Perioperative Thromboseprophylaxe bei Varizenoperationen

Abstract

Antithrombotic regimens to prevent venous thromboembolism are standard in the treatment of in-and outpatients with thrombotic risk factors. A classification of the level of risk is made depending on the age, kind of operation, existing hereditary or acquired thrombophilic diatheses and concomitant disease. The antithrombotic prophylaxis is performed in accordance with the classification of risk level in low, moderate, high and highest risk levels. Varicose disease is a thrombotic risk factor. Varicose vein surgery may be classified as thrombogenic. Patients with varicose vein surgery and without other clinical risk factors are low-risk patients. In case of other acquired or hereditary risk factors antithrombotic prophylaxis in varicose vein surgery with low molecular weight heparin should be used. Compression elastic stockings are obligatory.

Extension of saphenous thrombus into the femoral vein: A potential complication of new endovenous ablation techniques

“…Subcutaneous heparin has been used only for high-risk patients. 2,3 The surgical technique of GSV stripping includes its flush ligation with the CFV to avoid a cul-de-sac providing a nidus for proximal thrombus propagation. Although flush ligation can easily be accomplished with an open technique, the concept is compromised during endovenous therapy.…”

“…4,14 Both general anesthesia and concomitant varicectomy can increase the period of immobilization; however, historically they have not resulted in such high rates of DVT after stripping of the GSV. 2,3 The amount of laser energy delivered and the size and distension of the vein with blood may influence the relative extent of destruction of the vein wall. The number of patients treated in this early phase of our experience is too small to assess all of these variables.…”