Surgery News - February 2008 - (Page 17)

F E B R U A RY 2 0 0 8 • SURGERY NEWS VASCULAR 17 Tourniquet Control Improves Varicose Vein Stripping B Y P AT R I C E W E N D L I N G Else vier Global Medical Ne ws C H I C A G O — The minimally invasive venous ablation procedure may breathe new life into surgical ligation and stripping for patients with varicose veins. The procedure—which was developed at VeinSolutions, a nationwide practice that specializes in cosmetic and therapeutic vein care—borrows several characteristics from a conventional surgical stripping procedure, but the recovery time, return-to-work time, and cosmetic results are far superior, Dr. William Finkelmeier said at a symposium on vascular surgery sponsored by Northwestern University. The use of a tourniquet during the outpatient procedure allows the surgeon to strip the vein and perform the phlebectomies in a bloodless field, reducing the postoperative bleeding, bruising, and pain that typically develop following conventional surgical stripping. Most patients return to work in 2-7 days. “If you mention ligation and stripping to your patients, they think it’s their grandmother or mother’s operation,” he said. “This is not your mother’s operation.” Dr. Finkelmeier, an ACS Fellow, reported that excellent cosmetic and therapeutic results have been achieved with minimal morbidity in 1,234 procedures performed between May 2004 and April 2007 at the practice’s Indianapolis office, where he is a vascular surgeon and the director. Adverse events included three cases of deep vein thrombosis, of which two patients had previously undiagnosed hypercoagulable states; one had pulmonary embolism in which the primary source was not identified; and two had wound infections. No deaths have been reported. The patients were aged 20-80 years. There have been no early failures, as compared with an 8%-15% early failure rate for endovenous procedures, he said. Patients with significant saphenofemoral junction reflux are optimal candidates for the procedure, but its advantage may lie in the treatment of large duplicated saphenous systems, which occur in 30%-40% of patients. These systems often contain large, tortuous branches that are difficult to cannulate with an endovenous catheter and treat with laser ablation. The branches are often injected after the primary laser procedure with sclerotherapy, but this typically results in substandard results including pain, tenderness, chemical phlebitis, and hemosiderin staining. PHOTOS COURTESY DR. WILLIAM FINKELMEIER “The beauty of the procedure is that all branch varicosities are removed during the primary procedure,” he said. During the procedure the leg is exsanguinated, a tourniquet is placed on the thigh, and the saphenous tract and entire saphenous vein are pulled out through an incision in the groin. The phlebectomies are then performed using an 18-gauge needle to puncture the skin over the varicosities, and a No. 1 phlebectomy hook to capture the veins. The number of punctures depends on the number of varicosi- ties, he said. Because all branch varicosities have been decompressed, very large veins can be removed through the 18gauge needle holes. And because there are no incisions in the leg, “in 3 months you can’t tell we were there,” he said. The patient is able to walk out of the surgery center and shower that night, and only 4 of 10 patients require oral narcotics for pain, Dr. Finkelmeier said. “If the patient would be best treated endovenously, then that is what should be done. If the patient has very large veins or a torturous, paired system, then they would be best treated with minimally invasive venous ablation.” Dr. Linda Harris, who commented on the study, said, “This may be an alternative [for patients] not conducive to endovascular interventions, and it would be superior to standard ligation and stripping.” But the contention that 30%-40% of patients have a duplicated greater saphenous systems seems high, added Dr. Harris, associate professor of surgery at the State University of Buffalo and an ACS Fellow. ■ New from the American College of Surgeons and Thomson Healthcare I Need an Operation Now What? A Patient’s Guide to a Safe and Successful Outcome I Need an Operation…Now What? gives patients the information they need to boost their chances of having a successful surgical experience, with the best possible results. Written in patient-friendly, nontechnical language, this book is designed to help patients understand the process of having an operation from start to finish. Inside they’ll learn: » How to find a qualified surgeon—one who’s right for them » When to get a second opinion about their treatment—and how to go about finding one » How to ask about the risks and benefits of having an operation » How to prepare for an operation—from what to pack and what to wear to when to stop eating » What to expect, including advice from patients who’ve had various operations, from major gastrointestinal procedures to back surgery—and who will care for them—while in the hospital » Numerous "insider's" tips, such as how to help prevent infection and the best times to schedule an operation » All the costs of the operation » How to ensure a comfortable recovery period The experts agree “Along with your love and support, the greatest gift you can give a loved one or friend facing or weighing the beneﬁts and risks of surgery is a copy of this book. With his thoughtful, clear, very accessible writing, Dr. Russell, with the American College of Surgeons, provides a wealth of informational resources that every patient can draw on. He gives excellent advice on how to ask good questions and become an informed, empowered consumer. Most importantly, he urges you, the patient, to ‘take control and become fully informed about your options.’ This book will help you do that, prepare you for the effects of surgery and how to deal with them and give you conﬁdence as you navigate through the health care system.” Helen Darling, president of the ISBN 13: 978156363-700-1 Pub. Jan 2008 • Paperback $19.95 • 125 pp National Business Group on Health “Like a true professional, Dr. Russell gives surgical patients-to-be all the information and support needed to make decisions that meet their needs as only they can know them. This book is not only practical, but also highly respectful, most educational. Patients can use this book to navigate through their surgical experience while we all push for a better-organized health care delivery system.” Richard J. Umbdenstock, president and CEO of the American Hospital Association “Research shows that people who are well informed about their treatment options enjoy better surgical outcomes and are more satisfied with their results.” Dramatic outcome is seen 5 weeks after treatment with the procedure. To order or for further information visit http://www.facs.org/public_info/patientguidebook.html or call 312/202-5474 http://www.facs.org/public_info/patientguidebook.html http://www.facs.org/public_info/patientguidebook.html http://www.facs.org/public_info/patientguidebook.html

Table of Contents Feed for the Digital Edition of Surgery News - February 2008

Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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