Case – 7

Case – 7

Diagnosis

Bilateral Varicose veins

History

The patient has had prominent varicose veins for the past 10 years and have been progressively increasing. Now there is pain in the legs and discolouration at the right ankle.

The patient is a very fit young sportsman in good general health. He is not pale. There were markedly dilated veins on the right side with dermatitis at the ankle but no ulcers. There were also visible veins on the left leg but no dermatitis.

This case is the old technique where high ligation, stripping  and phlebectomies was done. Now it is obsolete and it has been over 15 years since I did it. It was a good technique and effective but very traumatic for the patient

Bed-side Doppler study

There was a strong reflux at the right SFJ and also minimal reflux at the right SPJ. On the left side there was reflux at the SFJ though not as marked as the contralateral side. Could not illicit reflux at the left SPJ.

Colour Doppler Study

The LSV was stripped to the knee and tight bandage applied to minimize the haematoma formation.

Multiple ligations done below the knee along with two large perforators. These veins were ligated with vycril

The patient was made prone and the short Saphenous vein ligated and divided.

Post-operative period

The patient had pain main in the back at the site of the spinal anesthesia. He was on bed rest for the first 24 hours and then mobilized.

Condition on discharge

The patient is mobilizing on the ward and on normal diet. He had some pain understandably, but this should settle fast. There are no haematomas.

Advise on discharge

  • Normal diet and plenty of fluids orally
  • Normal activity with long walks
  • Tab Distaclor 750 mg bd for 7 days
  • Cap Tramazac 1 tds for  days and then SOS, if in pain
  • Tab Nucoxia 1 at bed time, if in pain
  • To keep crape bandage on till Monday and retighten it if it becomes loose
  • To attend OPD on Monday 11.04.05.
  • (Dr. JAISOM CHOPRA)

    Consultant Vascular Surgeon