Combination Of Tumescent Fluid And High Ligation And Stripping Of The Long Saphenous Vein For The Treatment Of Primary Varicose Veins Of Lower Extremities

Objective:Varicose vein of lower extremities is one of the most common diseases in vascular surgery. Generally, it is necessary to conduct surgical treatment on patients who are suffered from modest or severe degree of varicose veins. High ligation and stripping of the long saphenous vein is the most common method to treat varicose veins. However, certain complications, such as postoperational pain, ecchymosis and subdermal edema, always bring adverse effects to the rehabilitation of patients who received this operation, due to its vast damage on tissue during the operation. Tumescent fluid, which commonly applied in maxillofacial operations and plastic operations, can not only reduce postoperational pain, but also prevent ecchymosis and subdermal edema effectively. This study is aimed to apply tumescent fluid on high ligation and stripping of the long saphenous vein while its effects on the mentioned complications will be observed.Methods:A classical perspective methodology is introduced in this study. The data was collected from patients who came to the Teaching Hospital of Chengdu University of TCM for treating varicose veins of lower extremities between September 2015 and November 2015 with their agreement and authorization.126 patients were included in the study according to inclusion criteria, exclusion criteria and rejection criteria. The patients were then divided into three groups randomly--experimental group, condition control group and blank control group--42 legs in each group(only one leg of each patient were recognized as the object of this study). All the patients received high ligation and stripping of the long saphenous vein. During the operation, being basic on the routine of high ligation and stripping of the long saphenous vein, tumescent fluid was used to flush the tunnel of the stripped vein in experimental group and normal saline was used in condition control group while no additional measures was carried out in blank control. All the preoperational and postoperational care was the same. Visual Analogue Scale was used to measure the feeling of pain during the first and the second day after the operation. On the third day after the operation, the bandage will be removed. Then ecchymosis of the thigh will be observed and its size will be measured while hematoma will be observed and measured by means of ultrasound. This study was conducted under approveal and authorization of the hospital’s ethics committee. All the data was record by ways of Microsoft Office Excel 2007 and then analyzed with SPSS 19.0 for windows.Results:1.126 patients were included in the study, among whom there were 43 males and 83 females; there is no significant statistical difference of gender among the three groups(x 2=0.494, p>0.05). The average age is 60.9 ± 10.2; inlcuding the youngest of 24 yrs and the oldest of 87 yrs;there is no significant statistical difference of age among the three groups(F=0.02, p>0.05). 126 legs were studied, which included 61 left legs and 65 right legs;there is no significant statistical difference of lateral distribution among the three groups(x 2=0.254, p>0.05).2. All the 126 operations were conducted under successful anesthesia. No perioperational or postoperational complications, including hypothermia, arrhythmia, respiratory and circulatory disturbance were observed. There is no significant statistical difference of perioperational and postoperational vital signs among the three groups(p>0.05).3. All the patients received on-time VAS evaluation. One patient in each of condition control and blank control groups requested analgesic while others did not. As statistically analyzed revealed, compared with condition control and blank control, the feeling of pain 6 hours and 12 hours after the operation in experimental group was significantly reduced (p<0.05). There is no significant statistical difference of the feeling of pain either 24 hours nor 48 hours after the operation among the three groups(p>0.05).4. Compared with blank control group, the experiment group has an increased incidence and size of the ecchymosis, but there is no significant statistical difference between the two groups(p>0.05). Compared with condition control group, the experiment group has a decreased incidence and size of the ecchymosis, but there is no significant statistical difference between the two groups(p>0.05).5. Compared with blank control group, the experiment group and condition control group have statistically significant decreased incidence and size of the subdermal edema(p>0.05). However, Compared with condition control group, although the experiment group has a decreased incidence and size of the subdermal edema, there is no significant statistical difference between the two groups(p>0.05).Conclusion:Applying tumescent fluid to flush the tunnel of great saphenous vein during the procedure of high ligation and stripping of the great saphenous vein can improve complications like postoperational pain and hematoma significantly, but shows little improvement to ecchymosis. This technique is with reliable safety and is worth expanding in clinical practice.