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Akın M, Topaloğlu S, Özel H, Avşar FM, Akın T, Polat E, Karabulut E, Hengirmen S. Awareness and wound assesment decrease surgical site infections. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection.
Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed.
Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p< 0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p< 0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p< 0.001).
Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.
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Borghese O, Pisani A, Di Centa I. Endovenous radiofrequency for chronic superficial venous insufficiency: Clinical outcomes and impact in quality of life. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:3-8. [PMID: 33546819 DOI: 10.1016/j.jdmv.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/22/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Endovenous treatment of lower limb varicose veins is progressively replacing conventional surgery. The authors are investigating radiofrequency (RFA) results in terms of vein occlusion, complications, patient's satisfaction and quality of life in a single centre. METHODS AND MATERIALS A retrospective analysis of medical charts with a prospective follow-up was performed on data about patients undergoing RFA for insufficiency of great saphenous vein (GSV). RESULTS A total number of 135 patients (164 limbs) (63% n 85 female; 37% n 50 male; mean age of 53.9 years, range 24-85 years; mean VCSS score (Venous Clinical Severity Score) 6, range 4-22) were included. Complete obliteration of GSV was obtained in 98.2% of the cases. No device- or procedure-related adverse events occurred. No deep venous thromboses, pulmonary embolism, phlebitis, major bleeding, paraesthesia nor skin burn were detected. Patients returned to normal activities in a mean of 8 days (range 5-10). One-month postoperatively, the mean quality of life scores 6 (range 5-9) and mean satisfaction score was 6 (range 4-8) in a scale from 0 to 8. At a median follow-up of 11 months (range 2-18), mean VCSS was 3.9 (range 2-8). CONCLUSIONS Radiofrequency guarantees good functional outcomes and low rate of complications. It is associated with high satisfaction rate and quality of life score.
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Affiliation(s)
- O Borghese
- Department of Vascular Surgery, Foch Hospital, 40, rue Worth, 92150 Suresnes, France.
| | - A Pisani
- Department of Cardiothoracic Surgery Bichat-Claude-Bernard Hospital, Paris, France
| | - I Di Centa
- Department of Vascular Surgery, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
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Ezzelarab MH, Nouh O, Ahmed AN, Anany MG, Rachidi NGE, Salem AS. A Randomized Control Trial Comparing Transparent Film Dressings and Conventional Occlusive Dressings for Elective Surgical Procedures. Open Access Maced J Med Sci 2019; 7:2844-2850. [PMID: 31844447 PMCID: PMC6901868 DOI: 10.3889/oamjms.2019.809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND: Surgical site infection is one of the major health-care-associated problems causing substantial morbidity and mortality and constituting a financial burden on hospitals as well. The wound management is one of the crucial evidence-based strategies in the reduction of surgical site infection rates AIM: To study the impact of standardisation of transparent semipermeable dressing procedure on the rate of surgical site infection in comparison with conventional dressing in clean and clean-contaminated surgeries. METHODS: The study included 100 patients who were admitted to surgical wards in Cairo university hospitals, for clean and clean-contaminated operations, in the period from February 2017 to August 2017. Immunocompromised and uncontrolled diabetic patients were excluded. Patients were randomly allocated into two groups; in the first group, patients wounds were covered using transparent semipermeable dressing, while the second group patients’ wounds were covered using conventional occlusive gauze dressing. Patients were followed up for criteria of infection every other day during the first week then at two weeks, three weeks and four weeks. RESULTS: In clean and clean-contaminated operations, the transparent dressing group showed a significantly lesser rate of surgical site infection at (2%), compared with the conventional occlusive gauze dressing group with a surgical site infection rate of (14%) (p-value of 0.02). CONCLUSION: The transparent semipermeable dressing is effective in reducing surgical site infection rate in clean and clean-contaminated operations.
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Affiliation(s)
| | - Omar Nouh
- Plastic and Reconstructive Surgery, Cairo University, Cairo, Egypt
| | | | - Mervat Gaber Anany
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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The Nature and Severity of Adverse Events in Select Outpatient Surgical Procedures in the Veterans Health Administration. Qual Manag Health Care 2019; 27:136-144. [PMID: 29944625 DOI: 10.1097/qmh.0000000000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research on adverse events (AEs) in outpatient surgery has been limited. As part of a Veterans Health Administration (VA) project on AE surveillance, we chart-reviewed selected outpatient surgical cases to characterize the nature and severity of AEs. METHODS We abstracted financial year 2012-2015 VA outpatient surgery cases selected with high (n = 1185) and low (n = 1072) likelihood of an AE based on postoperative health care utilization. The abstraction tool included established AE definitions and validated harm and severity scales. RESULTS We found AEs in 608 high-likelihood (51%) and 126 low-likelihood outpatient surgical procedures (12%). Among 1010 unique AEs, the most common were wound issues (n = 261, 26%), urinary retention (23%), and urinary tract infections (12%). While 63% of all AEs involved minimal harm, 28% required hospitalization, and 9% were severely harmful including 8 AEs requiring intervention to sustain life and 2 deaths. Overall, 102 AEs (10%) required, at minimum, a repeat surgery to treat. CONCLUSIONS Among VA outpatient surgical procedures selected based on likelihood of an AE, nearly 40% of identified events carried more than minimal patient harm, undermining the claim that outpatient surgery is relatively safe. Prevalent and preventable AEs such as wound dehiscence and urinary retention may be useful targets for quality improvement.
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Pivot D, Hoch G, Astruc K, Lepelletier D, Lefebvre A, Lucet JC, Beaussier M, Philippe HJ, Vons C, Triboulet JP, Grandbastien B, Aho Glélé L. A systematic review of surgical site infections following day surgery: a frequentist and a Bayesian meta-analysis of prevalence. J Hosp Infect 2019; 101:196-209. [DOI: 10.1016/j.jhin.2018.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/24/2018] [Indexed: 01/19/2023]
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Totty JP, Harwood AE, Cai PL, Hitchman LH, Smith GE, Chetter IC. Assessing the effectiveness of dialkylcarbamoylchloride (DACC)-coated post-operative dressings versus standard care in the prevention of surgical site infection in clean or clean-contaminated, vascular surgery (the DRESSINg trial): study protocol for a pilot feasibility randomised controlled trial. Pilot Feasibility Stud 2019; 5:11. [PMID: 30680225 PMCID: PMC6337832 DOI: 10.1186/s40814-019-0400-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/10/2019] [Indexed: 12/02/2022] Open
Abstract
Background Surgical site infection in vascular surgery has a reported incidence of up to 19%. A novel method of reducing this rate of infection is dressings coated with dialkylcarbamoylchloride (DACC), a hydrophobic wound contact layer that binds bacteria and removes them from the wound bed. Early research has suggested that DACC-coated wound dressings are effective in reducing surgical site infection when applied to wounds healing by primary intention post-operatively, therefore this trial aims to assess the feasibility of producing high-quality evidence assessing this theory. Methods Patients undergoing clean or clean-contaminated vascular surgery will be randomised to have their surgical wounds dressed with a DACC-coated dressing or a non-coated occlusive absorbent post-operative dressing. All other aspects of their peri-operative care will be standardised or carried out in line with hospital policy. Wound assessments will be carried out between day 5–7, day 30 (± 3 days) and 6 months post-operatively (± 7 days) by a blinded assessor using the ASEPSIS scoring tool. Quality of life data using EQ-5D and SF-36, resource use and mortality data will also be collected. This feasibility trial will dictate the conduct of a full-scale trial through the collection of data on recruitment and retention rates, and fitness-for-purpose of the follow-up arrangements. Discussion Surgical site infections are now the second most common hospital acquired infections with a significant cost implication. The aim of the DRESSINg trial is to investigate the effectiveness of a novel preventative measure at reducing wound infections post-surgery and will provide robust evidence to support or deny its use. Trial registration Clinicaltrials.gov identifier: NCT02992951, Registered 12/12/16. REC Reference: 16/LO/2135.
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Affiliation(s)
- Joshua P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Amy E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Paris L Cai
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Louise H Hitchman
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
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First 10-month results of the Vascular Quality Initiative Varicose Vein Registry. J Vasc Surg Venous Lymphat Disord 2017; 5:312-320.e2. [DOI: 10.1016/j.jvsv.2016.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
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Abstract
This review presents the common diseases associated with superficial venous insufficiency of the leg. These include varicose veins, swelling, skin damage and ulceration. The benefits and rationale behind treatment are discussed, followed by the historical advances from ancient mortality and prayer to the modern endovenous revolution. Finally, an overview of modern treatment options will discuss the evidence supporting the gold standard of endothermal ablation and the cost effectiveness of treatment at this time of challenging resource limitation.
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Affiliation(s)
- D Carradice
- Hull and East Yorkshire Hospitals NHS Trust, UK.
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Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S. [PMID: 21536172 DOI: 10.1016/j.jvs.2011.01.079] [Citation(s) in RCA: 826] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Mekako AI, Chetter IC, Coughlin PA, Hatfield J, McCollum PT. Randomized clinical trial of co-amoxiclav versus no antibiotic prophylaxis in varicose vein surgery. Br J Surg 2009; 97:29-36. [DOI: 10.1002/bjs.6849] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Wound infection rates of up to 16 per cent are reported following varicose vein surgery and the value of antibiotic prophylaxis in clean surgery remains unclear.
Methods
Some 443 patients undergoing varicose vein surgery randomly received a single prophylactic dose of 1·2 g co-amoxiclav (219 patients) or no antibiotic (224). Patients completed a wound diary on postoperative days 3, 5, 7, 9 and 10 using an adapted ASEPSIS method of wound assessment, and were reviewed after 14 days.
Results
Patients who had prophylaxis had lower ASEPSIS wound scores on days 3, 5 and 7 (P = 0·043, P = 0·032 and P = 0·003 respectively), and lower total ASEPSIS scores (median (interquartile range) 3 (0–9) versus 6 (0–15); P = 0·013). They were less likely to consult their general practitioner (16.0 versus 24·3 per cent; P = 0·040) or to receive postoperative antibiotics (4·7 versus 13·5 per cent; P = 0·002) for wound-related problems. Wound outcomes were worse with higher body mass index (odds ratio (OR) 0·92 (95 per cent confidence interval (c.i.) 0·87 to 0·97); P = 0·005) and current smoking (OR 0·5 (0·3 to 0·9); P = 0·033). Prophylactic antibiotics conferred satisfactory wound healing (OR 2·2 (95 per cent c.i. 1·3 to 3·6); P = 0·003).
Conclusion
Antibiotic prophylaxis reduced wound-related problems after varicose vein surgery. Registration number ISRCTN12467340 (http://www.controlled-trials.com).
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Affiliation(s)
- A I Mekako
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - I C Chetter
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - P A Coughlin
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - J Hatfield
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - P T McCollum
- Academic Vascular Surgery Unit, Alderson House, Hull Royal Infirmary, Hull HU3 2JZ, UK
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Eveillard M, Delbos V, Cambuzat D, Enon B, Picquet J, Joly-Guillou ML. [Surgical-site infections following varicose vein surgery according to a continuous series of 408 interventions in a teaching hospital]. ACTA ACUST UNITED AC 2009; 59:e37-42. [PMID: 19477081 DOI: 10.1016/j.patbio.2009.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 03/18/2009] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the incidence of surgical-site infections (SSI) following varicose vein surgery in the vascular surgery ward of a French teaching hospital. PATIENTS AND METHODS A prospective surveillance of SSI was conducted during one year, with a 30-day postoperative follow-up. SSI cases were identified by using the definitions of the Centers for Disease Control (CDC, USA). Data acquisition and analysis were performed with the Epi-Info 6.04 software (CDC). RESULTS Three quarters of the 408 included interventions were characterized by a NNIS score equal to 0. All patients underwent a hair removing practice before intervention. Hair removing methods were very heterogeneous and often not in accordance with national recommendations (e.g. mechanic shaving for 44.6% of patients). The incidence of SSI was 1.2% (95% confidence interval=[0.2-2.2]). All infections were identified after hospital discharge. Four infected patients out of five presented obesity or excess weight, and two patients had diabetes mellitus. The mean age of infected patients was significantly higher than non-infected ones (70.4 years versus 52.0; p<0.01). All SSI had consequences like rehospitalization, reintervention, or antimicrobial therapy. CONCLUSION According to our results, SSI following varicose vein surgery are scarce and mainly concerned high-risk patients. However, in an aim of prevention, it seems necessary to homogenize hair removing methods in this ward.
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Affiliation(s)
- M Eveillard
- Laboratoire de bactériologie-hygiène, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
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Topaloglu S, Akin M, Avsar FM, Ozel H, Polat E, Akin T, Karabulut E, Hengirmen S. Correlation of risk and postoperative assessment methods in wound surveillance. J Surg Res 2008; 146:211-7. [PMID: 17644112 DOI: 10.1016/j.jss.2007.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/12/2007] [Accepted: 05/07/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine practicality of SSI risk assessment methods (Study on the Efficacy of Nosocomial Infection Control [SENIC] and National Nosocomial Infections Surveillance [NNIS]) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure. MATERIALS AND METHODS Patients were followed with a prospective data chart from January 1, 2003, to December 31, 2005. Correlation of SENIC and NNIS together with ASEPSIS were performed. RESULTS During the study period, 222 SSI occurred. SSIs were determined within the 21-d period after operations. Correlation between SENIC with ASEPSIS (r(s) = 0.47, P < 0.001) was found better than that for NNIS with ASEPSIS (r(s) = 0.41, P < 0.001). Type of operation (emergency versus elective), body mass index, operation class, and American Society of Anesthesiologists scores were found independently predictive factors for SSI. CONCLUSIONS This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS.
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Affiliation(s)
- Serdar Topaloglu
- First Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
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Yeung TM, Cope AC, Whittome N, Lintott P. Raised BMI is an independent risk factor for groin surgical site infections in patients undergoing varicose vein surgery. Am J Infect Control 2008; 36:152-3. [PMID: 18313519 DOI: 10.1016/j.ajic.2007.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
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De Maeseneer MG, Vandenbroeck CP, Lauwers PR, Hendriks JM, De Hert SG, Van Schil PE. Early and late complications of silicone patch saphenoplasty at the saphenofemoral junction. J Vasc Surg 2006; 44:1285-90. [PMID: 17145432 DOI: 10.1016/j.jvs.2006.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 08/04/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND To reduce the incidence of postoperative recurrence after great saphenous vein (GSV) surgery, various barrier techniques have been introduced, aiming at containment of postoperative neovascularization at the saphenofemoral junction in the groin. Interposition of a prosthetic barrier (patch saphenoplasty) may be useful for this purpose; however, the incidence of postoperative complications after patch saphenoplasty is unknown. A prospective study examined the incidence of complications after patch saphenoplasty in primary and repeat varicose vein surgery. METHODS Silicone patch saphenoplasty was performed in a consecutive series of 462 limbs (primary GSV surgery in 380, repeat surgery in 82) in 387 patients. Early and late complications in the groin potentially related to patch saphenoplasty were registered at clinical follow-up after 1 week and at clinical and duplex ultrasound examination after 2 months, 1 year, and later in case of new symptoms. RESULTS Complications occurred in 44 limbs (9.5%), 28 (7.4%) after primary GSV surgery and 16 (19.5%) after repeat surgery (P < .01). After repeat surgery, half of the complications were lymphatic problems. Nine limbs (2.0%) developed a complication after >2 months. Wound infection was registered in 13 limbs (2.8%), lymphocele or lymphedema in the groin or thigh in 15 limbs (3.2%), symptomatic or asymptomatic proximal venous thromboembolism in 14 limbs (3.0%), and swelling of the thigh due to important stenosis of the common femoral vein visible on duplex scan in 4 limbs (0.9%). Two of the latter remained symptomatic even after venoplasty and stenting of the pinpoint stenosis of the common femoral vein. CONCLUSION Patch saphenoplasty can cause early and late postoperative complications in the groin, which are usually minor. In exceptional cases, major complications may cause important morbidity and may be difficult to handle.
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