The choice of treatment tactics in patients with acute varicothrombophlebitis of the superficial veins of the lower extremities

Abstract

Introduction. Acute trombosis of varicose veins (ATVV) is the most common complication of varicose veins of the lower extremities. The greatest danger of ATVV is the threat of transfascial thrombosis, and the possible occurrence of pulmonary embolism (PE). The advantages of surgical interventions are a reduction in the duration of inpatient treatment, prevention of transfascial thrombosis and DVT, prevention of PE. The tendency towards active surgical tactics in the case of ATVV, the accumulated theoretical baggage and practical aspects require systematization and the creation of clear algorithms for the treatment of ATVV. Goal. The purpose of the study is to improve the results of surgical treatment of patients with ATVV in the basin of the great saphenous vein. Materials and methods. The work analyzed the results of treatment of 87 patients with various forms of acute varicothrombophlebitis in the basin of the great saphenous vein who were treated in the surgical department of the Uzhhorod District Clinical Hospital for the period from 2018 to 2021. Research results and their discussion. All patients were divided into two groups – main and control. 44 patients who underwent surgical interventions were observed as the main group, and 43 patients who received only conservative treatment were observed as a control group. Emergency surgical interventions were performed in 40 (90.2%) patients of the main group. In cases of tributary ATVV with a risk of transfascial thrombosis, the first step was subfascial ligation of failed penetrating veins followed by miniphlebectomy. Crossectomy, short thigh stripping, phlebocentesis, or scleroobliteration were performed in 34.8% with the spread of the thrombotic process to the GSV. In patients with the apex of thrombotic masses at the mouth of the GSV, treatment of the latter, in order to prevent thrombus fragmentation, was performed after open thrombectomy from a venotomal incision of the terminal section of the GSV. In the case of ascending DVT, taking into account the rapid growth of the thrombotic process in the proximal direction, in all patients, the first stage was crossectomy, followed by short or long stripping. Conclusions. 1. In 45.1% of patients with ATVV on the lower leg, the process was localized in the main trunk without involvement of IPV inflows, which made it possible to perform isolated removal of the thrombosed IPV segment in 69.6% of them, in 30.4% of patients – phlebocentesis with scleroobliteration. 2. For transfascial thrombosis, the main standard of treatment is thrombectomy with combined drug anticoagulant therapy. 3. In the early postoperative period, a good and satisfactory result was observed in all patients. In the remote postoperative period, a good and satisfactory result was found in 97.8%.