Miniinvasive methods of phlebectomy in the treatment of varicosal extension of the legs of the perfantant type

Abstract

Introduction. Varicose veins of the lower extremities (HPVNC) is one of the most common vascular pathologies in the planet’s population, affecting up to 50% of the population of developed and developing countries. The spectrum of medical care for varicose veins is limited by compression therapy and surgical treatment options aimed at occlusion of aberrant subcutaneous venous system segments, including thermodestruction, sclero obliteration, scarification, ligation and, most often, a combination of different methods). The need for a combination of different methods is dictated by the variability of the caliber and configuration of the vascular bed and the inefficiency of each of the methods separately for complex disorders of venous hemodynamics. Two fundamentally different scenarios of damage to the venous macrocirculation are the ascending and descending variants, according to the literature, with approximately equal distribution and frequent combination. Traditional methods of surgical treatment of varicose veins have a number of fundamental features in conditions of perforant type of disease. The aim of the study. Comparison of efficacy and study of the results of the use of minimally invasive methods of treatment in patients with chronic venous insufficiency due to varicose veins of the lower extremities of the C2-6EpsApPr ascending type. Study of the quality of life of patients with varicose veins after complex treatment. Materials and methods. The study is based on the results of an analysis of 214 clinical cases of combined surgical treatment of patients with ascending varicose veins at the University Clinic (UK) ONMedU for the period 2015-2019. The total sample was divided into three groups: 1 – the first: the group in which transluminal occlusion of perforants with the use of end-light guide was performed – 158 patients; 2 – the second: the group in which foam sclero obliteration was used – 20 patients; 3rd – third: a group of 36 people, who have completed 60 leagues perforations. The dynamics of quality of life were examined using standard VenousClinicalSeverityScope (VCSS) clinical severity scale protocols. Results. Control of treatment was carried out by means of questioning and ultrasound control by the device intraoperatively and 7 days, 1, 2, 6 months after surgery. The parameter of completeness of obliteration of an incompetent perforant vein was chosen as a criterion for the quality of the performed intervention. For group 1 and group 2 results, a statistically significant difference (p <0.001) was determined in favor of group 2 results. For group 1 and group 3 results, the statistical significance of the difference (p <0.001) was confirmed in favor of group 3 results. Statistical results for groups 3 (p <0.05) were calculated for the results of groups 2 and 3. According to the results of the healing of trophic ulcers, the comparative effectiveness of the investigated ways of treating varicose veins is found. Conclusions. Transluminal perforant occlusion is the most effective minimally invasive treatment for horizontal venous reflux in patients with ascending varicose veins. A comprehensive approach with individual assessment of the morphological features of the patient’s body and the anatomical variant of the configuration of the venous network is the key to successful occlusion of sources of venous reflux.