We prefer to treat only the abdominal procedure if it is elective and is not radical, taking necessary precautions for DVT

You need not to treat varicose veins before elective abdominal surgery, if there is not an acute thrombophlebitis. If a person has severe varcosis it is sufficient to use compression stockings and unfractionated or low-molecular heparins. Early mobilisation is important, too.

Dear colleagues! Thank you for your opinions. Dear Dr. Becker can you provide some evidence (at least your institutional protocol) for such an approach. I'm agree with you but old guidelines (at least in my country) still recommended to treat varicose veins first. Thank you in advance.

Uncomplicated varicous veins are not a contra-indication for abdominal surgery. In our service a combination of elastic stockings, early mobilisation and BMI adapted LMWH are used with a very low complication rate.

Of course, uncomplicated varicose veins are not contraindication for any another types of surgery. From another hand, if both diseases are chronic (for example incisional hernia and varicose veins) and both a symptomatic (requires surgery) why not to treat varicose veins first or simultaneously? Such an approach seems to be rational (reducing the risk of VTE) and resource-saving. What do you think about?

Combined procedures bear a higher risk. In a young patient with no other pathology I might consider this. In the older patient with multiple disorders I would not and let myself be led by the relative urgency of the procedures.

I agree that varicose vein disease is not a contraindication for abdominal surgery even in the case of elective procedures for non malignant disease. However the varicose veins are a risk factor for dvt. In my hospital we have a score chart to quantify the risk of dvt in order to select the best prevention of dvt in where varicose veins count as obesity age etc......stocking and lwmh are all excellent even combined to prevent dvt

we usually take precautions as mentioned already by Dr Jutten but dont treat before or during Abdominal surgery.

Routine thromboprophylaxis, both LMWH and Stockings are the standard of care that I employ.

Please dont take care of these VV. Treat only the abdominal surgery, use a 30mmHg MCS and an early mobilisation in order to prevent a DVP +++ André

I agree with previous responses. LMWH heparin, 40 mm HG graduated compression stockings, and early mobilization. In addition, consider Duplex Ultrasound of the lower extremities to define the extent of superficial disease and to rule out any deep venous abnormalities.

Dear Dr Casian

CHEST guidelines in 2008 for VTE excluded varicose veins as a risk factor for VTE, but this decision was not unanimous. Although in the CHEST guidelines in 2012 it is not clear that varicose veins are a risk factor, they advise the use of Caprini score for risk stratification where varicose veins are included as a risk factor.

However, even being a risk factor there is no indication for varicose veins treatment before abdominal surgery or any. The only thing you need to do is VTE prophylaxis with LMWH and/or compression stockings depending on the risk. Early mobilization (when possible) must always be advised to patients.

Best regards

Carlos

General Surgeons usually do not think of lower extremity varicose veins before elective abdominal surgery in my instution. But they do care for post operative deep vein trombosis. Every in-patient takes prophilactic regimes for DVT after surgery. As a cardiovascular surgeon, who mostly treats varicose veins, i do also suggest just LMWH and compression stockings for VV before elective abdominal surgery. i think  in instutions in which vascular surgery is performed by general surgeons, both diseases can be treated simultaneously. Otherwise i think it is not important which is treated first as long as patient is taking prophilaxis for DVT.

Best Regards.

Cemal

I agree with Dr. Heretzman