Sokolov O. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. Decompensated forms of varicose veins (VV) of the lower extremities remain common in the world. The surgical approach of elimination of vertical and horizontal venous refluxes and removal of varicose veins is considered pathogenetically justified. In today’s conditions, the priority in the choice of intervention is increasingly shifting from traditional surgical techniques to minimally invasive endovenous procedures under ultrasound monitoring, such as radiofrequency ablation. The aim of the study. Comparative evaluation of long-term results of VV treatment by surgical treatment and radiofrequency ablation of the trunk of the great saphenous vein in patients with varicose veins of the lower extremities in stage C6. Object and methods of research. A prospective study with retrospective analysis was conducted. Under surveillance There were 111 patients with VV class C6 according to CEAP classification, with reflux in the basins of the great and small subcutaneous veins, who received treatment on the basis of the municipal institution “Regional Clinical Hospital named after II Mechnikov”, municipal non-profit enterprise “City Clinical Hospital №16” of Dnipro City Council and medical center “JMC Menorah” for the period 2010-2019. Men – 51 (45.9%), women – 60 (54.1%). Age of patients – from 27 to 74 years (average – 54.5±11.2 years). The average area of trophic ulcers was 8.6±5.7 cm. All patients were divided into two groups. Group I (n=54) included patients who, as a method of correcting venous reflux, underwent surgery under spinal anesthesia, which included crossectomy, stripping and miniphlebectomy of tributaries according to Varady’s method. Group II (n=57) included patients who, for the same purpose, underwent radiofrequency ablation of the saphenous trunk and miniphlebectomy of tributaries according to Varady’s method under local anesthesia with Klein’s solution under ultrasound control. The groups were comparable according to the main criteria. Postoperative follow-up in the study lasted 12 months. At the beginning of the study, the area of ulcers ranged from 1 to 16 cm2 in both groups, the average area of ulcers in group I was 6.4±3.3 cm2 , in group II – 6.3±3.7 cm2 (p=0.046). Complete epithelialization of ulcers occurred faster in group 2 and averaged 37.2±6.7 days against 42.2±6.2 days in group II (p=0.592). After 6 months, the number of healed ulcers in group I was 37 (68.5%) cases in patients of group I, and 51 (89.4%) cases in group II. Ulcer recurrence within a year after surgery was observed in 3 (5.6%) patients of group I. There were no recurrences of ulcer in patients of group 2. Six months later, the difference between the severity of chronic venous insufficiency according to the VSS system was 10.6±3.2 points in group I against 13.7±2.2 points in group II. One week after surgery, pain decreased by 54.1% in group I and 76.9% in group II. Conclusions. 1. Appliance of radiofrequency ablation in the bed of the great and small subcutaneous veins had an advantage over traditional phlebectomy in reducing the severity of CVI according to VSS system by 7.2% at the end of the 1-st year after surgery. 2. Complete epithelialization of ulcers occurred faster after radiofrequency ablation, its duration averaged 37.2±6.7 days against 42.2±6.2 days after traditional phlebectomy (p=0.032) 3. With the use of radiofrequency ablation, the intensity of the pain syndrome on the 7th day of the postoperative period was 58.5% lower than with the use of traditional phlebectomy. Perspectives for further research. Promising vectors are the improvement of prevention of decompensated forms of varicose veins of the lower extremities, optimization of a differentiated approach to their surgical treatment based on careful analysis of a large number of results of different methods and technologies, and development of clear indications for choosing the type of surgical interventions.

varicose disease, phlebectomy, radiofrequency ablation, trophic ulcers.

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«Bulletin of problems biology and medicine» Issue 1 (159), 2021 year, 128-133 pages, index UDK 616.147.3-007.64-089

10.29254/2077-4214-2021-1-159-128-133