Diagnosis and treatment of varicothrombophlebitis in patients with open trophic ulcers

Abstract

Introduction. The occurrence of such a complication as acute varicothrombophlebitis in patients with trophic disorders and open trophic ulcers due to varicose veins and/or postthrombophlebitic syndrome significantly worsens the prognosis of the disease. Improving the results of treatment of this group of patients is quite relevant and not fully studied in the literature. Aim. To improve the results of treatment of patients with decompensated chronic venous insufficiency complicated by acute varicothrombophlebitis, develop and implement a diagnostic and treatment algorithm in clinical practice. Materials and methods. On treatment in the surgical clinic named after Andriy Novak, Uzhhorod, during the period from 2011 to 2016, treated 80 patients with decompensated chronic venous insufficiency complicated by acute varicothrombophlebitis (VTP) of the large and small saphenous vein. Of these, 41 patients had open trophic ulcers due to varicose veins, 39 due to post-thrombotic syndrome (PTS). VTP in the first group of patients occurred in the large saphenous vein (LSV) in 37, in the small saphenous vein (SSV) in two, in the second group, respectively, in 35 and in two. According to computer planimetry, trophic ulcers up to 10 cm2 were observed in 10 and 9 patients of the first and second groups, respectively, up to 20 cm2 – in 18 and 15, over 20 cm2 in 13 and 15 patients. Research results and their discussion. The following types of VTP were observed in the first group: total varicothrombophlebitis with flotation of the top of the thrombus in the femoral vein was observed in 8 patients. In 18 patients, the process did not reach the saphenofemoral confluence by 8–10 cm, in 13 – to the lower third of the thigh. In two patients with VTP SSV, the transition of the thrombotic process to the flounder sinuses was observed. In patients of the second group, a floating thrombus in the femoral vein was not observed, in 15 the thrombus was localized at a distance of 12 cm from the sapheno-femoral junction, in 7 – at the level of the lower third of the thigh. In two patients with VTP SSV, the transition of the process to the calf sinuses was observed. In two patients with a combination of affected LSV and SSV, the thrombus reached the middle third of the thigh in the MPV system and passed to the sural sinuses on the lower leg. Due to the threat of pulmonary embolism (PE), 26 (32.5%) patients of the first group underwent urgent phlebectomy, which included: crossectomy (CE), if necessary, thrombectomy, short stripping and distal catheter scleroobliteration. Almost 8 people underwent thrombectomy, CE, short stripping, distal catheter scleroobliteration. In 15 patients with 18 CE, short stripping with distal catheter scleroobliteration. Three patients of this group underwent radiofrequency ablation (RFA) of the LSV due to the thrombosed area of the LSV. In the 1st group of patients, in the presence of horizontal reflux in the area of the trophic ulcer, 51 (64%) patients underwent echosclero obliteration of penetrating veins. Conclusions. Treatment of patients with CVI in the decompensation stage with trophic ulcers complicated by acute varicothrombophlebitis is aimed at eliminating the thrombotic process in embolic forms of thrombophlebitis, correcting violations of venous hemodynamics, and eliminating purulent-trophic defects. The use of vacuum therapy contributes to the early cleaning of wounds from layers of fibrin and areas of necrosis, the reduction of the area and depth of the wound, the growth of granulations, and the acceleration of marginal epithelization.