The outcome of recurrent varicose vein surgery: the patients' perspective

2005 ◽  
Vol 20 (2) ◽  
pp. 57-59 ◽  
Author(s):  
A G Edwards ◽  
O Donaldson ◽  
C Bennetts ◽  
D C Mitchell
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Varicose Vein Surgery ◽  
Failure Group ◽  
Recurrent Varicose Veins ◽  
Success Group ◽  
The Mean ◽  
Patient’S Perception ◽  
Patients Perspective

Objectives: This study was performed to assess the patient's perception of the outcome of recurrent varicose vein surgery. Methods: Patients who underwent surgery for recurrent varicose veins between 1 January 1995 and 31 December 1998 were sent a questionnaire and Aberdeen Varicose Vein Severity Score (AVVSS) in September 2003. Results: A total of 48 questionnaires were distributed and 40 responses (83%) were received. The mean length of follow-up was 81.78 months. Outcome was 'excellent' (no varicose veins) for four patients, 'satisfactory' for 22 (small, asymptomatic recurrence), 'unsatisfactory' for 10 (symptomatic recurrence) and 'worse' for four patients; 65% thought that the outcome was successful (excellent or satisfactory) and 35% a failure. The median AVVSS in the success group was 11.50 (IQR 7.94–19.69) compared with 29.63 (IQR 18.46–40.31) in the failure group ( P = 0.0009, Wilcoxon). Conclusions: Two-thirds of patients undergoing surgery for recurrent varicose veins are satisfied with the outcome, nearly seven years after surgery. One-third will regard surgery as having failed. Patients should be advised of these potential outcomes prior to surgery.

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.

Clinical Relevance of Neovascularisation on Duplex Ultrasound in the Long-Term Follow-up after Varicose Vein Operation

1999 ◽  
Vol 14 (3) ◽  
pp. 118-122 ◽  
Author(s):  
M. G. De Maeseneer ◽  
I. F. Tielliu ◽  
P. E. Van Schil ◽  
S. G. De Hert ◽  
E. J. Eyskens
Keyword(s):  
Varicose Vein ◽  
Clinical Relevance ◽  
Varicose Veins ◽  
University Hospital ◽  
Duplex Scanning ◽  
Recurrent Varicose Veins ◽  
Varicose Vein Operation ◽  
Long Term Follow Up

Objective: To evaluate the clinical relevance of neovascularisation at the saphenous ligation site. Design: Long-term follow-up after previous varicose vein surgery in a single patient group. Setting: Vascular clinic of a university hospital. Patients: Eighty-two patients (106 limbs) with a mean follow-up period of 56 months after correct saphenous ligation were submitted to duplex scanning. Intervention: Clinical assessment and colour duplex scanning of all the operated limbs. Reintervention in 15 limbs with perioperative evaluation of recurrent veins. Main outcome measures: Limbs with and without recurrent varicose veins were classified according to the degree of neovascularisation: grade 0 = no new communicating veins, grade 1 = tiny new vein with diameter <4 mm, grade 2 = new communicating vein with diameter >4 mm and pathological reflux. On reintervention the presence of neovascular veins at the site of the previous ligation was checked. Results: In 68 limbs without recurrent varicose veins, grade 0 was observed in 50 limbs (74%), grade 1 in 12 limbs (18%) and grade 2 in six limbs (9%). In 38 limbs with recurrent varicose veins, grade 0 was diagnosed in eight limbs (21%), grade 1 in four limbs (11%) and grade 2 in 26 limbs (68%). In 15 limbs with recurrent varicose veins and grade 2 neovascularisation, reintervention confirmed the duplex findings. Conclusions: The presence of grade 2 neovascularisation was associated with the recurrence of varicose veins, suggesting a causal relationship.

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.

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.

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.

Cellular senescence at the saphenofemoral junction in patients with healthy, primary varicose and recurrent varicose veins – A pilot study

Vascular ◽  
2021 ◽  
pp. 170853812110128
Author(s):  
Dominic Mühlberger ◽  
Anne-Katrin Zumholz ◽  
Erich Brenner ◽  
Achim Mumme ◽  
Markus Stücker ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cellular Senescence ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Common Finding ◽  
Venous Disease ◽  
Venous Reflux ◽  
Recurrent Varicose Veins ◽  
Primary Varicose Veins ◽  
Saphenofemoral Junction

Objectives Cellular senescence could play a role in the development of venous disease. Superficial venous reflux at the saphenofemoral junction is a common finding in patients with primary varicose veins. Furthermore, reflux in this essential area is associated with higher clinical stages of the disease and recurrent varicose veins. Therefore, this pilot study aimed to investigate cellular senescence in the immediate area of the saphenofemoral junction in patients with healthy veins, primary varicose veins and additionally in patients with recurrent varicose veins due to a left venous stump. Methods We analyzed vein specimens of the great saphenous vein immediately at the saphenofemoral junction. Healthy veins were collected from patients who underwent arterial bypass reconstructions. Samples with superficial venous reflux derived from patients who received high ligation and stripping or redo-surgery at the groin, respectively. Sections were stained for p53, p21, and p16 as markers for cellular senescence and Ki67 as a proliferation marker. Results A total of 30 samples were examined (10 healthy, 10 primary varicose, and 10 recurrent varicose veins). We detected 2.10% p53+ nuclei in the healthy vein group, 3.12% in the primary varicose vein group and 1.53% in the recurrent varicose vein group, respectively. These differences were statistically significant ( p = 0.021). In the healthy vein group, we found 0.43% p16+ nuclei. In the primary varicose vein group, we found 0.34% p16+ nuclei, and in the recurrent varicose vein group, we found 0.74% p16+ nuclei. At the p < 0.05 level, the three groups tended to be significant without reaching statistical significance ( p = 0.085). There was no difference in respect of p21 and Ki67. Conclusion We found significantly higher expression rates of p53 in primary varicose veins at the saphenofemoral junction than in healthy veins. p16 expression tended to be increased in the recurrent varicose vein group. These preliminary findings indicate that cellular senescence may have an impact in the development of varicose veins or recurrence. Further studies addressing this issue are necessary.

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.

Comparison of virtual visit versus traditional clinic for management of varicose veins

2018 ◽  
Vol 26 (1-2) ◽  
pp. 100-104 ◽  
Author(s):  
Judith C Lin ◽  
Dylan Mclaughlin ◽  
Dana Zurawski ◽  
Nicole Kennedy ◽  
Loay Kabbani
Keyword(s):  
Clinical Outcomes ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Statistical Testing ◽  
Categorical Variables ◽  
Venous Disease ◽  
Group A ◽  
Group B ◽  
Clinic Group

Introduction The objective of this study is to compare the clinical outcomes of patients with varicose veins managed in the telemedicine clinic and traditional clinic. Methods Retrospective analysis of all vein procedures in the institutional Vascular Quality Initiative Varicose Vein Registry (VQI VVR) was performed from January 2015 to August 2017. Patients were divided into two groups: Telemedicine versus Traditional Clinic. Comparison data included patient demographics, past medical history, clinical outcomes, patient-reported outcomes and postoperative complications. Statistical testing included chi-square test for categorical variables and student t-test for continuous variables using the SPSS statistical software. Results A total of 1034 varicose vein procedures were performed during the 31-month study period. There were 75 virtual encounters in the Telemedicine Clinic (Group A) and 959 face-to-face encounters in the Traditional Clinic (Group B). Most of the demographics characteristics were clinically similar in both groups. Comparing Group A and Group B, there were no differences in age, sex, race and body mass index. Early 3-month follow up was 100% in Group A and 90.7% in Group B. Both groups had low complication rates of haematoma (1.3% vs 0.3%, p = 0.884), paraesthesia (1.3% vs 0.6%, p = 0.767) and recanalisation (1.3% vs 4.0%, p = 0.383) during the early follow up period. Discussion Synchronous virtual visits for patient care are feasible for the management of chronic venous disease. Patients with varicose veins who choose to undergo telemedicine evaluations have similar pre-operative demographics, clinical classification and patient outcomes.

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