Difference between revisions of "Varicose vein stripping and ablation"

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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 =  
5-lead ECG
| considerations_preoperative = Contraindications:
*DVT
*Peripheral arterial insufficiency
*Pregnancy
| considerations_intraoperative =  
| considerations_intraoperative =  
| considerations_postoperative =  
| considerations_postoperative = DVT
}}
}}


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 have mostly replaced the surgical treatment of varicose veins
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 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, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities<ref name=":0" /><ref name=":1" />


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


Latest revision as of 00:06, 5 April 2022

Varicose vein stripping and ablation
Anesthesia type

General or regional/local/MAC

Airway

LMA

Lines and access

PIV

Monitors

Standard 5-lead ECG

Primary anesthetic considerations
Preoperative

Contraindications:

  • DVT
  • Peripheral arterial insufficiency
  • Pregnancy
Intraoperative
Postoperative

DVT

Article quality
Editor rating
In development
User likes
0

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[1]

Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux [1][2]

Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities[1][2]

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[1]. Varicose vein ablation involves using laser or light to cauterize the varicose veins to close them off [1].

Preoperative management

Patient preparation and premedication

  • IV midazolam
  • PO acetaminophen

Regional and neuraxial techniques

  • Spinal and/or epidural
  • Local/tumescent

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 [3]
    • 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
  • DVT
  • Infection
  • Lymph fistula

Procedure variants

Varicose Vein Stripping/Ablation
Position Supine
Surgical time 2-3 hours
EBL 50-250 mL
Postoperative disposition PACU, and usually discharged home
Pain management Minimal, multimodal
Potential complications Bleeding and ulcers

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)
  2. ↑ 2.0 2.1 Stoelting's anesthesia and co-existing disease. Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting (Eighth edition ed.). Philadelphia, PA. 2022. ISBN 978-0-323-71861-5. OCLC 1280374077. |edition= has extra text (help)CS1 maint: others (link)
  3. ↑ Cho, Sooyoung; Han, Jong In; Baik, Hee Jung; Kim, Dong Yeon; Chun, Eun Hee (2016-04). "Monitored anesthesia care for great saphenous vein stripping surgery with target controlled infusion of propofol and remifentanil: a prospective study". Korean Journal of Anesthesiology. 69 (2): 155–160. doi:10.4097/kjae.2016.69.2.155. ISSN 2005-6419. PMC 4823411. PMID 27066207. Check date values in: |date= (help)

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