Saphenous vein high ligation electrocoagulation
Treatment of varicose veins of the lower extremities
(with clinical analysis of 168 cases)
DANG Yongkang, ZHAO Haitao, GUO Jianquan, BAO Yongtao, XU Jingwei, Department of Vascular Surgery, Chifeng Hospital
Varicose veins of lower extremities are the most common vascular surgical diseases , according to a sample survey in two provinces and one city in East China, the incidence of varicose veins of lower extremities in people over 15 years old is more than 9.6%, according to this calculation, there are about 80 million – 100 million people in China1, which is a huge group of people who seek medical treatment.
Varicose veins in the lower extremities mostly require surgery in treatment. The traditional surgical method is high ligation and stripping of saphenous vein2, which requires complete stripping and removal of varicose blood vessels, which is not easily accepted by patients because of the large surgical trauma, incision, bleeding and long time out of bed. In recent years, Professor Dong Guoxiang of the Department of Vascular Surgery of the Third Clinical Hospital of Peking University innovated the treatment of varicose veins in lower limbs by electrocoagulation3, which has the advantages of small trauma, less bleeding, less incision, few incision marks in lower legs and short bed time. According to the follow-up statistics in Beijing, the recurrence rate is controlled below 5%-10%, which is 2 times lower than the normal 10%-20% recurrence rate of saphenous vein4.
A total of 168 cases with 238 affected limbs were operated in our hospital from April 2000 to April 2007. The recent and long-term results are good and are reported as follows.
1. Clinical data
1.1 General data: 168 cases with 238 affected limbs in this group. The age ranged from 27 to 64 years old. Age ranged from 27 to 64 years. The medical history ranged from 2-52 years, and the patients all had a clear history of varicose veins in the lower limbs at the time of hospitalization. In 23 cases, deep venography was performed and confirmed the patency of deep veins.
1.2 Surgical method: Using continuous epidural anesthesia, an inguinal skin incision, about 2-4 cm long, was made to free the saphenous vein, ligated at a high level, severed the geniculate branch, and inserted an electrocoagulation catheter (homemade: outer by insulated catheter, inner by stainless steel wire) down to the medial side of the knee. After the saphenous vein was cut and disconnected, the guidewire was connected to electrocoagulation, and the guidewire was pulled out at a uniform speed to electrocoagulate the intima, and the varicose vessels on the inner side of the calf were introduced into the electrode with a cannula needle to electrocoagulate the vessels, and after the operation, moist scalding cream was applied externally and the affected limb was wrapped with an elastic bandage under pressure.
2. Results: The patients in this group were bedridden for no more than 1 day, and the hospital stay was 3-12 days without incisional infection. 3 patients had local recurrence due to early excessive exercise; they were cured by outpatient reoperation. One patient had deep vein thrombosis, which was later treated with anticoagulation, fibrin-lowering and coagulation, and was discharged after 1 month of improvement. In the remaining cases, the recent and long-term results were good.
3.Discussion: The principle of surgery and evaluation; the traditional treatment method of varicose veins in lower extremities is saphenous vein high ligation and segmental stripping, which is the main surgical method to remove the vein. Electrocoagulation, on the other hand, by electrocautery of the endothelium of the vessel, causes the lumen of the vessel to adhere and close, cutting off the backflow of blood in the varicose vessels, and at the same time scalding the openings of the traffic branches of the deep veins and superficial veins of the lower extremities, reducing the subcutaneous bleeding caused by pulling off the traffic branches by stripping the vessels. The treatment effect is excellent. The procedure is also different from sclerotherapy, where a foreign body is stored in the lumen of the vessel. This procedure requires only 1-2 incisions, which effectively avoids the traumatic bleeding of the stripped vessels, thus reducing the surgical trauma and achieving the effect of less bleeding, shorter hospital stay and no blood transfusion for severe varicose veins, which is in line with the modern concept of minimally invasive and is a new procedure that is easy to perform and worthy of wide promotion. For patients with combined deep venous valve disease, deep venous retrograde angiography is needed to clarify the degree of regurgitation, and those with grade III or above need to undergo deep venous surgery at the same time in order to achieve complete treatment5.
References
1. 5 Dong Guoxiang, Practical Vascular Surgery and Nursing, 1st ed. Beijing, China Medical Science and Technology Press, 1995.187; 197-199.
2. Wu Jieping. Qiu Fazu. 6 Huangjiayi Surgery, 6th edition, Beijing, People’s Health Publishing House, 1999, 880
3. Dong Guoxiang, Treatment of varicose veins of lower limbs by electrocoagulation, Journal of Beijing Medical University, 2000, 32(2): 182.
4. Dong Guoxiang, 160 questions on prevention and treatment of common diseases of limb veins, Beijing, Jindun Publishing House, 1998, 47.
Author Affiliation: Department of General Surgery, Inner Mongolia Chifeng Hospital
Zip code (024000)