Ambulatory evulsion phlebectomy for truncal varicose veins
Article Abstract:
Varicose veins (tortuous, dilated veins with incompetent valves) are a common condition producing discomfort, aching, itching and poor cosmetic appearance of the legs. Complications can include phlebitis (inflammation of the veins), bleeding and ulceration of the skin. The traditional surgical correction of varicose veins is performed in the hospital under general anesthesia and involves stripping (removal) of the saphenous vein from the level of the groin to the ankle. This procedure assumes that the entire saphenous vein has incompetent venous valves. Several studies have observed that if routine stripping had been performed, from 24 to 50 percent of saphenous veins with excellent graft potential would have been destroyed for no reason. The saphenous vein can be valuable as vascular graft material for coronary and other bypass graft operations, and should be preserved when possible. A report is presented of a new technique for surgical treatment of varicose veins. This procedure is performed under local anesthesia on an outpatient basis. Preoperative medication is not routinely given since many patients drive to and from the surgeon's office. The procedure involves several small stab wounds made in the leg and evulsion of varicosities using special hooks; this results in less tissue damage. Over the past nine months this procedure was performed at one practice on 56 patients (69 legs). There were minimal complications and postoperative pain. Long-acting anesthetic is used for the surgery; its effect extends into the postsurgical period and reduces the need for pain medication. Cosmetic appearance was excellent. All patients returned to normal daily activities immediately, and loss of income and convalescence were eliminated. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1991
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Role of routine arteriography in blunt lower-extremity trauma
Article Abstract:
Blunt injury to the lower extremity, particularly fractures and dislocations of the knee, is often associated with vascular (blood vessel) injury. Delay in diagnosis and treatment of these vascular injuries can lead to unacceptably high leg amputation rates. It has been standard practice to perform arteriography (X-ray study of an artery using radiopaque dye) if there is evidence to suggest vascular injury (pulse deficit or murmur, neurological deficit). However, it has recently become common to perform arteriography as a screening procedure for all patients with major blunt injury to the lower extremity, with or without clinical indication of vascular injury. A prospective study was undertaken to determine how often arterial injuries without clinical signs are identified by arteriography. There were 53 patients with blunt lower extremity injury; all had arteriography performed. There were 31 patients (58 percent) who had one or more abnormal clinical findings suggestive of possible vascular injury; using arteriography, 12 arterial injuries were identified with four requiring vascular repair. Of the other 22 patients (42 percent) undergoing arteriography, who had knee dislocation or long-bone fracture without clinical findings of vascular injury, 3 artery injuries were identified, none of which required surgery. For all patients, two variables, pulse deficit and delayed capillary refilling, were strongly correlated with artery injury as shown on the arteriogram. It is concluded that arteriography should be performed selectively, only on patients who have clinical evidence suggesting vascular injury; routine use of arteriography only rarely may identify a vascular injury requiring repair in a patient without clinical signs. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1990
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Frequency of vascular injury with blunt trauma-induced extremity injury
Article Abstract:
Blunt orthopedic injuries, particularly certain types of fractures and dislocations of the knee and elbow, are believed to involve a high rate of associated vascular (blood vessel) injury. These vascular injuries appear to occur frequently enough that most patients undergo screening arteriography (X-ray study of an artery using radiopaque dye) to detect them. A study was undertaken to determine the actual incidence of these vascular injuries. A review was undertaken of all orthopedic and vascular patients seen over a four-year period; 569 cases with neurovascular injury secondary to blunt trauma induced by fracture/dislocation were identified. These cases were considered at risk for vascular injuries; nine (1.5 percent) cases actually had vascular injury. There were six cases that required surgery, and the leg was able to be saved in five of the six cases. The types of fractures in which vascular injury occurred were: supracondylar fracture of the humerus (long bone of the upper arm, where it forms the elbow joint); elbow dislocation; knee dislocation; and fracture of the two bones of the lower leg. It is concluded that vascular injuries do not occur often with blunt orthopedic trauma, except in knee and elbow dislocations and certain humeral fractures. These would be recognized by the orthopedic surgeon without the necessity of vascular consultation or routine angiogram. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1990
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