Ultrasound diagnostics in the treatment of varicose veins of the lower extremities by the method of radiofrequency ablation

Abstract

Introduction. Currently, ultrasound duplex scanning of the veins of the lower extremities is the "gold standard" of instrumental examinationin the diagnosis of varicose veins. This examination makes it possible to quickly, economically and informatively provide the surgeon with the necessary information for establishing a diagnosis. Examination of a patient with venous pathology of the lower extremities without an ultrasound examination should be considered insufficient. The aim of the study. To assess the role of ultrasound diagnostics of the veins of the lower extremities at the preoperative stage, during the surgical treatment of varicose veins of the lower extremities by the radiofrequency ablation (RFA)method, and in the postoperative period. Materials and methods. Over the past 2 years, 79 patients were operated on for varicose veins of the lower extremities and 90 interventions were performed in the vascular surgery department of the Municipal Non-Commercial Enterprise"Transcarpathian Regional Clinical Hospital named after A. Novak" of Zakarpattia Oblast Council, the clinical base of the Uzhhorod National University Medical Center. The study included patients with varicose veins C2–C4 according to the CEAP classification. The demographic structure of patients was significantly dominated by women (84.8%, p<0.00001). All patients underwent ultrasound duplex scanning of the veins of the lower extremities before the intervention. This examination was carried out on a TOSHIBA APLIO 400 device (Japan) using an 8–10 MHz linear sensor and a GENERAL ELECTRIC Vivid q (USA) using an 8 MHz linear sensor. Results and discussion. This paper presents data on the frequency of detection of various variants of hemodynamic disorders and expansion of superficial veins on the basis of ultrasound of the veins of the lower extremities. Widespread blood reflux through the great saphenous vein was observed in 76 (84.4%) patients, while total reflux was observed in only 4 (4.4%). In the small saphenous vein, widespread reflux was diagnosed in only 2 (2.2%) patients, while segmental reflux was observed in 3 (3.3%) patients. Widespread reflux was observed in the Leonardo's veinin 48 (53.3%) patients and in the anterior accessory saphenous veinin 8 (8.9%) patients. Insufficiency of the saphenofemoral junction of the first degree was diagnosed in 30 (33.3%) patients; second degree – 46 (51.1%), decompensated – in 9 (10.0%) patients. In the study of valvular insufficiency of the sapheno-popliteal junction, the first degree was diagnosed in 1 (1.1%) patients; second degree – 4 (4.5%). According to the data, the largest diameter of the great saphenous vein at the level of the sapheno-femoral junction was 15.3 mm, at the level of the femoral segment – 21.1 mm. Thus, the ultrasound examination of venous blood flow made it possible to assess the beginning of reflux, its spread and the degree of hemodynamic disturbances in the superficial veins of the lower extremities. The obtained results should be taken into account when choosing tactics and the volume of operative interventions. Conclusions. 1. Ultrasound duplex scanning of the veins of the lower extremities makes it possible to determine the individual anatomical and functional features of the deep and superficial venous system and to plan the volume of surgical intervention in a specific patient. 2. Ultrasound duplex scanning of the veins of the lower extremities makes it possible to perform radiofrequency ablation of the great saphenous vein on the thigh, minimally invasive interventions on varicose segments of the thigh and lower leg, as well as control in the postoperative period.