Disasters Following the Operation of Ligation and Retrograde Injection of Varicose Veins

Abstract

THE OPERATION of high ligation and retrograde injection of tlle saphenous vein has become the treatment of choice in those cases of varicose veins showing evidence of retrograde flow. This appears to be a rational method for, in the presence of incompetent valves, the weight of the column of blood from the femoral ring to the ankle interferes with venous return in the lower leg, and leads to pooling of blood in the large varicose veins.It appears to be the belief of the occasional operator that this is a simple, easily carried out procedure, free from hazard. Consequently, the operation is widely practised by inexperienced surgeons and hospital internes.As miiight be expected unfortunate results are occurring with increasing frequency. The purpose of this paper is to report 21 such cases, and, from a study of the results, to offer suggestions which might decrease the incidence of complications. It is quite obvious that minor surgical complications, such as haematomata and infections, will occur in a percentage of these cases depending on the care and skill with which the operation is carried out. However, we wish only to discuss the serious disasters such as occlusion of the artery by operative trauma, deep femoral phlebitis, and, perhaps, those more frequently unfavorable results due to damage caused by sclerosing solutions. It should also be mentioned that all these adverse results happened not only to occasional, or junior, operators, but also to senior surgeons of great experience and high standing. The operation of ligation of the great saphenous at the saphenofemoral junction miiay be difficult in an obese individual with a thinned out varix near the terminal portion, especially if, due to previous phlebitis and periphlebitis, firm adhesions are present. The varix is easily torn, or one of the large branches nmay escape the ligature. It shotuld be appreciated that very little pressture is reqluired to stol) this flowxr of blood but, at the momnenit, the unexpecte(l severity of the bleeding uipsets tlle calmii of the suirg,eon anid uincontrolled clanmpincg resuilts inl injurly to the deep felno-al vein, the artery or the nerve. Case 1.-Wlhile freciiig a large varicose saphenious vein a large tributary was torni near the terminal portioni. Kelly clamps were hurriedly applied which, oln later inlvestigation, proved to have included the femoral vein necessitating its ligation. When last seen some months later marked oedema of the leg was present. This patient, a soldier, had to be re-categorised and returned to base duties. On discharge he was found to he plensionlal)le because of this l)erinanent disal)ility. 426

Iatrogenic Vascular Injuries in Varicose Vein Surgery: a Systematic Review

“…When accidental intra-arterial injection during sclerotherapy of varicose veins occurred, the amputation rate was 100% (5/5). [16][17][18][19] Among the 9 arterial injuries reported by Cockett, 1 three underwent amputation secondary to stripping of the artery, and of the remaining 6,…”

“…Another patient had a venous laceration in the groin, with severe bleeding. 18 In spite of femoral vein ligation, she died after a few hours in hemorrhagic shock. Two almost identical cases had intraoperative bleeding in the groin, and after blind clamping, the femoral artery and vein were ligated.…”

Preventing medical malpractice in mid-20th-century Canada: CMPA and its approach to concerns about varicose vein treatments

“…Aggressive treatment of varicosities, how ever, sometimes left patients with serious injuries, and the procedures were contro versial. 2 In 1948, 2 Montréal surgeons issued an early warning about these poor outcomes, complaining that it "appears to be the belief of the occasional operator that this is a simple, easily carried out procedure, free from hazard," with the result that the operation was "widely practised by inexperienced surgeons and hospital internes." 2 In its 1948 annual report, the CMPA described a female patient who had suf fered from gangrene and the amputation of her leg after a varicose vein procedure, resulting in a settlement of $7800 (about $87 000 in 2021 dollars).…”

La prévention des fautes médicales au Canada au milieu du 20e siècle : l’ACPM et son approche des enjeux liés aux traitements contre les varices

“…Certains utilisaient des injections, souvent de morrhuate sodique, pour stopper la circulation sanguine dans les veines affectées. Le traitement agressif des varicosités, cependant, entraînait parfois des blessures graves chez les patients, et les interventions étaient controversées 2 . En 1948, 2 chirurgiens montréalais ont tiré la sonnette d’alarme : ils déploraient que les médecins qui ne la pratiquaient qu’à l’occasion considèrent cette intervention comme étant simple, facile à exécuter et sans danger, si bien qu’elle était souvent assignée à des chirurgiens qui avaient peu d’expérience et des stagiaires 2 .…”