Varicose Veins of the Lower Extremities
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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. -
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 -
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. -
Vein Disease: Your Personal Prevention Programme While Your
Vein disease: Your personal prevention programme While your arteries transport blood containing oxygen and nutrients to the body cells, the veins are responsible for taking ‘used’ blood via the heart back to the lungs, where it can be enriched with fresh oxygen. In order for blood to be returned to the heart against the force of gravity, the vein valves must close tightly and the tissue which surrounds the veins must be strong. Otherwise the veins expand and become varicose. There’s a danger of thromboses, emboli and so-called ‘open leg’ ulcers. Self-diagnosis Spider-bursts (left) and reticular veins (right) are changes in the blood vessels which can be early signs of vein disease. Varicose veins (left and right) should be treated, if necessary surgically, as soon as possible. Deep vein thrombosis (left) is highly dangerous: You must seek treatment immediately! If you have vasculitis (inflammation of the vein wall - right) you should also visit a doctor or specialist clinic without delay. The classic symptoms of vein disease are swollen legs, pins and needles and feelings of tension in the calves, foot and calf cramps, legs which feel heavy or tired in the evening. Standing the whole day or frequent flying put a special burden on the vein system of the legs. © heigel.com www.heigel.com These things are good for your veins: Take frequent long walks as this exercises the leg and foot musculature. Sports involving sustained activity, such as hiking, swimming, jogging, skiing, dancing, cycling and gymnastics, are especially recommended. Whenever you are involved in an activity which involves sitting or standing, take every opportunity which presents itself to walk around. -
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. -
Association Between Hemorrhoids and Lower Extremity Chronic Venous Insufficiency
Open Access Original Article DOI: 10.7759/cureus.4502 Association Between Hemorrhoids and Lower Extremity Chronic Venous Insufficiency Ugur Ekici 1 , Abdulcabbar Kartal 2 , Murat F. Ferhatoglu 2 1. General Surgery, Istanbul Gelişim University, Istanbul, TUR 2. General Surgery, Okan University Medical Faculty, Istanbul, TUR Corresponding author: Abdulcabbar Kartal, [email protected] Disclosures can be found in Additional Information at the end of the article Abstract Aim The aim of the present study was to evaluate the incidence of varicose veins among patients with hemorrhoidal disease and to compare its incidence reported in various community-based studies. Method The study group comprised of 100 patients who underwent surgery for symptomatic internal or external hemorrhoids; the control group consisted of 100 volunteers who received no prior therapy for hemorrhoidal disease and lacked any symptoms or findings suggestive of this condition. Subjects in both the groups were inquired with respect to their demographic data and risk factors. Both groups were asked to stand for two minutes before performing leg examinations while still in the standing position. The findings were recorded for both the groups. Varicose veins were classified according to the clinical appearance section of the Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) classification that was developed by the 1994 American Venous Forum. Results There was no significant difference between the two groups with respect to age and body mass index (BMI). Significant relationships were identified between the groups with respect to the incidence of varicose veins and chronic constipation. The incidence of C1 and C2 varicose veins observed in the study group was higher than that observed in the control group. -
Varicose Veins
Varicose Veins: Diagnosis and Treatment Jaqueline Raetz, MD; Megan Wilson, MD; and Kimberly Collins, MD University of Washington Family Medicine Residency, Seattle, Washington Varicose veins are twisted, dilated veins most commonly located on the lower extremities. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure. Risk factors include family history of venous disease; female sex; older age; chronically increased intra-abdominal pressure due to obesity, preg- nancy, chronic constipation, or a tumor; and prolonged standing. Symptoms of varicose veins include a heavy, achy feeling and an itching or burning sensation; these symptoms worsen with prolonged standing. Potential complications include infection, leg ulcers, stasis changes, and thrombosis. Con- servative treatment options include external compression; lifestyle modifications, such as avoidance of prolonged standing and straining, exercise, wearing nonrestrictive clothing, modification of car- diovascular risk factors, and interventions to reduce peripheral edema; elevation of the affected leg; weight loss; and medical therapy. There is not enough evidence to determine if compression stock- ings are effective in the treatment of varicose veins in the absence of active or healed venous ulcers. Interventional treatments include external laser thermal ablation, endovenous thermal ablation, endo- venous sclerotherapy, and surgery. Although surgery was once the standard of care, it largely has been replaced by endovenous thermal ablation, which can be performed under local anesthesia and may have better outcomes and fewer complications than other treatments. Existing evidence and clinical guidelines suggest that a trial of compression therapy is not warranted before referral for endove- nous thermal ablation, although it may be necessary for insurance coverage. -
Varicose Veins and Superficial Thrombophlebitis
ENTITLEMENT ELIGIBILITY GUIDELINES VARICOSE VEINS AND SUPERFICIAL THROMBOPHLEBITIS 1. VARICOSE VEINS MPC 00727 ICD-9 454 DEFINITION Varicose Veins of the lower extremities are a dilatation, lengthening and tortuosity of a subcutaneous superficial vein or veins of the lower extremity such as the saphenous veins and perforating veins. A diagnosis of varicose veins is sometimes made in error when the veins are prominent but neither varicose or abnormal. This guideline excludes Deep Vein Thrombosis, and telangiectasis. DIAGNOSTIC STANDARD Diagnosis by a qualified medical practitioner is required. ANATOMY AND PHYSIOLOGY The venous system of the lower extremities consists of: 1. The deep system of veins. 2. The superficial veins’ system. 3. The communicating (or perforating) veins which connect the first two systems. There are primary and secondary causes of varicose veins. Primary causes are congenital and/or may develop from inherited conditions. Secondary causes generally result from factors other than congenital factors. VETERANS AFFAIRS CANADA FEBRUARY 2005 Entitlement Eligibility Guidelines - VARICOSE VEINS/SUPERFICIAL THROMBOPHLEBITIS Page 2 CLINICAL FEATURES Clinical onset usually takes place when varicosities in the affected leg or legs appear. Varicosities typically present as a bluish discolouration and may have a raised appearance. The affected limb may also demonstrate the following: • Aching • Discolouration • Inflammation • Swelling • Heaviness • Cramps Varicose Veins may be large and apparent or quite small and barely discernible. Aggravation for the purposes of Varicose Veins may be represented by the veins permanently becoming larger or more extensive, or a need for operative intervention, or the development of Superficial Thrombophlebitis. PENSION CONSIDERATIONS A. CAUSES AND/OR AGGRAVATION THE TIMELINES CITED BELOW ARE NOT BINDING. -
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. -
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). -
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). -
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.