R839 – Internal iliac ligation

The following applies to surgical services (ligation/stripping) for the treatment of varicose veins involving the long and/or short saphenous vein(s): Surgical services are only insured when all of the following conditions are met: 1. There is incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction that is documented by Doppler or duplex ultrasound scanning; 2. The patient has failed a trial of conservative management of at least three months duration; and 3. The patient has at least one of the conditions described in either a. or b. below: a. One or more of the following signs of chronic venous insufficiency: i. Eczema; ii. Pigmentation; iii. Lipodermatosclerosis; iv. Ulceration b. Varicosities that result in one or more of the following: i. Ulceration secondary to venous stasis; ii. One or more significant hemorrhages from a ruptured superficial varicosity; iii. Two or more episodes of minor hemorrhage from a ruptured superficial varicosity; iv. Recurrent superficial thrombophlebitis; v. Stasis dermatitis; vi. Varicose eczema; vii. Lipodermosclerosis; viii. Unremitting edema or intractable pain interfering with activities of daily living and requiring chronic analgesic medication.