Effectiveness of Different Treatment Tactics of Superficial Thrombophlebitis of Lower Limbs (with Development of Mathematical Model for Prediction of Therapeutic Effectiveness)

Abstract

INTRODUCTION: The main goals of treatment of superficial thrombophlebitis of lower limbs (ST LL) can be achieved using different treatment tactics: conservative treatment, surgical intervention, and their combination.
 AIM: To perform a comparative analysis of the effectiveness of pharmacotherapy, crossectomy in combination with pharmacotherapy and of phlebectomy in combination with pharmacotherapy in patients with ST LL.
 MATERIALS AND METHODS: A comparative analysis of the effectiveness of the therapeutic tactics of ST LL was conducted (86 patients; 36 men and 50 women). Group 1 patients received only conservative treatment, group 2 patients underwent crossectomy and conservative treatment in the postoperative period, group 3 — phlebectomy in combination with conservative treatment. The clinical effectiveness of treatment was evaluated by the recurrence rate and/or progression of the disease within 3 months after treatment and the level of life quality (Chronic Venous Insufficiency Questionnaire, CIVIQ 20, visual analog scale, VAS). Based on the data obtained in the study, a mathematical model was developed to determine the maximally effective treatment method. For mathematical modeling, a ‘random forest’ method was used.
 RESULTS: All the studied treatment methods demonstrated a comparative clinical effectiveness. Analysis of the dynamics of the studied parameters (adjusted for gender and age of the patients) compared with their initial values within each group showed that statistically significant changes in the psychological factor were observed in the pharmacotherapy group already on the 7th control day (p = 0.024), while in the crossectomy and phlebectomy groups only on the 14th day. In the groups of pharmacotherapy (p = 0.001) and phlebectomy (p = 0.005), the improvement in terms of the social factor occurred faster than in the group of crossectomy, since statistically significant differences were found on the 7th day, and in the group of crossectomy only on the 14th day.
 CONCLUSION: All the groups demonstrated comparable clinical effectiveness in normalization of the quality of life and the recurrence rate and/or progression of the disease within three months after completion of treatment. On the basis of the data obtained, predictive models have been constructed that allow, based on the initial characteristics of the patient, to determine the tactics of therapy that can ensure maximum effectiveness in terms of normalization of values, reflecting the quality of life and VAS parameter.