A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery.
The primary superficial venous aneurysms of the foot are very rare. A 34-year-old female patient developed a dorsal foot mass during the second trimester of pregnancy with no history of previous trauma, puncture, or infection. One year later, she was referred to the surgical department for excision of “foot hygroma.” Based on the clinical findings, the venous aneurysm was suspected and duplex ultrasound confirmed the diagnosis of the aneurysm of the medial marginal vein of the foot. Excision of aneurysm with bipolar ligation of marginal vein was performed under local anesthesia. The postoperative evolution was uneventful. The authors hope that the presented case report will increase the awareness of general practitioners, dermatologists, and surgeons regarding the superficial venous aneurysms of lower limbs.
Introduction:Although saphenofemoral junction aneurysms are not so rare, only scarce of the published cases reported thrombosis of the aneurysmal sac and saphenous trunk.Presentation of case:A 65-year-old male with varicose disease, developed acute ascending superficial vein thrombosis of the left greater saphenous vein, involving the 6-cm saphenofemoral junction aneurysm. The patient underwent common femoral vein thrombectomy, aneurysm removal, and greater saphenous vein excision with uneventful postoperative course.Conclusion:Thrombosed giant saphenofemoral junction aneurysms require emergent surgical intervention aimed at preventing potential progression to deep vein thrombosis and pulmonary embolism.
Purpose
Management of superficial vein thrombosis (SVT) in patients with varicose veins (VV) is not currently standardized. We performed a survey aimed to demonstrate patterns in the management of SVT in the Republic of Moldova.
Materials and Methods
This was a descriptive study whereby members of the National Surgical Society were asked to complete an online questionnaire. In the questionnaire, multiple-choice questions were supplemented with four clinical vignettes of real patients with SVT.
Results
The questionnaire was completed by 102 participants (31.1% response rate). In the treatment of SVT, duplex ultrasound was routinely used by 74.5% of respondents, and anticoagulants were used by 70.5%. The full therapeutic dose of anticoagulants was recommended by 63.3% of surgeons, intermediate dose by 21.1%, and prophylactic dose by 15.6%. Only 50% of respondents were prescribed anticoagulants for 1 month or more. In case of surgical intervention for SVT, crossectomy and stripping were performed by 84.0% of surgeons, while isolated crossectomy by 10.7%. In all clinical vignettes, the majority of respondents opted for urgent surgical treatment. The rate of proponents of surgery varied from 43% in cases of isolated thrombosis of tributaries, and up to 72.5% in cases of thrombosis up to the sapheno-femoral junction.
Conclusion
Management of patients with SVT and VV in the Republic of Moldova is far from standardized. Prescribed doses of anticoagulants, as well as the duration of anticoagulation are highly variable and often contradict the recommendations of current guidelines. Urgent crossectomy and stripping dominate the pattern of current therapeutic approaches.
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