A combination of minimally invasive treatment for varicose disease of the lower extremities

Abstract

The aim — to compare the effectiveness of the combined phlebectomy with endovenous laser coagulation (EVLC) with bare‑tip laser fiber and the simultaneous endovenous chemical ablation of the GSV trunk in comparison with a similar procedure without sclerotherapy in patients of different age categories with varicose vein disease of lower extremities of С2‑С5 EpAsPr class.Materials and methods. A retrospective analysis of 152 clinical cases of the combined surgical treatment in patients that were operated at the period of 2015 — 2017 with GSV vertical reflux from the saphenous‑femoral junction was done. These patients were divided into 2 groups: 1) 44 patients underwent EVLC in the insufficient segment of the GSV during 2015; 2) 108 patients underwent EVLT + EnChA in the insufficient segment of the GSV during the period of 2016 — 2017. The age range of patients was from 25 to 65 years. The average age of patients in the 1st group — 38.2 ± 13.6 years, the second group — 45.1 ± 13.3 years. The length of the GSV insolvent segment was on average (277 ± 18) mm. To evaluate the effectiveness of the techniques, ultrasound control by the Toshiba Nemio XG SSA 580A was used intraoperatively, 7 days, 1, 2 and 6 months after the operation, as well as a survey. As a criterion, the completeness of the obliteration of the insolvent segment of the GSV was chosen.Results and discussion. According to completeness of the obliteration of the GSV trunk, statistically significant differences were found in the results of the 1 and the 2 groups. By additional criteria (pain, infiltration, pigmentation, phlebitis,) no statistically significant differences between the groups were detected.Conclusions. The combination of physical and chemical action methods on the inner layer of the venous wall allows the use lower‑energy regimens of EVLC and lower concentrations of sclerosant to achieve effective vein obliteration comparable to that in the application of high‑energy parameters than with the use of each treatment alone. The use of the combination of EVLC and echosclerosis allows to achieve effective lumen obliteration of large diameter subcutaneous veins compared with the only EVLC use.