The only text specifically devoted to the subject, this Second Edition serves as a complete and practical guide for office-based surgical treatment of varicose veins-providing numerous illustrations showcasing the anatomy of varicose veins, as well as step-by-step coverage of the ambulatory phlebectomy technique.

    Foreword

    Robert Muller

    Preface

    Interview of Dr Robert Muller

    A. A Ramelet

    Acknowledgments

    Introduction to the Second Edition

    Stefano Ricci

    History of Ambulatory Phlebectomy

    Robert Muller

    Who Discovered Saphenous Vein Incontinence?

    Stefano Ricci

    Part I: General Considerations

    Definition and Indications

    Indications

    Anatomical Bases of Ambulatory Phlebectomy

    General Organization of the Superficial Venous System

    Great Saphenous Vein Compartment

    Great Saphenous Vein

    Small Saphenous Vein

    Collateral Veins and Varicosities

    Autonomous Collateral Varicosities

    Combined Collateral and Saphenous Varicosities

    Perforating Veins

    Topographic Description

    Upper Thigh

    Medial Thigh

    Posterior Thigh

    Lateral Thigh

    Anterior Thigh

    Knee

    Medial Knee

    Anterior and Lateral Knee

    Popliteal Area

    Medial Leg

    Anterior Leg

    Lateral Leg

    Posterior Leg

    Foot

    Deep Veins of the Lower Limb

    Nerves and Lymphatics

    Surgical Anatomy of Venous Leg Telangiectasia

    References

    Appendix A: Atlas of Varicose Vein Patterns

    Patterns of Saphenous Vein Involvement in

    Varicose Vein Disease

    Primary Varicose Veins Circuits

    Patterns of GSV Involvement

    Anatomical Arrangement of the GSV and Related

    Varicose Patterns

    Segmental GSV Involvement

    Patterns of ASV Involvement

    Patterns of SSV Involvement

    Patterns Involving Both GSV and SSV

    Examination of the Patient with Varicose Veins

    Clinical Examination

    Medical History

    Physical Examination

    Doppler Orthostatic Reflux Test

    Method

    Groin Examination

    Popliteal Examination

    Interpretation and Pitfalls of Doppler Reflux Testing

    Additional Investigation

    Color-Duplex Ultrasound Examination

    Evaluation of the Leg Pump Function

    References

    Contents

    Selection of Patients for Office Varicose

    Vein Surgery

    Varicose Vein and Leg Conditions

    Asymptomatic Varicose Veins (CEAP –)

    Symptomatic Varicose Veins (CEAP –)

    Patient’s General Health Conditions

    Modifying the Procedure

    Infectious Disease

    Patient Consent

    References

    Staging of Surgery

    Part II: Technique of Phlebectomy

    Pre-Operative Marking Anesthesia

    Preparations, Dosage, and Techniques

    Traditional Technique

    Preparations and Dosage

    Tumescent Technique

    Preparations and Dosage

    Technique

    Pre-Operative Anesthesia

    Local Infiltration Anesthesia

    References

    Position of Patient During Surgery

    Phlebectomy

    Incision

    Vein Retrieval, Hooking, and Exteriorization

    Instruments

    Hooks

    Graefe Iris Forceps

    Toothed Clamps

    Technique

    Vein Avulsion

    Dissection

    Traction

    Progression of Phlebectomy

    Vein Division

    End Division

    PV Division

    Side Branch Division

    Contents

    Technical Difficulties

    Vein Fragility

    Varicose Clusters

    Foot

    Shin

    Knee

    Thigh

    Great Saphenous Vein

    Small Saphenous Vein

    Varicose Veins Recurrent After Sclerotherapy

    Varicose Veins Recurrent After Traditional Surgery

    Superficial Thrombophlebitis

    Lipodermatosclerosis

    Thin Skin

    Venous Leg Telangiectasia

    Periorbital Veins

    Hand

    Reference

    Post-Operative Medication and Bandaging

    Medication

    Bandaging

    Adhesive Bandage

    Removable Bandages

    Patient Discharge

    Reference

    Post-Operative Management and Follow-Up

    Post-Operative Management

    Between Phlebectomy Sessions

    After the Last Operation

    Further Compression

    Type and Duration of Compression

    Follow-Up

    Patients in Need of Special Care

    Small Saphenous Vein Phlebectomy

    Diagnostic Work-Up

    Staging

    Pre-Operative Marking

    Anesthesia

    Position of Patient

    Technique

    Incisions

    Starting the Phlebectomy

    Contents

    Distal Progression

    Proximal Progression

    Saphenopopliteal Division and Ligation

    Higher Popliteal Incision

    Atypical Popliteal Terminations of the SSV

    Post-Operative Compression

    Advantages of SSV Phlebectomy

    References

    Part III: Selected Phlebological Techniques

    Post-Operative Compression

    Protective Skin Underwrapping

    Local Compression Pads

    Protective Pads

    Adhesive Bandage

    Materials

    Extension of the Bandage

    Technique of Application

    Degree of Compression

    Testing the Bandage

    Difficult Areas

    Removable Bandage

    Errors of Bandaging

    Insufficient Compression

    Excessive Compression

    Compression Stockings

    References

    High Ligation, Division, and Groin to Knee Stripping of the GSV: An Office Procedure

    Indications

    Saphenofemoral Junction Incompetence

    GSV Dilatation

    Preservation of an Incompetent GSV/Saphenopopliteal Junction

    Alternative Treatments for GSV Incompetence

    Choice of Stripping Technique

    Programing the Operation

    Pre-Operative Marking

    Anesthesia

    Patient Position and Skin Preparation

    Instruments

    Surgical Anatomy of the SFJ

    Technique

    Ligation and Division of the SFJ

    GSV Stripping

    Contents

    Post-Operative Bandage

    Complications

    References

    Part IV: Conclusions

    Complications and Untoward Sequela of Ambulatory Phlebectomy

    Complications of Anesthesia

    Allergic Reactions

    Toxic Reactions

    Local Complications

    Late Reactions

    Complications of Phlebectomy

    Hematoma

    Hemorrhage at Home

    Wound Infection

    Lymphatic Disruption

    Lymphocele

    Lymphorrhea

    Persisting Edema

    Nerve Damage

    Vein Thrombosis

    Pulmonary Embolism

    Telangiectatic Matting

    Hypertrophic and Pigmented Scars

    Rare Complications

    Complications of Compression Bandage

    Excessive Compression

    Blister Formation

    Contact Dermatitis

    References

    Psychological Aspects

    Reference

    Advantages of Ambulatory Phlebectomy and Office Varicose Vein Surgery

    References

    Setting Up a Varicose Vein Surgery Practice

    Who Should Perform Office Varicose Vein Surgery?

    Phlebectomy

    High Ligation and Division of the Greater Saphenous Vein

    Alternative Applications of Phlebectomy

    Contents

    Safety in Office Surgery

    Pre-Operative Management

    Anesthesia

    Type of Surgical Procedure

    Operator’s Experience

    Post-Operative Management

    Emergency Measures

    The Free-Standing Surgical Office

    Operating Room

    Bureaucratic and Accreditation Requirements

    Equipment and Materials

    Room Equipment

    Surgical Instruments

    Specific Instruments for Phlebectomy (Single Set)

    Materials for Anesthesia

    Syringes

    Needles

    Materials for Bandaging

    Additional Localized Pressure

    Compression Bandages

    Compression Stockings

    Other Materials

    Emergency Equipment

    Examination Equipment

    Marking Solution

    Material for Local Anesthesia (MPG)

    Medication Material

    References

    Bibliography

    Part V: Advanced Techniques

    Autologous Vein Transplantation for Correction of Dermal Atrophic Changes

    Technique

    References

    Treatment of the Great Saphenous Vein with

    Endoluminal Laser or Radiofrequency Closure

    Mitchel P Goldman and Robert A Weiss

    History of Vein Obliteration

    Introduction

    RF Technology

    Animal Studies

    Histology

    Contents

    Clinical Experience

    RF Closure Without AP

    RF Closure with AP

    Side-Effects

    Technique of Closure Without Phlebectomy (Video CD)

    Technique for Closure with AP (Video CD)

    Follow-Up Care

    Closure of the GSV with Endoluminal

    Laser Ablation

    Technique for Closure Using Endoluminal

    Laser (Video CD)

    Summary

    References

    Ambulatory Phlebectomy of Recurrent Varicose Veins

    References

    Part VI: Appendices

    Instructions for Patients Affected by Chronic

    Venous Insufficiency

    Consent for Ambulatory Phlebectomy, Endovenous Closure with Laser or Radiofrequency,

    Administration of Anesthetics, and the Rendering of Other Medical Services

    Varicose Vein Surgery Suggestions Following Surgery

    Nursing Instructions

    Ambulatory Phlebectomy Operative Report

    Operative Report for Endoluminal

    Radiofrequency Closure

    Operative Report for Endoluminal

    Laser Closure

    Explanation Card for the Patient

    Post-Operative Explanation Card for the Patient

    Duplex Evaluation Forms

    Index

    Biography

    Mitchel P. Goldman, Mihael Georgiev, Stefano Ricci

    "…This is the kind of detail and commentary one would expect to obtain only in direct conversations with clinicians who are teaching this procedure."
    -The American Journal of Cosmetic Surgery

    "…[a] Practical manual for surgeons on the ambulatory surgical treatment of varicose veins. Includes examination, patient selection, and techniques. Appendices include sample patient instructions, consent forms, and nursing instructions."
    -Book News(for previous edition)