The management of arterial and venous injuries during saphenous vein surgery.

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.