Differentiated approach to the correction of post-surgical recurrence of decompensated forms of varicose veins of the lower extremities
DOI:
https://doi.org/10.24144/2415-8127.2020.61.96-100Keywords:
varicose veins, radiofrequency ablation, venous hemodynamics, venous ulcers, reccurence.Abstract
Introduction. Although the immediate results of surgical treatment of varicose veins of the lower extremities (VHNC) are generally successful, recurrences occur in 20% to 80% of patients, depending on the period of postoperative follow-up. The average time difference between primary surgery and surgical correction of recurrence can be from 6 to 20 years. The aim of the study. Evaluate the results of treatment of recurrences of varicose veins of the lower extremities with trophic ulcers using endovenous techniques and classical surgery. Materials and methods. The study included 23 patients with recurrences of varicose veins of the lower extremities in stage C6 after interventions with crossectomy. Patients were divided into two groups. Group I included 12 patients who underwent recurrence correction by re-attempting crossectomy and surgical removal of veins by stripping and miniphlebectomy. The second group included 11 patients who underwent correction of recurrence by combined endovenous interventions using radiofrequency ablation of the left stump and unremoved part of the trunks, sclerotherapy of neovascularization areas and surgical removal of varicose veins. Results of the studies and their discussion. Two months after the interventions, venous trophic ulcers healed in 10 patients (83.3%) of group I and 11 patients (100.0%) of group II. The rate of epithelialization of ulcers throughout the observation period was comparable in both groups and was 42.1±6.4 days (group I) and 39.2±6.1 days (group II). At the same time during the first month of reduction of the area of an ulcer, in relation to it in comparison with a condition before operation at patients of the I group in 2,3±0,5 (p> 0,005), at patients of the II group at 2,1± 0,4 > 0,005). The reopening of the ulcer during the two-year follow-up period occurred in 3 patients (25.0%) of group I. Ultrasound examination of all of them revealed significant horizontal reflux in incapable perforating veins in the ulcer area. No recurrence of ulcer in group II was observed. Conclusions. Careful examination of patients before surgery, the use of intraoperative ultrasound control and monitoring in the postoperative period can reduce the number of tactical errors in the treatment of recurrence of varicose veins. The use of endovenous methods in the treatment of recurrences of varicose veins of the lower extremities can improve treatment outcomes and reduce the number of complications.
References
Herman J, Musil D, Tichy M, Bachleda P. Recurrent varicose veins: causes and neovascularisation. A 17-year experience. IntAngiol. 2015 Feb;34(1):53–9.
O’Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J VascSurgVenousLymphatDisord. Elsevier; 2016 Jan 1;4(1):97–105.
Recurrent Varices after Surgery (REVAS), a Consensus Document:. SAGE PublicationsSage UK: London, England; 2016 Aug 27.
Rasmussen L, Lawaetz M, Serup J, Bjoern L, Vennits B, Blemings A, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J VascSurg Venous LymphatDisord. Elsevier; 2013 Oct 1;1(4):349–56.
Gloviczki P. et al. (ed.). Handbook of Venous and Lymphatic Disorders: Guidelines of the American Venous Forum. – CRC Press, 2017. 6. Winokur RS, Khilnani NM, Min RJ. Recurrence patterns after endovenous laser treatment of saphenous vein reflux:. Phlebology. SAGE PublicationsSage UK: London, England; 2015 Jul 16;31(7):496–500. 7. Nelzen O. Great uncertainty regarding treatment of varicose vein recurrence. Phlebologie. 2018 Jan 5;43(01):13–8. 8. Meneses L, Fava M, Diaz P, Andía M, Tejos C, Irarrazabal P, et al. Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome. CardiovascInterventRadiol. Springer-Verlag; 2012 May 1;36(1):128–32. 9. Jacob P. Recurrent Varicose Veins. Chronic Venous Disorders of the Lower Limbs. Springer, New Delhi; 2015: 95–103. 10. Usenko E. Khronicheskiezabolevaniyavennizhnikhkonechnostey i taza: diagnostika, lechenie, laboratornyykontrol’, profilaktikaoslozhneniy / E. Usenko, P. Nikul’nikov, L. Chernukha [et al.] // Klinicheskie i prakticheskierekomendatsii. Kyiv, 2014. 120 s. Russian.
