over a four-year period, she performed 152 groin procedures, closed 191 groin wounds and undertook phlebectomies on 91 legs with excellent results. A SCP can be used to improve theatre utilization and efficiency with no obvious drawbacks.

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