[Is there justification for varicose vein surgery with local anesthesia in successive procedures? Prospective study of 5,000 crossectomy/stripping operations]

Abstract

In a prospective study we examined the complications of 5,000 operations (n = 876 as outpatient; ligations of the SFJ/SPJ +/- stripping or recurrence operation of the SFJ/SPJ), that were carried out under local anaesthesia in a successive procedure. We registered only the in-hospital complications or those occurring during the first postoperative week of outpatient procedure: Mortality, deep venous thrombosis, pulmonary embolism, major vascular injuries, major nerval injuries, anaesthesia complications. The proof and/or exclusion of complications were done by clinical investigations with the parameters: Mortality, vascular and/or nerval injuries, anaesthesia complications as well as pulmonary embolism. With the parameter deep venous thrombosis n = 2,495 operations were examined by color duplex scan in the region of the sapheno-femoral (popliteal) junction before patients were discharged from hospital/ambulatory therapy. In the other patients the diagnosis was done according to clinical parameters.

Results: In the investigation period two complications occurred at the nerval-system after difficult ligation of the SPJ: a) Paresis concerning mainly the peroneal branch of the N. ischiadicus with regeneration after nine months. b) Lesion of the N. tibialis with paresis of the M. abductor digiti minimi that was unchanged after seven months.

Conclusion: Varicose vein surgery under local anaesthesia as a successive procedure represents a very safe treatment option. A comparison with literature data from prospective or retrospective studies is not possible, because of missing studies and/or unclear information or definition problems. It would be desirable if such studies could be performed.