Name of the Procedure:

Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Common name: Subfascial perforator vein ligation

Summary

Subfascial perforator vein ligation is a surgical procedure in which problematic veins that connect the superficial venous system to the deep venous system are tied off (ligated) to stop abnormal blood flow. This procedure often uses ultrasound for guidance and is performed on one leg.

Purpose

This procedure addresses chronic venous insufficiency and varicose veins. The goal is to reduce venous hypertension and improve circulatory efficiency in the leg, thereby alleviating pain, swelling, and preventing skin ulcers.

Indications

• Chronic venous insufficiency
• Recurrent venous ulcers
• Severe varicose veins with skin changes or ulcers
• Failed conservative treatments (compression therapy, medications)
• Patients suitable for surgery and with confirmed perforator vein incompetence via ultrasound

Preparation

• Pre-procedure instructions may include fasting for 8 hours prior
• Cease certain medications like blood thinners, as advised by the healthcare provider
• Pre-procedure assessments might include duplex ultrasound to map the veins, and blood tests

Procedure Description

1. The patient is positioned on the operating table, and the leg is sterilized.
2. General or spinal anesthesia is administered.
3. A small incision is made in the skin over the perforator vein.
4. The fascia (a tissue layer) covering the muscles is opened.
5. The surgeon locates the perforator vein using ultrasound guidance.
6. The vein is ligated (tied off) to stop abnormal blood flow.
7. The incision is closed with sutures.

Equipment and tools include a scalpel, ligatures, sutures, and ultrasound machine. The procedure involves anesthesia, which is typically general or spinal.

Duration

The procedure typically takes about 1-2 hours.

Setting

This procedure is performed in a hospital operating room or a surgical center.

Personnel

• Vascular surgeon
• Anesthesiologist
• Scrub nurse
• Circulating nurse
• Ultrasound technician (if needed)

Risks and Complications

• Common risks: bleeding, infection, bruising
• Rare risks: deep vein thrombosis (DVT), nerve injury, recurrence of varicose veins, anesthesia-related complications

Benefits

• Relief from pain and swelling
• Improved leg appearance
• Prevention of venous ulcers
• Enhanced circulation Benefits are often realized within weeks to a few months post-surgery.

Recovery

• Post-procedure care includes keeping the leg elevated, wearing compression stockings, and taking prescribed medications.
• Most patients can walk within a few hours but should avoid strenuous activities for 1-2 weeks.
• Follow-up appointments are necessary to monitor healing and effectiveness.

Alternatives

• Conservative management: compression stockings, exercise, weight management
• Sclerotherapy: injection of a solution to close veins
• Endovenous laser therapy (EVLT) or radiofrequency ablation (RFA): minimally invasive techniques to close veins

Each alternative has its own pros and cons regarding effectiveness, recovery time, and risk of complications.

Patient Experience

During the procedure, the patient will not feel pain due to anesthesia but may feel some pressure or discomfort when waking up. Post-procedure discomfort can be managed with prescribed pain medications. Patients can expect some bruising and swelling, which should subside with time and appropriate care.