Treatment of patients with inflow varicothrombophlebitis

Abstract

Introduction. The study of acute varicothrombophlebitis and the development of rational methods of diagnosis and treatment of this disease is due to its relevance among diseases of the veins of the lower extremities. The importance of HFTP is related not only to its possible transfascial spread into the deep vein system, but also to frequent pulmonary embolism (PE), which still requires refinement in the correctness of treatment approaches. Aim. Development and implementation in clinical practice of minimally invasive methods of treatment of inflow acute varicothrombophlebitis depending on the clinical state of chronic venous insufficiency according to CEAP in isolated inflow varicothrombophlebitis and in the transition of the process to the trunk of the great saphenous vein. Materials and methods. In the surgical clinic of the KNH “ZOKL named after A. Novak” Uzhgorod were treated 37 patients with tributary VTP in the BSV basin from 2018 to 2023. There were 8 (21.6%) men, 29 (78.4%) women. In 29 (78.4%) patients, isolated thrombosis of varicose changed veins and collaterals without transition to the trunk of the BSV were observed, in 8 (21.6%) patients. The VTP was transferred to the trunk of the BSV. The clinical distribution of patients according to the international classification of CEAP was as follows: patients with clinical class C2-2, C3-15, C4-11, C5-6, C6-3, where the majority of patients 20 (54.1%) had clinical class C4– 6. Research results and their discussion. In 6 patients with localization of the process in the medial additional branch of the BSV, sclerotherapy was performed at the point of confluence with the BSV, phlebocentesis from the distal part of the vein and scleroobliteration of the tributary. In two patients with thrombophlebitis in the external pubic vein, puncture sclerotherapy was performed at the point of confluence with the BSV followed by miniphlebectomy of the thrombosed tributary. In 7 patients with thrombophlebotic occlusion of the medial intersaphenous vein, scleroobliteration was performed at the confluence of the BSV and SSV with phlebocentesis of the thrombosed vein. In connection with the danger of the spread of thrombotic lesions due to incompetent veins to the deep venous system in the case of thrombotic occlusion of the veins of Leonardo, it was considered inadvisable to use phlebocentesis. Patients should be transferred to indirect anticoagulants. In patients with thrombotic occlusion of the vein of Leonardo and the absence of failed permeating veins, sclerotherapy of the thrombosed tributary at the point of confluence with the BSV was performed against the background of medical treatment. In 8 (21.6%) out of 37 patients, in addition to the thrombosed tributary, the BSV trunk was also partially involved in the pathological process of varicose transformation. Conclusions. The main task of treatment of inflow varicothrombophlebitis is surgical methods of preventing the transition of the process to the trunk and non-progressive perforant veins. The transition of inflow varicothrombophlebitis to the trunk of the BSV, clinical manifestations of CVI C4-6 according to CEAP, expand the indications to increase the volume of surgical intervention.