TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins

Aims The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure. Method Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet. Results A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure. 247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others. 40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure. Conclusion OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.

Study of the Clinical Profile of Varicose Vein Disease

Introduction: Varicose veins are part of the spectrum of chronic venous diseases and include dilated, tortuous veins of lower limbs, spider telangiectasia and reticular veins. Varicose vein disease is a very common problem of the western world and mostly their patients come for treatment because of cosmetic reasons. Indian scenario is different as mostly patients from lower socioeconomic strata of the society come for complications like ulceration, dermatitis etc. of varicose veins come for treatment. This problem sometimes results in chronic absenteeism from work, economic losses and change of occupation in many individuals. Methods: This observational study was carried out from 1st January 2017 to 30th June 2018 in Sri Aurobindo Medical College and Postgraduate Institute, Indore. Clinical profile of 52 patients of varicose vein disease was studied. All the patients were thoroughly examined and the pertaining data recorded. This data was tabulated and compared with the available literature on this subject. Results: Fifty two cases of varicose vein disease were studied. The commonest age group affected with the disease was between 41 to 50 years. Male patients were more and comprised of 84.6% of total number. Sapheno femoral junction valve was incompetent in 73.1 % cases as compared to saphenopopliteal junction[34.6%].Obesity was an important factor in causation of varicose vein disease. Flush ligation at SFJ with stripping was the commonest surgical procedure carried out our center. Conclusion: It is found that varicose vein disease with its associated sequelae brings the patient for treatment in our scenario. Long saphenous vein is the commonly affected part of the superficial venous system because of incompetency of the valve at SFJ. Although various etiological factors can be attributed to varicose vein disease but occupation and obesity remain the main factors. Accurate assessment of problem and adequate surgery will prevent recurrence. Key words: Varicose veins, venous ulcers, recurrent varicose veins.

A multicentre review comparing long term outcomes of endoscopic vein harvesting versus open vein harvesting for coronary artery bypass surgery

Background: Utilisation of the Endoscopic Vein Harvesting (EVH) technique has been increasing for coronary artery bypass grafting (CABG) for the last two decades. Some surgeons remain concerned about the long-term patency of the long saphenous vein harvested endoscopically compared to traditional Open Vein Harvesting (OVH). The aim of this study was to perform a retrospective analysis of the outcomes between EVH and OVH from three UK centres with 10 years follow-up. Methods: 27,024 patients underwent CABG with long saphenous vein harvested by EVH (n=13,794) or OVH (n=13,230) in three UK centres between 2007 and 2019. Propensity modelling was used to calculate the Inverse Probability of Treatment Weights (IPTW). The primary endpoint was mortality from all causes and secondary endpoints were length of hospital stay, postoperative complications, and incidence of repeat coronary re-vascularisation for symptomatic patients. IPTW was used to balance the two intervention groups for baseline and preoperative co-morbidities. Results: Median follow-up time was 4.54 years for EVH and 6.00 years for OVH. Death from any cause occurred in 13.8% of the EVH group versus 20.8% in the OVH group over the follow-up period. The hazard ratio of death (EVH to OVH) was 0.823 (95% CI: 0.767, 0.884). Length of hospital stay was similar between the groups (p=0.86). Post-operative pulmonary complications were more common in EVH vs OVH (14.7% vs. 12.8%, p<0.001), but repeat coronary re-vascularisation was similar between the groups. Conclusion: This large retrospective multicentre analysis indicates that EVH has a lower risk of mortality compared with OVH during the follow-up period of the study. The observed benefits of EVH may outweigh the risks but should be considered on a case-by-case basis. We hope this review gives confidence to other cardiac centres that offering an EVH approach to conduit harvesting does not affect long term patient outcomes.

Giant Carotid Artery Aneurysm

Carotid artery aneurysms account for 4% of peripheral aneurysms and may present as a neck mass, with hemispheric ischaemic symptoms, or with symptoms secondary to local compression. This case explores the presentation, investigations and management of a presumed mycotic common carotid artery aneurysm in a 77-year-old male, which was repaired using end-to-end interposition vein graft using long saphenous vein. This report discusses the aetiology, presentation and surgical management for carotid artery aneurysms, as well as focusing on that of the rare mycotic carotid artery aneurysm.

947 Mycotic Pseudoaneurysm Of the Common Carotid Artery: A Rare Neck Lump

Mycotic pseudoaneurysms are rare, potentially fatal arterial wall infections of either fungal or bacterial origin. The estimated incidence is 20 cases/decade. Trauma is the commonest cause and in 25% the cause remains unknown. A 62-year-old man presented with a three-week history of a non-tender enlarging neck lump associated with hoarseness of voice. He was apyrexial with no stridor nor dysphagia. The lump measured 10x10cm at levels II-III on the left side of the neck with no overlying erythema. After normal oral examination, flexible nasendoscopy revealed a left-sided pharyngeal swelling occluding 25% of the airway. He was commenced on intravenous antibiotics and steroids. A contrast enhanced CT demonstrated a mycotic pseudoaneurysm of the left common carotid artery (CCA) with a linear foreign body exiting the oesophagus. He underwent emergency surgery with the vascular team to excise 3cm of unhealthy CCA with long saphenous vein graft repair. Neck exploration and panendoscopy found no further defects including no foreign body. He made an excellent recovery and is awaiting an injection thyroplasty to manage his complete left vocal cord palsy. Although rare, vascular injury and subsequent pseudoaneurysm is an important differential and should always be considered in those presenting with neck swelling.

A COMPARATIVE STUDY OF TRENDELENBURG OPERATION AND TRENDELENBURG OPERATION COMBINED WITH STRIPPING OF LONG SAPHENOUS VEIN IN THE TREATMENT OF PRIMARY VARICOSE VEINS OF LOWER LIMB

Aims And Objectives: To compare the effectiveness, incidence of complications and recurrence after Trendelenburg operation and Trendelenburg operation combined with stripping of the thigh segment of long saphenous vein in the treatment of primary varicose veins of lower limb. Study is based on analysis Material & Methods: of 100 cases of primary varicose veins of long saphenous vein with or without perforator incompetence who got treated by either simple ligation or ligation with stripping of long saphenous vein from at Department of General Surgery, Osmania General Hospital, Hyderabad Telangana. After surgery residual long Results: saphenous vein reux was present in 22% cases in the group in which ligation alone was done and residual thigh perforators were identied in 11% of cases whereas in the group which underwent ligation combined with stripping of the thigh segment of long saphenous vein residual reux was present in 6% cases and no residual thigh perforators were identied. The i Conclusion: ncidence of Residual long saphenous vein reex and residual perforator in the thigh is less after ligation and stripping of long saphenous vein compared to Ligation of Saphenofemoral junction alone. The incidence of Nerve palsy and bleeding and hematoma is also not more in the ligation + stripping group compared to ligation alone.

A near-fatal case of pyoderma gangrenosum following coronary artery bypass surgery

A 58-year-old man on azathioprine with a history of ulcerative colitis underwent urgent coronary artery bypass grafting following a myocardial infarction, via a median sternotomy and open harvesting of the long saphenous vein. On postoperative day 5, he developed severe and progressive sternal and leg wound ulceration and necrosis, unresponsive to intravenous antibiotics and requiring surgical debridement. He developed septic shock requiring intensive therapy unit admission. Microbiology was negative and histology supported a diagnosis of pyoderma gangrenosum. Unresponsive to azathioprine and steroid therapy, he underwent a successful skin graft to the leg wound and pectoral reconstruction of the sternal wound.

Bilateral Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Salvage

Popliteal artery entrapment syndrome (PAES) is a rare cause of limb-threatening vascular disease. Usually, it arises from aberrant embryological development or acquired dysfunctionality of the popliteal artery and its surrounding musculotendinous structures in the popliteal fossa. Here, we present a case report of a young woman with relatively sudden-onset short-distance claudication and paraesthesia affecting her right leg primarily. She had no recent traumatic history and no atherosclerotic risk factors and was otherwise previously very active. She had a feeble right popliteal artery pulse and no foot pulses. Nerve conduction studies demonstrated no electrophysiological abnormalities. Following computed tomography angiography and magnetic resonance imaging, it was determined she had type 2 PAES. Subsequently, the patient underwent surgical division of a lateralised head of her medial gastrocnemius, resection of her fibrosed popliteal artery, and repair with a reversed long saphenous vein interposition graft. Following surgery, her symptoms resolved, and she remains on aspirin and ultrasound surveillance.

A clinical study on varicose veins of lower limb, surgical management and functional outcome at a tertiary care hospital of South India

Background: Varicose veins defined as dilated, tortuous, subcutaneous veins ≥3 mm in diameter, measured in the upright position with demonstrable reflux. Though the history of varicose veins dates prehistorically, the advances in diagnosis and new management modalities gained attention recently. The aim of the present study was to study the clinical profile, risk factors and their association, different types of surgical procedures employed and complications associated with varicose veins.Methods: A one year observational after ethical committee approval was conducted by department of general surgery at ACSR Medical College. Cases fulfilling the inclusion criteria were clinically examined and duplex ultrasound colour Doppler was performed for diagnosing the varicose veins and findings of site of incompetence was noted. All the cases were operated and followed up for six months period. The results were tabulated and analyzed in Microsoft Excel for any corrections.Results: Eighty cases with 66.25% males and 33.75% females with mean age of 40.24 years and majority (40%) were in 41 to 50 years group. 60% of cases had varices in right limb and long saphenous vein was involved in 52.5% of cases.85% had dilated veins, perforator incompetence was noted below the knee in 30% of cases. 41.25% of cases saphenofemoral flush ligation with stripping of long saphenous vein. Wound infection was the common postoperative complication.Conclusions: Operative line of management should be the first line of treatment even though conservative management relieves the symptoms but always requires a definitive management.