Varicose vein stripping and ablation
Anesthesia type |
General vs regional vs local + MAC |
---|---|
Airway |
LMA |
Lines and access |
PIV |
Monitors |
Standard, 5 Lead EKG |
Primary anesthetic considerations | |
Preoperative |
Pregnancy, DVT, and peripheral arterial insufficiency |
Intraoperative | |
Postoperative |
DVT |
Article quality | |
Editor rating | |
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
- Multimodal
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
- ↑ 1.0 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) - ↑ 2.0 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) - ↑ 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)
Top contributors: Cornel Chiu and Chris Rishel