Клініка та діагностика первинного варикозного розширення вен пахових каналів як одна з форм несафенового первинного хронічного захворювання вен під час вагітності

Abstract

A distinct form of chronic venous disease (CVD) which meet the obstetrician-gynecologists, surgeons and vascular surgeons on the stages of pregnancy management is the primary varicose veins of the inguinal canals named non-saphenous varicose veins. This pathology is little studied and little known but there is a rather big obstetric problem for obstetricians-gynecologists, vascular surgeons, and as a surgical problem for surgeons and clinical and cosmetic for patients. The objective: to study the primary varicose veins of the inguinal canals frequency and forms, as well as development dynamics during pregnancy. Materials and methods. Based on Rivne Regional Perinatal Center Rivne Regional Council Municipal Institution for the period from 2013 to 2019, the observation of 1,367 pregnant women with primary chronic venous disease pool of saphenous and non-saphenous veins (according to the CEAP classification as of 2002). In 285 (20.8%) of them, one of the forms of non-saphenous varicose vein the primary varicose veins of the inguinal canals was diagnosed: in isolated form 129 (45.3%) patients, in 156 (54.7%) pregnant women combined with lower extremities’ primary chronic vein disease. All pregnant women for the diagnosis of venous pathology and the venous hemodynamics study in the lower extremities veins, the iliac veins pool, inguinal canals, a study of the sources, forming the primary varicose veins of the inguinal canals, used the second diagnostic level, under the guidance of Ukrainian Consensus on the treatment of lower extremities’ varicose veins as of 2005 which included the anamnesis data, clinical examination and duplex angioscanning. For all patients, ultrasound examination was performed in the supine standing position (orthostasis) with Valsalva maneuvre using Mc Kenna D. A. and co-authors criteria (2008). Results. Among 285 (20.8%) pregnant women with the primary varicose veins of the inguinal canals, 129 (45.3%) patients were diagnosed with an isolated form; 28 (21.7%) had varicose veins within the inguinal canal, and 101 (78.3%) of the pregnant women spread through the outer inguinal ring to the external genitals, perineum, and lower limbs. 156 (54.7%) pregnant women in the primary varicose veins of the inguinal canals different forms combined with primary CVD of the lower extremities saphenous veins pool. Found that among 285 patients with the primary varicose veins of the inguinal canals sources on duplex angioscanning in 141 (49.7%) was dominated by reflux from the uterine plexus veins, 73 (25.61%) mainly from the ovaries veins, 42 (14.73%) of pregnant women primarily from the veins of the uterus + ovaries, 18 (6.32%) mainly from the veins of the uterus + ovaries + cremasteric vein, failed to clearly identify the source for 11 (3.86%) patients. This pathology progressed throughout pregnancy and during subsequent pregnancies for 285 (100%) patients. The primary varicose veins of the inguinal canals isolated form did not progress between pregnancies. At that time all the 156 pregnant women with the concomitant disease, marked by the progression of primary CVD pool of saphenous veins during pregnancy and between pregnancies. Conclusion. The use of the second level diagnosis during pregnancy which combined the data of anamnesis, clinical examination and LANWIND MIRROR 2 duplex angioscanning apparatus with 8–10 MHZ linear sensor frequency, McKenna D.A. and co-authors criteria (2008) in the supine and standing (orthostasis) with the Valsalva maneuvre in 100% is safe for both mother and fetus. The use of the inguinal canals venous pathology’s second level diagnosis among the pregnant women gave one hundred percent diagnosis of this pathology’s various forms. On duplex angioscanning the primary varicose veins of the inguinal canals found in 20.23% among pregnant women with primary chronic vein disease to 45.3% in isolated form, but more often in 54.7% in combination with lower extremities’ primary chronic vein disease. Sources of the primary varicose veins of the inguinal canals’ formation were mostly uterus venous plexuses’ reflux in 49.7% of pregnant women, the ovaries in 25.61% of the patients. Key words: D.A. McKenna and co-authors criteria (2008), duplex angioscanning, non-saphenous varicose veins, inguinal canal varicose veins.