Prophylaxis of complications in venous surgery

R. Romano; M. Leo; R. Di Mitri

doi:10.12687/phleb2383-5-2017

Phlebologie, Table of Contents

Phlebologie 2017; 46(05): 271-275
DOI: 10.12687/phleb2383-5-2017

Review

Schattauer GmbH

Prophylaxis of complications in venous surgery

Prophylaxe von Komplikationen bei Venen - chirurgie

R. Romano

¹Tuscany Vascular Center, San Rossore’s Clinic, Pisa/Italy

,

M. Leo

¹Tuscany Vascular Center, San Rossore’s Clinic, Pisa/Italy

,

R. Di Mitri

¹Tuscany Vascular Center, San Rossore’s Clinic, Pisa/Italy

› Author Affiliations

Abstract

Summary

Aim: The purpose of this article is to underline complications in venous surgery during the past 30 years and new ones arising with the introduction of technologies. We also discuss the “natural reduction” of some of these and how to prevent complications.

Methods: We have analysed different types of studies on different surgical procedures in the treatment of varicose veins and compared them with own outcomes.

Results: Considering all techniques, we have wound infections in 2,3–4 % of cases, cellulitis in 2,6–16 %, lymphatic complications in 1,3–60 %, pain in 2–23 %, neurologic disease including nerve damages, bruising and numbness in 0–50 %, thrombophlebitis in 0,3–20 %, deep vein thrombosis with or without pulmonary embolism in 0–5,7 %, injury of major vessel in 0,17 %, haematoma in 1,3–31 %, oedema in <1–15 %, hyperpigmentation in 3–11 %, ecchymosis in 0,8–9 %, skin burns in 0,2–8 %, erythema in 2–33 % and endothermal heat-induced-thrombosis (HEIT) in 0–7,5 % of cases.

Conclusion: Our outcomes confirmed literature results. We conclude that new technologies improve results and reduce complications, as do tumescent anaesthesia, medical stockings, early mobilization and low weight heparin prophylaxis (LMWH) in high risk patients.

Zusammenfassung

Ziel: Es sollen die Komplikationen der Varizenchirurgie der letzten 30 Jahre und die der neuen Technologien erörtert werden, besonders in Bezug auf den Effekt der “natürli-chen” Reduktion derselben durch neue Methoden.

Methode: Es wurden verschiedene Studien zu unterschiedlichen chirurgischen Techniken zur Behandlung von Varizen analysiert.

Ergebnisse: In dieser Analyse fanden wir folgende Komplikationen: Wundinfektionen in 2,3–4 % der Fälle, Zellulitis in 2,6–1,6 %, Lymphkomplikationen in 1,3–60 %, Schmerzen in 2–23 %, neurologische Komplikationen mit Nervenläsionen und Parästhesien in 0–50 %, Thrombophlebitis in 0,3–20 %, tiefe Venenthrombosen mit oder ohne Pulmonalembolie in 0,5–7 %, Verletzungen größerer Gefäße in 0,17 %, Hämatome in 1,3–31 %, Ödeme in <1–15 %, Hyperpigmentationen in 3–11 %, Blutergüsse in 0,8–9 %, Hautverbrennungen in 0,2–8 %, Erytheme in 2–33 % und EHIT in 0–7,5 % der Fälle.

Schlussfolgerung: Nach der Analyse der chirurgischen Vorgehensweisen bei Varikose können wir feststellen, dass die neuen Technologien die Resultate verbessern und Komplikationen reduzieren, wie auch die Tumeszenzanästhesie, Kompressionsstrümpfe, Frühmobilisation und fraktioniertes Heparin beim Hochrisikopatienten.

Keywords

Varicose vein surgery - prophylaxis in varicose vein surgery - postoperative complications

Schlüsselwörter

Varizenchirurgie - Vorbeugung in der Varizenchirurgie - postoperative Komplikationen

Full Text

References

References
1 Campbell WB, Ridler BMF. Varicose vein surgery and deep vein thrombosis. British Journal of Surgery 1995; 82: 1494-1497.
2 Caprini JA, Arcelus JI, Hoffmann K. et al. Prevention of venous thromboembolism in North America: results of a survey among generale surgeons. J Vasc Surg 1994; 20: 751-758.
3 Critchley G, Handa A, Maw A. et al. Complications of varicose vein surgery. Ann R Coll Surg Engl 1997; 79: 105-110.
4 Sam RC, Silverman SH, Bradbury AW. Nerve Injuries and Varicose Vein Surgery. Eur J Endovasc Surg 2004; 27: 113-120.
5 Cix SJ, WellWood JM, Martin A. Saphenous nerve injury caused by stripping of the long saphenous vein. BMJ 1974; 1: 415-417.
6 Munn SR, Morton JB, Macbeth WAAG, McLeish AR. To strip or not to strip the long saphenous vein? A varicose veins trial. Br J Surg 1981; 68: 426-428.
7 Holme JB, Skajaa K, Holme K. Incidence of lesiono f the saphenous nerve after partial or complete stripping of the long saphenous vein. Acta Chir Scand 1990; 156: 145-148.
8 Van Rij AM, Chai J, Hill GB, Christie RA. Incidence of deep vein thrombosis after varicose vein surgery. British Journal of Surgery 2004; 91: 1582-1585.
9 Puggioni A, Carmo M, Mozes G, Gloviczki P. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg 2005; 42: 488-493.
10 Abbott D, Dharmarajah D, Davies AH. Varicose vein surgery and deep vein thrombosis prophylaxis. Phlebology 2007; 22 (Suppl. 01) 1-2.
11 Gibson KD, Ferris BL, Polissar N. et al. Endovenous laser Treatment of the short saphenous vein: Efficacy and complications. J Vasc Surg 2007; 45: 795-803.
12 Disselhoff BCVM, der Kinderen DJ, Moll FL. Is there a risk for lymphatic complications after endovenous laser treatment versus cryostripping of the great saphenous vein? A prospective study. Phlebology 2008; 23: 10-14.
13 Fernandez CF, Roizental M, Carvallo J. Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience. J Vasc Surg 2008; 48: 947-952.
14 Knipp BS, Blackburn SA, Bloom JR. et al. Endovenous laser ablation: Venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg 2008; 48: 1538-1545.
15 Laser and Radiofrequency Ablation Study (LARA study).. a randomized Study Comparing Radiofrequency Ablation and Endovenous Laser Ablation (810 nm). Eur J Vasc Endovasc Surg 2010; 40: 246-253.
16 Pannier F, Rabe E, Rits J, Kadiss A, Maurins U. Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radiale fibre – follow-up after six months. Phlebology 2011; 26 (Suppl. 01) 35-39.
17 NN.. Endovascular Laser Therapy for Varicose Veins. Ont Health Technol Assess Ser 2010; 10 (Suppl. 06) 1-92.
18 Almeida JI, Kaufman J. Gockeritz et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multi center, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol 2009; 20 (Suppl. 06) 752-759.
19 Murad MH, Coto-Ylgesias F, Zumaeta-Garcia M. et al. A systematic review and meta-analysis of the treatments of varicose veins. J Vasc Surg 2011; 53: 49S-65S.
20 Pittaluga P, Chastanet S. Lymphatic complications after varicose veins surgery: risk factors and how to avoid them. Phlebology 2012; 27 (Suppl. 01) 139-142.
21 Anwar MA, Lane TRA, Davies AH, Franklin IJ. Complications of radiofrequency ablation of varicose veins. Phlebology 2012; 27 (Suppl. 01) 34-39.
22 Siribumrungwong B, Noorit P, Wilasrumee C. et al. A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Endovenous Ablation and Surgical intervention in PAtients with Varicose Vein. Eur J Vasc and Endovasc Surg 2012; 44: 214-223.
23 Van Eekeren RJP, Boersma D, Konijn V. et al. Postoperative pain and early quality of life after radio-frequency ablation and mechanochemical endovenosu ablation of incompetent great saphenous veins. J Vasc Surg 2013; 57: 445-450.
24 Joh JH, Kim W-S, Jung I. et al. Consensus for the treatment of Varicose Vein with Radiofrequency Ablation. Vasc Specialist Int 2014; Dec; 30/4: 105-112.
25 Whiteley MS. Glue, Steam and Clarivein – Best practice techniques and evidence. Phlebology 2015; 30 2s 24-28.
26 Pavlovìc MD, Schuller-Petrovìc S, Pichot O. et al. Guidelines of the First International Consensus Conference on Endovenous Thermal Ablation for Varicose Vein Disease – ETAV Consensus Meeting 2012. Phlebology 2015; 30 (Suppl. 04) 257-273.
27 Hirokawa M, Ogawa T, Sugawara H. et al. Comparison of 1470 nm Laser and Radial 2ring Fiber with 980 nm Laser and Bare-tip fiber in Endovenous Laser Ablation of Saphenous Varicose Veins: a Multicenter, Prospective, Randomized, non-blind Study. Ann Vasc Dis 2015; 8 (Suppl. 04) 282-289.
28 Morrison N, Gibson K, McEnroe S. et al. Randominzed trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg 2015; 61: 985-994.
29 Bellmunt-Montoya S, Escribano JM, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Sys Rev 2015; 6: cd009648.
30 Wozniak W, Kryzysztof Mlosek R, Ciostek P. Complications and Failure of Endovenous Laser Ablation and Radiofrequency Ablation Procedures in Patients with Lower Extremity Varicose Veins in a 5-year follow-up. Vasc Endovasc Surg 2016; 50 (Suppl. 07) 475-483.
31 Boersma D, Kornmann VN. Van Eekeren et al. Treatment modalities fro Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2016; 23 (Suppl. 01) 199-211.
32 Kurihara Nobuhisa, Hirokawa Masayuki, Yamamoto Takashi. Postoperative Venous Thromboembolism in Patients undergoing Endovenous Laser and Radiofrequency Ablation of the saphenous vein. Ann Vasc Dis 2016; 9 (Suppl. 04) 259-266.
33 Tang TY, Kam JW, Gaunt ME. ClariVein – Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins. Phlebology 2017; 32 (Suppl. 06) 6-12.