Venectomy pentru varice

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Venectomy pentru varice

Nov 18, Author: Wesley K Lew, MD; Chief Editor: Noncosmetic indications include symptomatic varicosities eg, pain, fatigability, heaviness, recurrent superficial thrombophlebitis, bleedingor for the treatment venectomy pentru varice venous venectomy pentru varice after skin or subcutaneous tissue changes, such as lipodermatosclerosis, atrophie blanche, ulceration, or hyperpigmentation, have developed.

Conservative treatment with stockings and external compression is an acceptable alternative to surgery, but worsening cutaneous findings or symptoms despite these measure usually warrant intervention. Patients with venous outflow obstruction should not have their varicosities ablated, because they are important bypass venectomy pentru varice that venectomy pentru varice blood to flow around the obstruction.

Those patients who cannot remain active enough to reduce the risk of postoperative deep vein thrombosis DVT should not undergo surgery. Surgery during pregnancy is contraindicated because many varicose veins of pregnancy spontaneously regress after delivery.

Management of varicose veins has evolved over the centuries and will continue to do so. Less invasive techniques continue to be refined, but long-term efficacy must always be questioned and compared with the criterion standard of surgical saphenectomy.

Surgical treatment of varicose veins has been under development for more than years, but until the venectomy pentru varice era, relatively little weight was given to the cosmetic outcome of treatment. Current therapies venectomy pentru varice becoming less invasive and yielding improved recovery, but long-term outcomes are uncertain.

Therapies aim to remove the superficial venous system through either surgery, endovenous ablation, or sclerotherapy venectomy pentru varice. Additionally, if severe deep venous incompetence exists, treatment of the GSV alone usually does not resolve the venous hypertension.

For now, the authors will discuss the procedures to remove or obliterate the superficial venous system, proceeding from most Varicele sarcinii to least invasive. Historical perspectives, advantages, and disadvantages to each technique will also be addressed.

However, prior to any intervention, venectomy pentru varice ultrasonography US should always be used to map all major reflux pathways, and a skin marker should be used to mark all surface vessels to be removed. This wound was left open to heal by granulation. The Venectomy pentru varice procedure, introduced in the late s, used a large linear medial leg incision that brought into view all the superficial and perforator veins of the leg.

Incompetent superficial veins were removed, and perforating veins were interrupted. In the late s, Trendelenburg introduced a midthigh ligation of the GSV. Later, even better outcomes were found if saphenectomy removal of the Venectomy pentru varice with ligation at the SFJ was performed in place of ligation alone.

In a randomized trial, two thirds of patients treated with ligation without saphenectomy could be expected to venectomy pentru varice reintervention within 5 years for recurrent reflux, either from recanalization or from collateral formation around the ligated GSV.

Surgical removal of the GSV has evolved from large open incisions to less invasive stripping. Original methods of stripping used different devices venectomy pentru varice variations of techniques.

The Mayo stripper was an extraluminal ring that cut the tributaries as it was passed along the vein. Greutate și varice Babcock venectomy pentru varice was an intraluminal stripper with an acorn-shaped head that pleated up the vein as it pulled the vessel loose from its attachments. The Keller device was an internal wire used to pull the vein through itself, as is done today with perforation-invagination PIN strippers.

Currently, the technique of PIN stripping begins with a 2- to 3-cm incision made at the groin crease. The femoral vein and the SFJ are exposed with dissection, and all tributaries of the SFJ must be identified and flush-ligated to minimize venectomy pentru varice incidence of reflux recurrence.

Venectomy pentru varice ligation and division of the junction, the stripping instrument usually a venectomy pentru varice but flexible length of wire or is passed into the GSV at the groin and threaded through the incompetent vein distally to the level of the upper venectomy pentru varice. An inverting head is attached to the stripper at the groin and is secured to the proximal end of the vein.

The vessel is then inverted into itself, tearing away from each venectomy pentru varice and perforator as the stripper is pulled downward venectomy pentru varice the venectomy pentru varice and out through the incision in the upper calf see the image below. If desired, a long epinephrine-soaked gauze or ligature may be secured to the stripper before invagination, allowing hemostatic packing to be pulled into place after stripping is complete.

An older technique of stripping to the ankle rather than to just the knee has fallen into disfavor because of a link incidence of complications, including damage to the saphenous nerve, which is closely associated with the vein below the knee. After ligation and division of the Venectomy pentru varice, the stripping instrument often a more rigid stripper that facilitates navigation is passed downward into the distal calf, where it is brought out through a small mm incision.

The stripper is secured to the proximal end of the vein, which is invaginated into itself as it is pulled downward from knee to ankle and withdrawn from below. Performed by Galen as early as the second century, stab phlebectomy also venectomy pentru varice to venectomy pentru varice ambulatory phlebectomy came back into modern favor during the s and has increased in popularity ever since.

This procedure is extremely useful for the treatment of residual vein clusters after saphenectomy venectomy pentru varice for removal of nontruncal tributaries when the saphenous vein is competent. A microincision is made over the vessel with a tiny blade or a large venectomy pentru varice, a phlebectomy hook is introduced into the microincision, and the vein is delivered through the incision. With traction, as long a segment as possible is pulled out of the body until the vein breaks or cannot be pulled any further.

Another microincision is made and the process is begun again and repeated along the entire length of the vein to be extracted. Short segments of veins can be removed through tiny incisions without ligatures, and skin closure is not necessary.

A laser fiber produces endoluminal heat that destroys the vascular endothelium. In endovenous laser treatment of varicose veins, a Seldinger technique is used to advance a long catheter along the entire length of the truncal varicosity to be ablated usually the GSV. A bare laser fiber is passed through the catheter until the end protrudes from the tip of the catheter by approximately 2 cm, and the laser fiber tip is positioned at the SFJ just distal to the subterminal valve.

The position is confirmed by means of US and the use of the laser guide light. Under ultrasound guidance, tumescent solution with a local anesthetic is injected around the entire length of the vessel, separating it from its fascial sheath.

This serves to venectomy pentru varice the heat from damaging adjacent structures, including nerves and skin, as well as pain control. The fiber and catheter are withdrawn approximately 2 mm, and the laser is fired again. This process is repeated along the entire course of the vessel.

In radiofrequency ablation RFA of varicose veins, radiogfrequency RF thermal energy is delivered directly to the vessel wall, causing protein denaturation, collagenous contraction, and immediate closure of the vessel. Unlike the endovenous laser fiber, the RF catheter actually comes into contact with the lumen walls. An introducer sheath is inserted into the proposed vein of treatment again, usually the GSV.

A special RF catheter is passed through the sheath and along the vein until the active tip is at the SFJ just distal to the subterminal venectomy pentru varice. As with the endovenous laser, venectomy pentru varice local anesthetic is injected.

Metal fingers at the tip of the Here catheter are deployed until they make contact with the vessel endothelium.

RF energy is delivered venectomy pentru varice in and around the vessel to be treated. Thermal sensors record the temperature within the vessel and deliver just enough energy to ensure endothelial ablation. The RF catheter is withdrawn a short distance, and the process is repeated all along the length of the vein to be treated. Subramonia and Lees found that in comparison with conventional high ligation and stripping, RFA of GSV varicosities took longer to perform, but patients returned to their normal activities significantly earlier and had significantly less postoperative pain.

This is an old technique involving electrical cautery for destruction of small vessels. Because of the disfiguring cutaneous injury, it is rarely used today.

Chemical sclerosis of varicose veins has waxed and waned in popularity since the late s. Modern sclerosants with an acceptable risk profile became widely available in the s, and since that time, their use has expanded. Initially, sclerotherapy was used as a surgical adjunct after saphenectomy to treat residual varicosities, reticular veins, or telangiectasias. Currently, it is being used to treat the GSV and main tributaries.

Under US guidance, a sclerosing substance is injected into abnormal vessels to produce endothelial destruction that is followed by formation of a fibrotic cord and eventual reabsorption of all vascular tissue layers see the image below. Local treatment of the superficial manifestations of venous insufficiency will always fail if the underlying high points of reflux have not been found and treated.

Even when the patient appears to have only primary telangiectasias and the initial treatment seems to be successful, recurrences will be seen very quickly if unrecognized reflux exists in larger subsurface vessels. Caution must be exercised in the use of sclerosing agents.

Inadvertent injection of concentrated sclerosants into the deep system can cause DVT, pulmonary embolism PEand venectomy pentru varice. The most commonly used sclerosants today are polidocanol and sodium tetradecyl sulfate.

Both are known as detergent sclerosants because they are amphiphilic substances, inactive in dilute solution but biologically active when they form micelles. These agents are preferred because they have a low incidence of allergic reactions, produce a low incidence of staining and other adverse cutaneous effects, and are relatively forgiving if extravasated. Polidocanol, the most forgiving sclerosing agent, was originally developed as a local anesthetic agent.

Other agents that have fallen out of favor include sodium morrhuateassociated with a relatively high incidence of anaphylaxis. Ethanolamine oleatea weak detergent, is excessively soluble, decreasing its ability to venectomy pentru varice cell surface proteins. If extravasated, it almost invariably causes significant necrosis. The addition of foam with the sclerosing agents has allowed reduction of the amount of sclerosing agent injected, as well as improved efficacy.

Homemade foam is usually air-agitated in saline. Because of the theoretical risks of air embolism, commercially available foam consists mostly of carbon dioxide. In the US, sodium tetradecyl sulfate, sodium morrhuate, and ethanolamine oleate were all developed before the establishment of the US Food and Drug Administration FDA.

These agents have never been submitted to the FDA for approval, but they are available in the United States as grandfathered agents. In NovemberVarithena Biocompatibles, Oxford, CT venectomy pentru varice approved by the FDA for clinical use in the United States. After treatment of large varicose veins by any method, a to mm Hg gradient compression stocking is applied, and patients are instructed to maintain or increase their normal activity levels.

Most practitioners also recommend the use of gradient compression stockings even after treatment of venectomy pentru varice veins and smaller tributary veins. In a randomized trial in patients undergoing foam sclerotherapy for primary uncomplicated varicose veins, no significant difference was noted in vein occlusion, phlebitis, skin discoloration, or pain at 2 and 6 weeks with the two techniques. Ace wraps and other long-stretch bandages should not be used. These elastic bandages fail to maintain adequate compression for more than a few hours.

They often slip or are misapplied by patients, with a resulting tourniquet effect that causes distal swelling and increases the risk of DVT. Activity is particularly important after treatment by any technique because all modalities of treatment for varicose venectomy pentru varice have the potential to increase the risk of DVT. Activity is a strong protective factor against venous stasis.

Activity is so venectomy pentru varice that most venous specialists will not treat a patient who is unable to remain active asterisk tratament varice treatment.

A correct diagnosis of superficial venous insufficiency is essential. Veins should be treated only if they are incompetent and if a normal collateral pathway exits. Removal of a saphenous vein with a competent termination will not aid in the management of nontruncal tributary varices.

In the setting of deep system obstruction, varicosities are hemodynamically helpful because they provide a bypass pathway for venous return. Hemodynamically helpful varices must not be removed or sclerosed.

Ablation of these varicosities will cause rapid venectomy pentru varice of pain and swelling of the extremity, eventually followed by the development of new varicose bypass pathways. The most annoying minor complications of any venous surgery are dysesthesias from injury to the sural nerve or the saphenous nerve. Subcutaneous hematoma is a common complication, regardless of treatment technique used.

It is easily managed with warm compress, nonsteroidal anti-inflammatory drugs NSAIDs venectomy pentru varice, or aspiration if necessary. At venectomy pentru varice SFJ, accidental treatment of the femoral vein by inappropriate RF or laser catheter placement, spread of sclerosant not visualizing progression with USand inappropriate surgical ligation can all lead to endothelial damage at the deep vein, causing DVT formation with the potential for PE and even death.

Other complications, such as postoperative infection and arterial injury, are less common and may be kept to a minimum through strict attention to good technique.

Endovenous treatment techniques with RF and laser therapy have the potential of excessive tissue heating, which can lead to skin burns. This problem can be avoided if sufficient volumes of tumescent anesthetic are injected venectomy pentru varice elevate the skin away from the vein. Royle J, Somjen GM. Hippocrates venectomy pentru varice Jerry Moore. Shami SK, Sarin S, Cheatle TR, Scurr JH, Smith PD.

Venous ulcers and the superficial venous system. Conception of the venous hemodynamics in the lower extremity. Weiss RA, Feied CF, Weiss MA. A Comprehensive Approach, 1st ed. Pappas PJ, Lal BKL, Cerveira JJ, et al. The Management of Venous Disorders. Sales CM, Bilof ML, Petrillo KA, Luka Venectomy pentru varice. Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux. Coon WW, Willis PW 3rd, Keller JB.

Venous thromboembolism and other venous disease in the Tecumseh community health study. Epidemiology of varicose veins. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: Lurie F, Creton D, Eklof B, et al.

Venectomy pentru varice randomized study of endovenous radiofrequency obliteration closure procedure versus ligation and stripping in a selected patient population EVOLVeS Study.

Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O. Prospective randomised study of endovenous radiofrequency obliteration closure versus ligation and vein stripping EVOLVeS: Eur J Vasc Endovasc Surg. Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B.

Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping venectomy pentru varice patients with varicose veins: Carradice D, Mekako AI, Mazari FA, Samuel N, Hatfield J, Chetter IC. Clinical and technical outcomes from a venectomy pentru varice clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins.

Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Venectomy pentru varice clinical trial comparing endovenous laser click to see more, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins.

Wright Venectomy pentru varice, Gobin JP, Bradbury AW, et al. European randomized controlled trial. Obi AT, Reames BN, Rook TJ, Mouch SO, Zarinsefat A, Stabler C, et al. Outcomes associated with ablation compared to combined ablation and transilluminated powered phlebectomy in the treatment of venous varicosities.

Same Site Recurrence is More Frequent After Endovenous Laser Ablation Compared venectomy pentru varice High Ligation and Stripping of the Great Saphenous Vein: Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great venectomy pentru varice varicose veins.

Hafner J, Ramelet AA, Schmeller W, et al. Management of Leg Ulcers. New York, Venectomy pentru varice York: Revision of the CEAP classification for chronic venous disorders: Naoum JJ, Hunter GC. Pathogenesis of varicose veins and implications for clinical management. Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, et al.

Comparing endovenous laser de varice, foam sclerotherapy, and conventional surgery for great saphenous varicose veins.

Kalra M, Gloviczki P. Surgical treatment of venous ulcers: Surg Clin Venectomy pentru varice Am. Caggiati A, Allegra Venectomy pentru varice. Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the venectomy pentru varice saphenous vein reduces the rate of reoperation for recurrent varicose veins: The hemodynamic paradox as a phenomenon triggering recurrent reflux in varicose vein disease. Johnson CM, McLafferty RB. Endovenous laser ablation of varicose veins: Subramonia S, Lees T.

Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Rabe E, Otto J, Schliephake D, Pannier F. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam ESAF: US Food and Drug Administration.

Randomized clinical trial of different bandage regimens after foam sclerotherapy for varicose veins. Alpha Omega AlphaAmerican Association for the Surgery of TraumaAmerican College of SurgeonsAmerican Heart AssociationAmerican Surgical AssociationAssociation for Academic SurgeryPhi Beta KappaSociety for Vascular SurgerySociety of University SurgeonsWestern Surgical AssociationVascular and Endovascular Surgery SocietySociety for Clinical Vascular Surgery Disclosure: Received consulting venectomy pentru varice from CVRx for review panel membership.

Received salary from Medscape for employment. American College of SurgeonsAmerican Surgical AssociationPacific Coast Surgical AssociationSociety for Clinical Vascular SurgerySociety for Vascular SurgeryWestern Vascular Society Disclosure: Craig F Feied, MD, FACEP, FAAEM, FACPh Professor of Emergency Medicine, Georgetown University School of Medicine; General Manager, Microsoft Enterprise Health Solutions Group.

Craig F Feied, MD, FACEP, FAAEM, FACPh is a member of the following medical societies: American Academy of Emergency MedicineAmerican College of Emergency PhysiciansAmerican College of PhlebologyVenectomy pentru varice College of PhysiciansAmerican Medical AssociationAmerican Medical Informatics AssociationAmerican Venous ForumMedical Society of the District of ColumbiaSociety for Academic Emergency Medicineand Undersea and Hyperbaric Medical Society. If you venectomy pentru varice out, you will be required to enter your username and password the next time you visit.

Share Email Print Feedback Close. Sections Varicose Vein Surgery. Approach Considerations Surgical removal or obliteration of varicose veins read article often for cosmetic reasons alone. Surgical Therapy Surgical treatment of varicose veins has been under development for more than years, but until the present era, relatively little weight was given to the cosmetic outcome of treatment.

Perforation-invagination PIN stripping schematic. Ultrasound image of the GSV after foam sclerotherapy treatment. Note the hyperechogenicity within the vein is from the foam. Varisolve canister and appearance of foam with polidocanol. Complications A correct diagnosis of superficial venous insufficiency is essential. Pathway leading to varicose veins and other venectomy pentru varice manifestations of venous hypertension. Schematic diagram of the deep and superficial venous systems of the lower extremity: What would you like to print?

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Vein Ligation and Stripping for Varicose Veins

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