Endovenous Laser Coagulation Research Articles

Local therapy in the postoperative management of patients with lower limb varicose vein disease

Introduction. Varicose veins of the lower extremities are one of the most common diseases, affecting 20 to 40% of the population. One of the most common treatment methods is endovenous laser coagulation (EVLC).Aim. To evaluate the effectiveness of local gel therapy based on escin, heparin and essential phospholipids in the postoperative administration of patients after endovenous laser coagulation.Materials and methods. A complex treatment of 53 patients with varicose veins of the lower extremities of classes C2-C3 according to the CEAP nomenclature was carried out. Patients were divided into 2 statically homogeneous groups with an equal number. All patients underwent endovenous laser obliteration of the trunk of the great saphenous vein in combination with miniphlebectomy of tributaries on the thigh and lower leg.Results. In both groups, the largest number were patients with incompetence of the GSV trunk up to the border in /3 and c/3 of the lower leg, with further discharge along the tributaries of the GSV along the medial surface of the lower leg. The failure of the GSV trunk to the level of the knee joint gap was accompanied by the presence of varicose-transformed tributaries along the anterior surface of the thigh, in the area of the knee joint. The addition of Detragel led to the relief of phlebitis and hematomas, a pronounced decrease in pain and edematous syndrome.Discussion. Transdermal drug delivery has great promise as an alternative to oral and intravenous treatment, especially for patients suffering from chronic diseases. The three-component composition allows you to influence all parts of the pathogenesis of the disease.Conclusion. The data obtained on the use of local gel therapy based on escin, heparin and essential phospholipids after EVLO of the GSV indicate the need for local therapy to improve the quality of life of patients, their rapid rehabilitation and improve immediate and long-term results.

Is it safe to discontinue anticoagulant after surgical treatment of varicose vein disease, which caused pulmonary embolism?

Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.

Trophic ulcers of venous etiology and their treatment tactics by endovasal laser coagulation

The main goal of the study was to identify a unified and pathogenetically justified method of surgical treatment of patients with trophic ulcers of venous etiology, as well as an algorithm for preoperative preparation of such patients for minimally invasive intervention. The article presents the results of the treatment of trophic ulcers of venous etiology by endovenous laser coagulation. In a comparative aspect, modern data on its effectiveness are presented, the success of this operation is 93–100 %. When comparing the results of using lasers with different wavelengths and energies, the incidence of severe complications (deep vein thrombosis, thrombophlebitis, pulmonary embolism, skin burn) ranges from 0.1 to 2.4 %. In the analysis of the literature, no evidence was found that the wavelength affects the clinical outcome, but the power of the laser energy used matters. The main elements of preparation and performance of operative interventions aimed at elimination of venous blood reflux in lower extremities are indicated, and therapeutic tactics for healing of soft tissue defect in postoperative period are determined.

EFFICIENCY OF THE COMBINED APPLICATION OF RADIOFREQUENCY AND ENDOVENOUS LASER ABLATION OF VEINS IN THE TREATMENT OF VARICOSE DISEASE OF THE LOWER EXTREMITIES

SUMMARY. Radiofrequency ablation (RFA) and endovenous laser coagulation of veins (EVLC) are of priority in the treatment of varicose veins of the lower extremities in outpatient settings. Although the indications for these operations and the technology of their application are defined, the issue of improving their functional results, in particular the involution of collateral veins on the lower leg after ablation of the great saphenous vein, is relevant.
 The aim – to improve the results of the treatment of varicose veins in an outpatient setting by using a combination of radiofrequency and laser vein ablation.
 Material and Methods. Under observation were 154 patients who were operated on with the help of RFA and 111 patients who underwent combined thermal ablation GSV RFA (on the thigh) and EVLС (on the leg).
 To compare the effectiveness of RFA and the combination of RFA with EVLС (hybrid thermoablation of veins), a quantitative and qualitative assessment of their results was carried out. In particular, the quantitative assessment was performed using a number of scales VCSS, VDS, VSDS, VSS. Questionnaires: MOS SF–36 and CIVIQ–20 were used for qualitative assessment. The results of operations were evaluated after 3, 6 months and a year after their implementation.
 Results. The analysis of the results of operations shows that, according to quantitative and qualitative indicators, combined operations with the simultaneous use of RFA and EVLС are more effective than RFA. These indicators were directly influenced by the number of residual veins after 6 months of observation (33.1 % after RFA and 5.4 % after hybrid thermoablation).
 Conclusion. The use of hybrid thermal ablation for the treatment of varicose veins of the lower extremities, in outpatient conditions, is qualitatively and quantitatively more effective than RFA.

Experience in the lower extremities trophic ulcers treatment in patient with combined pathologies: varicose veins and rheumatoid arthritis

Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.

Comparative analysis of the use of endovenous laser coagulation and radiofrequency vein obliteration in patients who have previously undergone sclerobliteration

Introduction. Sclerobliteration of varicose veins of the lower extremities is one of the most common methods of treating patients with varicose veins. However, the main disadvantage of echosclerobedation of the trunks of the great and small saphenous veins is the possibility of recanalization of sclerosed veins. In this regard, it is of interest to compare the results of using radiofrequency vein obliteration and endovenous laser coagulation in these patients. Aim. To study the effectiveness, advantages and disadvantages of the use of radiofrequency vein obliteration and endovenous laser photocoagulation of recanalized varicose veins in patients undergoing sclerobliteration. Materials and methods. 44 patients aged 18 to 62 years underwent radiofrequency obliteration and endovenous laser coagulation of varicose veins after previous sclerobliteration. A comparative assessment of the duration of the operation, technical success, intensity of the pain syndrome, the level of postoperative complications and relapses of the disease after the use of these methods of recanalized saphenous veins after previous sclerotherapy was made. Results and discussion. The technical success of endovenous laser coagulation of reknalizirovanny varicose veins was 100%, radiofrequency obliteration of veins – 90.9%. The intensity of postoperative pain on the 7th day from the moment of radio wave exposure was 12.1% lower than after the use of endovenous laser coagulation, the average duration of laser thermolysis was 32 ± 0.6 minutes, radio wave – 39 ± 0.7 minutes. Conclusion. Laser coagulation compared to radiofrequency is a more reliable and feasible operation, but is accompanied by a higher level of postoperative pain and side effects.

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

Выбор метода профилактики тромботических осложнений у пациентов с хирургическими заболеваниями желудка высокого риска

INTRODUCTION: Despite the significant advances in the prevention and treatment of venous thromboembolic complications (VTEC), pulmonary embolism (PE) remains the most common preventable cause of hospital postoperative mortality. One of the causes of thrombosis is surgical operations, especially laparoscopic, associated with the activation of the hemostasis system. Aim: The choice of a prevention method of thrombotic complications in comorbid patients with signs of varicose veins of the lower extremities requiring laparoscopic surgical treatment of benign gastric diseases (BGD). MATERIALS AND METHODS: The study is based on a treatment analysis of 128 patients with BGD in combination with a high comorbid background. The treatment of these patients was divided into several stages, which included both vascular interventions for the prevention of VTEC and a laparoscopic stage aimed at treating the underlying disease. The patients were divided into 3 groups comparable in gender and age. The first group, consisting of 45 people, VTEC prevention was carried out using a standard conservative technique (anticoagulant therapy in combination with mechanical prophylaxis). The second group included 43 patients who underwent both standard conservative therapy and open surgery aimed at correcting venous insufficiency in the great saphenous vein system. The third group is represented by 40 patients who, in addition to the standard conservative prevention of VTEC, underwent a combined surgical treatment (crossectomy and endovenous laser coagulation (EVLC) of the trunk of the great saphenous vein by retrograde method). All patients underwent coagulogram analysis and ultrasound triplex scanning of the veins of the lower extremities at each stage of the treatment. RESULTS: In the first group of patients, the largest number of thrombotic complications was noted — 24.4%, in the second group their number was 14%, while in the third group, thrombotic complications were detected in only 7.5% of patients. In the second and third groups, there was no development of PE, both after the first operation and after the main laparoscopic stage of treatment. In the first group, on the contrary, 2 episodes of PE (4.4%) were noted after the main surgical treatment. In turn, the standard anticoagulant therapy carried out in all three groups led to the development of both small and large hemorrhagic complications. At the same time, it should be noted that their frequency was comparable in all three groups, and their number did not exceed the number of such complications based on literature data. CONCLUSION: Carrying out active operative prevention of thrombotic complications significantly reduces their frequency in comorbid patients with signs of varicose veins of the lower extremities, thereby allowing to improve the result of the treatment. Considering that laparoscopic surgical interventions on the stomach increase the risk of developing VTEC in comorbid patients, according to our data, performing EVLC in combination with crossectomy, as the first stage of prophylaxis, prevents the development of PE and reduces the risk of venous thrombotic complications by 16.9%.

COMPARISON OF ENDOVASCULAR AND STRIPPING METHODS IN COMBINATION WITH PROLONGED INTRAVENOUS INFUSION THERAPY OF LIDOCAINE IN TREATMENT OF CHRONIC VENOUS INSUFFICIENCY

The aim of the work: to compare the results of using endovascular and classical stripping methods in combination with intravenous administration of lidocaine solution for the treatment of chronic venous disease in the stage of trophic wounds. Materials and Мethods. The results of treatment of 78 patients with chronic venous insufficiency in stage C6 and C6r were evaluated. Subjects were divided into two clinical groups: group 1 - endovenous laser ablation (n=31) and group 2 (n=47) – classical surgical intervention (high ligation + great saphein vein stripping). In both groups method of prolonged intravenous lidocaine 2 % solution injection was used according to the proposed method. Postoperative monitoring was performed 1, 3, 6 months and 1 year after the surgical treatment. The result was evaluated when compared with the VCSS, VDS, VSDS scales. Results and Discussion. The dynamics of the pain syndrome when evaluated after 1, 3, 6 months generally showed its rapid regression among patients of both groups. In both experimental groups, the average value of the "number of active ulcers" before surgical treatment was (1.89 ± 0.06) points in the prospective group and (1.92 ± 0.08) points in the retrospective group, respectively, which indicated the presence of an average almost 2 active ulcers in one patient. After the treatment in group 1, rapid dynamics of healing of the wound surfaces was observed already after 1-3 months of postoperative treatment. While in group 2, after 6 months, somewhat slower dynamics were observed. In the same group, a year after treatment, the presence of recurrence of active trophic ulcers was noted in 10 % of patients.It was established that the combination of minimally invasive methods of treatment of varicose veins with endovenous laser coagulation in combination with prolonged administration of lidocaine solution significantly accelerates the healing of trophic wounds. At the same time, analyzing the indicators of the VCSS, VDS, VSDS scales, significantly better clinical indicators were established in terms of follow-up up to 1 year.

Endovenous laser coagulation of varicose veins: evolution continues

The article discusses the evolution of the endovenous laser ablation technique for the treatment of varicose vein disease of lower extremities. The history of studies aimed at improving the endovenous laser ablation is provided. The authors described the features of endovenous laser ablation with wavelengths from λ = 0.445 to 1.94 µm, alongside with edge- and radial-emitting working fibers, as well as fibers with radiation absorption at its distal end. The physical and biophysical mechanisms of the most popular to-date method for outpatient treatment of varicose vein disease of lower extremities are reviewed. The propagation process of laser radiation in the scattering medium is described, and the important role of the radiation scattering effect on the depth of its penetration into biological tissues is shown. The processes that take place during endovenous laser ablation are considered. The difference in physical processes that take place during the use of laser radiation mainly absorbed by hemoglobin (hemoglobin-absorbed range) and by water (water-absorbed range) is described. Expedience of simulating the processes that take place during endovenous laser ablation with the use of blood plasma has been substantiated. The blood plasma simulation demonstrated the decisive action of laser-induced boiling on thermal damage to the vein wall, which causes its fibrous transformation. It has been shown that the use of radial-emitting fibres during intense boiling generates steam bubbles around the site of radiation coupling. The contents of such steam bubbles do not absorb radiation, which thus reaches the venous wall, causing its symmetrical thermal damage. The advantages of using water-absorbing radiation with a wavelength of λ = 1.94 µm in conjunction with a radial-emitting fibre have been substantiated.

Puncture miniinvasive methods of surgical treatment of primary varicoses of the superficial veins of the lower extremities c2-c6s

Abstract. Treatment results of primary varicose disorders has been shown in article. The experience of using of thermal (endovenous laser ablation, radiofrequency ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2-С6 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 218 patients was analyzed. In the group of patients who underwent EVLA, reflux was detected in 2 cases at the follow-up after week. In our opinion, this is due to insufficient exposure of the laser irradiation using a single-ring type of light guide. To correct the detected reflux, a single injection of foam scleroterapy. Foam form (3%) was used. In the group of patients after RFA, inflow reflux was detected in 1 patient (5.2%), in other cases complete obliteration was observed (17 patients - 89.4%). In the group of patients with mechanochemical obliteration, recanalization was determined in 5 patients (19.2%) with control ultrasound after 1 month. It was corrected by carrying out the procedure of foam scleroobliteration. In the group of patients with the cyanoacrylate obliteration, inflow reflux was detected in 2 patients (14.2%) on examination after 1 month. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a more reliable method of threatment and the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. In our study, foam sclerotherapy was the method of choice for treatment correction, if necessary.

The significance of minimally invasive treatment methods in the single-stage elimination of varicose vein disease of the great and small saphenous veins of the lower limbs and their branches

Introduction. This article presents a clinical case of successful and single-stage endovenous laser coagulation combined with miniphlebectomy in a patient with extensive and combined varicose lesion of all major subcutaneous veins of the lower limbs with significant symptoms of chronic venous insufficiency.Aim. To determine the possibilities of simultaneous elimination of all main subcutaneous veins and their varicose tributaries on both lower limbs using minimally invasive methods.Materials and methods. A 44-year-old female patient complained of gastrocnemius muscle cramps, swollen shins, feeling of heaviness at the end of the working day and the presence of varicose veins in both lower extremities. The severity of the chronic vein disease before the intervention according to the VCSS (Venous clinical Severity Score) was 8. As a result, patency of deep veins and condition of their valve apparatus, insufficiency of valves of the sapheno-femoral and sapheno-popliteal annexes on both sides with reflux through large and small saphenous veins and anterior accessory large saphenous vein on the right, insufficiency of perforating veins of both tibias were determined. Endovenous laser coagulation of the great and small saphenous veins on both sides and the right anterior accessory great saphenous vein, miniphlebectomy of dilated tributaries within both lower limbs was performed. The symptoms of chronic venous insufficiency decreased markedly. Swelling of the lower legs and cramps in the gastrocnemiu muscles have almost completely disappeared, and the feeling of heaviness in the legs after static loads has significantly decreased.Conclusion. Endovenous laser coagulation with miniphlebectomy should be given preference in varicose vein disease with combined affection of all great saphenous veins of both lower limbs. Their application provides an opportunity to eliminate simultaneously incompetence of all target veins and to remove varicose dilated tributaries, providing good therapeutic and cosmetic effect without hospitalization and detachment of the patient from his or her work activity.

Comparative analysis of the effectiveness of thermal methods for the treatment of varicose veins of the lower extremities

The aim of the work is to analyze the effectiveness and safety of thermal methods (endovenous laser coagulation (EVLC) and radiofrequency ablation (RFA)) for the treatment of varicose veins of the lower extremities and the impact on the quality of patient life. Materials and methods. An open, prospective study of the comparative efficacy of EVLC (124 patients) and RFA (112 patients) for the treatment of patients with varicose vein disease was conducted. Both groups were compared by age, sex, body mass index, clinical manifestations of the venous pathology severity and assessed the risk of potential complications. Determination of quality of life criteria was performed using the AVVQ questionnaire. Results. The average number of cycles performed for the RFA procedure was 13.8 (7; 14), and the energy was 60.1 (8; 80) J/cm for EVLC. The average value of the VAS during the first 14 days after treatment in the EVLC group was 2.2 (sd 1.9), RFA – 0.8 (sd 0.9), P > 0.05. The majority of patients who underwent EVLC used painkillers – 82 (66.1 %), RFA – 48 (42.9 %), P < 0.001. The results of duplex monitoring in the first 48 hours recorded 100 % occlusion of the treated segments of the great saphenous vein in both study groups; after 1 and 12 months – in 98.4 % (96.0 %) of patients after EVLC and in 100.0 % (98.2 %) – after RFA, respectively. One or more adverse events during the first 2 weeks after treatment were reported by 86 patients (69.4 %) in EVLC group, 52 (46.4 %) – in RFA group. The differences between EVLC and RFA were statistically significant (P < 0.001). VCSS and AVVQ values were significantly decreased one month after treatment, continuing the positive trend for up to 12 months. However, no significant difference between ablation methods was observed (P > 0.05). Conclusions. Endovenous laser coagulation and radiofrequency ablation are safe and effective thermal treatments for varicose veins of the lower extremities, which lead to a statistically significant improvement in the quality of patient life. Radiofrequency ablation has the advantage of a lower risk of developing general complications.

Вплив гонартрозу на перебіг і ефективність лікування варикозної хвороби вен нижніх кінцівок

Актуальність. Гонартроз (ГА) у хворих на варикоз вен нижніх кінцівок (ВВНК) зустрічається частіше, ніж в популяції, а дегенеративні зміни колінних суглобів погіршують перебіг такої судинної патології. Мета: оцінити вплив ГА на перебіг та ефективність хірургічних методів лікування ВВНК, виділити прогностичні критерії. Матеріали та методи. Під наглядом перебувало 302 хворі (75 чоловіків і 227 жінок віком 29–72 роки), 16 % з яких раніше перенесли флеботромбоз, а частота II, III, IV, V і VI класів венозної недостатності становила 10, 14, 37, 16 і 23 %. Ендовенозну лазерну коагуляцію виконано 263 пацієнтам, 39 — традиційну флебектомію або лігування перфорантів. Результати. ГА діагностовано у 18 % від числа хворих на ВБВ ніг, частіше у чоловіків більш старших вікових груп, із залученням до процесу великої підшкірної вени, з приустєвим її розширенням і поєднанням з артеріосклерозом судин нижніх кінцівок, що супроводжується більш вираженими класами венозної недостатності, при цьому на клініко-лабораторні прояви варикозу чинять вплив стадія захворювання, зміни рогів менісків, наявність і ступінь вираженості субхондрального склерозу, остеокістозу, синовіту, кіст Бейкера, інтраартикулярных тіл Штайді та Гоффа, а ефективність результатів лікувальних хірургічних заходів у хворих на ГА гірше, причому повна оклюзія вени за місяць після ендовенозної лазерної абляції спостерігається в 2,8 раза рідше, а число ускладнень в 7,3 раза частіше, що визначається субхондральним склерозом, остеоузурами, кістами Бейкера й внутрішньосуглобовими тілами Гоффа. Висновки. Наявність ГА є чинником ризику тяжкого перебігу варикозу вен ніг, прогнознегативним чинником відносно ефективності хірургічного лікування цього захворювання і числа ускладнень.

Болевой синдром при варикозной болезни под влиянием эндовенозной лазерной абляции

Параллельное с эндовазальной (эндовенозной) лазерной абляцией проведение кроссэктомии повышает аналгетическую эффективность оперативного лечения варикозной болезни нижних конечностей на начальных этапах наблюдения за больными (через 1 неделю). Интегральная динамика физико-химических показателей адсорбционно-реологических свойств венозной крови у больных с кроссэктомией и без таковой не отличается, причем независимо от выполненной кроссэктомии к первому месяцу после лазерной эндовенозной коагуляции происходит нормализация параметров поверхностной вязкости и упругости, модуля вязкоэластичности, улучшение значений объемной вязкости и поверх­ностной релаксации. Маломощная эндовенозная лазерная абляция с излучением 10 ватт и менее через 4 недели после операции превосходит по аналгетической эффективности выполненное хирургическое лечение варикозной болезни нижних конечностей с излучением в 15 ватт, при этом способствует уменьшению релаксационных свойств сыворотки венозной крови, а интегральные параметры адсорбционно-реологических свойств сыворотки зависят от влияния энергии лазера на длину и площадь просвета стриппинга.

Modern possibilities of the surgeon in the diagnosis and treatment of trophic ulcers of venous etiology (literature review)

The review article presents literature data on the conservative and surgical treatment of trophic ulcers of venous etiology, taking into account modern views on the etiology and pathogenesis of the complicated course of chronic venous insufficiency. One of the mechanisms for increasing the size of trophic ulcers is the emergence of a fibrinoid necrosis zone with the rejection of overlying tissues. Current approaches in the diagnosis of this pathology have been reported. Various methods of treating trophic ulcers in varicose veins and their long-term results are compared, the peculiarities of the use of endovenous laser coagulation and obliteration in practice are considered. The question is raised about the need to unify algorithms for preparing patients with trophic ulcer for minimally invasive intervention, the principles of its implementation and postoperative management of patients in order to achieve good and excellent immediate and long-term results. The national clinical guidelines for phlebology are analyzed, in which until now the priority in the treatment of trophic ulcers is given to local treatment, which unreasonably delays and lengthens the process of their healing. Surgical treatment should be aimed at early elimination of the pathogenetic link in the development of trophic ulcers.

THERMAL AND NON-THERMAL METHODS OF TREATMENT OF PATIENTS WITH PRIMARY VARICOSЕ DISEASES OF THE LOWER LIMBS OF STAGE C2

Abstract. Treatment results of primary varicose disorders has been shown. The experience of using of thermal (endovenous laser ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 58 patients was analyzed. In the group of patients who underwent endovenous laser obliteration, reflux was not detected. In the group of patients with mechanochemical obliteration, reflux was determined in 3 patients (27.2%) at follow-up after 3 months required supplementation with foam sclerobliteration. In the group of patients with the introduction of bio glue, reflux was determined in 1 patient (20%) at the examination after 3 months. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a reliable method of threatment, the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. Non-thermal methods require further research and widespread implementation in practice.

Morphological changes of veins and perivenous tissues during endovenous laser coagulation using 2-μm laser radiation and various types of optical fibers

ObjectiveTo determine the morphological changes in veins and perivenous tissues after endovenous laser coagulation (EVLC) using laser radiation with a wavelength of 1910 nm and different types of fibers (bare tip and radial). MethodsThe EVLC procedure was carried out on 22 surface veins of six sheep. The radiation source was a diode-pumped solid-state laser, which was based on a LiYF4:Tm crystal and had an emission wavelength of 1910 nm and a maximum output power of 10 W. Two types of optical fibers were used: (1) bare tip and (2) radial or radial with two rings. Histological and morphometric methods were used, and the statistical digital data were analyzed. ResultsThe use of a linear endovenous energy density of 20 J/cm and optical bare fibers for veins with diameters of 3-4 mm resulted in a slit-shaped or wide venous wall perforation. A thermal effect was observed on the perivenous connective tissue (PVCT), which caused damage to its structures. Wide perforations were accompanied by complete destruction of the PVCT in the projection of the formed defect. The distance between the remaining vein wall fragment, located opposite to the perforation, and injured small vessels was 257.7 ± 23.6 μm. The radius of thermal damage increased to 2073.5 ± 8.0 μm near the vessel perforation. Using optical radial fibers for veins with diameters of 3.9 ± 0.5 mm did not lead to perforations. The destructive effect of the laser on small vessels of the PVCT extended to a distance of 425.7 ± 22.0 μm. ConclusionsAnalysis of thermal vessel damage in perivenous tissue after EVLC with bare-tip fiber shows that in the projection of a wide perforation, the damaged vessels of the PVCT are located at a large distance from the coagulated vein wall. On the opposite side of the perforation, the distance from the coagulated vein wall to the damaged vessels of the PVCT is significantly reduced because of the minimal output of laser radiation energy through the poorly damaged part of the wall. Using an optical radial fiber facilitates the application of a uniform distribution of thermal energy to the vein wall and damage to all its layers; at the same time, it minimizes the thermal energy that extends beyond the vein wall and damages the surrounding tissue. Clinical RelevanceThe use of radiation with a wavelength of 1910 nm will make it possible to carry out endovenous laser coagulation of varicose veins at lower power values compared with radiation in the micron and one and a half micron regions of the spectrum. Understanding of morphological changes of veins and perivenous tissues after endovenous laser coagulation with 1910-nm laser radiation and different types of optical fibers (bare-tip, radial, radial 2ring) help predict possible complications and reduce their rate.

Modeling of 980 nm and 1470 nm Laser Radiation Absorbance Efficiency in the Blood Vessel Depending on the Structure of Titanium–Containing Optothermal Fiber Converter

Using quartz fiber with titanium-containing optothermal fiber converter (TOTFC) is promising in endovenous laser coagulation (EVLA) for the treatment of varicose veins. This study aims to research the variation in the optical properties of TOTFC as its microstructure changes under the condition that TiO2 spheres inside converter are arranged in such a way that the Mie theory approximation can be applied. The absorbance efficiency of laser energy with 980 nm and 1470 nm wavelengths for TOTFC has been calculated. Optical multidimensional simulation for the EVLA process was developed and calculated. The optimal ranges of microstructure’s parameters for TOTFC in the EVLA process were discussed.

Endovenous laser coagulation: asymmetrical heat transfer and coagulation (modeling in blood plasma)

The objective of this study was to describe the dynamics of blood plasma heating and coagulation processes carried out by continuous laser radiation with wavelengths 1.55 and 1.94 μm through bare-tip fibers and fibers with radial output (radial fibers) used for endovenous laser coagulation (EVLC). The study was performed in previously thawed frozen donor blood plasma using high-speed shooting of the heating process through the shadow optical method. It has been shown that in the case of highly water-absorbed laser radiations, convection, explosive, and small-bubble boiling play a major role in the process of heat transfer and coagulation. It has been shown that in the case of radiation with wavelength λ = 1.94 μm, effective heat transfer begins at significantly lower levels of power compared to radiations with λ = 1.55 μm. It has been established that heat transfer is sharply asymmetrical and is directed mainly upwards and forwards (bare-tip fiber) or upwards (radial fibers). For a wavelength of 1.94 μm, the effect of self-cleaning of the fiber surface from coagulated plasma fragments was found. Except for short-term acts of explosive boiling, the heat transfer is asymmetrical and directed mainly upwards. This effect should lead to uneven heating and thermal damage to the vein wall with the maximum at its upper part. For EVLC, the use of radiation with a wavelength of 1.94 μm is more efficient and safer.