Major vascular complications after varicose veins conventional surgery
Affiliations: Vascular Surgery, Unidade Local de Saúde de Gaia e Espinho (ULSGE), Portugal
Iatrogenic vascular injuries during varicose vein surgery (VVS) are rare (0.0017%-0.3%).
Clinical case 1. 45-year-old women, submitted to VVS of lower limb (LL) 2 weeks earlier presented with foot pain and paresthesias. She had thigh hematoma, paler foot, and no pulses. On Doppler ultrasound, there was visualized femoral-bifurcation hematoma and superficial femoral artery (SFA) thrombosis. Computed tomography angiography (CTA): SFA partial avulsion. Thrombectomy and great saphenous vein (GSV)-femoro-femoral interposition graft were performed. At 1 year, she is asymptomatic and with feet pulses.
Clinical case 2. 4-year-old male, submitted to VVS with reported massive bleeding controlled by local compression, transferred 6 days after to our department with severe edema of LL. Doppler and angioCT confirmed extensive thrombosis with partial loss of integrity of the venous femoroiliac segment. She was submitted to an IVC filter, thrombectomy, and femoroiliac interposition graft. At 6 months follow-up, there was no edema and graft was patent.
Clinical case 3. A 29-year-old man was sent with massive bleeding due to common femoral vein avulsion during VVS. A femoral-external iliac vein interposition graft was performed. Fifteen years after, he remains asymptomatic with permeable graft.
Clinical case 4. A 51-year-old woman with history of VVS complicated with right femoral vein thrombosis. At the time, the patient was hypocoagulated and wore elastic stockings. Fifteen years later, she went to consultation with complaints of severe LL edema. Doppler ultrasound showed stenosis of the femoral vein. She underwent phlebography with angioplasty and stenting of femoral vein. The patient is asymptomatic at 1 month.
Although VVS is associated with low morbidity, sequelae of major vascular complications have a great impact on lives of a young and active population.
