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ISBN 13: 9780824759094
Author: Mitchel P Goldman, Mihael Georgiev, Stefano Ricci
The only text specifically devoted to the subject, this Second Edition serves as a complete and practical guide for office-based surgical treatment of varicose veins-providing numerous illustrations showcasing the anatomy of varicose veins, as well as step-by-step coverage of the ambulatory phlebectomy technique.
Part I: General Considerations
Definition and Indications
Indications
Anatomical Bases of Ambulatory Phlebectomy
General Organization of the Superficial Venous System
Great Saphenous Vein Compartment
Great Saphenous Vein
Small Saphenous Vein
Collateral Veins and Varicosities
Autonomous Collateral Varicosities
Combined Collateral and Saphenous Varicosities
Perforating Veins
Topographic Description
Upper Thigh
Medial Thigh
Posterior Thigh
Lateral Thigh
Anterior Thigh
Knee
Medial Knee
Anterior and Lateral Knee
Popliteal Area
Medial Leg
Anterior Leg
Lateral Leg
Posterior Leg
Foot
Deep Veins of the Lower Limb
Nerves and Lymphatics
Surgical Anatomy of Venous Leg Telangiectasia
References
Appendix A: Atlas of Varicose Vein Patterns
Patterns of Saphenous Vein Involvement in
Varicose Vein Disease
Primary Varicose Veins Circuits
Patterns of GSV Involvement
Anatomical Arrangement of the GSV and Related
Varicose Patterns
Segmental GSV Involvement
Patterns of ASV Involvement
Patterns of SSV Involvement
Patterns Involving Both GSV and SSV
Examination of the Patient with Varicose Veins
Clinical Examination
Medical History
Physical Examination
Doppler Orthostatic Reflux Test
Method
Groin Examination
Popliteal Examination
Interpretation and Pitfalls of Doppler Reflux Testing
Additional Investigation
Color-Duplex Ultrasound Examination
Evaluation of the Leg Pump Function
References
Contents
Selection of Patients for Office Varicose
Vein Surgery
Varicose Vein and Leg Conditions
Asymptomatic Varicose Veins (CEAP –)
Symptomatic Varicose Veins (CEAP –)
Patient’s General Health Conditions
Modifying the Procedure
Infectious Disease
Patient Consent
References
Staging of Surgery
Part II: Technique of Phlebectomy
Pre-Operative Marking Anesthesia
Preparations, Dosage, and Techniques
Traditional Technique
Preparations and Dosage
Tumescent Technique
Preparations and Dosage
Technique
Pre-Operative Anesthesia
Local Infiltration Anesthesia
References
Position of Patient During Surgery
Phlebectomy
Incision
Vein Retrieval, Hooking, and Exteriorization
Instruments
Hooks
Graefe Iris Forceps
Toothed Clamps
Technique
Vein Avulsion
Dissection
Traction
Progression of Phlebectomy
Vein Division
End Division
PV Division
Side Branch Division
Contents
Technical Difficulties
Vein Fragility
Varicose Clusters
Foot
Shin
Knee
Thigh
Great Saphenous Vein
Small Saphenous Vein
Varicose Veins Recurrent After Sclerotherapy
Varicose Veins Recurrent After Traditional Surgery
Superficial Thrombophlebitis
Lipodermatosclerosis
Thin Skin
Venous Leg Telangiectasia
Periorbital Veins
Hand
Reference
Post-Operative Medication and Bandaging
Medication
Bandaging
Adhesive Bandage
Removable Bandages
Patient Discharge
Reference
Post-Operative Management and Follow-Up
Post-Operative Management
Between Phlebectomy Sessions
After the Last Operation
Further Compression
Type and Duration of Compression
Follow-Up
Patients in Need of Special Care
Small Saphenous Vein Phlebectomy
Diagnostic Work-Up
Staging
Pre-Operative Marking
Anesthesia
Position of Patient
Technique
Incisions
Starting the Phlebectomy
Contents
Distal Progression
Proximal Progression
Saphenopopliteal Division and Ligation
Higher Popliteal Incision
Atypical Popliteal Terminations of the SSV
Post-Operative Compression
Advantages of SSV Phlebectomy
References
Part III: Selected Phlebological Techniques
Post-Operative Compression
Protective Skin Underwrapping
Local Compression Pads
Protective Pads
Adhesive Bandage
Materials
Extension of the Bandage
Technique of Application
Degree of Compression
Testing the Bandage
Difficult Areas
Removable Bandage
Errors of Bandaging
Insufficient Compression
Excessive Compression
Compression Stockings
References
High Ligation, Division, and Groin to Knee Stripping of the GSV: An Office Procedure
Indications
Saphenofemoral Junction Incompetence
GSV Dilatation
Preservation of an Incompetent GSV/Saphenopopliteal Junction
Alternative Treatments for GSV Incompetence
Choice of Stripping Technique
Programing the Operation
Pre-Operative Marking
Anesthesia
Patient Position and Skin Preparation
Instruments
Surgical Anatomy of the SFJ
Technique
Ligation and Division of the SFJ
GSV Stripping
Contents
Post-Operative Bandage
Complications
References
Part IV: Conclusions
Complications and Untoward Sequela of Ambulatory Phlebectomy
Complications of Anesthesia
Allergic Reactions
Toxic Reactions
Local Complications
Late Reactions
Complications of Phlebectomy
Hematoma
Hemorrhage at Home
Wound Infection
Lymphatic Disruption
Lymphocele
Lymphorrhea
Persisting Edema
Nerve Damage
Vein Thrombosis
Pulmonary Embolism
Telangiectatic Matting
Hypertrophic and Pigmented Scars
Rare Complications
Complications of Compression Bandage
Excessive Compression
Blister Formation
Contact Dermatitis
References
Psychological Aspects
Reference
Advantages of Ambulatory Phlebectomy and Office Varicose Vein Surgery
References
Setting Up a Varicose Vein Surgery Practice
Who Should Perform Office Varicose Vein Surgery?
Phlebectomy
High Ligation and Division of the Greater Saphenous Vein
Alternative Applications of Phlebectomy
Contents
Safety in Office Surgery
Pre-Operative Management
Anesthesia
Type of Surgical Procedure
Operator’s Experience
Post-Operative Management
Emergency Measures
The Free-Standing Surgical Office
Operating Room
Bureaucratic and Accreditation Requirements
Equipment and Materials
Room Equipment
Surgical Instruments
Specific Instruments for Phlebectomy (Single Set)
Materials for Anesthesia
Syringes
Needles
Materials for Bandaging
Additional Localized Pressure
Compression Bandages
Compression Stockings
Other Materials
Emergency Equipment
Examination Equipment
Marking Solution
Material for Local Anesthesia (MPG)
Medication Material
References
Bibliography
Part V: Advanced Techniques
Autologous Vein Transplantation for Correction of Dermal Atrophic Changes
Technique
References
Treatment of the Great Saphenous Vein with
Endoluminal Laser or Radiofrequency Closure
Mitchel P Goldman and Robert A Weiss
History of Vein Obliteration
Introduction
RF Technology
Animal Studies
Histology
Contents
Clinical Experience
RF Closure Without AP
RF Closure with AP
Side-Effects
Technique of Closure Without Phlebectomy (Video CD)
Technique for Closure with AP (Video CD)
Follow-Up Care
Closure of the GSV with Endoluminal
Laser Ablation
Technique for Closure Using Endoluminal
Laser (Video CD)
Summary
References
Ambulatory Phlebectomy of Recurrent Varicose Veins
References
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Tags: Mitchel P Goldman, Mihael Georgiev, Stefano Ricci, Ambulatory, Phlebectomy
