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The management of arterial and venous injuries during saphenous vein surgery

Department of Vascular Surgery, ‘S. Paolo’ Hospital ASL RMF, Civitavecchia, Rome, Italy

*Corresponding author. S. Paolo Hospital ASL RMF, Largo donatori di sangue 1 00053 Civitavecchia, Via Luigi Pigorini, 16 00162, Roma, Italy. Tel.: +3333105043; Hospital number: +039.0766591460; fax: +039.0766591464.

E-mail address: lucamaria.siani{at}tin.it (A. Siani).

Objectives: Arterial injury of the lower limb is a rare but catastrophic complication of saphenous vein stripping with a high morbidity rate and severe medico-legal implications. Diagnosis is often delayed and outcome depends on the severity of injury. We report two cases of severe ischemia due to arterial lesion during varicose veins surgery. Methods: In the first case, a superficial femoral artery ligature after an operation for recurrent varicose veins surgery occurred; in the second case, an intraoperative ligature of the superficial femoral artery and vein was detected. In the first case, an angiography was carried out and a superficial–superficial femoral artery interposition graft with PTFE was performed. In the other case, an interposition graft with a contralateral saphenous vein between the common and superficial femoral artery and an end-to-end anastomosis of the superficial femoral vein was carried out. Results: No amputation occurred, good patency rate of the graft was achieved and no neurologic-muscle complications were revealed. Conclusions: Femoral artery injury after venous stripping shows a high amputation rate due to delayed diagnosis and severity of arterial involvement. Angiography must be reserved in any case of late ischemia. Prompt diagnosis and aggressive management is mandatory.

Key Words: Femoral artery; Varicose veins; Vascular injuries

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