Differentiated approach to correction of post-surgical recurrence of decompensated forms of varicose veins of the lower extremities

Sokolov, Oleksandr (2020) Differentiated approach to correction of post-surgical recurrence of decompensated forms of varicose veins of the lower extremities. In: POLISH SCIENCE JOURNAL. Sp. z o. o. "iScience", Warsaw, pp. 67-73. ISBN 978-83-949403-4-8

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Abstract

The aim of the work. Optimization of the choice of the method of treatment of recurrences of varicose veins of the lower extremities with trophic ulcers on the basis of comparative evaluation of direct and long-term results of recurrence treatment using endovenous techniques and classical surgery. Materials and methods. We included 23 patients with recurrences of varicose veins of the lower extremities in the stage of decompensation (stage C6 according to the CEAP classification) after crossectomy, re-surgical treatment of which took place at the Department of Vascular Surgery of State Institution "Regional Clinical Hospital named after І. І. Mechnikov”(Dnipro), State Institution “City Hospital №16” and Medical Center “JMC”. The total number of men was 10 (43.5%), women - 13 (56.5%). The age of patients ranged from 44 to 76 years (mean age 56.5 ± 7.9 years). The time difference between the primary and corrective surgery ranged from 1 to 12 years, the average was 6.2 ± 2.3 years. The average time of recurrence of trophic ulcers was 4.6 ± 1.8 years. At the same time, the recurrence of pathological reflux detected on ultrasound was 5.9 ± 1.7 years, the clinical recurrence with the appearance of symptoms of post-surgical reccurence of varicose veins - 6.1 ± 1.9 years. Patients were divided into two groups. Group I included 12 patients who underwent recurrence correction by repeated crossectomy and surgical removal of pathological veins by stripping and / or miniphlebectomy. Group II included 11 patients who underwent recurrence correction by a combination of endovenous interventions using radiofrequency ablation of the left stump and the unremoved part of the saphenous trunks, sclerotherapy of neovascularization zones and miniphlebectomy of varicose deformities. At the beginning of the survey, groups of patients were comparable according to the main criteria. Results and discussion. The preoperative ultrasound examination revealed the causes of recurrence in patients of both groups. Two months after the interventions, venous trophic ulcers healed in 10 patients (83.3%) of group I and 11 patients (100.0%) of group II. The time to complete epithelialization of ulcers in patients of both groups was comparable and amounted to 42.1 ± 6.4 days (group I) and 39.2 ± 6.1 days (group II) p> 0.05. The rate of epithelialization was also comparable. Thus, during the first month, the decrease in the area of the ulcer, in relation to its condition before surgery, among patients of group I was 2.3+-0.5 times (p> 0.005), in patients of group II in 2.1+-0.4 times (p> 0.005). Secondary recurrence of ulcers during the two-year follow-up period occurred in 3 (25.0%) patients of group I. Ultrasound examination revealed significant horizontal reflux in the incapable perforating veins in the subulcer area. Recurrence of ulcers in group II was not observed. Conclusions Careful examination before surgery, the use of intraoperative ultrasound control and monitoring in the postoperative period can reduce the number of tactical errors in the treatment of recurrence of varicose veins. The use of endovenous methods in the treatment of post-surgical recurrences of varicose veins of the lower extremities allows to achieve comparable effectiveness of treatment results and fewer complications.

Item Type:	Book Section
Additional Information:	ISBN 978-83-949403-4-8 POLISH SCIENCE JOURNAL (ISSUE 5(26), 2020) - Warsaw: Sp. z o. o. "iScience", 2020. Part 1 - 199 p.
Uncontrolled Keywords:	varicose veins, radiofrequency ablation, venous hemodynamics, venous ulcers, reccurence; варикозное расширение вен, радиочастотная абляция, венозная гемодинамика, венозные язвы, рецидивы.
Subjects:	Surgery
Divisions:	Departments > Department of Surgery №2
Depositing User:	Елена Шрамко
Date Deposited:	15 Mar 2021 10:12
Last Modified:	15 Mar 2021 10:12
URI:	http://repo.dma.dp.ua/id/eprint/6323

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