Varicose vein surgery and obesity

Summary

Varicose vein surgery outlines an excellent treatment option among overweight and obese patients. The impact of obesity varies pending on the planed clinical finding. Despite obesity vena saphena parva surgery as well as surgery of side branch varicose veins are fairly unproblematic. However, varicose vein surgery of vena saphena magna has to be planned and adapted to overweight. Apart from very few exceptions (e.g. leg ulcer) BMI 40 represents the maximum BMI for varicose vein surgery at our hospital. Starting from BMI ≥ 30 we add general anaesthesia to local tumescent anaesthesia. When operating obese patients surgical access should be chosen above the groin in order to reduce the number of wound infections. Furthermore, operational access should be chosen great enough to ensure a sufficient preparation considering depth and width. In case of bleeding a great operational access is required to achieve successful haemostasis. Non-absorbable sutures should be used for ligation of the vessel and endothelial tissue should be coagulated at the end in order to reduce the number of recurrent veins. Both, after varicose vein surgery and after endovenous therapy, recurrent varicose veins represent a great challenge for the physician in charge. A modified surgical access named after Junod proves to be successful. Overall the rate of complications during and after varicose vein surgery is low. Nerve injuries, deep vein thrombosis, bleeding, wound infections and postoperative seroma outline the most common complications of varicose vein surgery. Most complications are not effected by obesity. Surprisingly the number of postoperative seroma at BMI > 30 decreases, nevertheless it appears more frequent after recurrent varicose vein surgery. There are no data available representing lower treatment risks of endovenous therapy in comparison to varicose vein surgery of obese patients. However, greater veins diameter (especially vena saphena magna) decreases the rate of success and increase the recurrent varicose veins significantly after endovenous therapy. Therefore, we prefer varicose vein surgery from veins diameter > 10 mm.

English version available at: www.phlebologieonline.de

Keywords

Chronic venous insufficiency - obesity - varicose vein surgery - recurrent varicose veins - endovenous treatment

• Literatur

• 1 Rabe E, Pannier-Fischer F, Bromen K, Schuldt K, Stang a, Poncar C. et al. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie. Phlebologie 2003; 32 (01) 1-14.
• 2 Smith KB, Smith MS. Obesity Statistics. 2016; 121-35.
• 3 Göstl K, Obermayer A, Hirschl M. Pathogenesis of chronic venous insufficiency by obesity. Phlebologie 2009; 108-13.
• 4 Faubel R, Schäfer I, Augustin M, Bruning G. Langzeitergebnisse und Analysen von Zusammenhängen 5 Jahre nach Varizenstripping. Phlebologie 2010; 263-269.
• 5 Mann S. Chirurgie der Rezidivvarikose. Chirurgen Magazin. 2008
• 6 Bruning G, Standl T, Diedrich A, Moll I. Prilocaine pharmacokinetics and the influence of vitamin C on methaemoglobin concentrations in tumescent anaesthesia. Phlebologie 2007; 145-150.
• 7 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, Pronk P, Gaastra MTW, Mooij MC. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation using local tumescent anesthesia. Journal of Vascular Surgery 63 (02) 420-428.
• 8 Bruning G, Schinagl H. Die operative Sanierung des inguinalen Crossenrezidivs mittels modifiziertem Zugang nach Junod. J Dtsch Dermatol Ges 2011; 09 (08) 646-647.
• 9 Hofer T. Komplikationen nach varizenchirurgischen Eingriffen. Phlebologie 2001; 30: 26-30.
• 10 Hamann SAS, Giang J, De Maeseneer MGR, Nijsten TEC, van den Bos RR. Editor’s Choice - Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis. Eur J Vasc Endovasc Surg 2017; 54 (06) 760-770.
• 11 Rass K, Frings N, Glowacki P, Graber S, Tilgen W, Vogt T. Same Site Recurrence is More Frequent After Endovenous Laser Ablation Compared with High Ligation and Stripping of the Great Saphenous Vein: 5 year Results of a Randomized Clinical Trial (RELACS Study). Eur J Vasc Endovasc Surg 2015; 50 (05) 648-656.