РЕЗУЛЬТАТЫ КОМБИНИРОВАННОЙ МИНИИНВАЗИВНОЙ ФЛЕБЭКТОМИИ И PRP-ТЕРАПИИ ПРИ СОЧЕТАНИИ ВАРИКОЗНОЙ БОЛЕЗНИ С ГОНАРТРОЗОМ

Abstract

Objective: To analyze the results of combined minimally invasive phlebectomy (CMIP) with platelet-rich plasma (PRP) therapy for the treatment of chronic venous insufficiency (CVI) and knee osteoarthritis (KOA). Methods: The study analyzed the treatment results of 26 patients (11 men, 15 women, average age of 49.3±4.6 years) with CVI and KOA who underwent CMIP with PRP therapy. The patients' average body mass index (BMI) was 28.9±2.1 kg/m². It was observed that patients with CVI exhibited different grades of severity according to the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. Out of 26 patients, 7 (27%) were classified as CEAP class 2, 15 (58%) as class 3, and 4 (15%) as class 4. Isolated insufficiency of the great saphenous vein (GSV) and its tributaries was noted in 9 (35%) patients and the small saphenous vein (SSV) – in 2 (8%) patients. Of the 26 patients, 15 (58%) had combined insufficient GSV and SSV trunks and tributaries. All patients presented with bilateral saphenous vein insufficiency, predominantly on the left side in 19 (73%) cases and on the right side in 7 (27%) cases. Of 26 patients, 17 (65%) had insufficient tibial perforators. According to the Kellgren JH & Lawrence JS classification of osteoarthritis (OA), 4 (15%) of the patients had grade I KOA, 14 (54%) had grade II, and 8 (31%) had grade III. Phlebological status was assessed visually and with duplex scanning (DS) of the venous system in the lower extremities. The knee joints were evaluated using the WOMAC Osteoarthritis Index. Results: The median total index on the WOMAC scale before treatment was 65.5 (61.0-74.0) points, including pain index – 14.0 (13.0-16.0) points, knee joint stiffness – 6.0 (5.0-6.0) points and joint functioning – 47.0 (45.0-49.0) points. All patients underwent CMIP as the first stage, followed by four sessions of PRP therapy, one per week as the second stage. The average duration of surgical procedures was 115.5±35.5 minutes, and patients stayed an average of 2.8±0.4 days in the hospital. There were no significant complications in any case. After the treatment, there was a substantial decrease in pain and stiffness and an improvement in knee joint function. Therapy was ineffective in 4 (15%) cases. The effectiveness of PRP therapy is lower when certain factors are present. These factors include an advanced stage of KOA with a longer duration of the degenerative process in the joint, chronic use of painkillers, and the combined insufficiency of the GSV and SSV trunks. There is a direct correlation between these factors and the low effectiveness of platelet-rich autologous plasma. Conclusion: In patients with CVI and KOA, performing CMIP and PRP therapy can significantly decrease pain and improve daily knee joint function. Keywords: Varicose veins, knee osteoarthritis, microphlebectomy, stripping, PRP therapy.