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Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure)

CPT4 code

Name of the Procedure:

Ligation and Division of Short Saphenous Vein at Saphenopopliteal Junction (Separate Procedure) Common name: Short Saphenous Vein Ligation

Summary

The procedure involves tying off and cutting the short saphenous vein where it meets the popliteal vein at the back of the knee. It is typically done to prevent blood from flowing backward into the vein and causing varicose veins.

Purpose

Medical Condition:
  • Varicose veins
  • Chronic venous insufficiency
Goals:
  • Remove problematic veins
  • Improve venous blood flow
  • Alleviate symptoms such as pain and swelling

Indications

  • Visible varicose veins in the leg
  • Leg pain, heaviness, or swelling
  • Skin changes or ulcers caused by poor circulation
  • Failure of conservative treatments like compression stockings

Preparation

  • Pre-procedure ultrasound to map veins and assess structure
  • Fasting typically not required
  • Adjustments to medications, particularly blood thinners
  • Wear loose, comfortable clothing

Procedure Description

  1. Anesthesia is administered; usually, local anesthesia with sedation.
  2. A small incision is made at the saphenopopliteal junction.
  3. The short saphenous vein is identified and isolated.
  4. The vein is tied off (ligated) and then divided.
  5. The incision is closed with sutures or adhesive strips.
Tools:
  • Surgical scalpel
  • Ligature material (sutures)
  • Hemostats and other standard surgical instruments
  • Ultrasound guidance

Duration

Approximately 30-60 minutes.

Setting

Typically performed in a hospital or outpatient surgical center.

Personnel

  • Vascular surgeon
  • Surgical nurse
  • Anesthesiologist or nurse anesthetist
  • Ultrasound technician (if needed)

Risks and Complications

Common Risks:
  • Bleeding
  • Infection
  • Bruising
Rare Risks:
  • Deep vein thrombosis (DVT)
  • Nerve injury
  • Recurrence of varicose veins
Management:
  • Monitoring and medication for DVT
  • Antibiotics for infection
  • Follow-up appointments to assess healing

Benefits

  • Relief from leg pain and heaviness
  • Reduction or elimination of varicose veins
  • Improved leg appearance and function
  • Benefits often realized within a few weeks as swelling and bruising subside

Recovery

  • Avoid heavy lifting and strenuous activities for a few days
  • Wear compression stockings as directed
  • Keep the leg elevated when possible
  • Return to normal activities typically within 1-2 weeks
  • Follow-up visit to assess healing and remove sutures if necessary

Alternatives

  • Sclerotherapy: Injection of a solution to close the vein
  • Endovenous laser treatment (EVLT): Laser energy to seal the vein
  • Radiofrequency ablation (RFA): Heat to close off the vein
  • Pros and Cons: Minimally invasive alternatives may have shorter recovery times but may also have different risk profiles and effectiveness rates.

Patient Experience

  • Some discomfort or mild pain during and after the procedure
  • Swelling and bruising around incision site
  • Pain management with over-the-counter pain relievers
  • Improvement in symptoms often noticed within a few weeks

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