The operation of Troyanov - Trendelenburg in the modern minimally invasive approach to the treatment of varicose disease with endovenous laser photocoagulation

Abstract

Despite the widespread and active introduction of new minimally invasive technologies in clinical phlebology, the Troyanov - Trendelenburg operation today is an important step in the extensive complex of various methods of surgical treatment of varicose veins of the lower extremities. This intervention can be performed under local anesthesia with minimal trauma and excellent cosmetic results. The leading position in the treatment of chronic venous diseases currently takes endovenous laser photocoagulation, the implementation of which is being offered now even to patients with complicated and advanced forms of the disease. The combination of Troyanov - Trendelenburg operation and laser thermocoagulation can significantly reduce the risk of downward recanalization of the great saphenous vein, as well as eliminate side effects and complications that occur during traction of the vein. To eliminate technical errors in the course of ligation of great saphenous vein in the area of sapheno-femoral anastomosis under local infiltration anesthesia and to simplify the detection of the target vessel, especially in obese patients with severe subcutaneous fat, we have developed a method for performing Troyanov - Trendelenburg, which decreases the time of the surgical treatment of the mouth section is up to 10-15 min; the risk of possible complications is reduced. In addition, this treatment does not increase the bed-day and recovery periods. It was concluded that the use of a laser beam at the end of the working part of the fiber, previously carried out under ultrasound control directly into the area where the great saphenous vein falls into the deep system, as a visual guide, greatly facilitates the search for the main saphenous vein, especially in obese patients. The operation of Troyanov -Trendelenburg allows you to process all branches of the Delbe beam and eliminate the continued progression of thermally induced thrombosis proximal to the anastomosis, and therefore possible pulmonary thromboembolism from the large subcutaneous vein subjected to laser coagulation.