DOCSLIB.ORG

Results of Long Saphenous Vein Stripping M H Kam, S G Tan

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Results of Long Saphenous Vein Stripping M H Kam, S G Tan Original Article Singapore Med J 2003 Vol 44(12) : 639-642 Results of Long Saphenous Vein Stripping M H Kam, S G Tan ABSTRACT in several prospective studies(4). High ligation of the sapheno-femoral junction, stripping of the thigh Objective: To audit retrospectively all long segment of the long saphenous vein and avulsion of saphenous vein stripping performed or supervised varicosities is the standard procedure to date. Studies intra-operatively by a single surgeon over a have shown, too, that there are differences in results seven-year period. depending on the surgeon’s experience(5), and few Patients: One hundred and twenty-four patients studies have tried to minimise this variable. (156 limbs) operated primarily in standard This study seeks to determine, retrospectively, surgeon-supervised operations, were audited. the recurrence rate for patients who underwent Methods: All patients were questioned via stripping of the long saphenous vein for varicosities. telephone interviews, and those with symptoms or Each operation was performed or supervised intra- recurrent varicosities were recalled for clinical operatively by a single surgeon, to minimise inter- review and investigations by the surgeon. operator variability. Results: Eighty-seven cases presented with lower PATIENTS AND METHODS limb pain, 36 with eczema and 27 with ulcer. Two hundred and fifty-three patients underwent Eighty-one percent of operations were performed surgery for varicose veins, performed or supervised for symptomatic varicose veins and 19% were by a single consultant vascular surgeon, from January done for cosmesis. There were 153 limbs with 1993 to December 1999. Of these, only the records of varicosities, 121 of these had documented long 222 were available for review. The rest were no longer saphenous vein reflux preoperatively. One hundred located in the hospital medical records office. Thirty and sixteen limbs resolved post-operatively, five patients were excluded from the study as they had did not resolve, and four recurred. Incompetent previous varicose vein operations by other surgeons. perforators and short saphenous veins were Sixty-six patients were lost to follow-up and two died the commonest causes of non-resolution and soon after the operation from unrelated causes. Thus, recurrence. Complications, including five cases of 156 lower limbs of 124 patients were finally included saphenous nerve paraesthesias, were temporary in our cohort. and met with full resolution eventually. The patients had a mean age of 48.7 years Conclusion: A 96% success rate is possible after (Std Deviation +/- 12.3 years) and 64 % of them were high tie, stripping of the long saphenous vein with female. Pre-operative assessment was performed by Department of General Surgery multiple avulsions of varicosities. Recurrence is Duplex scans or bedside Doppler by the consultant Singapore General surgeon. A total of 121 limbs were thus diagnosed Hospital 3% over the period of follow-up. Outram Road pre-operatively with long saphenous reflux as the Singapore 169608 Keywords: varicose veins, varicosities, long cause of varicosities. These were selected for subgroup saphenous vein, short saphenous vein, venous M H Kam, MBBS, analysis of recurrence of varicosities. MRCS (Edin), reflux, vein stripping MMed (Surgery) Every one of the standardised operations was Registrar Singapore Med J 2003 Vol 44(12):639-642 performed or supervised intra-operatively by the S G Tan, MBBS, FRCS (Glas), FAMS single surgeon-in-charge. The refluxing veins were Senior Consultant INTRODUCTION marked on the affected leg pre-operatively and general Correspondence to: Varicose veins are a commonly encountered problem anaesthesia was administered to all. Patients were placed Mr Tan Seck Guan Tel: (65) 6321 4051 in daily surgical practice. It has been shown that in the Trendelenburg position. Care was taken in the Fax: (65) 6220 9323 stripping of the long saphenous vein reduces the rate dissection, identification, isolation and subsequent Email: gsutsg@ sgh.com.sg of subsequent recurrence(1-3). This has been borne out ligation of every tributary at the sapheno-femoral Singapore Med J 2003 Vol 44(12) : 640 Table 1. Unresolved varicosities. S/N Refluxing veins on Non-operative therapy Operative therapy Final outcome post-op Duplex U/S Patient 1 (R leg) SSV, PV, ICP Pt refused Pt refused Refused treatment. (L leg) SFV, ICP Small below-knee varicosities. Patient 2 (R leg) PV, ICP GPS and IS Pt refused Improved. (L leg) SFV, PV, ICP Refused subfascial ligation Patient 3 Below-knee LSV, SFV, PV GPS Stripping of Varicosities resolved below-knee LSV Below-knee LSV - long saphenous vein SFV - superficial femoral vein SSV - short saphenous vein PV - popliteal vein ICP - incompetent perforators GPS - Graduated pressure stockings IS - Injection sclerotherapy junction, including a high saphenous ligation of the Fig. 1 Presenting Symptoms. long saphenous vein. Particular attention was paid to 200 this step of the operation as recurrence can occur if no. with symptoms 153 any tributaries are missed. Stripping was carried out 150 with the introduction of the Codman@ disposable vein stripper through a separate incision below the knee. 100 87 Stab avulsions of the varicosities in the leg were carried 50 out with miniature mosquito arteries. The entire leg 36 27 19 was then bandaged for 24 hours and ambulation 6 4 4 0 commenced in less than 24 hours post-operatively. Pain Swelling Ulcer Varicose Eczema Throm- Cellulitis Bleeding veins bophlebitis varicosities Prophylaxis for possible deep venous thrombosis was Note: Forty-one patients had more than one presenting symptom. therefore unnecessary. Tubigrip stockings were worn for two weeks post-operatively. All patients in our cohort were undergoing varicose eczema (Fig. 1). Forty-one patients had more than one vein surgery for the first time. They were all reviewed symptom at presentation. Few patients presented one month post-operatively, to document resolution with thrombophlebitis, cellulitis or bleeding. of the presenting problems. Subsequent follow-up Varicosities were the commonest presenting was carried out by personal telephone interviews symptom. Of these 153 limbs, 121 had pre-operative with the patients from July 2000 to October 2000. Duplex scans at the Vascular Laboratory or Doppler Standardised questions were put forth to the patients. scans personally performed by the vascular surgeon, All were asked for the presence or absence of aching which documented long saphenous vein reflux as the pain, swelling in the legs, ulcers, or varicosities. Those cause of varicosities. Such documented proof was with symptoms were recalled for review by the unavailable for the remaining 32 limbs. These 121 limbs authors. Patients with symptoms attributable to were selected for subgroup analysis of recurrence after varicose veins underwent a duplex scan to identify long saphenous vein stripping for varicosities. the incompetent vessel. The median time to interview There were five limbs (three patients) with unresolved was four years (one to seven years). varicosities at six months post-operatively. Patients 1 and 2 had pre-operative Duplex scans and Patient 3 RESULTS had pre-operative Doppler. All were subsequently The majority (153 of 156 limbs) of our patients investigated with post-operative Duplex scans (Table I). presented with varicosities. Of these, 29 (19%) were The remaining 116 limbs were free of varicosities at asymptomatic varicose veins and the operations clinic review of up to six months. However, four of were performed for cosmesis. The remaining 81% these 116 limbs (three patients) later presented with had operations done for symptomatic varicose veins. recurrent varicosities over a variable period of 12 - 15 These included 87 legs presenting with pain and months after the initial operation. These, too, were 19 who had swelling. There were 27 lower limb investigated with duplex ultrasound scanning ulcers at the time of presentation and 36 legs with (Table II). 641 : 2003 Vol 44(12) Singapore Med J Table II. Recurrent varicosities. S/No Time of Onset Refluxing veins Non-operative Operative Final Outcome on Duplex U/S Treatment Treatment Patient 1 12 months SFV Nil Nil Small varicosities. Not keen for follow-up Patient 2 14 months SSV, ICP GPS and IS only Nil Not keen on stripping Patient 3 (R) 15 months Pt refused GPS Nil Improved. Duplex U/S Small below-knee varicosities. (L) 15 months GPS SFV - superficial femoral vein SSV - short saphenous vein ICP - incompetent perforators IS - Injection sclerotherapy GPS - Graduated pressure stockings U/S - Ultrasound Fig. 2 Absence of Varicosities Post-up (Kapler-Meier). no permanent post-operative sequelae. As seen in Table III, the complication rate was between 3-7%. 97 s ie it s 96 DISCUSSION o ic r The aim of this study was to review the results of a a v 95 f single-surgeon supervised varicose vein operation, o e c namely, the high saphenous ligation, long saphenous n 94 e s b vein stripping with multiple stab avulsions, in an Asian a e 93 g population. This has become the standard of care in a t n e 92 our institution and the results of this study strongly c r suggest a high level of patient satisfaction with Pe 91 1 2 3 4 5 6 7 the procedure. Number of years The overwhelming majority of operations were performed for symptomatic disease while only Table III. Complications. 19% had the operation purely for cosmesis. Of the symptomatic patients, it appears that operations done Complications No. of cases % age of all limbs operated for pain or swelling due to varicose veins and those 1. Wound Infections 09 5.8% with thrombophlebitis, cellulitis or bleeding were 2. Bruising 10 6.4% beneficial as there were no recurrent symptoms. 3. Stitch sinus 08 5.1% Majority of our Asian patients seem to seek treatment only when varicosities are present (153/156 4. Paraesthesia 05 3.2% limbs). This allowed us to focus our subgroup analysis of outcome on those with documented pre-operative Thus, a patient presenting with varicosities will long saphenous reflux (121 limbs).
Load more

Recommended publications
  • Endoscopic Vein Harvest of the Lesser Saphenous Vein in the Supine Position: a Unique Approach to an Old Problem†
    Interactive Cardiovascular and Thoracic Surgery 16 (2013) 1–4 NEW IDEAS - ADULT CARDIAC doi:10.1093/icvts/ivs414 Advance Access publication 9 October 2012 Endoscopic vein harvest of the lesser saphenous vein in the supine position: a unique approach to an old problem† C. Phillip Brandt*, G. Clark Greene, Michael L. Maggart, William C. Hall, Lacy E. Harville, Thomas R. Pollard and Chadwick W. Stouffer NEW IDEAS East Tennessee Cardiovascular Surgery Group, Knoxville, TN, USA * Corresponding author: East Tennessee Cardiovascular Surgery Group, PC, 9125 Cross Park Drive, Suite 200, Knoxville, TN 37920, USA. Fax: 865-637-2114; e-mail: [email protected] (C.P. Brandt). Received 8 May 2012; received in revised form 15 August 2012; accepted 20 August 2012 Abstract OBJECTIVES: To obtain a suitable conduit from the lesser (short) saphenous system for use in coronary artery bypass surgery. We wanted to perform this while the patient was in the supine position as to not disrupt the standard operation, and at the same time, util- izing the endoscopic vein harvest technique with its obvious abilities to decrease vein harvest morbidity. We also theorized that through endoscopic techniques instead of the open technique we could harvest greater lengths of conduit, thus providing quality vein segments for additional grafts if needed. METHODS: We were able to perform endoscopic vein harvest while in the supine position with one unique centrally located incision that has not been previously described. RESULTS: The lesser saphenous vein harvested in the described technique provided excellent conduit for our patients that were conduit poor. The endoscopic technique allowed increased length of harvested segments, by giving us the ability to travel under the gastrocnemius muscle with minimal morbidity as opposed to the open technique, where the traditional endpoint is the aforemen- tioned muscle.
    [Show full text]
  • ICD~10~PCS Complete Code Set Procedural Coding System Sample
    ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00
    [Show full text]
  • Femoral Nerve Block Versus Spinal Anesthesia for Lower Limb
    Alexandria Journal of Anaesthesia and Intensive Care 44 Femoral Nerve Block versus Spinal Anesthesia for Lower Limb Peripheral Vascular Surgery By Ahmed Mansour, MD Assistant Professor of Anesthesia, Faculty of Medicine, Alexandria University. Abstract Perioperative cardiac complications occur in 4% to 6% of patients undergoing infrainguinal revascularization under general, spinal, or epidural anesthesia. The risk may be even greater in patients whose cardiac disease cannot be fully evaluated or treated before urgent limb salvage operations. Prompted by these considerations, we investigated the feasibility and results of using femoral nerve block with infiltration of the genito4femoral nerve branches in these high-risk patients. Methods: Forty peripheral vascular reconstruction of lower limbs were performed under either spinal anesthesia (20 patients) or femoral nerve block with infiltration of genito-femoral nerve branches supplemented with local infiltration at the site of dissection as needed (20 patients). All patients had arterial lines. Arterial blood pressure and electrocardiographic monitoring was continued during surgery, in PACU and in the intensive care units. Results: Operations included femoral-femoral, femoral-popliteal bypass grafting and thrombectomy. The intra-operative events showed that the mean time needed to perform the block and dose of analgesics and sedatives needed during surgery was greater in group I (FNB,) compared to group II [P=0.01*, P0.029* , P0.039*], however, the time needed to start surgery was shorter in group I than in group II [P=0. 039]. There were no block failures in either group, but local infiltration in the area of the dissection with 2 ml (range 1-5 ml) of 1% lidocaine was required in 4 (20%) patients in FNB group vs none in the spinal group.
    [Show full text]
  • Leg Saphenous Vein Stripping with Powered Phlebectomy with Saphenectomy with Greater Saphenectomy Consent Form
    Left Right Bilateral Leg Saphenous Vein Stripping With Powered Phlebectomy With Saphenectomy With Greater Saphenectomy Consent Form Patient Name: Date of Birth: Guardian Name (if applicable): Patient ID: Washington State law guarantees that you have both the right and the obligation to make decisions regarding your health care. Your physician can provide you with the necessary information and advice, but as a member of the health care team, you must participate in the decision making process. This form acknowledges your consent to treatment recommended by your physician. 1 MY PROCEDURE I hereby give my consent for Dr. or his/her associates to perform a Left Right Bilateral Leg Saphenous Vein Stripping With Powered Phlebectomy With Saphenectomy With Greater Saphenectomy upon me. I understand the procedure is to be performed at the First Hill Surgery Center. This has been recommended to me by my physician in order to diagnose and/or treat Left Right Bilateral varicose veins. I understand that the procedure or treatment can be described as follows: Removal of the saphenous vein through small incisions, removal of varicose veins using a powered phlebectomy device (Trivex). This procedure requires anesthesia. Either general or spinal anesthetic are appropriate; your anesthesiologist will help determine which is most appropriate for you. 2 MY BENEFITS Some potential benefits of this procedure include: Relief of symptoms associated with superficial venous reflux and elimination of prominent varicose veins. While saphenous vein stripping and powered phlebectomy is often an effective test/treatment for varicose veins and superficial venous insufficiency, not all conditions, diseases or problems can be diagnoses or treated solely by saphenous vein stripping and powered phlebectomy.
    [Show full text]
  • Our Vascular Surgery Capabilities Include Treatment for the Following
    Vascular and EXPERIENCE MATTERS Endovascular The vascular and endovascular surgeons at LVI are highly experienced at performing vascular surgery and Surgery minimally invasive vascular therapies, and they are leading national experts in limb salvage. We invite you to consult with us, and allow us the opportunity to share our experience and discuss the appropriateness of one Our vascular surgery or more of our procedures for your patients. capabilities include treatment for the following conditions: Abdominal Aortic Peripheral Aneurysm Aneurysm Peripheral Artery Aortic Dissection Disease Aortoiliac Occlusive Portal Hypertension Disease Pulmonary Embolism Ritu Aparajita, MD Tushar Barot, MD Atherosclerosis Renovascular Vascular Surgeon Vascular Surgeon Carotid Artery Disease Conditions Chronic Venous Stroke Insufficiency Thoracic Aortic Deep Vein Aneurysm Thrombosis Vascular Infections Fibromuscular Vascular Trauma Disease Medicine Vasculitis Giant Cell Arteritis Visceral Artery Lawrence Sowka, MD Mesenteric Ischemia without limits Aneurysm Vascular Surgeon 1305 Lakeland Hills Blvd. Lakeland, FL 33805 lakelandvascular.com P: 863.577.0316 F: 1.888.668.7528 PROCEDURES WE PERFORM Minimally Angiogram and Arteriogram Endovascular treatment These vascular imaging tests allow our vascular Performed inside the blood vessel, endovascular specialists to assess blood flow through the arteries treatments are minimally invasive procedures to treat invasive and and check for blockages. In some cases, treatments peripheral artery disease. may be performed during one of these tests. Hybrid Procedures for Vascular Blockage surgical Angioplasty and Vascular Stenting Combines traditional open surgery with endovascular Angioplasty uses a balloon-tipped catheter to open a therapy to repair vessels or place stents, when an blocked blood vessel. Sometimes, the placement of endovascular procedure by itself is not possible for treatment a mesh tube inside the artery is required to keep the the patient.
    [Show full text]
  • Endovascular Treatment for Iliac Vein Compression Syndrome: a Comparison Between the Presence and Absence of Secondary Thrombosis
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by PubMed Central Endovascular Treatment for Iliac Vein Compression Syndrome: a Comparison between the Presence and Absence of Secondary Thrombosis Wen-Sheng Lou, MD Jian-Ping Gu, MD Objective: To evaluate the value of early identification and endovascular treat- ment of iliac vein compression syndrome (IVCS), with or without deep vein throm- Xu He, MD bosis (DVT). Liang Chen, MD Hao-Bo Su, MD Materials and Methods: Three groups of patients, IVCS without DVT (group 1, Guo-Ping Chen, MD n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic Jing-Hua Song, MD resonance venography, computed tomography or venography. The fresh venous Tao Wang, MD thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. Results: Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), Index terms: 83% (group 2) and 50% (group 3), respectively, and were similarly significantly Iliac vein compression syndrome different (p = 0.001).
    [Show full text]
  • Novel Diagnostic Options Without Contrast Media Or
    diagnostics Article Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases Chien-Wei Chen 1,2,3, Yuan-Hsi Tseng 4,5, Chien-Chiao Lin 4,5, Chih-Chen Kao 4,5, Min Yi Wong 4,6 , Bor-Shyh Lin 6 and Yao-Kuang Huang 4,5,6,* 1 Institute of Medicine, Chung Shan Medical University, Chiayi 61363, Taiwan; [email protected] 2 Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taoyuan 61363, Taiwan 3 College of Medicine, Chang Gung University, Taoyuan 61363, Taiwan 4 Division of Thoracic and Cardiovascular Surgery, ChiaYi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan 61363, Taiwan; [email protected] (Y.-H.T.); [email protected] (C.-C.L.); [email protected] (C.-C.K.); [email protected] (M.Y.W.) 5 Wound and Vascular Center, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan 6 Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan; [email protected] * Correspondence: [email protected] or [email protected]; Tel.: +886-975-368-209 Received: 13 May 2020; Accepted: 27 May 2020; Published: 29 May 2020 Abstract: Objectives: Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. Methods: An observational study with retrospective data analysis. Materials: Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV).
    [Show full text]
  • MR Venography for the Assessment of Deep Vein Thrombosis in Lower Extremities with Varicose Veins
    Ann Vasc Dis Vol. 7, No. 4; 2014; pp 399–403 ©2014 Annals of Vascular Diseases doi:10.3400/avd.oa.14-00068 Original Article MR Venography for the Assessment of Deep Vein Thrombosis in Lower Extremities with Varicose Veins Kiyoshi Tamura, MD, PhD, and Hideki Nakahara, MD, PhD Objective: To assess the performance of magnetic resonance venography (MRV) for pelvis and deep vein thrombosis in the lower extremities before surgical interventions for varicose veins. Materials and Methods: We enrolled 72 patients who underwent MRV and ultrasonography before strip- ping for varicose veins of lower extremities. All images of the deep venous systems were evaluated by time- of-flight MRV. Results: Forty-six patients (63.9%) of all were female. Mean age was 65.2 ± 10.2 years (37–81 years). There were forty patients (55.6%) with varicose veins in both legs. Two deep vein thrombosis (2.8%) and three iliac vein thrombosis (4.2%) were diagnosed. All patients without deep vein thrombosis underwent the stripping of saphenous veins, and post-thrombotic change was avoided in all cases. Conclusion: MRV, without contrast medium, is considered clinically useful for the lower extremity venous system. Keywords: magnetic resonance venography, varicose vein, stripping Introduction patients with VV. The venography of the lower extrem- ity veins has been used for various reasons, includ- Varicose veins (VV) are disability condition, represent- ing: (1) exclusion of deep venous thrombosis (DVT); ing a critical public health problem with economic (2) observing of post-thrombotic changes in deep and social consequences. Prevalence is high, being veins; (3) presentation of venous malformations; (4) about 20% to 73% in females and 15% to 56% in preoperative imaging for saphenous venous stripping, males.1–5) Elastic compression stockings are the initial and (5) determination if the saphenous vein is suit- treatment.
    [Show full text]
  • Open Vascular Surgery
    11/10/2017 Open Vascular Surgery Still Relevant in 2017? u Carotid Endarterectomy vs Stenting? u Aortic Endografts vs Grafting? u Mesenteric Stents vs Reconstruction? u Saphenous Stripping vs RFA? Carotid Endarterectomy u Millions of cases performed u Extensive experience by individual physicians u Hundreds—if not thousands—of published studies u Well defined outcomes, long and short term u Well defined costs and optimal approach 1 11/10/2017 FDC/Cox Carotid Experience Reviewed single surgeon carotid endarterctomies at Cox, 1998-2005: Mortality rate of 0.01% Stroke rate of 0.5% Length of stay 1.8 days Long term patency >95% Recurrent stenosis rate of <5% Reviewing multiple surgeon outcomes, 2005 to present Carotid Final data collection Endarts ongoing Thus far, no change in outcomes CEA Outcomes…. u FDC/Cox “all comers” outcomes better than national average--- u ---and better than national studies with selected surgeons u Many studies from good centers with stroke rate of 1-2% u NASCET 6.5% (symptomatic patients) u ACAS 3% (asymptomatic) u Medicare 3.8% (asymptomatic) 2 11/10/2017 Stenting ? Multiple studies suggesting “clinical equipoise” for CEA and CAS Significant debate between professional societies as to indications and preferability for CEA vs CAS The SVS represents the only group of physicians who perform both procedures Who is right? Stenting? u Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis u Kenneth Rosenfield, M.D., M.H.C.D.S., Jon S. Matsumura, M.D., Seemant Chaturvedi, M.D., Tom Riles, M.D., Gary M. Ansel, M.D., D. Chris Metzger, M.D., Lawrence Wechsler, M.D., Michael R.
    [Show full text]
  • AORTIC ANEURYSM Treatment Has Failed, Surgery Can Be Performed to Alleviate Symptoms
    Jersey Shore Foot & Leg Center provides orthopedic and vascular limb services in the Monmouth and Ocean County areas. Jersey Shore Michael Kachmar, D.P.M., F.A.C.F.A.S. Foot & Leg Center Diplomate of the American Board of Podiatric Surgery RECONSTRUCTIVE Board Certified in Reconstructive Foot and Ankle Surgery ORTHOPEDIC FOOT & ANKLE SURGERY Thomas Kedersha, M.D., F.A.C.S. ADVANCED VEIN, Diplomate of American Board of Surgery VASCULAR & WOUND CARE Dr. Kachmar and Dr. Kedersha have over 25 Years of Experience Vincent Delle Grotti, D.P.M., C.W.S. Board Certified Wound Specialist American Academy of Wound Management 1 Pelican Drive, Suite 8 Bayville, NJ 08721 Dr. Michael Kachmar 732-269-1133 Dr. Vincent Delle Grotti www.JerseyShoreFootandLegCenter.com Dr. Thomas Kedersha VASCULAR SURGERY CAROTID OCCLUSIVE DISEASE Vascular Surgery is a specialty that focuses on surgery Also known as Carotiod Stenosis, occurs when one or of the arteries and veins. It can be performed using both of the carotid arteries in the neck become reconstructive techniques or minimally invasive blocked or narrowed. Vascular surgeries for catheters. Over the years, vascular surgery has evolved peripheral arterial and carotid occlusive disease include: to use more minimally invasive techniques. Dr. • Angioplasty With or Without Stenting - a minor procedure where a Kachmar and Dr. Kedersha, at the small catheter is passed into the artery and a balloon is used to open Jersey Shore Foot & Leg Center, perform diagnostic it up. Sometimes a stent is then inserted into the artery to ensure it testing of your arterial and venous systems of your lower stays open.
    [Show full text]
  • Agenesis of Inferior Vena Cava Associated with Deep Venous
    CASE REPORT Agenesis of inferior vena cava associated with deep venous thrombosis Agenesia de veia cava inferior associada à trombose venosa profunda Clovis Luis Konopka1, Marcelo Salame2, Geórgia Andrade Padulla2, Raquel Rodrigues Muradás3, Julio César Batistella4 Abstract The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The CT angiotomography demonstrated a complex venous anomaly with absence of the inferior vena cava. Keywords: cardiovascular abnormalities ; vena cava, inferior; venous thrombosis. Resumo A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior. Palavras-chave: anormalidades cardiovasculares; veia cava inferior; trombose venosa. Introduction found in 5 to 10% of the DVT cases1, and one or more risk factors may be identified in over 80% of these patients1,4,5. Deep venous thrombosis (DVT) is relevant because of The increasing use of CT angiography and mag- its high frequency and morbidity/mortality rates. Its preva- netic resonance imaging (MRI) has allowed physicians lence in the western population is estimated to be 1:1,000 to identify more frequently the presence of inferior vena individuals per year1-3.
    [Show full text]
  • Development of the ICD-10 Procedure Coding System (ICD-10-PCS)
    Development of the ICD-10 Procedure Coding System (ICD-10-PCS) Richard F. Averill, M.S., Robert L. Mullin, M.D., Barbara A. Steinbeck, RHIT, Norbert I. Goldfield, M.D, Thelma M. Grant, RHIA, Rhonda R. Butler, CCS, CCS-P The International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision (ICD-9-CM). The development of ICD-10-PCS was funded by the U.S. Centers for Medicare and Medicaid Services (CMS).1 ICD-10- PCS has a multiaxial seven character alphanumeric code structure that provides a unique code for all substantially different procedures, and allows new procedures to be easily incorporated as new codes. ICD10-PCS was under development for over five years. The initial draft was formally tested and evaluated by an independent contractor; the final version was released in the Spring of 1998, with annual updates since the final release. The design, development and testing of ICD-10-PCS are discussed. Introduction Volume 3 of the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) has been used in the U.S. for the reporting of inpatient pro- cedures since 1979. The structure of Volume 3 of ICD-9-CM has not allowed new procedures associated with rapidly changing technology to be effectively incorporated as new codes. As a result, in 1992 the U.S. Centers for Medicare and Medicaid Services (CMS) funded a project to design a replacement for Volume 3 of ICD-9-CM.
    [Show full text]