ABSTRACT
Aim: in varicose veins, traditional surgery for long saphenous vein disease has been saphenofemoral disconnection along with stripping of the vein. This, however, can result in morbidity in the form of pain and bruising. The objective of the study is to evaluate sequential vein avulsion as an alternative to vein stripping
Patients and methods: sixty-one patients with primary varicose long saphenous vein and saphenofemoral incompetence were randomly treated by saphenofemoral flush ligation with either stripping to just below the knee or sequential avulsion
Results: there was significantly more pain after stripping during the first postoperative week. The mean pain score was 50, reducing to 20 after one week after stripping compared with 20, reducing to 10, after sequential avulsion. The mean area of bruising measured after one week was 210 [range 20-1830] cm 2 for stripping and 85 [range 10-640] cm 2 for sequential avulsion. Sequential avulsion is less painful, reduces bruising and avoids a significant scar below the knee. There was no significant difference between the two methods as regards the time taken for vein removal
Conclusion: sequential avulsion avoids the inconvenient below knee scar of stripping. It is significantly less painful and causes less bruises. The length of surgery is almost the same for both methods and sequential avulsion is reliable in removing the whole LSV without complication
ABSTRACT
This study summarizes our experience in the management of popliteal aneurysms in 23 limbs [21 patients] during a 3-year period. The aim being to provide what constitutes our strategy of management and to determine the factors that influence the outcome. The data of 21 patients with 23 aneurysms were reviewed. There were 20 males and only one female, age ranging between 28 and 70 years, 18 aneurysms were atherosclerotic and 5 were arteritic. Patients were classified into group 1, the acutely ischaemic, group II with no evidence of acute ischaemia and group Ill, the asymptomatic cases. All patients brad colour coded duplex assessment, arteriograpgy was done in cases presenting with, ischaemia whether acute or chronic. 21 aneurysms were managed by operative repair while only one small asymptomatic aneurysm with no mural thrombus was managed conservatively. Also, one limb was treated by primary amputation because of irreversible ischaemia. The overall limb salvage rate in this series was 82.6%. All lost limbs belonged to group I i.e. those presenting with acute ischaemia. There was no hospital mortality and a follow up period ranging from 6 to 18 months brought forth neither mortality nor complications. Operative repair is the ideal treatment for all popliteal aneurysms. Exclusion and bypass, is the recommended procedure. Resection being particularly indicated when compression symptoms are conspicuous. There is a place to conserve in small asymptomatic aneurysms with no mural thrombi as well as in symptomatic aneurysms in non- threatened limbs with poor outflow vessels. In the latter situation, ill-advised surgery may end in limb loss. The results of this study also confirm that the outcome is strongly related to the initial presentation, being worse in time acutely ischaemic cases and hence elective repair is recommended