Surgery of the Superficial Venous System in Elderly Patients

Abstract

Chronic venous insufficiency, which traditionally has been attributed to failure of the deep venous system, may result from reflux in the superficial venous system. Chronic venous insufficiency is common in elderly patients, but surgical treatment is seldom offered to this patient population. We evaluated the results of superficial venous surgery for the treatment of severe chronic venous insufficiency in a cohort of elderly patients. The authors assessed patients aged 70 years or more with chronic venous insufficiency that had failed conventional conservative treatment. The superficial and deep venous systems were thoroughly investigated by duplex ultrasonography. Associated medical conditions were reevaluated and their treatment optimized. Twenty-eight patients (11 men, 17 women), aged between 70 and 89 years (mean 79), underwent superficial venous surgery. Open ulcers, active dermatitis and recurrent erysipelas were evident in 12, 9 and 7 patients, respectively. Limb swelling and severe pain were present in 25 (89%). The operations were performed under general or regional anesthesia with overnight hospitalization. Surgical treatment consisted of ligation of the points of reflux at the junctions of the superficial and deep systems, as defined by the duplex examination (21 saphenofemoral junctions, 5 saphenopopliteal junctions, 10 perforator veins), and stripping of the long saphenous vein to knee level (15 patients). Postoperative ambulatory treatment was continued until the wounds were completely closed. All ulcers healed completely within 8 weeks. No cardiac, respiratory, or renal complications were encountered. Wound infection at the groin occurred in 1 patient. Cellulitis of the calf area developed in 4 patients. Two ulcers recurred during follow-up of 1 to 5 years (mean 2.5). Surgery of the superficial venous system for treatment of severe chronic venous insufficiency is effective and can be achieved with minimal morbidity in selected elderly patients. The risk/benefit ratio for this procedure has been reduced sufficiently to ensure a major improvement in the quality of life of such patients.

Practical advice for the treatment of venous disease in the elderly

“…Although many elderly patients have medical conditions that make them less suitable for a general anaesthetic, the full range of interventions can be made available to those with superficial venous disease. Weinmann et al 2 reported the results of superficial venous surgery in a group of patients (mean age 79 years) with severe chronic venous insufficiency who had not responded to conservative management. 2 They showed that surgery could be undertaken safely, with significant improvements in quality of life (QoL).…”

“…Weinmann et al 2 reported the results of superficial venous surgery in a group of patients (mean age 79 years) with severe chronic venous insufficiency who had not responded to conservative management. 2 They showed that surgery could be undertaken safely, with significant improvements in quality of life (QoL). New endovenous thermal ablation techniques (laser, radiofrequency) can be performed under tumescent local anaesthetic, and as an outpatient with considerable advantage in this age group.…”

Outcomes of cyanoacrylate closure of the truncal varicose vein insufficiency: A comparison between young and elderly patients

“…14 Unfortunately, CVI symptoms deteriorate in this population as a result of ineffective conservative therapy. 15 The elderly population's inability to wear MCSs unassisted and low compliance with treatment are the primary causes of ineffective conservative treatment. 12,16 As a result, when the symptoms seriously impair the patient's quality of life, an aggressive approach should be considered in addition to medical therapy.…”

Tratamiento quirúrgico de la enfermedad venosa crónica en octogenarios

“…La técnica de cirugía abierta ha demostrado la misma seguridad en pacientes mayores de 65 años que en pacientes jóvenes 11,12 . Un metaanálisis reportado por Gang 13 , et al encuentra que la recurrencia clínica referida por el paciente puede ser hasta del 33% a 2 años utilizando estas técnicas y la tasa de complicaciones puede ascender hasta el 18 a 20%.…”