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Abstract: The patient in this case had swelling in the lower extremities for more than 30 years, and the symptoms worsened in the afternoon and at night. Saphenous varicose vein is a common disease in vascular surgery, and it is also a problem for many people. The surgical adaptation proves that timely surgical treatment can prevent further development of varicose vein.
Basic information】Male, 63 years old
Disease Type】Saphenous varicose vein
Hospital】Xing’an League People’s Hospital in Inner Mongolia
Date of consultation】March 2022
Treatment plan】Surgical treatment (high saphenous vein ligation and stripping, foam sclerotherapy injection) + medication (Diosmin) + physical therapy (varicose veins elastic stockings)
Treatment period】3 days of inpatient treatment, 1 month of postoperative outpatient follow-up
Treatment effect] The varicose veins disappeared and were cured.
I. Initial consultation
The patient was 63 years old and had inadvertently discovered a varicose vein on the inner side of the knee with a light blue surface more than 30 years ago, accompanied by swelling of the calf after activity, which was obvious in the afternoon and at night, and could be relieved after rising in the morning. The swelling was not significantly relieved after the recent treatment with medical elastic stockings, so the patient came to our clinic. Ultrasound of lower extremity veins showed that the superficial veins of left lower extremity were tortuous and dilated, and the deep veins of both lower extremities were flowing smoothly.
II. Treatment history
Superficial varicose vein caused by saphenous vein lesion is a common disease in vascular surgery. After admission, the expert teacher of ultrasound department was asked to give lower limb vein ultrasound examination again, which clarified the location of the patient’s saphenous vein lesion, the relationship with the deep vein penetrating branch, and marked the offender vessel. After detailed explanation of the surgical procedure and related risks with the patient and family members, the patient and family members’ consent was obtained to improve the relevant preoperative examination and preparation, and the treatment of high saphenous vein ligation and stripping and foam sclerotherapy injection was carried out electively. The alignment and extent of the varicose vein were marked in detail before surgery, and the main trunk of the saphenous vein was marked. After careful freeing of the varicose vein in the lower leg, foam sclerosing agent (polydocanol) was injected into it, and the incision was closed with continuous cosmetic sutures within the skin.
III. Treatment results
Patients were given elastic bandages after surgery, instructed to get out of bed appropriately, elevated the affected limb 30° when lying in bed to promote venous reflux in the lower limb, and orally administered Diosmin to improve venous circulation and avoid deep vein thrombosis in the lower limb. The swelling of the lower extremity was significantly reduced after the postoperative activities, and the patient was discharged on the first postoperative day. On the third day after the operation, the patient was changed to wear level 2 therapeutic medical elastic stockings, and the incision was well healed with no redness, swelling and exudation. The patient returned to the outpatient clinic 1 month after surgery for a review, and the varicose vein disappeared and was cured.
IV. Notes
We are glad that the varicose vein disappeared and the patient was cured after surgery, but after surgery, we should pay attention to avoid sitting and standing for a long time, avoid straining, avoid weight bearing, pay attention to light and easy to digest diet, avoid cold, spicy and greasy food, avoid constipation and do not cough hard. After surgery, change the medication every 2-3 days to observe the healing of the incision. It is recommended to wear varicose veins elastic stockings for 24 hours in the first week after surgery, and from the second week onwards, wear elastic stockings during the daytime and can be taken off at night, and elevate the affected limb 30° when lying in bed. Showering is allowed after surgery, but care should be taken to apply a waterproof dressing to the incision while bathing. Patients who have swelling and pain in the lower limbs and redness and swelling of the incision should follow up with the hospital in time.
V. Personal insight
1.Superficial varicose veins of lower extremities are the most common diseases in vascular surgery, but they should not be taken lightly because they are common.
2.Pay attention to the prevention of deep vein thrombosis after surgery, and ask the patient to get out of bed as soon as possible, and patients with high risk of thrombosis can be prevented with anticoagulant drugs.
3, preoperative detailed explanation to patients and family members of the surgery and postoperative recovery process is crucial, only after obtaining the trust of patients and family members, the treatment can be twice as successful with half the effort.