Endovenous electric welding as a modern and effective technique minimally invasive treatment of varicose veins of large diameters

Abstract

Introduction. Today, varicose veins of the lower extremities are a fundamentally important issue in the health care system of most countries due to their extreme prevalence, latent progressive course with severe complications and life-threatening consequences. In the development of treatment tactics today, preference is given to transcutaneous interventions. The reference method of minimally invasive treatment is endovenous laser coagulation (EVLK) using diode optical fibers, which is characterized by high efficiency with a diameter of the insolvent segment less than 20 mm and a dose-dependent spectrum of complications. This determines the urgency of finding a new method of thermal ablation with less tissue heating and a more advanced control algorithm. The aim of the study. To compare the effectiveness of methods of endovenous electric welding and laser ablation in the treatment of chronic venous insufficiency of the lower extremities. Materials and methods. The study was conducted on a sample of 279 patients (178 women, 106 men aged 29 to 76 years) with chronic venous insufficiency of the lower extremities C2-6ErsAspPr, who underwent endovenous ablation of subcutaneous venous trunks with diameters of incapable segments from 14 to 28 mm. The control group consisted of 192 patients who underwent laser coagulation of the trunk of the great saphenous vein using a 1470 nm diode fiber. In the main group (67 patients) the operation was performed using endovenous electric welding. The effectiveness of treatment was evaluated based on objective and subjective data. Research results and their discussion. All patients underwent follow-up at 7 days, 1 and 6 months, and then every six months. Physical examination and color duplex scanning of the operated limb were performed to assess the quality of BPV occlusion and possible reflux and recanalization. In order to control the quality of life, patients were asked to complete a CIVIQ questionnaire 1 and 6 months after surgery. As a result of treatment after 6 months, the frequency of cases of partial recanalization of the trunk of the great saphenous vein in 1 group was 4%, in the second - 0% (p> 0.05 on the parameter χ2). In all cases, recurrences in the first group were observed with the diameter of the cervical region of the vessel above 21 mm. In the early postoperative period, cases of low-intensity pain during the course of ERW were observed with the same frequency. When analyzing the quality of life of patients on the CIVIQ scale, both methods are equally effective. The method of endovenous electric welding (EVE) has a simpler principle of conversion of electrical energy into heat, as well as the ability to self-regulate the duration of exposure of the working surface of the electrode in the lumen of the vein, which allows to achieve occlusion of observation. Conclusions. EVEZ is an effective analogue of EVLK with a higher safety profile and a perfect control algorithm. The technique is of interest for further research and practical application. EVE allows you to effectively perform transcutaneous venectomy in varicose veins of the lower extremities with a diameter of the insolvent segment of the subcutaneous vein from 20 to 30 mm with a minimum range of complications.