Varicose vein stripping and ablation - Revision history

Chris.Rishel at 08:06, 5 April 2022

2022-04-05T08:06:30Z

← Older revision		Revision as of 01:06, 5 April 2022
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	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = General vs regional vs local + MAC		\| anesthesia_type = General or regional/local/MAC
	\| airway = LMA		\| airway = LMA
	\| lines_access = PIV		\| lines_access = PIV
	\| monitors = Standard, 5 ~~Lead EKG~~		\| monitors = Standard
	\| considerations_preoperative = ~~Pregnancy,~~ DVT~~, and peripheral~~ arterial insufficiency		5-lead ECG
			\| considerations_preoperative = Contraindications:
			*DVT
			*Peripheral arterial insufficiency
			*Pregnancy
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative = DVT		\| considerations_postoperative = DVT
	}}		}}

	Varicose vein stripping is a procedure involving removing the portion of the incompetent vein. It is the gold standard. Endovenous thermal ablation (laser and light) have mostly replaced the surgical treatment of varicose veins<ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>		'''Varicose vein stripping''' is a procedure involving removing the portion of the incompetent vein. It is the gold standard. Endovenous thermal ablation (laser and light) have mostly replaced the surgical treatment of varicose veins<ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>

	Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux <ref name=":0" /><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1280374077\|title=Stoelting's anesthesia and co-existing disease\|date=2022\|others=Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting\|isbn=978-0-323-71861-5\|edition=Eighth edition\|location=Philadelphia, PA\|oclc=1280374077}}</ref>		Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux <ref name=":0" /><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1280374077\|title=Stoelting's anesthesia and co-existing disease\|date=2022\|others=Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting\|isbn=978-0-323-71861-5\|edition=Eighth edition\|location=Philadelphia, PA\|oclc=1280374077}}</ref>

Cornel.Chiu at 03:48, 22 January 2022

2022-01-22T03:48:10Z

← Older revision		Revision as of 20:48, 21 January 2022
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	\| lines_access = PIV		\| lines_access = PIV
	\| monitors = Standard, 5 Lead EKG		\| monitors = Standard, 5 Lead EKG
	\| considerations_preoperative =		\| considerations_preoperative = Pregnancy, DVT, and peripheral arterial insufficiency
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative =		\| considerations_postoperative = DVT
	}}		}}

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	Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities<ref name=":0" /><ref name=":1" />		Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities<ref name=":0" /><ref name=":1" />

			Varicose vein stripping usually begin with small incisions at pre-marked sites directly over the varicose veins. Dissection occurs to reveal the varicose vein which is then avulsed. Compression is applied to achieve hemostasis and once all varicosity is removed, dressing and compression bandage are applied to affected lower extremity<ref name=":0" />. Varicose vein ablation involves using laser or light to cauterize the varicose veins to close them off <ref name=":0" />.

	== Preoperative management ==		== Preoperative management ==
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	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

	* Lower extremity regional techniques		* Spinal and/or epidural
	* Spinal and or epidural		* Local/tumescent

	== Intraoperative management ==		== Intraoperative management ==
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	* Ulcers		* Ulcers
	* Nerve injury		* Nerve injury
			* DVT
			* Infection
			* Lymph fistula

	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Varicose Vein Stripping/Ablation
	\|-		\|-
	\|Position		\|Position

Cornel.Chiu at 03:33, 20 January 2022

2022-01-20T03:33:37Z

← Older revision		Revision as of 20:33, 19 January 2022
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	}}		}}

	Varicose vein stripping ~~and ablation~~ is a procedure involving removing		Varicose vein stripping is a procedure involving removing the portion of the incompetent vein. It is the gold standard. Endovenous thermal ablation (laser and light) have mostly replaced the surgical treatment of varicose veins<ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>

	Endovenous thermal ablation (laser and light)have mostly replaced the surgical treatment of varicose veins<ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>		Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux <ref name=":0" /><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1280374077\|title=Stoelting's anesthesia and co-existing disease\|date=2022\|others=Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting\|isbn=978-0-323-71861-5\|edition=Eighth edition\|location=Philadelphia, PA\|oclc=1280374077}}</ref>

	Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux <ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1280374077\|title=Stoelting's anesthesia and co-existing disease\|date=2022\|others=Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting\|isbn=978-0-323-71861-5\|edition=Eighth edition\|location=Philadelphia, PA\|oclc=1280374077}}</ref>

	Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities<ref name=":0" /><ref name=":1" />		Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities<ref name=":0" /><ref name=":1" />

Cornel.Chiu at 03:24, 20 January 2022

2022-01-20T03:24:16Z

← Older revision		Revision as of 20:24, 19 January 2022
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	Varicose vein stripping and ablation is a procedure involving removing		Varicose vein stripping and ablation is a procedure involving removing

	Endovenous thermal ablation have mostly replaced the surgical treatment of varicose veins		Endovenous thermal ablation (laser and light)have mostly replaced the surgical treatment of varicose veins<ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>

	Usual indications include ~~aching~~, ~~swelling~~, ~~heaviness, cramps, itching, cosmesis, stasis dermatitis, pigmentation, burning, and ulcers~~ <ref>{{Cite book\|url=https://www.worldcat.org/oclc/~~1117874404~~\|title=~~Anesthesiologist~~'s ~~manual of surgical procedures~~\|date=~~2020~~\|others=~~Richard A~~. ~~Jaffe~~, ~~Clifford A~~. ~~Schmiesing~~, ~~Brenda Golianu~~\|isbn=978-1-~~4698~~-~~2916~~-6\|edition=~~Sixth~~ edition\|location=Philadelphia\|oclc=~~1117874404~~}}</ref>		Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux <ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1280374077\|title=Stoelting's anesthesia and co-existing disease\|date=2022\|others=Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting\|isbn=978-0-323-71861-5\|edition=Eighth edition\|location=Philadelphia, PA\|oclc=1280374077}}</ref>

	Contraindication to surgery include pregnancy, and arterial insufficiency of the lower extremities		Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities<ref name=":0" /><ref name=":1" />

	== Preoperative management ==		== Preoperative management ==
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	!		!
	!Variant 1		!Variant 1
	\|-
	~~\|Unique considerations~~
	\|
	\|-		\|-
	\|Position		\|Position
	\|		\|Supine
	\|-		\|-
	\|Surgical time		\|Surgical time
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	\|-		\|-
	\|Pain management		\|Pain management
	\|		\|Minimal, multimodal
	\|-		\|-
	\|Potential complications		\|Potential complications
	\|		\|Bleeding and ulcers
	\|}		\|}

Cornel.Chiu: Most sections

2022-01-19T21:39:37Z

Most sections

New page

{{Infobox surgical procedure
| anesthesia_type = General vs regional vs local + MAC
| airway = LMA
| lines_access = PIV
| monitors = Standard, 5 Lead EKG
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Varicose vein stripping and ablation is a procedure involving removing

Endovenous thermal ablation have mostly replaced the surgical treatment of varicose veins

Usual indications include aching, swelling, heaviness, cramps, itching, cosmesis, stasis dermatitis, pigmentation, burning, and ulcers <ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=Sixth edition|location=Philadelphia|oclc=1117874404}}</ref>

Contraindication to surgery include pregnancy, and arterial insufficiency of the lower extremities

== Preoperative management ==

=== Patient preparation and premedication ===

* IV midazolam
* PO acetaminophen

=== Regional and neuraxial techniques ===

* Lower extremity regional techniques
* Spinal and or epidural

== Intraoperative management ==

=== Monitoring and access ===

* Standard ASA monitors
* 5-lead EKG
* PIV x 1

=== Induction and airway management ===

* If general is chosen, standard induction
** LMA or Mask vs ETT
** Neuromuscular blockade may not be needed
* If regional/neuraxial is chosen, minimal to deep sedation is reasonable
* If local + MAC, deep sedation to general may be required <ref>{{Cite journal|last=Cho|first=Sooyoung|last2=Han|first2=Jong In|last3=Baik|first3=Hee Jung|last4=Kim|first4=Dong Yeon|last5=Chun|first5=Eun Hee|date=2016-04|title=Monitored anesthesia care for great saphenous vein stripping surgery with target controlled infusion of propofol and remifentanil: a prospective study|url=https://pubmed.ncbi.nlm.nih.gov/27066207/|journal=Korean Journal of Anesthesiology|volume=69|issue=2|pages=155–160|doi=10.4097/kjae.2016.69.2.155|issn=2005-6419|pmc=4823411|pmid=27066207}}</ref>
** May require airway manipulation including oral airway or chin lift

=== Positioning ===

* Supine

=== Maintenance and surgical considerations ===

* Maintenance with volatile anesthetics or TIVA
* If regional/neuraxial is chosen, minimal to deep sedation is reasonable

=== Emergence ===

* PONV prophylaxis

== Postoperative management ==

=== Disposition ===

* PACU
* Usually discharged home

=== Pain management ===

* Pain is minimal to mild
** Multimodal
*** PO/IV acetaminophen
*** PO/IV NSAIDS
*** PO/IV short acting opioid
*** Regional technique

=== Potential complications ===

* Bleeding
* Ulcers
* Nerve injury

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|
|-
|Position
|
|-
|Surgical time
|2-3 hours
|-
|EBL
|50-250 mL
|-
|Postoperative disposition
|PACU, and usually discharged home
|-
|Pain management
|
|-
|Potential complications
|
|}

== References ==

[[Category:Surgical procedures]]