Influence of the Angle of Anastomosis on the Patency of Arteriovenous Fistulas for Hemodialysis

Abstract

Objectives: The surgery of the varicose veins under tumescent local anesthesia is not very widespread. We sought to evaluate the feasibility and the short-term results of this technique. The patient filled follow-up questionnaires by connecting on a secure server via his email. Materials and Methods: This twin centers prospective study relating to 603 patients and 707 interventions was conducted from January 1st to December 31st, 2014. All the patients operated for varicose veins under tumescent local anesthesia with or without sedation and having a valid email address were included. The collection of the postoperative data was carried out using dedicated software sending the questionnaires to the patients from D0 till D7, then at D15 and D30 about their pain, bleeding, functional capacity and satisfaction. Results: The population comprised 72.8%of women, with amean age of 51 years and a BMI of 24.4. Recurrence was present in 24.2% of the patients. The average score of clinical severity (VCSS) was 4.5/30, the preoperative pain reached 2.53 on an analogical visual scale (AVS) and the CEAP was: C11⁄41%, C21⁄453%, C31⁄414%, C41⁄46%, C51⁄40.7%, C61⁄40.6%. A local anesthesia without any sedation was carried out in 79%of the cases. Amean of 20 phlebectomies was carried out. The additional procedures were: crossectomy in 15% of the cases, stripping in 19%, radio frequency in 26%, laser in 3%, foam sclerotherapy in 10%, embolization in 0.4%, perforating vein ligation in 0.3%, and redo crossectomy in 0.7%. No peroperative complication resulted in stopping the procedure. At D0 and D1 the rates of respondents were 66% and 57%, respectively. The average AVSwas 1.73 and 1.24, respectively. The activity was regarded as normal or subnormal in respectively 85% and 93% of the cases. 99.6% of the patients were satisfied or very satisfied at D0. At D30, we observed 0.1% of infection, 0.3% of superficial venous thrombosis, no major venous thrombosis, no hematoma, no lymphorrhea, and 0.1% of neurological complications. Conclusion: The surgery of varicose veins under tumescent local anesthesia with or without sedation can be carried out without risk. It gives excellent immediate results in terms of pain, functional recovery and satisfaction without major complications. The data-processing tool for evaluation we used seems to be a mode of collection of medical data extremely useful and reliable.