This is a study of interventions performed to patients with varicose veins at a local hospital, whose influence area is from 51,547 people, divided into 26,130 women and 25,417 men. However, the 68,45% of interventions performed with a diagnosis of varicose veins correspond to women. We divided the patients by ages and by used surgical techniques. We notice the lack of complications and the scarse number of reinterventions. The technique used in most cases was the saphenectomy through inner stripping.
Translation: Sabrina Gisella Cordone.
Varicose veins in lower extremities, as a common contingency, with reference to a specific town. Optative surgical technique.
Carbonell-Tatay A, Casp V, Landete FJ, Manzanares C, Garay M. General and Digestive Surgery Service, Ontinyent Hospital (Valencia).
Torró R (Muvale, Valencia).
Llopis. A, Clinical Documentation Service. Ontinyent Hospital (Valencia).
Translation: Sabrina Gisella Cordone. Más información en http://www.portalesmedicos.com/traductores-medicina/cordone/
Abstract
This is a study of interventions performed to patients with varicose veins at a local hospital, whose influence area is from 51,547 people, divided into 26,130 women and 25,417 men. However, the 68,45% of interventions performed with a diagnosis of varicose veins correspond to women. We divided the patients by ages and by used surgical techniques. We notice the lack of complications and the scarse number of reinterventions. The technique used in most cases was the saphenectomy through inner stripping.
Introduction
The first references to procedures related to varicose veins are dated from Hippocrates times (460 B. C.) During many centuries, varicose veins have been treated by means of punctures, bonds and other minor techniques, until last century, when Federico Trendelemburg recommended the saphena bond as high as possible. At the beginning of the XX century, saphenectomy is presented as the surgical technique chosen by physicians Mayo (1), Seller and Babcock( 5).
Rumour has it that the first phleboextraction was performed by Keller in 1905 and that in 1916, Homans (2) describes the inner saphenectomy technique as it stands today. Thus, currently the saphenectomy is performed through an inner phleboextractor (inner saphenectomy), as the chosen technique for treating essential varicose veins.
It is well known that 10% of adults have varicose veins to a greater or lesser degree, being most frequent in women than in men. It is also known that etiology is caused by a malfunctioning of venous valves, or lack of them.
Material and method.
We began by presenting an anatomic memory of venous systems, both superficial and deep ones, of lower extremities, according to the drawings of Darío Aguilar MD, at the instigation of Jorge Latorre MD.
Common perforans
Inner and outer saphena
Superficial and deep venous systems of lower extremities.
Deep venous systems of lower extremity.
We study them for a period of 10 years, aiming at patients between the most frequent 25th Diagnosis Related Groups from our hospital, according to the diagnosis when they are released from hospital. We had 596 operated on patients, in whose procedure (always according to the DRG) it was applied a venous extraction of bond. This procedure has the 5th place among the 25th most frequent procedures of the General and Digestive Surgery service from our Center. Out of this 596 people, a saphenectomy has been performed to 579 people and a bond or cut has been performed to 17 of them.
We count 408 women and 188 men. That is to say, the intervention in women corresponded to a 68,45% of the total interventions.
The distribution according to ages was as follows:
People older than 50 represented a 59,3%, having a lower incidence among people younger than 30. Out of 596 operated on patients, only 17 of them were treated by means of a second intervention in order to bond residual varicose veins. In the diagnosis, a doppler ultrasound scan was used as a help for dismissing possible deep thrombosis, as well as for identifying malformations (3) and (4).
The technique par excellence was the classic saphenectomy:
Careful dissection of the stick of the inner saphena. The attached images are taken from patients operated on at our center.
Saphena dissection at the inner malleolus.
Introduction of the phleboextractor in malleolar saphena. Whenever we can, we introduce the phleboextractor in the same direction of the venous valves. We extract it through the inguinal incision and we place the header.
It is proved that the vein is completely extracted.
There are no severe complications, although there are a few cases of inguinal seroma. Hematomas proper of interventions are not considered a complication. The average days of absence of work in patients in age to work was 21 years old.
Conclusions.
Saphenectomy has the 5th place among the 25th most frequent procedures of our service. it is accepted as a programmed intervention in the General Surgery Services from town hospitals where there is no Vascular Surgery. We coincide with the rest of the publications when they highlight that it is twice more frequent in women than in men, and that more than half the population operated on had more than 50 years old.
The technique used par excellence was the classic saphenectomy, and the irrelevant complications. The average of operated on varicose veins per year has been 60. The satisfaction level of the patines which was measured by other surveys has been very good.
Acknowledgements.
We thank the collaboration of the Valencian Institute of Statistics and the clinical documentation service from our hospital.
Bibliography.
1.- Mayo CH. Varicose veins of the lower extremity. St Paul Med J 1900;2:595. Babcock W. A new operation for the extirpation of varicose veins of the leg. St Paul Med J 1907;86:153-4.
2.- Homans J. The etiology and treatment of varicose veins and ulcers based upon a classification of these lesions. Surg Gynecol Obstet 1917;24:300-5.
3.- Díaz Gómez F, Castells Ferrer P, Recio Valenzuela E, García Armengol J, Fernández Martínez C, Roig Vila JV. Estudio comparativo entre la flebografía poplítea dinámica y el Eco-Doppler en color en el diagnóstico de la insuficiencia venosa en el hueco poplíteo. Cir Esp 1998; 63: 373-377.
4.- Benabou JE, Molnar LJ, Cerri GG. Duplex sonographic avaluation of the sapheno-femoral venous junction in patients with recurrent varicose veins after surgical tretment. J Clin Ultrasound 1998; 26: 401-404.
5.- Babcock W. A new operation for the extirpation of varicose veins of the leg. St Paul Med J 1907;86:153-4.
Translation: Sabrina Gisella Cordone. Más información en http://www.portalesmedicos.com/traductores-medicina/cordone/
