Phlebectomy and its indications

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Also known as venectomy; it is a procedure in which a segment of a vein is cut down to get vascular acess for other procedures to be done upon.

Common sites of venous cutdown;

  • Great saphenous vein,
  • Anticubital vein,
  • Cephalic vein.

Technique of Cutdown on Long Saphenous Vein

Full aseptic measures, good light and immobilization.

Infiltrate an area above and anterior to medial malleolus with local anaesthesia.  Make a transverse skin incision just above and medial, to medial malleolus.  Artery forceps should be used to open up the subcutaneous tissue by blunt dissection until long saphenous vein is visible lying on the tibia.  Mobilize the vein from the surrounding fascia, taking particular care to separate it from saphenous nerve, which lies anteriorly.

  • Pass two stay ligatures (e.g. Silk 3/0) under the vein, and by traction on the distal stay; lift the vein up into the incision.  Incise about one third of the vein’s circumference and introduce the desired cannula or Silastic catheter.  If a tourniquet has been used, the non-sterile assistant should be asked to remove it at this stage.
  • The proximal stay ligature is tied around the vein, and then the canula is secured with it.  Ligate of the distal stay to occlude the vein below the venotomy site.
  • The incision is closed with one or two sutures and covered with a sterile dressing.

Cephalic Venous Cutdown

 

Indications:

Safer a blind percutaneous approach especially indicated in coagulopathic patient.

Patient cannot tolerate pneumothorax.

Trendelenberg positioning.

Elective placements of permanent venous access device.

Technique:

Local anaesthetic is infiltrated subcutaneously over the prepared deltopectoral groove, just medial to the coracoid process.  An incision is made parallel to the deltopectoral groove.  The clavipectoral fascia is incised and the vein is mobilized and ligated distally.  A transverse venotomy is made and a #16G, size and name of venous catheter is passed directly into the vein.