Procedure: Endovenous laser ablation of Right GSV and SSV left great and left small saphenous veins        

Indication: Long-standing venous insufficiency with failed medical therapy  

Date:

Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow)    

Site:  Left great saphenous and left small saphenous  veins

Treatment length: GSV 55 cm .    Power Setting: 8  Watts. Energy:  4449 Joules; [ ] sec

Treatment length: SSV 23 cm .     Power Setting: 8  Watts.  Energy:  2841 Joules time [ ] sec

Complications:  None immediate.

 

Procedure and technique:

The risks, benefits, and alternatives to the procedure were explained to the patient. The specific risks of bleeding, PAIN; infection, DVT, and nerve injury were discussed and accepted. Written informed consent was obtained.  A time out/call to order was performed prior to procedure initiation.

The patient ambulated for [0] minutes prior to venipuncture.

The patient was placed SUPINE OR PRONE on the treatment table, and the lower extremity prepped and draped in sterile fashion from the ankle to the groin . 

Using ultrasound guidance, the GSV AND SSV  saphenous vein was punctured antegrade mid Calf areas using  21-gauge needles. A 0.018″ wire was placed, and the needle exchanged for a transitional dilator. 

A 0.035″ guidewire was advanced through the transitional dilator centrally. The dilator was exchanged for the laser sheath.  The laser fiber was placed through the sheath and the sheath tip location was ultrasonographically confirmed to lie within the GSV vein, and SSV approximately 3 cm from the confluence with the Deep  veins. The SSV had an above knee superficial extension after the main trunk joined the popliteal above knee.

Tumescent anesthesia (buffered dilute lidocaine) was injected along the entire course of the treated segments of the veins utilizing a motor operated pump.  

Utilizing 8 Watts power at 50 t0 100 Joules / Cm. as noted above, The lasers were  removed and Steri-Strips applied.

The sites were sterilely dressed. Compression stockings were placed on the treated limb immediately post-procedure.  

 

Instructions: 

  1. The patient was instructed to wear the compression hose continuously for 24 hours and then during all waking hours for an additional 3 weeks. 
  2. No strenuous activity/exercise for one week. 
  3. No jacuzzi, sauna or heating pad for 3 months.
  4. NSAID for 1 week with food

 

Follow-up was scheduled for call on Monday and  vein perforator vein treatments in 2 weeks..

Impression:   Uneventful laser ablation of the RG and RS saphenous veins as described above.