Clean up varicose vein surgery--use a tourniquet. A prospective randomised trial of tourniquet in varicose vein surgery. Varicose vein surgery using a pneumatic tourniquet: reduced blood loss and improved cosmesis.
A controlled randomised trial has been carried out to ascertain if there are tangible benefits from using a tourniquet when avulsing varicose veins during routine varicose vein surgery. Twenty-six patients have been studied. Twenty limbs were operated on with a tourniquet and 20 limbs without a tourniquet. The mean weight of varices excised was 2.76 g (range 0.51-8.79 g) with a tourniquet and 2.68 g (0.77-11.27 g) without a tourniquet (NS, Wilcoxon's rank sum test). Mean blood loss was 16 ml (0-136 ml) with a tourniquet and 107 ml (16-581 ml) without a tourniquet (P less than 0.01, Wilcoxon's rank sum test). The mean time to complete avulsions was 38 min with a tourniquet and 35 min without a tourniquet (NS, Student's t test). The tangible benefits of a tourniquet are limited to the saving of blood which can amount to 500 ml per leg. Losses could amount to 1 litre in bilateral cases operated upon without tourniquet. The method is simple, provides a clean operating field and should be more widely used. A prospective randomised trial of 50 patients was carried out to assess the autoclavable Lofquist cuff (Boazal, Sweden) as a tourniquet in varicose vein surgery and determine the effect on bleeding, bruising, cosmesis and patient pain and activity. Patients undergoing unilateral long saphenous vein ligation, stripping and avulsions were randomised to tourniquet or no tourniquet. Lofquist cuffs were applied after inflation to 120 mmHg to the upper thigh for the duration of the surgery. Varicose vein grade, duration of surgery, blood loss, extent of bruising at 7 days, pain and activity scores over the first week, and wound complications and cosmetic result at 6 weeks were recorded. Patients' age, sex, and varicose vein grade were similar in the two groups. Peroperative blood loss (median, range) was significantly reduced in the tourniquet group (0 ml, 0-20 ml) compared to the no tourniquet group (125 ml, 20-300; P < 0.01). Operative time and thigh bruising (median, range) were also reduced in the tourniquet group (30 min, 11-47 min; 72 cm2, 30-429 cm2), respectively, compared to the no tourniquet group (37 min, 18-50 min; 179 cm2, 24-669 cm2) both (P < 0.01). There was no difference in pain and activity scores in the two groups and cosmetic results were also similar. The use of the Lofquist cuff tourniquet during varicose vein surgery reduces peroperative blood loss, operative time and postoperative bruising without any obvious drawbacks. A prospective controlled randomised study has been performed of 100 consecutive patients undergoing varicose vein surgery. One group underwent saphenofemoral flush ligation and multiple lower leg avulsions with the leg exsanguinated with a Rhys-Davies cuff, and ischaemia maintained with a pneumatic tourniquet. The other group underwent identical surgery but with a 30 degree head down tilt only. Blood loss was significantly less (13.5 +/- 12 ml vs 133 +/- 78 ml; P less than 0.01) and postoperative cosmesis was significantly improved in patients in the tourniquet group. Operating time was similar (27 +/- 11 min vs 30 +/- 13 min) in the two groups.
Although there were significant quality issues with the available evidence, the use of a tourniquet would appear to reduce blood loss during surgery. There were no reported differences between the use or non-use of a tourniquet in terms of complications and morbidity. However, the available trials were not of sufficient size to detect rarer complications such as nerve damage.