Use of a tourniquet during surgery for varicose veins

Varicose veins are obvious, dilated veins just under the skin. In normal veins the valves make sure blood only moves in one direction. The valves in varicose veins are faulty, allowing blood to pool and the veins to enlarge. This can cause aching legs, itching and poor cosmetic appearance. People with varicose veins may wear compression stockings, have an injection of irritant substance to close the veins under the skin (sclerotherapy), or have the veins removed surgically. There is a potential for large blood loss during surgery, especially if both legs are operated on at the same time. Tourniquets on the upper leg during surgery may be useful to minimise blood loss.

This review found that the amount of blood loss was clearly reduced when a tourniquet was used during surgery for varicose veins, with no overall increase in operative time, reported adverse events or change in patient reported pain and activity after surgery. Three trials were included in the review, in which a total of 176 men and women (211 legs) were randomised to either use or non-use of a tourniquet. All trials took place in the UK between 1989 and 2000. Those patients who did not have a tourniquet had a wider range of total blood loss and patients in the upper limits lost a significant amount of blood. A reduction in blood loss may also result in a reduction in post-operative bruising but only one of the trials (50 patients) looked at this. It found a clear reduction in the area of bruising with the use of a tourniquet. The trials did not have a large enough number of participants to determine any rarer complications of surgery with the use of a tourniquet such as nerve damage or arterial injury, especially in older patients.

Authors' conclusions: 

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.

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Background: 

Varicose vein surgery is a common surgical procedure but there is no consensus regarding the best surgical technique. The use of tourniquets during varicose vein surgery has been advocated as a means of reducing the potential for blood loss during the operation.

Objectives: 

To identify whether the use of a tourniquet should be recommended when undertaking surgery for the management of primary varicose veins.

Search strategy: 

For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2013) and the CENTRAL (2013, Issue 3).

Selection criteria: 

All studies described as randomised controlled trials that examined the use of tourniquets during surgery for patients with primary varicose veins were included.

Data collection and analysis: 

Data from eligible studies were extracted and summarised independently by two authors. All studies were cross-checked independently by the authors.

Main results: 

No additional studies were included or excluded in the updated review. Twenty papers detailing 18 trials were considered. Only three trials were randomised controlled trials and were included in the review. The remaining fifteen studies were excluded for various reasons. All three included trials had a small sample size and reported the trial design, outcome measures and analysis poorly. There were also variations in the outcome measures used between the trials. In addition, there was no consistency on the reporting of mean and medians for blood loss during the operation. It was therefore not possible to pool the data to perform meta-analysis. However, the reported blood loss when using a tourniquet was between 0 and 16 ml compared to between 107 to 133 ml when not using a tourniquet (P < 0.01).

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