CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 7, August 2013
AFRICA
e1
Case Report
Radiofrequency ablation of the great saphenous vein in
an elderly patient with co-morbid disease
ALİ ÜMİT YENER, ÖZLEM YENER, HIKMET SELÇUK GEDIK, KEMAL KORKMAZ, TURGUT ÖZKAN,
AYŞE LAFÇI, KERIM ÇAĞLI
Abstract
An 86-year-oldmale patient with hypertension, Parkinsonism,
benign prostatic hyperplasia, cataract and chronic obstruc-
tive pulmonary disease had a history of coronary bypass
surgery in two veins due to anterior myocardial infarction
one year earlier. He presented with pain and feelings of
paresthesia below the knee of his left leg, and had fallen
twice. He had used compressions and venoprotective medica-
tion for two years and had also received physiotherapy but
it had not alleviated the symptoms. He had varicose dilata-
tions in the left leg and pigmentation and a recovered venous
ulcer scar were present on the medial malleolus. The patient
was classed as grade 4 according to the CEAP classification.
Because there was no deficiency in the superficial femoral
and popliteal veins, the patient was taken for endovenous
ablation. He had no pain or sensation of heaviness in the
legs on postoperative day 10, and the first, third and sixth
months of check up. Endovenous ablation is a procedure that
increases the quality of life and comfort in elderly patients,
with minimal pain. Radiofrequency catheter procedures have
proven to be more successful in patients of all age groups
than procedures such as standard surgery and foam therapy.
Keywords:
catheter ablation, venous insufficiency
Submitted 6/5/13, accepted 14/8/13
Cardiovasc J Afr
2013;
24
: e1–e2
DOI: 10.5830/CVJA-2013-060
With chronic venous insufficiency, surgical indications are
determined according to the symptoms of the patient, objective
data based on varicosities, and complications. The aim of surgery
is to eliminate the cause of venous hypertension, diminish the
symptoms of patients, and prevent complications such as venous
ulcers from occurring in the future.
1
In elderly patients, remission
of venectasia ulcers is difficult due to venous hypertension.
2
Case report
An 86-year-old male patient with hypertension, Parkinsonism,
benign prostate hyperplasia, cataract (with no vision in the left
eye) and chronic obstructive pulmonary disease had a history of
coronary bypass surgery in two veins due to anterior myocardial
infarction one year earlier. The patient was taking medication for
these diseases.
Presenting with pain and feelings of paresthesia below the
knee of his left leg, the patient had also fallen twice due to
sensations of heaviness in his legs. He had used compressions
and venoprotective medication for two years and also received
physiotherapy, but he presented to our clinic unable to alleviate
the symptoms.
The patient’s physical examination revealed varicose
dilatations in the left leg. Pigmentation and a recovered venous
ulcer scar were present in the medial malleolus of his left leg due
to a saphenous vein graft that had been used for bypass surgery.
Active cardiac symptoms were not present. No heart problem was
found from the cardiac tests conducted in our clinic (normal left
ventricular ejection fraction, no ischaemia on ECG). His clinical
status was classified according to the CEAP (Clinical severity,
aEtiology or cause, Anatomy, Pathophysiology) classification
pre-operatively as grade 4.
Along with high output reflux through the sinus of Valsalva
in the sapheno-femoral junction, the saphenous diameter at the
sapheno-femoral junction was measured as 8 mm, and the upper
left knee saphenous diameter was 5.6 mm. Due to the fact that no
deficiency was present in the superficial femoral and popliteal
veins, the patient was taken for endovenous ablation.
The patient was cannulated with a 16-g needle from the area
under the left knee with accompanying local anaesthesia. A
guide wire was moved forward through the needle and a sheath
was inserted. Under the guidance of continuous-wave Doppler
and duplex scanning ultrasonography, a radiofrequency ablation
catheter was inserted so as to keep the superficial epigastric vein
open up to 2 cm behind the sapheno-femoral junction. Tumescent
anesthesia was administered throughout the saphenous vein trace
to be ablated.
Department of Cardiovascular Surgery, Medical Faculty,
Çanakkale Onsekiz Mart University, Kepez, Çanakkale, Turkey
ALİ ÜMİT YENER, MD,
Department of Radiology, Turkiye Yuksek Ihtisas Hospital,
Ankara, Turkey
ÖZLEM YENER, MD
Department of Cardiovascular Surgery, Ankara Numune
Research and Education Hospital, Ankara, Turkey
HIKMET SELÇUK GEDIK, MD
KEMAL KORKMAZ, MD
KERIM ÇAĞLI, MD
Department of Anaesthesiology, Ankara Numune Research
and Education Hospital, Ankara, Turkey
AYŞE LAFÇI, MD
Department of Cardiovascular Surgery, Ankara Yuksek
İhtisas Hospital, Ankara, Turkey
TURGUT ÖZKAN, MD
