Ambulatory Phlebectomy, Second Edition

by Goldman; Mitchel P.

• ISBN13: 9780824759094
• ISBN10: 0824759095
• Edition: 2nd
• Format: Hardcover
• Copyright: 2005-05-26
• Publisher: CRC Press

Summary

Third author, Mitchel P. Goldman, is with the Univ. of San Diego, CA. Discusses office-based surgical treatment of varicose veins and provides step-by-step coverage of the ambulatory phlebectomy technique. Updated edition includes new concepts for individually tailored surgical treatments. Previous edition: c1995.

Table of Contents

Foreword	xv
Robert Muller
Preface	xix
Interview of Dr. Robert Muller	xxiii
A.A. Ramelet
Acknowledgments	xxv
Introduction to the Second Edition	xxix
Stefano Ricci
History of Ambulatory Phlebectomy	xxxiii
Robert Miller
Who Discovered Saphenous Vein Incontinence!	xli
Stefano Ricci
Part I: General Considerations
1. Definition and Indications	3	(2)
Indications.	3	(2)
2. Anatomical Bases of Ambulatory Phlebectomy	5	(52)
General Organization of the Superficial Venous System	5	(22)
Great Saphenous Vein Compartment	11	(16)
Great Saphenous Vein	11	(6)
Small Saphenous Vein	17	(3)
Collateral Veins and Varicosities	20	(1)
Autonomous Collateral Varicosities	20	(2)
Combined Collateral and Saphenous Varicosities	22	(2)
Perforating Veins	24	(3)
Topographic Description	27	(15)
Upper Thigh	27	(2)
Medial Thigh	29	(1)
Posterior Thigh	30	(1)
Lateral Thigh	30	(2)
Anterior Thigh	32	(1)
Knee	32	(4)
Medial Knee	32	(1)
Anterior and Lateral Knee	33	(1)
Popliteal Area	34	(2)
Medial Leg	36	(1)
Anterior Leg	37	(1)
Lateral Leg	37	(1)
Posterior Leg	37	(3)
Foot	40	(2)
Deep Veins of the Lower Limb	42	(1)
Nerves and Lymphatics	43	(1)
Surgical Anatomy of Venous Leg Telangiectasia	44	(1)
References	45	(2)
Appendix A: Atlas of Varicose Vein Patterns	47	(10)
Patterns of Saphenous Vein Involvement in Varicose Vein Disease	47	(7)
Primary Varicose Veins Circuits	53	(1)
Patterns of GSV Involvement	53	(1)
Anatomical Arrangement of the GSV and Related Varicose Patterns	53	(1)
Segmental GSV Involvement	54	(1)
Patterns of ASV Involvement	54	(2)
Patterns of SSV Involvement	56	(1)
Patterns Involving Both GSV and SSV	56	(1)
3. Examination of the Patient with Varicose Veins	57	(18)
Clinical Examination	57	(4)
Medical History	57	(1)
Physical Examination	58	(3)
Doppler Orthostatic Reflux Test	61	(6)
Method	61	(2)
Groin Examination	63	(1)
Popliteal Examination	64	(1)
Interpretation and Pitfalls of Doppler Reflux Testing	64	(3)
Additional Investigation	67	(6)
Color-Duplex Ultrasound Examination	69	(2)
Evaluation of the Leg Pump Function	71	(2)
References	73	(2)
4. Selection of Patients for Office Varicose Vein Surgery	75	(6)
Varicose Vein and Leg Conditions	75	(1)
Asymptomatic Varicose Veins (CEAP 1-2)	75	(1)
Symptomatic Varicose Veins (CEAP 3-6)	76	(1)
Patient's General Health Conditions	76	(3)
Modifying the Procedure	78	(1)
Infectious Disease	78	(1)
Patient Consent	79	(1)
References	79	(2)
5. Staging of Surgery	81	(10)
Part II: Technique of Phlebectomy
6. Pre-Operative Marking	91	(6)
7. Anesthesia	97	(10)
Preparations, Dosage, and Techniques	98	(6)
Traditional Technique	98	(1)
Preparations and Dosage	98	(1)
Tumescent Technique	99	(3)
Preparations and Dosage	99	(3)
Technique	102	(11)
Pre-Operative Anesthesia	102	(1)
Local Infiltration Anesthesia	102	(2)
References	104	(3)
8. Position of Patient During Surgery	107	(2)
9. Phlebectomy	109	(36)
Incision	109	(4)
Vein Retrieval, Hooking, and Exteriorization	113	(8)
Instruments	113	(3)
Hooks	113	(1)
Graefe Iris Forceps	114	(2)
Toothed Clamps	116	(1)
Technique	116	(5)
Vein Avulsion	121	(14)
Dissection	121	(1)
Traction	121	(4)
Progression of Phlebectomy	125	(5)
Vein Division	130	(5)
End Division	130	(3)
PV Division	133	(1)
Side Branch Division	133	(2)
Technical Difficulties	135	(9)
Vein Fragility	135	(1)
Varicose Clusters	135	(1)
Foot	136	(2)
Shin	138	(1)
Knee	138	(1)
Thigh	138	(1)
Great Saphenous Vein	139	(1)
Small Saphenous Vein	139	(1)
Varicose Veins Recurrent After Sclerotherapy	140	(1)
Varicose Veins Recurrent After Traditional Surgery	140	(1)
Superficial Thrombophlebitis	140	(1)
Lipodermatosclerosis	140	(1)
Thin Skin	141	(1)
Venous Leg Telangiectasia	142	(1)
Periorbital Veins	143	(1)
Hand	144	(1)
Reference	144	(1)
10. Post-Operative Medication and Bandaging	145	(6)
Medication	145	(1)
Bandaging	146	(5)
Adhesive Bandage	146	(1)
Removable Bandages	147	(4)
11. Patient Discharge	151	(2)
Reference	152	(1)
12. Post-Operative Management and Follow-Up	153	(6)
Post-Operative Management	153	(3)
Between Phlebectomy Sessions	153	(1)
After the Last Operation	153	(2)
Further Compression	155	(1)
Type and Duration of Compression	155	(1)
Follow-Up	156	(3)
Patients in Need of Special Care	157	(2)
13. Small Saphenous Vein Phlebectomy	159	(18)
Diagnostic Work-Up	159	(3)
Staging	162	(1)
Pre-Operative Marking	162	(1)
Anesthesia	162	(1)
Position of Patient	162	(1)
Technique	162	(9)
Incisions	162	(1)
Starting the Phlebectomy	163	(5)
Distal Progression	168	(1)
Proximal Progression	168	(1)
Saphenopopliteal Division and Ligation	169	(1)
Higher Popliteal Incision	169	(2)
Atypical Popliteal Terminations of the SSV	171	(1)
Post-Operative Compression	171	(2)
Advantages of SSV Phlebectomy	173	(1)
References	174	(3)
Part III: Selected Phlebological Techniques
14. Post-Operative Compression	177	(10)
Protective Skin Underwrapping	177	(1)
Local Compression Pads	177	(1)
Protective Pads	178	(1)
Adhesive Bandage	178	(6)
Materials	178	(1)
Extension of the Bandage	179	(1)
Technique of Application	179	(3)
Degree of Compression	182	(1)
Testing the Bandage	183	(1)
Difficult Areas	183	(1)
Removable Bandage	184	(1)
Errors of Bandaging	184	(1)
Insufficient Compression	184	(1)
Excessive Compression	184	(1)
Compression Stockings	185	(1)
References	185	(2)
15. High Ligation, Division, and Groin to Knee Stripping of the GSV: An Office Procedure	187	(28)
Indications	187	(3)
Saphenofemoral Junction Incompetence	188	(1)
GSV Dilatation	189	(1)
Preservation of an Incompetent GSV/Saphenopopliteal Junction	189	(1)
Alternative Treatments for GSV Incompetence	190	(1)
Choice of Stripping Technique	191	(1)
Programing the Operation	191	(1)
Pre-Operative Marking	192	(2)
Anesthesia	194	(1)
Patient Position and Skin Preparation	194	(1)
Instruments	194	(3)
Surgical Anatomy of the SFJ	197	(1)
Technique	198	(9)
Ligation and Division of the SFJ	198	(4)
GSV Stripping	202	(5)
Post-Operative Bandage	207	(1)
Complications	208	(1)
References	209	(6)
Part IV: Conclusions
16. Complications and Untoward Sequela of Ambulatory Phlebectomy	215	(16)
Complications of Anesthesia	215	(3)
Allergic Reactions	217	(1)
Toxic Reactions	217	(1)
Local Complications	218	(1)
Late Reactions	218	(1)
Complications of Phlebectomy	218	(8)
Hematoma	218	(1)
Hemorrhage at Home	219	(1)
Wound Infection	220	(2)
Lymphatic Disruption	222	(1)
Lymphocele	222	(1)
Lymphorrhea	223	(1)
Persisting Edema	223	(1)
Nerve Damage	223	(1)
Vein Thrombosis	223	(1)
Pulmonary Embolism	224	(1)
Telangiectatic Matting	225	(1)
Hypertrophic and Pigmented Scars	225	(1)
Rare Complications	225	(1)
Complications of Compression Bandage	226	(2)
Excessive Compression	226	(2)
Blister Formation	228	(1)
Contact Dermatitis	228	(1)
References	228	(3)
17. Psychological Aspects	231	(4)
Reference	234	(1)
18. Advantages of Ambulatory Phlebectomy and Office Varicose Vein Surgery	235	(6)
References	238	(3)
19. Setting Up a Varicose Vein Surgery Practice	241	(14)
Who Should Perform Office Varicose Vein Surgery?	241	(1)
Phlebectomy	241	(1)
High Ligation and Division of the Greater Saphenous Vein	241	(1)
Alternative Applications of Phlebectomy	242	(1)
Safety in Office Surgery	242	(3)
Pre-Operative Management	243	(1)
Anesthesia	244	(1)
Type of Surgical Procedure	244	(1)
Operator's Experience	244	(1)
Post-Operative Management	244	(1)
Emergency Measures	245	(1)
The Free-Standing Surgical Office	245	(2)
Operating Room	245	(1)
Bureaucratic and Accreditation Requirements	245	(2)
Equipment and Materials	247	(4)
Room Equipment	247	(1)
Surgical Instruments	247	(1)
Specific Instruments for Phlebectomy (Single Set)	248	(1)
Materials for Anesthesia	248	(1)
Syringes	248	(1)
Needles	248	(1)
Materials for Bandaging	249	(1)
Additional Localized Pressure	249	(1)
Compression Bandages	249	(1)
Compression Stockings	249	(1)
Other Materials	250	(1)
Emergency Equipment	250	(1)
Examination Equipment	250	(1)
Marking Solution	250	(1)
Material for Local Anesthesia (MPG)	250	(1)
Medication Material	250	(1)
References	251	(1)
Bibliography	251	(4)
Part V: Advanced Techniques
20. Autologous Vein Transplantation for Correction of Dermal Atrophic Changes	255	(6)
Technique	256	(3)
References	259	(2)
21. Treatment of the Great Saphenous Vein with Endoluminal Laser or Radiofrequency Closure	261	(26)
Mitchel P. Goldman and Robert A. Weiss
History of Vein Obliteration	261	(2)
Introduction	263	(3)
RF Technology	266	(2)
Animal Studies	268	(1)
Histology	268	(2)
Clinical Experience	270	(1)
RF Closure Without AP	270	(1)
RF Closure with AP	271	(3)
Side-Effects	274	(1)
Technique of Closure Without Phlebectomy (Video CD)	274	(3)
Technique for Closure with AP (Video CD)	277	(1)
Follow-Up Care	277	(1)
Closure of the GSV with Endoluminal Laser Ablation	278	(4)
Technique for Closure Using Endoluminal Laser (Video CD)	282	(1)
Summary	283	(1)
References	283	(4)
22. Ambulatory Phlebectomy of Recurrent Varicose Veins	287	(34)
References	293
Part VI: Appendices
1. Instructions for Patients Affected by Chronic Venous Insufficiency	297	(4)
2. Consent for Ambulatory Phlebectomy, Endovenous Closure with Laser or Radiofrequency, Administration of Anesthetics, and the Rendering of Other Medical Services	301	(4)
3. Varicose Vein Surgery Suggestions Following Surgery	305	(2)
4. Nursing Instructions	307	(2)
5. Ambulatory Phlebectomy Operative Report	309	(2)
6. Operative Report for Endoluminal Radiofrequency Closure	311	(2)
7. Operative Report for Endoluminal Laser Closure	313	(4)
8. Explanation Card for the Patient	317	(4)
9. Post-Operative Explanation Card for the Patient	321	(2)
10. Duplex Evaluation Forms	323	(2)
Index	325