ObjectiveTo evaluate optimal surgical timing of high ligation and ambulatory phlebectomy in treatment of primary great saphenous varicose vein. MethodsThe patients who met the inclusion criteria were divided into simple varicose vein (C2) group and soft tissue complications (C3-C4) group.All the patients were received high ligation and ambulatory phlebectomy.The surgery-related indexes,hospital costs,improvement of quality of life,postoperative recurrence rate were observed. ResultsAll the operations were successful.The operative time,the number of operative incision,and the hospital costs in the C2 group were significantly less than those in the C3-C4 group (P<0.05).The total postoperative complications rate in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative AVVQ score on month 3 in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative recurrence rate on month 3 had no statistical significance between these two groups (P>0.05). ConclusionsEarly stage (C2) is the optimal surgical timing of primary great saphenous varicose vein,benefits of surgery and health economics in early stage are significantly better than those in mid-advanced stage (C3-C4).It is suggested that surgery should be underwent at early stage in patients with primary great saphenous varicose vein.
Foam sclerotherapy is one of the major therapies for varicose veins in lower limbs. It is important to know the influence factor of foam stability which is beneficial to curative effect. The present experiment explored influence of 9 kinds of driving speed on foam stability when using the method of Tessari. Syringes of 5 mL were chosen to do this experiment which was carried out at the liquid gas ratio of 1:4 and the environment temperature of 20℃. A home-made automatic sclerosing foam preparation equipment was used to prepare the foam. A camera recorded the entire process of foam decay. And foam stability indexes which includes drainage time, half-life, foam half-life volume and the drainage rate curve, were analyzed. The results showed that when driving speed ranged from 100 mm/s to 275 mm/s, foam drainage time and the half-life showed a trend of rising. When the driving velocity was greater than 275 mm/s, the foam drainage time and half-life time reduced a little. The largest drainage time and the half-life differences were 340.0% and 118.8% compared to their minimum value. Meanwhile the pressure increased with the increase of driving speed, so that the solubility of carbon dioxide increased and the foam half-life volume decreased with the increase of the driving speed. It can be concluded that when using the method of Tessari to prepare sclerosing foam, driving speed has a significant effect on its stability. With driving speed increasing, foam decay mechanism changes from gas diffusion to liquid drainage as the main function, so the foam stability increased at first and then decreased later. The foam is relatively more stable at the speed of 275 mm/s, which could be considered as the best driving speed.
Objective To compare scar and incision satisfaction between Prolene polypropylene suture and conventional silk suture for dermal suture in high ligation and stripping of primary great saphenous varicose vein. Methods A total of 83 patients who met the inclusion criteria were admitted in the West China Hospital, including 27 males and 56 females. The average age was 46.7 years old, ranging from 30 to 63 years old. Forty-two patients were grade C2 and 41 were grade C3 according to the CEAP grading. Patients were divided into a polypropylene suture group (even number,n=45) and a silk suture group (odd number,n=38) according to admission date order. Prolene 5-0 polypropylene suture was used for dermal suture in the patients of the polypropylene suture group and 1# silk suture in the patients of the silk suture group. The pigments of incision area and suture area and their widths, and the points of Patient and Observer Scar Assessment Scale score (POSAS) and patient and observer satisfaction score of incision were observed on month 6 for following-up. Results ① The gender, age, body mass index, and proportion of C2 of the CEAP grading or smoking had no significant difference between these two groups (P>0.05). ② All the operations were successful and all the patients were followed up. All the incisions healed well and had no infection. There was a few subcutaneous hematoma in one incisionof the 2 patients on day 3 after operation in the two groups, which markedly improved after dressing treatment. The sutures of all the patients were removed on day 14 after operation. ③ The pigment of incision area and its width, and the points of POSAS had no significant differences between the two groups (P>0.05). The pigment of suture area and its width, and the points of patient and observer satisfaction score of the incision in the polypropylene suture group were significantly better than those in the silk suture group (P<0.05). Conclusion Prolene polypropylene suture is preference to conventional silk suture in aesthetic results and patient satisfaction for dermal suture of great saphenous varicose vein surgery.
Objective To summarize research progress of postoperative complications of transilluminated powered phlebectomy in treatment of varicose veins. Method The clinical and scientific research about the treatment of varicose veins with transilluminated powered phlebectomy in recent years were searched and the progress of the postoperative complications were reviewed. Results With the evolution of surgical techniques and the accumulation of experience, a variety of translucent resection of the postoperative complications such as the cellulitis, wound abscess, hematoma, residual vein, nerve damage reduced. Conclusions From current development trend, incidence of complications after transilluminated powered phlebectomy might continue to decline. It has a potential to become a mainstream surgical technique for varicose veins in future.
ObjectiveTo explore the outcome of ultrasound-guided radiofrequency ablation in the treatment of overweight and obesity patients, and develop a more reasonable day-to-day surgical procedure.MethodsA retrospective analysis of the patients undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein under fine management from July 1st, 2017 to June 30th, 2019 was performed. According to the body mass index (BMI), the patients were divided into normal group (18.5 kg/m2≤BMI<24 kg/m2), overweight group (24 kg/m2≤BMI<28 kg/m2), and obese group (BMI≥28 kg/m2). The observation items during and after surgery of each group were compared and analyzed. The quantitative data were presented as median (lower quartile, upper quartile), and the qualitative data were presented as frequency and/or percentage.ResultsA total of 189 patients were included, including 65 in the normal group [BMI: 22.6 (21.3, 23.4) kg/m2], 77 in the overweight group [BMI: 26.1 (25.3, 27.0) kg/m2], and 47 in the obese group [BMI: 29.7 (28.4, 31.2) kg/m2]. Radiofrequency ablation time in the obese group [195 (185, 215) s] was significantly longer than that in the normal group [185 (175, 195) s] and the overweight group [185 (177.5, 198) s] (P<0.05). The numerical rating scale score of postoperative 24-hour pain in the radiofrequency ablation area in the obese group [1 (1, 2)] was significantly higher than that in the normal group [1 (1, 1)] and the overweight group [1 (1, 1)] (P<0.05). The postoperative 1-month residual vein length in the normal group [1.0 (0.8, 1.3) cm] was significantly shorter than that in the overweight group [1.2 (0.9, 1.8) cm] and the obese group [1.3 (0.9, 1.8) cm] (P<0.05). The incidence of postoperative 1-month radiofrequency ablation area induration in the obese group (66.0%) was significantly higher than that in the normal group (10.8%) and the overweight group (20.8%) (P<0.05). The postoperative 3-month residual vein length in the obese group [1.2 (1.1, 1.4) cm] was significantly longer than that in the normal group [1.0 (0.9, 1.2) cm] and the overweight group [1.1 (1.0, 1.2) cm] (P<0.05).ConclusionPatients with BMI≥24 kg/m2 undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein require longer radiofrequency ablation time, as well as more postoperative pain assessment and outpatient follow-up.
ObjectiveTo compare the intraoperative, postoperative indicators and economic costs of varicose veins patients between day surgery and inpatient surgery, and to explore the safety and benefit of large-scale varicose veins day surgery in China.MethodsA retrospective study was conducted to collect varicose veins patients in West China Hospital of Sichuan University from January 2016 to January 2019. Patients were divided into the day surgery group and the inpatient surgery group, and the subjects were matched by the propensity score matching (PSM) method according to the basic characteristic data. Intraoperative and postoperative indicators and economic costs were compared between the two groups.ResultsA total of 1 806 varicose vein patients were enrolled in the study, and 502 patients were enrolled in each of the two groups after PSM matching. After matching, there were no statistically significant differences in gender, age, nationality, marriage status, working status, residence, number of operative legs, medical insurance type, grade of American Society of Anesthesiologists, and complications (including hypertension, diabetes, coronary heart disease, and respiratory system diseases) between the two groups (P>0.05), which were comparable and the differences were not statistically significant. Compared with the inpatient surgery group, the day surgery group had shorter hospital stay, less intraoperative infusion volume, lower total cost, bed cost, nursing cost, drug cost, examination cost, medical insurance, and out-of-pocket (P<0.05). ConclusionThe varicose veins day surgery is not only safe and effective, but also can reduce the medication insurance payment.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
ObjectiveTo explore the feasibility of radiofrequency ablation of great saphenous varicose veins in ambulatory surgery.MethodsPatients who underwent radiofrequency ablation of great saphenous varicose veins between May 2018 and June 2019 in General Hospital of Northen Theater Command were prospectively selected. According to their choices of treatment modes, patients were divided into two groups, day surgery group and routine inpatient group. The preoperative waiting time, length of hospital stay, and hospitalization expenses of the two groups were compared. The postoperative pain, tenderness, and complications were followed up on the first day (the next day after operation), the third day, and the fourteenth day after operation, and the time of return to normal life and work and patients’ satisfaction in two groups were recorded.ResultsA total of 95 patients were enrolled, including 52 in the day surgery group and 43 in the routine inpatient group. There was no significantly difference in age, gender, heart rate, mean arterial pressure, or operation time between the two groups (P>0.05). Compared with the routine inpatient group, the day surgery group had shorter preoperative waiting time, shorter length of hospital stay, and lower hospitalization expenses (P<0.05). In the day surgery group, the time of return to normal life and the time of return to work were shorter and patients’ satisfaction was significantly higher than those in the routine inpatient group (P<0.05). There was no significant difference in pain, tenderness, or paresthesia scores between the two groups after surgery according to the follow-up assessment (P>0.05); the pain, tenderness, and paresthesia scores on the first day and the third day were significantly different from those on the fourteenth day after surgery, indicating that the longer the postoperative time of the two groups, the less pain, tenderness, and paresthesia scores were.ConclusionRadiofrequency ablation of great saphenous varicose veins in ambulatory surgery has a short hospital stay, low medical cost, high patient satisfaction, and can ensure the safety of treatment at the same time, which is worthy of clinical promotion
Pancreatic sinistral portal hypertension (PSPH) is a clinical syndrome resulting from pancreatic disease that blocks splenic vein return, which includes acute and chronic pancreatitis, pancreatic tumors, and iatrogenic factors related to pancreatic surgery. Most PSPH patients present with isolated gastric varices, splenomegaly and hypersplenism, with normal liver function, and upper gastrointestinal bleeding caused by varices in the fundus of the stomach is the most serious clinical manifestation. The treatment of PSPH can be divided into the treatment of portal hypertension in the spleen and stomach region, including close follow-up, medication, endoscopic therapy, splenic artery embolization and splenectomy, etc. The primary diseases of pancreas are mainly treated for acute pancreatitis, chronic pancreatitis and pancreatic tumor. In particular, PSPH related to pancreatic surgery should be concerned.
ObjectiveTo understand the prevalence of iliac vein stenosis in crowds without lower extremityvenous disease and symptoms (abbreviated as asymptomatic crowd) and patients with lower extremity varicose vein and analyze relevant to factors of iliac vein stenosis. MethodsAccording to the inclusion and exclusion criteria, the CT imaging data and clinical informations of objects in the department of vascular surgery, the First Affiliated Hospital of Chongqing Medical University from 2020 to 2021 were collected. The objects included the patients with lower extremity varicose vein in the department of vascular surgery of this hospital and asymptomatic crowds in the physical examination center of this hospital. The occurrence of iliac vein stenosis of the objects was compared and the relevant to risk factors affecting the occurrence of iliac vein stenosis were analyzed. ResultsA total of 268 subjects who met the criteria were included in this study, the iliac vein stenosis was occurred in 63 (23.5%) subjects. there were 162 asymptomatic crowds and 106 patients with lower extremity varicose vein. The incidence of iliac vein stenosis was higher in the patients with lower extremity varicose vein than that in the asymptomatic crowds [36.8% (39/106) versus 14.8% (24/162), χ2=17.212, P<0.001]. The results of multivariate logistic regression analysis showed that the female crowds had a higher risk of iliac vein stenosis as compared with the male crowds [OR=3.131, 95%CI (1.188, 8.257), P=0.021] and the crowds with higher body mass index (BMI) had a lower risk of iliac vein stenosis [OR=0.802, 95%CI (0.666, 0.966), P=0.020] in the asymptomatic crowds, as well as the risk of iliac vein stenosis was decreased in the older patients with lower extremity varicose vein [OR=0.946, 95%CI (0.901, 0.993), P=0.026]. ConclusionFrom the results of this study, the incidence of iliac vein stenosis is not low, and the incidence rate of patient with lower extremity varicose vein is higher than that of asymptomatic crowd, and there may be associated with gender, age, or BMI.