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Abstract: The patient complained of varicose veins for more than 20 years and had been putting off surgery for fear of pain and postoperative recurrence. 2 years ago, the heaviness in the legs worsened and the skin of the calves became darker, itchy and eczema-like changes, so he came to our hospital for consultation. After examination, it was determined that the varicose vein on the left side of the saphenous vein, which is a common varicose vein in the lower limbs, was given microwave ablation of the left saphenous vein, penetrating branch closure and sclerotherapy, and after treatment the varicose vein in the lower limbs disappeared and the lower limbs were not swollen or painful.
Basic information】Male, 65 years old
Disease Type】Left saphenous varicose vein
Hospital】Zhejiang Hospital of Traditional Chinese Medicine
Consultation time】November 2021
Treatment plan】Surgical treatment (microwave ablation of the left saphenous vein, closure of the penetrating branch and sclerotherapy)
Treatment period】Discharge 24 hours after surgery, regular outpatient follow-up for 1 year
Effectiveness】The varicose veins in the lower extremities disappeared after 1 week, no swelling and pain in the lower extremities, and the patient was satisfied.
I. Initial consultation
The patient complained that varicose veins have been treated for more than 20 years, but because of the fear of surgery pain and recurrence after surgery, they have been delayed to do surgery, and sought medical help everywhere, such as massage, gua sha, cupping, bloodletting, wearing varicose socks and sclerotherapy, etc. The effect could be seen at that time, but it would recur in less than 3 months. 2 years ago, the heaviness of legs increased, and the skin of calves became darker, itchy and eczema-like. Upon inquiry there was no hypertension, diabetes mellitus, hyperlipidemia, etc. Physical examination: slightly obese (BMI 24.5), earthworm-like projection and distortion of the medial popliteal fossa and medial calf on the left side, skin pigmentation near the inner ankle, no ulcer, mild swelling of the left calf, acupressure depression, calf circumference: 38 cm on the left and 36 cm on the right, normal dorsalis pedis artery pulsation, ankle-brachial index: 1.1 bilaterally. after admission, heart, liver, kidney and other important organ diseases were excluded, ultrasound suggested: left saphenous The diagnosis was: left saphenous varicose vein with dilatation, tortuosity and reflux, proximal diameter 1.22cm, venous valve reflux, tortuosity and dilatation of the calf branch, and reflux of a penetrating branch 8cm above the calf inner ankle, diameter 0.45cm, reflux time 900ms.
II. Treatment history
We introduced the advantages and disadvantages of various surgeries to the patient and his family in detail, and finally decided to perform day surgery for saphenous vein, which is a minimally invasive procedure and can be discharged within 24 hours, and the patient was happy to accept it. The patient was happy to accept it. We started to make an appointment, hospitalization, examination and surgery according to the procedure of day surgery, and advised pre and postoperative precautions. After admission, low-dose CT of the chest, electrocardiogram, cardiac ultrasound, biochemistry, coagulation, and blood and urine routine were examined, bedside ultrasound evaluation was done to observe hemodynamic changes before and after surgery, venograms were traced on the skin of the lower extremity in the standing position (marking the saphenous vein, superficial varicose vein, and the point of reflux of the penetrating branch), clinical evaluation: VCSS (venous clinical severity score) 8, CEAP classification C4 (saphenous varicose vein grade 4), ultrasound assessment: regurgitation of the left saphenofemoral valve, no significant varicosity of the saphenous vein branches, significant distortion of the geniculate branch, pathological regurgitation of the penetrating branch. After microwave ablation of the left saphenous vein, closure of the penetrating branch and sclerotherapy, the minimally invasive procedure was performed under ultrasound guidance throughout, with local swelling anesthesia and precise adjustment of microwave energy according to the varicose veins, and the procedure took only 30 minutes without bleeding.
III. Treatment effect
Patients can get out of bed immediately after the surgery, which is conducive to blood circulation in the lower limbs, speeding up the recovery and reducing postoperative complications, and the pain during the whole procedure is mild. He was discharged from the hospital on the 2nd day after the treatment with no special discomfort and basically resumed normal life. At the follow-up examination 1 week after the operation, varicose veins of lower limbs disappeared without swelling and pain of lower limbs. By comparing the situation before and after the treatment, it can be seen that the surgical effect is good and the patient is satisfied.
IV. Notes
I am glad that after the surgical treatment the patient’s varicose veins were controlled and the swelling and pain were relieved. Varicose veins are a more serious disease and will not heal on their own once they develop, so patients should pay attention to the following points in their daily life.
1, usually should try to avoid long standing, sitting, weight bearing, once there is a sense of lower limb heaviness, afternoon calf soreness, night foot cramps, etc., should self-examine whether there are varicose veins, under the guidance of professional doctors wear varicose veins stockings, promote lower limb venous reflux, reduce lower limb venous pressure.
2.When it is impossible to avoid standing and sitting for a long time, you should move every hour, stand on your feet and kick your legs after standing for a long time, and get up and move or hook your feet and ankle pump after sitting for a long time to help the blood flow back to the lower limbs.
3.Wear elastic stockings correctly for 1-3 months after surgery, usually get up during the day and put on the stockings and take off the stockings at night.
4.Strengthen the exercise after surgery, such as walking, brisk walking, cycling, dancing, tai chi, squatting, kicking, toe pads, etc.
5.Follow up in the clinic on the 3rd day, 7 days, 28 days, 3 months and 1 year after surgery according to the doctor’s prescription.
V. Personal insight
Varicose veins are divided into 6 stages, stage 1 is early stage, conservative treatment is recommended, change bad habits, wear elastic stockings and other measures, if necessary, sclerotherapy. stage 2 is early to middle stage, varicose veins are difficult to be cured by conservative treatment, on the basis of conservative treatment, sclerotherapy or minimally invasive surgery can have good effect. stage 3 is middle stage, the best time for surgery. stage 4 is middle to late stage, the latest time for surgery. The surgery in time can change the discolored legs, but after this period, it is difficult to avoid the sequelae of surgery. 5-6 stage is the late performance, often have old rotten legs, and often have sequelae after surgery. Minimally invasive surgery for varicose veins in lower limbs is recognized by the people for its advantages of small trauma, quick recovery, less pain and no scar after surgery. However, many patients do not pay attention to wearing varicose veins stockings after surgery, which leads to superficial phlebitis, pain and recurrence of varicose veins, etc. Doctors suggest wearing suitable varicose veins stockings after surgery, and generally insist on wearing them for 3 months.