Case – 9

Case – 9

Diagnosis –

Venous perforator left leg

History –

Mr. X has pain left leg and dermatitis left ankle for long. He had varicose veins surgery left leg at AIIMS in January 2005, but the pain persisted and the dermatitis became worse over time.

Examination –

Discolouration at the anterior part of the left shin which had become more painful over time and is tender to touch. There are no prominent veins over the left leg.

Bed Side Doppler –

No reflux at the left SFJ. Perforator reflux at the mid calf.

Colour Doppler Study –

The long saphenous vein has been ligated at the SF junction but stripped to the mid thigh. The remaining portion has thrombosed. However, there is a prominent perforator in the mid calf which is patent and communicating with the LSV. This is the site clinically where he has the pain and tenderness.

Surgery –– Spinal anesthesia –

The perforator was located. There were three large branches arising and feeding a distended Long Saphenous Vein. All three were ligated and divided.

Post-Operative Period –

Uneventful. The patient was on bed rest for 24 hours to avoid chances of spinal headache. He was given I/V fluids. The patient was on normal diet and apyrexial.

Condition on discharge –

The patient was stable, on normal diet and mobilizing on the ward. He did not have much pain or local haematomas.

Advise on Discharge –

  1. Normal diet
  2. Normal activity
  3. To walk at least 1 km daily
  4. Tab Distaclor 750 mg bd for 7 days
  5. Tab Nucoxia 90 mg od, if pain is present
  6. To leave crape bandage on till Monday 16.05.05
  7. To review in the OPD on 16.05.05

Dr. Jaisom Chopra

Consultant Vascular Surgeon