Varicose Vein Surgery Research Articles

Morphological restructuring of the connective tissue elements of the wall of the great saphenous vein of a person on the lower leg during the development of varicose transformation

Introduction : the relevance of further study of the morphogenesis of changes occurring in the superficial veins of the lower extremities is due to the high prevalence of varicose veins and the lack of answers to many questions of interest to phlebologists. The aim of the study was to study the morphological restructuring of connective tissue elements of the human great saphenous vein wall on the calf in norm, ectasia and development of varicose transformation. Material and methods. The study of morphological restructuring of the great saphenous vein wall on the calf was carried out in 3 comparison groups (norm, ectasia, varicose veins) by light microscopy. In 1th group, the structure of the GSV wall was studied on autopsy material of people who died from various causes at the age of 5 to 80 years. In the 2nd and 3rd groups, fragments of GSV in the calf were taken by biopsy (miniphlebectomy) during the execution of the operations for varicose veins. In order to conduct a quantitative analysis of the nature of structural changes in the connective tissue elements of the GSV wall on the calf, a visual analog scale of morphological changes was developed-Visual Analog Morphology Scale (VAMS), in which a certain number of points (from 1 to 10) corresponded to a certain character of morphological changes. Statistical analysis of the obtained data in groups was performed using the IBM SPSS Statistics software package (USA). Results . The general morphological analysis of histological preparations made it possible to visually identify various variants of changes in connective tissue elements inherent in the inner, middle and outer shells of the GSV wall. Conclusions . Age-related morphological changes in the connective tissue elements in the GSV wall on the calf, over the course of a person’s life, do not have the same character as changes occurring in its wall during the development of its ectasia and varicose transformation.

Conventional Varicose Vein Surgery: Comparison between Single versus Staged Surgery Using Patient Reported Outcomes

In the Brazilian public health system, conventional surgery is the standard procedure for treatment of varicose veins (VV). We aimed to compare clinical and quality of life (QoL) results of patients subjected to bilateral treatment of VV by a single-procedure or staged-procedure approach. A total of 111 patients undergoing bilateral treatment for VV were treated either by a single-surgery or 2 staged procedures (minimal: 30-day interval) depending on institutional protocol. Patients were evaluated with respect to clinical symptoms and quality of life markers before and after treatment, by use of the VEINES-Sym/QoL and EQ5D-5L scores, and these results were then compared between groups. QoL scores improved in general after treatment. VV specific symptoms and QoL aspects improved equally between the Staged-procedure and Single-surgery groups (VEINES-Sym mean variation 29.7 ± 2.1 vs. 29.9 ± 2.7, respectively; P=0.340 and VEINES-QoL mean variation 5.5 ± 3.4 vs. 4.5 ± 4.3, respectively; P=0.369). General QoL, however, showed more improvement in the Staged-procedure than the Single-surgery group (EQD5-5L mean increase 0.1678 ± 0.1555 and 0.0785 ± 0.1384, respectively; P = 0.007). When propensity matched, patient subgroups maintained this same differences in QoL results. Our findings suggest that the both the Staged- and Single-surgery approach for VV surgical treatment incur similar improvement in disease-specific QoL, and that the Staged-approach may impose less of a burden in the patients' recovery.

Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy.

Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated. In this retrospective study, treatment and clinical outcomes of patients' who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed. A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation. Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

TP5.2.7 COVAS: Assessing the impact of Covid-19 On VAscular Surgery: A Single Centre Experience

AimsTo quantify the impact Covid-19 has had on vascular surgery during the pandemic at our unit compared to previous operating activity levels at a single vascular centre.MethodsRetrospective analysis of all vascular operations undertaken in the department dating from 11th March 2020 to 16th November 2020. Historical average data (HD) from the previous five years (2015-2019) over the same timeframe were then collected for comparison.ResultsDuring the Covid-19 pandemic 237 vascular operations were performed which represented a 48% operative reduction compared to average HD (454). 57 elective day-case procedures (varicose veins/temporal artery biopsies/renal access) were performed compared to a median of 259 from HD. Varicose vein surgery had an 79% reduction (37 vs 180). Renal access surgery was unaffected (15 vs 9). Major limb revascularisation procedures were reduced by 41% (36 vs 61) however this did not equate to any increase in amputation rates (79 vs 84). There was no reduction in carotid procedures performed during the pandemic (26 vs 30). There was a 60% (14 vs 35) reduction in all types of aneurysm procedures.ConclusionThe Covid-19 pandemic has dramatically affected vascular surgery at our unit. In terms of arterial work the largest disparities compared to previous years was major revascularisation and aneurysm surgery. In respect to elective day case procedures, venous work has unsurprisingly been hardest hit which, once resources allow, will require significant provision to overcome the shortfall. This quantitative study can direct future service delivery and prepare for the post-pandemic recovery.

Evaluation and usefulness of venous clinical severity score (VCSS) in patients of varicose veins, undergoing surgery in a tertiary care hospital

Background: The purpose of this study is to evaluate the Venous Clinical Severity Score (VCSS), as a valuable tool, for adequately describing symptoms, signs and patient’s response to surgical treatment. Aims and Objectives: To study VCSS as a efficient quantification tool in assessing the patients with venous disease pre and postoperatively. Methodology: This study was conducted on 90 patients who underwent surgery for varicose veins during the period of January 2019 to December 2019 from the in-patients of surgical unit in Dr. PSIMS & RF. Results and Conclusion: The VCSS was devised to include both symptoms and signs in assessing the severity of the disease and evaluation of outcome of surgical treatment. Although the assessment of clinical etiological anatomical and pathophysiological (CEAP) classification might be adequate for daily clinical purposes, VCSS should be used in clinical practice to quantify post operative outcome.

Ultrasound-assisted varicose vein surgery and endovenous laser ablation using 1470-nm laser for treatment of great saphenous vein incompetence has similar outcomes at 1 year in a single-center prospective randomized study

BackgroundTechnical errors are the most common preventable cause of recurrence after high ligation and stripping procedures for the treatment of great saphenous vein incompetence. Ultrasound-assisted varicose vein surgery (UAVS) uses intraoperative ultrasound during high ligation and stripping to minimize such failures, although no data have been reported regarding its use during open surgery. The present study compared the short-term outcomes of UAVS and endovenous laser ablation (EVLA) with a 1470-nm laser. MethodsThe present prospective randomized study was conducted from January 2019 to December 2019. We compared 40 patients who had undergone UAVS under regional anesthesia with an equal number of patients who had undergone EVLA under tumescent anesthesia. Both groups received 1 week of standardized postoperative analgesia. The improvements in the pain score, venous clinical severity score, and recurrence at 6 months and 1 year were studied. ResultsNo significant differences were found in either clinical or radiologic great saphenous vein recurrence after UAVS compared with EVLA at 1 year. The mean pain score at 8 hours after the procedure was higher in the UAVS group (3.7 ± 1.2 vs 2.9 ± 1.0; P = .03). At 1 week, the score was higher in the EVLA group (1.8 ± 0.7 vs 1.4 ± 0.5; P = .01). At 6 months, the venous clinical severity score had improved from 9.2 ± 3.7 to 2.4 ± 1.4 in the UAVS group and from 9.3 ± 3.2 to 2.1 ± 0.8 in the EVLA group (P = .64). At 1 year, the corresponding scores were 1.3 ± 0.7 and 1.4 ± 0.6 (P = .21). ConclusionsUAVS has high technical success, making it a suitable alternative to EVLA using a 1470-nm laser.

A Higher Body Mass Index Means Worse Satisfaction Outcome in Obese Patients Undergoing Varicose Vein Surgery

Introduction: Obesity (body mass index [BMI] >30) and lower limb venous disease (LLVD) is a common problem, yet there is a sparsity of evidence in its management. The aim was to carry out a satisfaction survey on such patients following their venous surgery from a single center. Methods: Three hundred and thirty procedures carried out from January 2017 to April 2018. Eighty-seven patients with BMI > 30 were selected and case notes reviewed retrospectively. Data on demography, risk factors, Clinical, Etiology, Anatomy, Pathology (CEAP) status, operative data, and complications were collected. Fifty-three patients had a telephone follow-up to assess satisfaction in terms of symptoms and appearance. Logistic regression analysis was carried out to identify factors contributing to a worse outcome. Results: The mean age was 53.1 (50.6% were male). The mean BMI was 36.11 (30–56). CEAP grade of more than 3 was present in 69.8% (44/87). Most patients were treated by radiofrequency ablation (81.6% [71/87]). Significant complications occurred in 3.4% (3/87) after surgery. The median follow-up was 22 months (14–30). Symptoms improvement was reported in 74% (39/53), while 5.6% (3/53) reported worse symptoms. In terms of appearance, 71.6% (38/53) reported improvement, while 7.5% (4/53) reported worse appearance. Logistic regression analysis identified BMI to be a significant risk factor (odds ratio 1.257 (95% confidence interval 1.004–1.575). Conclusions: The higher the BMI, the lesser the patient satisfaction after varicose vein surgery. Obese patients with LLVD can be treated successfully with a high satisfaction rate for BMI class 1 and 2.

A One-Year Audit of Varicose Vein Surgery at a Vascular Surgical Unit with a Long-Term Duplex and Quality of Life Follow-Up

Objective: With the introduction of endovenous treatments, open varicose veins surgery was discarded due to a claimed high risk of neovascularisation. A one-year audit was set up to look at results from performing mainly open surgery. Methods: All varicose vein interventions were registered and prospectively followed with colour Duplex assessments after 4-6 weeks, 1 and >5 years. In addition, Aberdeen Varicose Vein Questionnaire (AVVQ) was used in addition to Varicose Vein Severity Score (VCSS) to assess patients’ quality of life (QoL) and the disease severity. Results: During the year, 236 patients/252 legs were operated and 28% were re-do procedures. Median age was 55 years (16-87) and 70% were females. Duplex at 4-6 weeks showed a primary success rate of 91%. Neovascularisation was noted in 8% one year after primary surgery. The long-term assessment was done after a median of 69 months (39-75) and 67% of all legs were examined. After primary surgery 16% showed neovascularisation compared with and 27% after re-do procedures. VCSS improved significantly from 6 (range 1-22) to 2 at the long-term follow-up (p<0.001). The AVVQ score improved from 20 (range 3-55) down to 10 (p<0.001). Conclusion: The risk for neovascularisation seems to have been overestimated and good long-term results can be achieved following modern open surgery. The major problem is to avoid varicose vein recurrence since results from re-do procedures seem less favourable long term.

Surgical procedures in inpatient versus outpatient settings and its potential impact on follow-up costs

ObjectiveWe examined real-world effects of cantonal legislations to direct surgery patients from the inpatient to the outpatient setting in Switzerland. MethodsAnalyses were based on claims data of the Helsana Group, a leading Swiss health insurance. The study population consisted of 13’145 (in 2014), 12’455 (in 2016), and 12’875 (in 2018) insured persons aged >18 years who had haemorrhoidectomy, inguinal hernia repair, varicose vein surgery, knee arthroscopy/meniscectomy or surgery of the cervix/uterus. We assessed the proportion of inpatient procedures, index costs, length of hospital stays, outpatient costs and hospitalizations during follow-up, stratified by procedure, in-/outpatient setting, and the presence (enacted/effective in 2018) of a cantonal legislation. We used difference-in-differences methods to study the impact of cantonal legislations. ResultsOverall, the proportion of procedures performed in the inpatient setting decreased between 2014 and 2018 (p < 0.001). The decrease between 2016 and 2018 was significantly steeper in cantons with a legislation (p < 0.001; effect size: 0.57; 95% CI: 0.51, 0.64), leading to steeper decreases in healthcare costs of index procedures in cantons with a legislation, with no impact on length of hospital stays. The legislation also had no impact on outpatient costs or hospitalizations during follow-up. ConclusionsThe cantonal legislations achieved the intended effects of inpatient surgery substitution by outpatient surgery, with no evidence suggesting negative effects on costs or hospitalizations during follow-up.

Short-term compression therapy in chronic vein disease without trophic disorders: possibilities of medical compression knitwear

Introduction.Medical compression stockings are one of the main methods in a conservative strategy for the treatment of chronic vein diseases as well as for adjuvant treatment after superficial venous interventions. however, compliance to this treatment is low.Objective.To evaluate patient satisfaction with medical compression knitwear therapy in a short-term follow-up.Materials andмethods.The study included 150 patients of both sexes aged 42 ± 8.3 years. Endovenous laser obliteration combined with mini-phlebectomy and/or sclerotherapy for varicose veins was performed. All patients after the surgery wore compression stockings of compression class 2 with a recommended wearing period of 14 days. At the control visit at the end of the follow-up period all patients were asked to complete a satisfaction survey with a specially prepared questionnaire including 7 questions.Results and discussion.No significant adverse events and complications related to either the invasive intervention or the compression therapy were observed during the follow-up period. There were no abnormalities such as compression sensations or changes in blood flow under the knitwear. The compression was totally adequate, with no areas of over- and/or under-compression. All respondents felt that the knitwear was well anchored to the leg and no slipping or twisting due to the wide elastic band with droplet silicone. In addition to all of the above, the patients noted that the knitwear offered to them in the study had good tactile properties: it was soft and pleasant to the skin. According to the survey, the average score for all questions was 9.5 (QR 8-10).Conclusion.Elastic compression is an effective and safe means of preventing adverse events, complications and pain in patients after superficial varicose veins surgery. Additional consumer properties of medical compression knitwear can significantly influence patients’ compliance and therefore the effectiveness of treatment.

English

BACKGROUND Chronic venous disorders are an important cause of disease and disability worldwide. Varicose veins are dilated, tortuous elongated veins. Varicose veins are either primary or secondary. Most of the patients are asymptomatic. Indian populations present with complications like venous bleed, thrombophlebitis, chronic venous insufficiency leading to edema, eczema, lipodermatosclerosis, and venous ulcers. Varicose vein surgery is characterized by a high recurrence rate of 20 % to 60 % after 5 years and even higher after longer periods of observation. Recurrence may be due to several causes like inaccurate initial diagnosis, progression of disease, inadequate initial surgery, altered venous dynamics, and neovascularisation. METHODS In this cross sectional single center study, 100 patients above 18 years of of age of both genders presenting with complications of varicose veins and cases of postoperative recurrent varicose veins were included. This study was conducted in the Department of General Surgery, Sri Venkateswara Ramnarayan Ruia Government General Hospital (SVRRGGH), Tirupati, over a period of one year. RESULTS In the present study, the great saphenous vein (GSV) was involved in 85 % of cases, the short saphenous vein (SSV) in 2 %, and both long and short saphenous in 9 %. The commonest complication was edema in 88 % of the patients, followed by 43 % with eczema. Recurrent varicose veins were seen in 4 % of patients. CONCLUSIONS Complications were more common in our setting at the time of presentation. Variable anatomy of the venous system of the lower limb makes prior duplex scan assessment compulsory in the surgical management of cases. Surgical management is to be planned properly after complete evaluation and should be planned at the right time, as it is a progressing clinical entity. KEYWORDS Varicose Veins, Complications, Recurrence, Management

Stripping surgery for varicose veins

Stripping surgery for varicose veins

OUTCOME OF SCLEROTHERAPY IN THETREATMENT OF NON-HEALING VARICOSE ULCERS UNDER ULTRASOUND CONTROL

BACKGROUND &amp; OBJECTIVE: Varicose veins are the commonest vascular problem both in men and women worldwide. Lack of timely management, inadequate treatment, and maltreatment of varicose veins can lead to the development of nonhealing ulcers and affects the quality of life in terms of health. Surgery, heat therapy, chemical therapy, and endoscopic treatment are the options of treatment. Foam sclerotherapy is relatively a new technique being practiced all over the world and has promising results.The objective was to determine the outcomes of foam sclerotherapy in the treatment of non-healing varicose ulcers.&#x0D; METHODOLOGY:In this descriptive study, 240 patients with chronic leg ulcers with varicose veins had been managed with foam sclerotherapy under ultrasound and compression bandage. All patients were reviewed at 7 days, 1month, 3 months, 6 months, 1 year, and 18 months both clinically and radiologically with a doppler ultrasound to assess the ulcer healing rates.&#x0D; RESULTS:The overall healing after 04 weeks of foam sclerotherapy was 83%. Two hundred and twenty-nine patients (95.4%) with ulcers healed within 02 months of the start of ultrasound-guided foam sclerotherapy. Delayed healing occurred after four months in11 cases. All those cases had either previous varicose veins surgery or deep vein thrombosis,or extensive perforator disease. During 18 months of follow-up, seven patients showed recurrence with a mean symptom-free period of 07 months.&#x0D; CONCLUSION:Chronic venous ulcers treated with foam sclerotherapyunder ultrasound guidance are associated with a high healing rate and low recurrence rate.

Intermittent pneumatic compression after varicose vein surgery

ObjectiveIntermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects of IPC applied directly after varicose vein surgery performed with high volumes of tumescent local anesthesia have not been investigated. The aim of the present study was to evaluate the use of postoperative IPC concerning its effects on the leg volume and patient comfort after surgery. MethodsWe performed an investigator-initiated, single-center, open-label randomized controlled trial. A total of 186 patients indicated for saphenofemoral junction ligation and great saphenous vein or anterior accessory saphenous vein stripping or great saphenous vein redo surgery were randomly assigned 1:1 to the intervention or control group. The patients in the intervention group were treated with IPC at 40 mm Hg for 45 minutes directly after surgery. The outcome measures were the leg volume changes calculated using an optical three-dimensional scanning system (primary objective), quality of life (QoL; Freiburg Life Quality Assessment for chronic venous disease, short form), pain, and extent of ecchymosis with follow-up examinations on days 1 and 7 after surgery. ResultsThe patients in both groups had comparable mean leg volume reductions from baseline to day 1 (IPC group, 58.8 mL; control group, 37.4 mL; P = .967) and to day 7 (63.1 mL and 57.0 mL, respectively; P = .546). We also did not observe significant differences between the two groups in QoL and pain. The patients in the IPC group had developed larger areas of ecchymosis compared with the control group (16% vs 13.3% of leg surface, respectively; P = .046), with a tendency toward an increase in pain at 7 days after surgery compared with no IPC application. ConclusionsThe present randomized controlled trial was designed to evaluate the decongestive effects of a single postoperative session of IPC and its effect on QoL, pain, and ecchymosis in patients who had undergone varicose vein surgery under tumescent local anesthesia. Because no evidence for a benefit from IPC could be found in the present study and increased ecchymosis was found, its standard use after varicose vein surgery cannot be recommended.

Evaluation of the results of varicose vein surgery with radio frequency ablation and sclerotherapy in the same or separate sessions

Evaluation of the results of varicose vein surgery with radio frequency ablation and sclerotherapy in the same or separate sessions

СОВРЕМЕННЫЕ СТАНДАРТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВЕНОЗНЫХ ТРОФИЧЕСКИХ ЯЗВ НИЖНИХ КОНЕЧНОСТЕЙ

Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standard sare proposed. The main aim of surgical therapy is the elimination of the lower extremity venous refluxso that the solution of this problem significantly reduces the incidencerate ofrecurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemicalablation(MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplastywith free split perforatedcutaneousflap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery(SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous refluxin the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation.

The current state of vascular surgery presence and educational content in Google and YouTube internet search results

BackgroundInformation on the internet regarding vascular disease has not been extensively assessed. Our goal was to compile and appraise the information available via Google and YouTube searches regarding various topics of interest for vascular surgeons (VS) and related procedures with a focus on the role of the VS. MethodsThe Google and YouTube platforms were independently queried for 25 keywords/phrases relating to common vascular diagnoses and procedures by two separate researchers from March to July 2019. Paid advertisements or a Society for Vascular Surgery (SVS) webpage or affiliated video in the first 25 results was documented. Results were reviewed for information regarding the responsible medical specialty and the target audience, and disease-related information (screening, risk factors, risk reduction, diagnostic testing, operative treatment, alternative treatment, follow-up, complications, and recovery). ResultsFrom the Google search, 357 unique domains of 1241 total webpages were identified with 75% directed toward the public. An SVS page was present in 56% of the first-page results and least likely to be present in searches for claudication, gangrene, carotid stent, rib resection, and thrombolysis. VS were mentioned as referral physicians in 56% of the 68% of websites that mentioned a specialty, endovascular specialists/interventional radiology in 20%, and cardiothoracic surgeons in 19%. Only 4% of the websites contained information from all categories, with the greatest number for aortic dissection. Advertisements were present in 18% of all searches (most commonly for “varicose vein,” “varicose vein surgery,” and “inferior vena cava filter”). From YouTube, 1247 search results (613 unique videos) were evaluated with 64% directed toward the public. An SVS affiliated video was present in 36% of searches. In the 47% of videos where a specialty was mentioned, 56% mentioned VS, interventional radiology in 10%, and cardiothoracic surgeons in 7%. Only 0.24% of the videos contained information from all categories. The greatest number of content categories was in videos related to peripheral arterial disease. Across both platforms, dialysis access searches yielded results with the least number of content categories. ConclusionsPatient-related information regarding vascular surgical topics is readily available on the internet, but the content is highly variable and not comprehensive. Only half of the searches mention VS as the referral physician of choice or authority for these medical conditions. Further efforts should focus on developing the online presence of vascular surgery, improving the quality of education of vascular disease on the internet, and directing patients to the vascular specialists to treat these conditions.

“Quality of Life after Varicose Vein Surgery in Patients with High-ligation and Stripping, External Valvuloplasty and Sapheno-femoral Redo Surgery”

High-ligation and stripping (HL/S) and external valvuloplasty (eVP) with the implantation of an external device to restore the valve's function, are surgical methods to eliminate reflux at the saphenofemoral junction. Furthermore, redo-surgery (RedoS) can be performed in terms of same side groin recurrences. It is unclear, if there is a difference in quality of life (QoL) between these 3 surgical treatment options. Therefore, it was the aim of our study to elucidate QoL in patients before and after surgical treatment at the saphenofemoral junction by comparing HL/S, eVP, and RedoS. A total of 303 participants (156 HL/S, 81eVP, 64 RedoS) were recruited during the daily clinical routine. QoL was measured at admission and 6 weeks after the surgical procedure by means of SF-12 (12 item short form health survey) and Aberdeen Varicose Vein Questionnaire. The mean value of Aberdeen Varicose Vein Questionnaire was 14.5 (SD 2.1) preoperatively and 4.9 (SD 3.3) postoperatively in the HL/S group, 16.4 (SD 1.4) preoperatively and 6.8 (SD 2.5) postoperatively in the eVP group and 15.5 (2.2) preoperatively and 5.8 (SD 4.2) postoperatively in the RedoS group, which was statistically significant (P< 0.05) in all groups. Postoperatively, the mean values were statistically significant within the groups. Concerning physical aspects of the SF-12 we found a significant improvement in the RedoS group, while mental aspects were significantly better in the HL/S and eVP group postoperatively. Nevertheless, the clinical relevance of these SF-12 differences is questionable under consideration of the minimal important difference. Varicose vein surgery leads to a significant improvement of QoL in all groups. The implantation of an external patch could have a negative influence in QoL.

Patient literacy on varicose veins in cases presenting at university hospital of Nepal subjected for surgical management of varicose veins

Varicose veins are prominent dilated veins usually present in the lower limbs leading to complications if not managed well. Knowledge regarding varicose vein among the patients in Nepal is not yet known. We aim to examine the knowledge regarding varicose vein diagnosis and treatment among patients to better understand the barriers to care. This is a descriptive cross-sectional study adopting census sampling method. We collected data from the surgical ward where patients were admitted for surgery of varicose veins. Self-developed tool "Dhulikhel Hospital Patient Perception Questionnaire on Varicose Vein" was used for data collection after validation (Kuder-Richardson Reliability Coefficient was 0.75). Collected data were analyzed using software SPSS 23.0. Descriptive statistics was performed to present sociodemographic variables and varicose veins literacy scores. Independent sample t-test was performed for dichotomous variables and one-way ANOVA with post hoc analysis were performed for variables with multiple groups. Total 80 participants were included in the study of which 60% were men. The mean age was 45.66years with SD 13.27. Varicose veins literacy score was high among 52.4% (more than 50% score) and low (less than 50% score) among 47.6%. There was significant mean difference (P<.01) among male and female sex, different educational groups, and different occupational groups. Patients admitted for varicose vein surgery had less than 50% knowledge in different components of varicose vein. Regular educational intervention is recommended to ensure better care of these patients.

The experience of hospital-replacing surgery for varicose veins in St Petersburg outpatient clinics

Introduction.Over the last 20 years the widespread introduction of ultrasound imaging into clinical practice and the emergence of new endovascular technologies in the treatment of varicose veins have brought about a paradigm shift in the surgical treatment and the introduction of innovative minimally invasive technologies (thermoobliteration, chemical obliteration, microphlebectomy), which can be performed on outpatient basis under local anesthesia. Therefore, the widespread introduction of these technologies into the outpatient practice is the foremost task.Objective of the study.Analyse the results of the experience gained in the St Petersburg polyclinics concerning the introduction of hospital-replacing surgical treatment of varicose vein diseases and appropriate training. Materials and methods. We have performed 854 surgeries including endo-venous laser coagulation (EVLС), sclerobliteration (SO) and Varadi miniflebectomy (MF) under local infiltration anesthesia: EVLC + MF in 71%, MF in 12%, EVLC + SO in 9%, EVLC + MF + SО in 3%, EVLC in 3% and SО in 2% of cases. The patients operated on ranged in age from 19 to 78 years (53 ± 21 g), among them there were 611 women and 202 men. The clinical distribution of patients was in accordance with CEAP classification: C2 – 62%, C3 – 22%, C4a/b – 12%, C5 – 2.5%, C6 – 1.5%.Results and discussion.The evaluation of treatment results based on a retrospective analysis of patients’ examination findings after 1, 39, 180 and 365 postoperative days has demonstrated that there is no evidence of intra- and postoperative complications requiring hospitalization, disease recurrence. However, ecchymosis in 35% of cases, limited superficial infiltrates - in 18%, limited superficial thrombophlebitis - in 0.8% have been reported after MF. They have been treated using topical agents. According to the questionnaire, after a year of treatment 96% of patients appear to be satisfied with the results obtained. After a year payback financial costs have been achieved. An effective practical training program has been developed and implemented for innovative technologies for surgery of varicose veins of lower extremities. 42 physicians of outpatient clinics underwent the program.Conclusions.It can therefore be concluded that the further introduction of innovative technologies into the polyclinics is reasonably practicable as it is safe, effective, expands the population’s access to modern technologies, is economically feasible and is perceived positively by patients, reduces the burden on surgical hospitals, improves professional qualifications and expands the professional competencies of surgeons in outpatient settings.