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CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT Pierre GOUNY Vascular surgeon BREST, FRANCE CHU BREST FRANCE AIPCV-ADVASE CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT ANATOMY The venous network is divided into systems : - Deep veins, which include the anterior tibial, posterior tibial, peroneal, popliteal, deep femoral, superficial femoral, and iliac veins - Superficial veins, which include the lesser and greater saphenous veins and their tributaries - Perforating or communicating veins CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT • - Superficial veins, which include the lesser and greater saphenous veins and their tributaries CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT - Perforating or communicating veins CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT Blood flow Two major mechanisms in the body prevent venous hypertension - Valves in the veins prevent backflow and venous pooling valve - During normal ambulation, calf muscles decrease venous pressures by approximately 70% in the lower extremities CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT • Noninvasive studies • Duplex Ultrasonography CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT • COMPLICATIONS superficial venous thrombosis ++ Deep venous thrombosis Hemorrhage on varicose vein Ulcer CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT SURGICAL TREATMENT : I - Vein ligation II - Superficial vein ablation III - Phlebectomy CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT I - The crossectomy : Vein ligation at the level where the great saphenous vein joins the deep femoral vein CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT II– Through a long wire the great saphenous vein is removed (reversal from groin to the foot) CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT III PHLEBECTOMY Several 2- to 3-mm incisions are made overlying the greater saphenous at various levels The vein is dissected from the underlying tissues and any perforators are ligated A small hook or blunt needle is used CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT III PHLEBECTOMY A small hook or blunt needle is used to extract as much of the vein as possible CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT Postoperatively : Hematoma, Sural or saphenous nerve damage, Superficial groin infection Compression stockings and leg elevation CHRONIC VENOUS INSUFFICIENCY SURGICAL TREATMENT • Pierre GOUNY Vascular surgeon • BREST, FRANCE CHU BREST FRANCE AIPCV-ADVASE