DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Symptomatic chronic superficial venous insufficiency, left leg, with varicose veins.
POSTOPERATIVE DIAGNOSIS:
Symptomatic chronic superficial venous insufficiency, left leg, with varicose veins.
PROCEDURES PERFORMED:
1. Left greater saphenous vein radiofrequency ablation.
2. Ligation division, left saphenofemoral junction.
3. Stab phlebectomies, left leg.
SURGEON: John Doe, MD
ANESTHESIA:
General endotracheal.
INDICATION FOR OPERATION:
The patient is a (XX)-year-old lady who presented to the office complaining of left leg pain. She was found to have large varicosities around her left proximal thigh and calf. It was recommended the patient undergo venous duplex scan, which demonstrated reflux throughout the left greater saphenous vein as well as a large anterolateral branch off the saphenofemoral junction feeding her lateral thigh varicosities.
It was recommended she undergo radiofrequency ablation of the left greater saphenous vein as well as ligation and division of the saphenofemoral junction to treat the large feeding branches to the varicose veins of the thigh. It was also recommended she undergo stab phlebectomies. The patient expressed understanding of the risks, benefits and agreed to proceed.
DESCRIPTION OF OPERATION:
The patient was brought to the operating room and placed on the operating table in the supine position. After adequate induction of anesthesia, the left groin and leg were prepped and draped in a sterile fashion. The procedure was begun by making an oblique incision in the left groin crease overlying the femoral pulse. The subcutaneous tissue was divided down to the greater saphenous vein, which was then dissected up to the saphenofemoral junction.
The saphenofemoral junction was then skeletonized, ligating branches with 3-0 silk and clips. Following completion of this, the wound was packed with saline-soaked gauze. The patient was placed in reverse Trendelenburg. The ultrasound scanner was sterilely passed onto the field. The greater saphenous vein was identified just below the knee using ultrasound. A needle was used to percutaneously puncture the greater saphenous vein. A wire was passed without difficulty followed by a 6-French sheath, which was secured in place using a 2-0 silk suture.
A 6-French radiofrequency ablation catheter was inserted and advanced up to the saphenofemoral junction without difficulty. Its location was confirmed by visualization and palpation, and it was withdrawn approximately 1 cm below the saphenofemoral junction. Using ultrasound, tumescent fluid was injected into the perivenous sheath throughout the length of the thigh and proximal calf. The patient was placed in Trendelenburg, and the greater saphenous vein was ablated using a standard pullback technique heating the vein to 85 to 90 degrees centigrade.
The sheath and catheter were then pulled out after completion of the pullback. Saphenofemoral junction was then clamped proximally and distally and divided. It was oversewn with 2-0 silk suture ligatures. The groin was then closed using 3-0 Vicryl in two layers deep and subcuticular stitch of 4-0 Vicryl. The marked varicosities throughout the thigh and calf were then removed using a stab phlebectomy technique using Oesch hooks. Following completion of this, the stab puncture sites were closed using Steri-Strips only. A clean, sterile, dry compressive dressing was placed, and the patient was transferred to the recovery room in stable condition having tolerated the procedure well.
