[Varicose vein surgery and obesity--experience with a new Boazul cuff in leg circumference up to 90 cm]

The combination of varicose vein disease and obesity is common in clinical practice. Long operations, high blood loss and extensive bruises are the results. Since 2005, a new roll-on cuff for varicose vein surgery with a thigh circumference of 90 cm is available (big cuff).

Between 1.4.1995 and 31.3.2006, surgeons at the Clinic for Vascular Medicine, Venous and Wound Care Centre Krefeld carried out varicose vein surgery in 10 054 cases. 92% (n=9,249) of the operations were done with a roll-on cuff tourniquet. The cuff was inflated to 120 mmHg and rolled up to the thigh of the leg. We present the results of the "big cuff" pilot-study and our general experience with varicose vein surgery in bloodless technique.

1) Big Cuff: A transducer was located between cuff and the skin. A cuff pressure of 120 mmHg and a median thigh circumference of 79.5 cm led to a median pressure of 218.6 mmHg. The tourniquet time was 35 minutes and the systolic blood pressure during the operation did not exceed 120 mmHg. Under these conditions we did not encounter any problems. 2) Bloodless limb technique: 9 249 of our own operations using the Boazul cuff were analysed. We did not find any major complications such as acute arterial occlusion or deep vein thrombosis (DVT) during the procedure. At present the DVT rate amounts to 0.05 %.

The use of the bloodless limb technique for varicose vein surgery is very comfortable, especially in cases of severe varicose veins and obesity. Maintenance of operation standards and utmost care of the cuffs lead to the successful use of this procedure.