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Varicose vein invasive intervention at university hospital of Nepal, our experience in the last six years

Authors Karmacharya RM, Shrestha BK, Shrestha B, Singh AK, Bhandari N, Dhakal P, Dahal S

Received 8 May 2019

Accepted for publication 26 August 2019

Published 10 September 2019 Volume 2019:12 Pages 21—25


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Luigi Bonavina

RM Karmacharya, BK Shrestha, B Shrestha, AK Singh, N Bhandari, P Dhakal, S Dahal

Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal

Correspondence: RM Karmacharya
Department of Surgery (Cardio Thoracic and Vascular), Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel Hospital Road, PO Box no 45210, Dhulikhel, Kavrepalanchok, Nepal
Tel +977 981 872 9013

Introduction: Varicose vein is a common venous condition affecting quality of life presenting as an asymptomatic condition to a feeling of heaviness, pain, pigmentation, palpable superficial veins, itchiness and ulceration. Proper management of varicose vein is of huge importance due to its high prevalence and the impact it has on patients’ quality of life, productivity as well as on health-care resource burden. Various conservative and invasive interventions are available for the management of varicose veins. Here we present our experience with the invasive intervention of varicose veins during a period of six years at a tertiary care center (Dhulikhel Hospital) in Nepal. Although Radio Frequency Ablation (RFA) is recently introduced in Nepal, it has shown promising outcome.
Method: This is a retrospective descriptive cross-sectional study between the years 2013 and 2018 at the Dhulikhel Hospital among patients that underwent surgical management of varicose veins. For ease in interpretation, patients who underwent surgery for both lower limbs in the same setting are considered as separate cases.
Results: In a total of 533 limbs, the most common vein involved was isolated great saphenous vein in 70.4%. In terms of side affected, 157 patients (33.8%) were affected on the right side, 238 (51.3%) were affected on the left side and 69 (14.9%) patients had bilateral involvement. The most common clinical feature was prominent vein present in 94.5% limbs. This was followed by pain in 55.7%, pigmentation in 25.3%, itchiness in 14.6% and ulceration in 13.1%. Mean hospital stay was 1.1 days (S.D. 0.64, Range 0–3). In terms of complication, one case with deep vein thrombosis (0.18%) developed in the seventh postoperative period. There was skin burn in two cases (0.53% of RFA cases) and in 11 cases (2.06%) there was painful superficial thrombosed veins of which three required excision under local anesthesia (0.56%).
Conclusion: There are multiple invasive interventions for varicose veins. With the availability of the facilities, RFA is the procedure of choice in feasible cases. The most common complication after surgical treatment was painful thrombosed superficial veins. DVT was a rare complication.

Keywords: varicose veins, varicose vein surgery, radiofrequency ablation

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