A modern approach to the treatment of patients with varicose disease of the lower extremities and evaluation of its effectiveness
DOI:
https://doi.org/10.32782/2415-8127.2023.67.5Keywords:
varicose disease, venous reflux, endovasal laser coagulation, phleboscleroobliteration.Abstract
Introduction. Among the literature data, there are many described methods of treating varicose disease, which dictates the need to define clear indications for each of them. In order to obtain a quality result without further relapse of varicose disease, an individual approach is required in each specific case. The effectiveness of one or another method of treating varicose disease is an urgent issue in vascular surgery. The aim. In order to improve the results of treatment of patients with varicose disease of the lower extremities, conduct a literature analysis of surgical treatment methods with inherent complications for each of them. Materials and methods. The available sources of domestic and foreign literature related to the treatment of patients with varicose disease and the use of various modern methods were analyzed. Research results and their discussion. A rational combination of surgery and phleboscleroobliteration makes it possible to maximize the advantages and eliminate the disadvantages of each of the methods. Today, authoritative phlebologists talk about sclerosurgery – a combined method of treating varicose disease. Thus, scleroobliteration was and remains a very popular method of varicose vein correction. Today, very popular methods of eliminating vertical venous reflux are endovasal thermal obliteration methods. Supporters of such interventions are among domestic and foreign specialists. Unlike surgical treatment, phleboscleroobliteration is certainly less traumatic, economically available, can be performed in an outpatient setting, is accompanied by smaller cosmetic losses and a shorter period of medical and social rehabilitation. The need to perform crossectomy before trunk scleroobliteration increases the likelihood of damage to large blood and lymphatic vessels, lymphorrhea. In this connection, the idea of carrying out the manipulation without a previous crossectomy arose. Conclusions. Surgical and sclerosurgical interventions are most often used in the treatment of patients with VD, an objective comparative assessment of their results is necessary to clarify the effectiveness of the studied methods in the long-term observation period.
References
Boiko V. V., Taraban I. A., Prasol V. O., Oklei D. V. Obgruntuvannia pokazan ta vybir metodu likuvannia tromboziv hlybokykh ven nyzhnikh kintsivok z urakhuvanniam porushen flebohemodynamiky. Kharkivska khirurhichna shkola. 2019(5-6):82-85. [In Ukrainian]
Humenchuk O, Shevchenko O, Kobzar O. Istorychni ta suchasni aspekty likuvannia varykoznoi khvoroby nyzhnikh kintsivok (ohliad literatury). Klinichna anatomiia ta operatyvna khirurhiia. 2021;20(1):56-69. [In Ukrainian]
Kutovyi OB, Sokolov OV. Optymizatsiia khirurhichnoho likuvannia dekompensovanykh form varykoznoï khvoroby ven nyzhnikh kintsivok. Art of medicine. 2018 Dec 1:109-13. [In Ukrainian]
Petrushenko VV, Tatarin AIe, Hrebeniuk DI. Analiz yakosti zhyttia patsiientiv pislia vykonannia endovenoznykh vtruchan z pryvodu varykoznoi khvoroby ven nyzhnikh kintsivok. Halytskyi likarskyi visnyk. 2016;3(2):110-2. [In Ukrainian]
Rusyn V.I., Korsak V.V., Boldizhar P.O. Likuvannia venoznykh trofichnykh vyrazok shliakhom ekhoskleroobliteratsii pronyznykh ven. Klinichna khirurhiia. 2014(2):5-7. [In Ukrainian]
Rusyn VI, Korsak VV, Popovych YaM, Boldizhar PO, Boiko SO, Nebylitsyn YuS. Funktsionalnyi stan klubovoho kolektoru pry hostrykh ileofemoralnykh venoznykh trombozakh. Arkhiv klinichnoi medytsyny. 2014;2(20):108-10. [In Ukrainian]
Rusyn VI, Rusyn VV, Kalynych SS, Kochmar OM, Nosenko OA. Rezultaty diahnostyky ta khirurhichnoho likuvannia varykotromboflebitu u khvorykh iz khronichnoiu venoznoiu nedostatnistiu v stadii dekompensatsii. Naukovyi visnyk Uzhhorodskoho universytetu : Seriia: Medytsyna. Uzhhorod : Spektral. 2016;2 (54):124-129. [In Ukrainian]
Tamm TI, Reshetniak OM, Zakharchuk AP. Profilaktyka uskladnen varykoznoi khvoroby nyzhnikh kintsivok u praktytsi simeinoho likaria. Problemy bezperervnoi medychnoi osvity ta nauky. 2018(1):87-91. [In Ukrainian]
Tamm TI, Reshetniak OM, Zakharchuk AP. Profilaktyka uskladnen varykoznoi khvoroby nyzhnikh kintsivok u praktytsi simeinoho likaria. Problemy bezperervnoi medychnoi osvity ta nauky. 2018(1):87-91. [In Ukrainian]
Babcock WW. A modified extractor for the removal of varicose veins of the leg. JAMA. 1910;55(3):210.
Bobrova AO. Obhruntuvannia pokazan i vybir sposobu khirurhichnoho likuvannia khvorykh na retsydyv varykoznoi khvoroby nyzhnikh kintsivok. Shpytalna khirurhiia. Zhurnal imeni LIa Kovalchuka. 2017(2):21-5. [In Ukrainian]
Bozkurt A, Yılmaz M. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insuffi ciency. Phlebology: The Journal of Venous Disease. 2016;31(1 Suppl):106-13.
Dziubanovskyi IY, Prodan AM, Pjatnichka OZ. Ultrazvukovi zminy pry varykoznii khvorobi nyzhnikh kintsivok na foni dysplazii spoluchnoi tkanyny. UKRAINIAN JOURNAL OF SURGERY. 2017(2.33):21-7. [In Ukrainian]
Dzyubanovskyi IY, Prodan AM. Rezultaty likuvannia varykoznoi khvoroby nyzhnikh kintsivok, asotsiiovanoi z dysplaziieiu spoluchnoi tkanyny, z vykorystanniam endovenoznoi lazernoi koahuliatsii. Klinicheskaia khirurgiia. 2018 Jan 28(1):41-4. [In Ukrainian]
Ermish, E., Kaserbereg U. Segmental sclerosing instead of stripping an alternative method in phlebosurgery (11000 interventions): proc. XII UIP World Congress (London, 3-8 Sept. 1995). Phlebology. 1995(1):561-563.
Garcia R, Labropoulos N. Duplex ultrasound for the diagnosis of acute and chronic venous diseases. Surgical Clinics. 2018 Apr 1;98(2):201-18.
Goodyear S, Nyamekye I. Radiofrequency ablation of varicose veins: best practice techniques and evidence. Phlebology: The Journal of Venous Disease. 2015;30(2 Suppl):9-17. doi: 10.1177/0268355515592771.
Joh J, Kim W, Jung I, Park K, Lee T, Kang J. Consensus for the treatment of varicose vein with radiofrequency ablation. Vasc Specialist Int. 2014;30(4):105-12. doi: 10.5758/vsi.2014.30.4.105.
Khvalyboha DV, Venher IK, Kostiv SY, Vaida AR, Kostiv OI. Ultrazvukova tromboelastohrafiia u vybori likuvalnoi taktyky pry pisliaoperatsiinomu venoznomu trombozi. Klinichna anatomiia ta operatyvna khirurhiia. 2019 Oct 24;18(4):107-11. [In Ukrainian]
Kokhan RS, Goshchynsky VB, Pyatnychka JZ. Zastosuvannia suchasnykh tekhnolohii u likuvanni khvorykh iz dekompensovanoiu formoiu varykoznoi khvoroby nyzhnikh kintsivok. UKRAINIAN JOURNAL OF SURGERY. 2017(1.32):46-50. [In Ukrainian]
Milleret R. Mon experience de la cryochirurgie des varices. Phlebologie. 1989;4:573-7.
Morrison N, Gibson K, Vasquez M, Weiss R, Cher D, Madsen M, et al. VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2017;5(3):321-30. doi: 10.1016/j.jvsv.2016.12.005.
Mulkens, P.J.M., Rabe E., Pannier-Fisher F. Treatment of superficial refluxing veins with the VNUS closure vein treatment system: abstr. UIP European Congress (Bremen, Germany, 26 Sept. – 01 Oct. 1999. J. Vase. Diseases. Vasomed. 1999(1):40.
Mulla SA, Pai S. Varicose veins: a clinical study. International Surgery Journal. 2017 Jan 25;4(2):529-33.
Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, DeJong MR, Streiff MB, Meissner MH. Ultrasound for lower extremity deep venous thrombosis: multidisciplinary recommendations from the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018 Apr 3;137(14):1505-15.
Oesch, A. PIN stripping: A novel method of atraumatic stripping. Phlebology. 1993(8):171-173.
Raetz J, Wilson M, Collins K. Varicose veins: diagnosis and treatment. American family physician. 2019 Jun 1;99(11):682-8.
Rusyn VI, Pavuk FM, Fedusyak VY. Determination of the form of venous hypertension in patients with decompensated chronic venous insufficiency with varicose disease and postthrombotic syndrome. Art of Medicine. 2022:121-7.
Tavel, E. Behandlung der Varicen durch die Ligatur und die kunstliche Thrombose. Corrsbl. Schweiz. Arzte. 1904(34):617-623.
Unger, E. Einiges tiber Krampfadern. Klin. Wschr. 1911:2306-2307.
Usenko OY, Artemenko MO, Varga AV, Uninets GM. Profilaktyka trombotychnykh uskladnen pry zastosuvanni endovenoznykh metodyk v likuvanni varykoznoi khvoroby nyzhnikh kintsivok. Klinicheskaia khirurgiia. 2017 Jul 26(7):25-7. [In Ukrainian]
Yang SS. Diagnosis and treatment of varicose veins and chronic venous insufficiency. Journal of the Korean Medical Association. 2020 Dec;63(12):756-63.
Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. The Korean journal of internal medicine. 2019 Mar;34(2):269.
Zuker-Herman R, Ayalon Dangur I, Berant R, Sitt EC, Baskin L, Shaya Y, Shiber S. Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis. Journal of thrombosis and thrombolysis. 2018 Jan;45:99-105.
