Lower Extremity Vein Therapy

Radiofrequency or laser ablation of the greater saphenous vein (GSV) is gaining popularity as an alternative, less invasive method for GSV stripping in the treatment of varicose veins. This transforms varicose vein treatment into an office practice and limits the anesthesia needs to infiltration of local anesthetics. The skin is typically infiltrated at the site of insertion of the sheath through which the laser or radioablation catheter is introduced. Because of the heat generated with the venous ablation, additional anesthesia is needed along the course of the GSV. Tumescent anesthesia is used for this purpose. Tumescent anesthesia is prepared by the following concentration:

500 cc of normal saline in IV bag

16cc of 8.4% sodium bicarbonate solution

50 cc of 1% lidocaine with epinephrine 1 : 100,000

It is infiltrated along the course of the GSV using a long spinal needle. In addition to providing anesthesia to the infiltrated area, tumescent anesthesia provides a protective layer between the vein and the dermis to avoid thermal skin injury during the laser or radiofrequency ablation. This tumescent anesthesia is also used during stab avulsion of branch varicosities. In addition to providing pain control, it is useful in minimizing subcutaneous bleeding from the ends of the avulsed veins.

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