Possibilities of surgical correction of complicated forms of chronic venous insufficiency in patients after coronavirus infection

Abstract

Introduction. COVID-19 causes generalized endothelitis and impaired arthriolo-venular circulation leading to a slowdown in blood flow and venous hypervolemia. This leads to decompensation of the drainage function of perforated veins and the occurrence of horizontal venous reflux. Aim. To determine the possibilities of surgical correction of decompensated forms of chronic venous insufficiency (CVI) in patients after COVID-19, when determining the localization of pathological venous reflux by ultrasound duplex scanning of the lower extremity veins. To determine the character of microcirculatorydisorders in the examined patients. Material and methods. Ultrasound duplex scanning with a 7.5-10 MHz linear sensor was performed in 59 patients aged 40-78 years, 34 women and 25 men who had suffered from COVID-19 in a moderate form that did not require hospitalization. Patients had not previously noted manifestations of CVI and did not use diosmin drugs. The reason for treatment was the manifestation of complicated forms of CVI, which first appeared after COVID-19. 39 patients of group I underwent surgical correction of horizontal venous reflux, 20 patients of group II received conservative treatment. The microcirculatory bed was examined using a high-frequency ultrasound Dopplerograph on the nail bed of the 1st finger of the upper limb with a 25 MHz sensor. Results. The revealed microcirculatory disorders were characterized by a depletion of the Doppler spectrum, which corresponds to parietal stasis. Isolated horizontal venous reflux was recorded in the area of trophic disorders: pigmentation, induration and trophic ulcers (TU) of the shin. In group I patients, as compared to group II, pain syndrome, edema, induration and inflammation significantly decreased after treatment when assessed by the VCSS scale. More rapid and complete healing of TU was observed. Conclusions. COVID-19 provokes accelerated progression of isolated horizontal venous reflux, due to generalized microcirculatory disorders reported in patients in the post-COVID period. The surgical intervention for its elimination in the nearest future after applying undoubtedly surpasses conservative methods of treatment and allows achieving a good cosmetic and clinical result.