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deep vein thrombosis
Venous Disease > Ambulatory Phlebectomy

This surgery is performed as a day care operation where the patient can go home the same evening and has no stitches in his legs.

Ambulatory Phlebectomy
Ambulatory Phlebectomy

LSV surgery

Trendelenberg position with 20 - 30° head down
Legs abducted 10 -15°
Saphenofemoral junction (SFJ) found 2 cm below and lateral to pubic tubercle
Essential to identify SFJ before performing flush ligation of the LSV
Individually divide and ligate all tributaries of the LSV
 
Superficial circumflex iliac vein
Superficial inferior epigastric vein
Superficial and deep external pudendal vein
Check that femoral vein clear of direct branches for 1 cm above and below SFJ
Stripping of LSV reduces risk of recurrence
Only strip to upper calf.
Stripping to ankle is associated with increased risk of saphenous neuralgia
Post operative care:
 
Elevate foot of bed for 12 hours
Class 2 stockings should be worn for at least 2 weeks

Ambulatory Phlebectomy

Ambulatory Phlebectomy
Ambulatory Phlebectomy

Ambulatory Phlebectomy
Ambulatory Phlebectomy

SSV surgery

Patient prone with 20-30° head down
Saphenopopliteal junction (SPJ) has very variable position
Preoperative localisation with duplex ultrasound is strongly recommended
Identify and preserve the sural nerve
Need to identify the SPJ
Stripping associated with risk of sural nerve damage
Subfascial ligation inadequate

Multiple Stab Avulsion

The veins are marked pre-operatively. Stab incisions are made along the blow outs. With Phlebectomy hooks, the veins are avulsed at multiple points. Wounds are closed with glue.

Perforator surgery

Significance of perforator disease is unclear
Perforator disease may be improved by superficial vein surgery
Perforator surgery (e.g. Cockett's and Todd's procedure) associated with high morbidity
Subfascial endoscopic perforator surgery (SEPS) recently described
Not indicated for uncomplicated primary varicose veins
May have a role in addition to saphenous surgery in those with venous ulceration

Indications for SEPS

Incompetent perforator veins
Lipodermatosclerosis
Ulceration

Advantages of SEPS

Accurate localization of perforator veins in the subfascial compartment
Minimally invasive surgery done as day care
Morbidity from wound complications is eliminated
Ulcer healing rates are improved

Dr. Pankaj Patel a vascular surgeon has expertise in peripheral vascular diseases, varicose veins and deep vein thrombosis