Results of complex treatment of patients with chronic venous insufficiency in the stage of decompensation

Abstract

Introduction. One of the pathogenetic mechanisms leading to the formation of trophic ulcers in chronic venous insufficiency (CVI) is considered to be ischemia as a result of impaired oxygen supply to tissues as a result of blocking the microcirculatory channel. CVI, as a rule, have different variants of valvular insufficiency in different departments of the venous system and at different levels. At the same time, it is often unclear why, with seemingly similar parameters of the venous wall, there will be a different clinical picture. However, among the available types of treatment for CVI, the most justified is currently operative. Aim. To evaluate the results of treatment of patients with chronic venous insufficiency in the stage of decompensation against the background of varicose desease and post-thrombotic syndrome. Materials and methods. In the surgical clinic of the Regional hospital named after A.Novak for 2017–2023, were treated 174 patients with chronic venous insufficiency in the decompensation stage. The results of complex treatment were evaluated according to a three-point system: good, satisfactory, unsatisfactory. We evaluated the relationship between the extent of reflux in the subcutaneous veins after complex treatment, taking into account the etiology of CVI in the decompensation stage. The assessment of the quality of life of 174 patients with chronic obstructive pulmonary disease in the decompensation stage before and after comprehensive treatment was carried out, depending on the obtained result using general questionnaires MOS SF – 36. Results. Thus, satisfactory results of dermatoplasty in the first group of patients were observed in 98.3% of patients and in the second group in 97.1% of cases. In 27 patients, PTS of both lower extremities was present in 95% of cases. At the same time, most of the unsatisfactory results of autodermatoplasty were related to technical reasons and were observed with the vintage method of the latter. The best results were achieved with plastic surgery with a perforated split flap. After a year, the healing rate of TU with VD was 97.1%, with PTS 91.3%. In the patients of the first group (superficial venous hypertension) KE operation + short stripping + distal scleroobliteration, postoperative complications were observed in only 2 (4.3%) patients in the form of suppuration of the operative wound on the thigh and liphorea. No complications were observed in deep venous hypertension in the early postoperative period. Conclusions. Early postoperative complications were observed in 2 (4.3%) patients with superficial venous hypertension and in two (66.6%) patients with mixed form of venous hypertension. In the long-term observation period, 9 (19.1%) patients of group I had partial recanalization of the IVC, and one (2.1%) had complete recanalization. TU did not heal in one patient with conservative treatment, relapse of TU occurred in 7 (4.1%) patients. According to the obtained data, on all scales of the quality of life, patients with healed TU showed a pronounced improvement in the almost all functions 2 times more.