EFFICIENCY ASSESSMENT OF MINIMALLY INVASIVE TREATMENT OF SEVERE FORMS OF CHRONIC VENOUS INSUFFICIENCY OF LOWER EXTREMITIES

Aim. To improve the results of treatment of severe chronic venous insufficiency (CEAP 4-6) using the methods of minimally invasive phlebology. Materials and methods. The study included 158 patients aged 26-72 (mean age 49,5±1,2) suffering from chronic venous insufficiency (CEAP 4-6). All patients underwent the following examination methods: assessment of subjective and objective symptoms, duplex ultrasound scan and laboratory examinations. Results. Comparative study of endovenous laser hemadostenosis of great and small saphenous veins in combination with subfascial endoscopic perforator vein surgery (SEPS) in the control group and the combined use of endovenous laser coagulation and microfoam echo-sclerotherapy in the main group showed significant benefits in the primary group in the form of a significant reduction of pain syndrome, decrease of postoperative complications, a significant reduction of terms of rehabilitation. The study demonstrated the absence of significant differences between main and control groups of respondents according to the criteria of recurrence of the disease in the late postoperative period (difference in frequency of the detected unsatisfactory effects of the studied medical interventions in the late postoperative period was not statistically significant (p=0,67). Conclusions. Positive dynamics of the combined use of endovenous laser coagulation and microfoam echosclerotherapy of the main group in the immediate postoperative period demonstrate the effectiveness of this method in patients with chronic venous insufficiency (CEAP 4-6).

1. Савельев В.С. Варикозная болезнь − современное состояние старой хирургической проблемы. Анналы хирургии. 1999; 2: 6-10. [Savel'ev V.S. Varicose vein desease − the current state of the old surgical problems. Annals of surgery. 1999; 2: 6-10. (In Russ., English abstract)].

2. Стойко Ю.М., Лыткин М.И., Шайдаков Е.В. Венозная гипертензия в системе полых вен. С-Петербург, 2002. 276. [Stoyko Yu.M. Lytkin M.I., Shaydakov E.V. Venoznaya gipertenziya v sisteme polykh ven. St-Petersburg, 2002: 276. (In Russ.)].

3. Callam M.J. Epidemiology of varicose veins. Br J Surg. 1994; 81(2): 167-173.

4. Rhodes J.M., Gloviczki P., Canton L.G. et al. Factors affecting clinical outcome following endoscopic perforator vein ablation. Am J Surg. 1998; 176: 162-167.

5. Ярич А.Н., Брюшков А.Ю., Золотухин И.А. Недостаточность перфорантных вен при варикозной болезни: патогенетическое значение и методы коррекции. Флебология. 2010; 4: 29-34. [Yarich A.N., Bryushkov A.Yu., Karalkin A.V., Zolotukhin I.A. Incompetence of perforating veins in patients with primary varicosis: role in the pathogenesis and methods of correction. Phlebology. 2010; 4: 29-34. (In Russ.,English abstract)].

6. Nelzen O. Leg ulcers: economic aspects. Phlebology 2000; 15(3-4): 110-114.

7. Хитарьян А.Г., Гусарев Д.А., Велиев К.С., Леденев А.А., Ефанов С.Ю., Лукашевич Г.Н. Проспективное рандомизированное сравнительное исследование малоинвазивной коррекции низкого горизонтального вено-венозного сброса. Анналы хирургии. 2015; 1: 31-36. [Khitar'yan А.G., Gusarev D.A., Veliev K.S., Ledenev A.A., Efanov S.Yu., Lukashevich G.N. Prospective randomized comparative study of minimally invasive correction of low horizontal weino-veinous reset. Annals of surgery. 2015; 1: 31-36. (In Russ., English abstract)].

8. Богачев В.Ю., Кириенко А.И., Золотухин И.А. и др. Эндовазальная лазерная облитерация большой подкожной вены при варикозной болезни. Ангиология и сосудистая хирургия. 2004; 10(1): 93-100. [Bogachev V.Y., Kiriyenko A.I., Zolotukhin I.A., Bryushkov A.Yu., Kuravleva O.V. Endovenous laser ablation of the great saphenous vein in varicose disease. Angiology and vascular surgery. 2004; 10(1): 93-100. (In Russ., English abstract)].

9. Салимжанов Н.Н. Лазерные технологии в сосудистой хирургии. Амбулаторная хирургия 2003; 1(9): 39-41. [Salimzhanov N.N. Laser technology in vascular surgery. Ambulatory surgery. 2003; 1(9): 39-41. (In Russ., English abstract)].

10. Липницкий Е.М. Лечение трофических язв нижних конечностей. М.: Медицина, 2001. 160 с. [Lipnitskiy Ye.M. Lecheniye troficheskikh yazv nizhnikh konechnostey. M.: Meditsina, 2001. 160 p. (In Russ., English abstract)].

11. Чернышев В.Н., Крыгин С.Г. Применение эндоскопической технологии пересечения коммуникантных вен голени при хронической венозной недостаточности. Ангиология и сосудистая хирургия. 1997; 3(2): 94-104. [Chernyshev V.N., Krygin S.G. Application of endoscopic techniques of intersection of the communicating veins of the leg in chronic venous insufficiency. Angiology and vascular surgery. 1997; 3(2): 94-104. (In Russ., English abstract)]