PATHOPHYSIOLOGICAL AND PATHOMORPHOLOGICAL ASPECTS OF RELAPSE OF VARICOSE VEINS AFTER ENDOVASCULAR LASER VEIN COAGULATION

2020 ◽  
Vol 73 (11) ◽  
pp. 2468-2475
Author(s):  
Volodymyr B. Goshchynsky ◽  
Bogdan O. Migenko ◽  
Svitlana S. Riabokon
Keyword(s):  
Endothelial Dysfunction ◽  
Postoperative Period ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Lower Extremities ◽  
Venous System ◽  
Circulating Endothelial Cells ◽  
Electron Microscopic ◽  
Deep Venous System ◽  
Vein Disease

The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the EVLC. Materials and methods: In 173 patients with varicose veins of the lower extremities, the level of markers of endothelial dysfunction was determined: P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, adhesion molecules of type 1 vascular endothelium (sVCAM-1-soluble vascularcellularmolecula), circulating endothelial cells (CEC) before surgery (EVLC), on the 10th and 60th day of the postoperative period.At the same time, a morphological and electron microscopic examination of the state of the deep venous system in 31 patients with varicose vein disease of the lower extremities who died from acute heart failure, was performed. Results: Increased values of markers of endothelial dysfunction in patients with varicose veins of the lower extremitiesbefore surgery of EVLC were established. We found that, despite the operation, the parameters of endothelial dysfunction decrease, but in the remote postoperative period do not come to the norm. Morphological and electron microscopic studies of the deep vein wall revealed pathomorphological changes in all of their layers, especially the endothelial layer. At the heart of the development of endothelial dysfunction in the postoperative period, the leading role belongs to changes in mitochondria. Conclusions: 1. Based on our research, we can state that there are significant pathomorphological and pathophysiological changes in the deep venous system of the lower extremities in conditions of varicose vein disease. 2. The initiator of postoperative relapse of varicose veins are structural changes in the wall of deep veins with a violation of the integrity of the endothelial lining, contributing to the absorption of plasma and leukocyte contents from the blood stream in the interstitium, with the following pathological changes in the layers of deep veins.Such changes are the basis for the manifestations of endothelial dysfunction in the postoperative period.

scholarly journals Comparison of results of treatment varicose vein disease using a method of endovenous laser oblitetation with radial light guide and combined phlebectomy

2017 ◽  
Vol 16 (1) ◽  
pp. 16-20
Author(s):  
A. N. Galileeva ◽  
M. A. Parikov ◽  
V. B. Karpovich ◽  
A. A. Kotslova ◽  
V. V. Davydenko
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Lower Extremities ◽  
Term Efficacy ◽  
Results Of Treatment ◽  
Radial Fiber ◽  
Vein Disease

We compare the short- and long-term efficacy of endovenous laser oblitetation (EVLO) using a radial fiber with radial emission versus combined phlebectomy for the surgical treatment of varicose vein disease of the lower extremities. Participated 58 patients (46 females, 12 males) with ages ranging between 24 and 75 years with varicose vein disease of the lower extremities affecting the great saphenous vein (GSV) were prospectively enrolled in this observational trial. Patients were randomized to receive either combined phlebectomy - first group - 29 patients (33 extremities) or endovenous laser obliteration using a radial fiber-second group - 29 patients (36 extremities). A total of 69 extremities with functional classes C2 - 28 (40.58 %) cases, C3 - 30 (43.48 %) cases and C4 - 11 (15.94 %) cases according to CEAP classification were treated. Post-treatment CIVIQ-2 Questionnaire and VCSS scale, physical examination, duplex angioscan was conducted at 1st day, 1 week, 12 and 36 months later. The frequency of recurrence was assessed at one and three years after the surgery. 2nd group is characterized by higher quality of life in postoperative period. 100 % ablation in group with EVLO and 93.1 % - with combined phlebectomy. The frequency of recurrence presenting with new visible varicose veins was noted through 3 year in 8 patients (9 extremities) (34 %) from first group and in 4 patients (6 extremities) (21 %) from the second of 80 % examined patients. Endovenous laser obliteration has significant advantages in short-term efficacy: lower post-procedure pain, quicker rehabilitation period, possibility to carry out in outpatient settings, higher quality of life in long-term efficacy, lower frequency of recurrence.

scholarly journals OPTIMIZATION OF SURGICAL TREATMENT OF PATIENTS WITH A VARICOSE VEIN DISEASE OF THE LOWER EXTREMITIES

2020 ◽  
pp. 99-101
Author(s):  
K. Y. Parkhomenko ◽  
K. E. Payunov ◽  
S. M. Diahiliev ◽  
A. G. Drozdova ◽  
V. P. Kolesnik ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Varicose Vein ◽  
Comparison Group ◽  
Varicose Veins ◽  
Lower Extremities ◽  
Invasive Technique ◽  
Duration Of Treatment ◽  
Surgical Department ◽  
Commercial Enterprise ◽  
Vein Disease

Summary. The aim of the study — to improve the results of surgical treatment of patients with a varicose vein disease of the lower extremities by using a minimally invasive technique such as endovasal endowelding. Matherials and Methods of the study. The results of surgical treatment of 82 patients with varicose veins of the lower extremities who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council «Regional Clinical Hospital», from 2015 to 2020 were analyzed. All patients were divided into two groups: the main (43 patients) and the comparison group (39 patients). The main group consisted of patients, in the treatment of which the method of endovasal endowelding was used. These patients were treated in 2017–2020. The comparison group consisted of patients who were operated on by performing a combined venectomy in 2015–2017. Results of the study. In patients treated with the endovasal endowelding technique, there is a decrease in the frequency of postoperative complications and the duration of treatment in the surgical department. Conclusions. The study proves the feasibility of using endovasal endowelding in the surgical treatment of patients with varicose veins of the lower extremities.

Evaluation of the results of planned open surgical interventions in primary chronic vein disease in pregnant women

2020 ◽  
pp. 51-56
Author(s):  
V.М. Аntonyuk-Kysil ◽  
◽  
І.Y. Dziubanovskyi ◽  
V.М. Yenikeeva ◽  
S.І. Lichner ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Postoperative Period ◽  
Postpartum Period ◽  
Clinical Manifestations ◽  
Lower Extremities ◽  
Vascular Surgeon ◽  
Surgical Interventions ◽  
Perinatal Center ◽  
Vein Disease

The objective: to evaluate the results of planned open surgical interventions (POSI) in pregnant women with primary symptomatic chronic vein disease (PSCVD). Materials and methods. The study included 457 pregnant women operated on a routine basis with PSCVD. The patients underwent ultrasound duplex angioscanning (USDA) of the veins of the lower extremities, inguinal canals, and iliac veins. The severity of the clinical manifestations of PSCVD was evaluated on a VCSS scale. With the help of the circadian visual-analog scale, the dynamics after the operative pain were studied. The effect of POSI on uterine tone and cardiac function of the fetus was investigated using cardiotocography. When forming the results for POSI, data from USDA, the severity of clinical and cosmetic manifestations of PCVD, the need for active prevention of thrombophlebetic, thromboembolic and hemorrhagic complications, minimization of surgical childbirth were taken into account. The results of treatment were studied in 2 groups of patients. Patients of the first group were treated with conservative therapy, the second group – POSI. Parametric indicators, which were presented as mean and standard error M(SD), were used for statistical data processing of the study, and their reliability was estimated using Student’s t-test. The species was determined to be significant at p<0.05. Results. 495 POSI were performed at 28-38 weeks gestation in an obstetric hospital (perinatal center), by a vascular surgeon from the staff of the center, who was familiarized with the peculiarities of working with this contingent of patients. Surgery was performed under local anesthesia in 346 (75.49%) pregnant women at one extremity, in 111 (24.51%) – at two in one session. According to the results of the study, it was noted that in the first group 33.7% of patients had a positive clinical result due to the reduction of pain syndrome, while 67.5% of patients had an increase and spread of varicose transformation in the area of saphenous and/or non-saphenous veins with spread of pathological venous reflux in the distal direction. 78% of patients had the need to administer prophylactic doses of low molecular weight heparins, both during pregnancy and in postpartum period. Out of 126 pregnant women with pronounced varicose veins of the external genital organs and perineum in 36 (28.6%) deliveries were performed by caesarean section. In 9 (3%) patients there was an acute thrombophlebitis of the subcutaneous veins of the lower extremities, which required 5 pregnant women to undergo urgent surgery when the inflammatory process had spread to the middle and above along the femoral vein of the large subcutaneous vein. Pregnant women of the second group with PSCVD on the basis of obstetric hospital (perinatal center) POSI were performed in the organization, which laid the ideology of the FTS program, strictly individual indications for intervention in the optimal terms of pregnancy, multidisciplinary management of patients, due to this in 93% of operated patients regression of clinical manifestations of the disease was noted, whch contributed to the correct and safe delivery of pregnancy with 100% absence of preterm birth, abnormalities in fetal development, pregnancy course, negative impact on obstetric and somatic condition of the pregnant woman. No hemorrhagic, thrombophlebic, thromboembolic complications were noted. Patients in the postoperative period did not require medical support, as during the period of pregnancy, during delivery and in the postpartum period. There were no indications for surgical delivery. 2.4% of patients experienced complications of post-operative wounds in the form of cheese, which had no effect on pregnancy and was eliminated before delivery. In the postoperative period, if necessary, it was recommended to use elastic compression class garments 1–2. Conclusion. POSI made at PSCVD in optimal terms of pregnancy in a specialized obstetric hospital by a vascular surgeon in strictly individual indications is safe, both for the fetus and the pregnant woman. It is promising to further study the results of POSI in pregnant women with PSCVD to introduce it into the arsenal of treatment of this pathology. Key words: FTS ideology, planned open surgical interventions in pregnant women.

An Undescribed Iatrogenic Complication of Varicose Vein Surgery: Entrapment of the Stripper in the Proximal Deep Venous System

2007 ◽  
Vol 31 (7) ◽  
pp. 1528-1528
Author(s):  
Andrea Siani ◽  
Giustino Marcucci ◽  
Luca Maria Siani ◽  
Emanuele Baldassarre
Keyword(s):  
Varicose Vein ◽  
Venous System ◽  
Varicose Vein Surgery ◽  
Deep Venous System ◽  
Iatrogenic Complication

scholarly journals A perioperative phlebotropic therapy compliance study in patients with varicose veins

2020 ◽  
pp. 81-88
Author(s):  
S. N. Zhabin ◽  
A. A. Shitikov ◽  
A. V. Tsukanov ◽  
E. G. Obedkov ◽  
S. S. Dudchenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lower Extremity ◽  
Varicose Vein ◽  
Conservative Therapy ◽  
Varicose Veins ◽  
Laser Coagulation ◽  
Entire Study ◽  
Wide Range ◽  
Vein Disease

Introduction: Lower extremity varicose vein disease is one of the common problems in vascular surgery. Clinically, this disease is accompanied by a wide range of complaints and external symptoms, which eventually lead to a worse patients’ quality of life. The integrated approach is being applied to the disease treatment, which involves the use of various phlebotropic drugs as conservative therapy along with minimally invasive surgical correction and sclerotherapy.Objective: to improve the quality of phlebotropic therapy for patients with lower extremity varicose vein disease, based on the study of factors that shape the patient’s compliance with the effective treatment of clinical symptoms. The term «compliance» means the precise and informed implementation of the doctor’s recommendations during the treatment by the patient. Most often, «compliance» is assessed by the drug use index, which is the quotient of dividing the number of days on which the full dose of the drug was taken by the duration of the entire study period. Materials and methods: The analysis of 368 + 111 patients with lower extremity varicose vein disease was carried out. Of these, 111 patients turned out to be beyond the correct study of compliance (a phlebectomy was performed in a hospital). 368 patients were divided into the following groups: Group 1: the patients, who were assigned modern surgical treatment of varicose veins (endovenous laser coagulation, scleroobliteration); Group 2: the patients, who withdrew from assigned interventions. As it turned out, the different groups of patients differed in compliance.Results. The patients who were shown and performed surgical treatment – 320 (86.9%), can be considered highly compliant with the prescribed conservative therapy – the average value of the compliance index is 0.83, compared to the representatives who refused to perform the recommended surgical procedures recommended by them – 48 (13.1%), the compliance index is 0.78.In the course of the investigation, the factors shaping compliance with phlebotropic drugs were identified, a comparative assessment was carried out on the main indicators of the effectiveness of phlebotropic drugs.Conclusion. Thus, the compliance of the patients suffering from LEVVV during the treatment with phlebotropic drugs varies depending on the multiplicity and convenience of the form of the drug, on the effectiveness of the proposed phlebotropic therapy according to the influence on the complaints and symptoms, on the psychological readiness of the patient to entrust the result of the final treatment of the disease to the surgeon.

Descending varicose venography of the lower extremities. An alternate method to evaluate the deep venous system.

Radiology ◽  
1982 ◽  
Vol 145 (3) ◽  
pp. 832-834 ◽  
Author(s):  
D H Gordon ◽  
S Glanz ◽  
R Stillman ◽  
P N Sawyer
Keyword(s):  
Lower Extremities ◽  
Venous System ◽  
Deep Venous System

scholarly journals Ways of Improvement of Safety and Efficiency of Endovenous Laser Coagulation in Treatment of Lower Limb Varicose Vein Disease

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
Roman Kohan ◽  
Volodymyr Goshchynsky
Keyword(s):  
Mathematical Model ◽  
Laser Radiation ◽  
Varicose Vein ◽  
Lower Limb ◽  
Linear Density ◽  
Varicose Veins ◽  
Laser Coagulation ◽  
Light Pipe ◽  
The Mathematical Model ◽  
Vein Disease

Nowadays endovenous laser coagulation is the priority method of treatment of lower limb varicose vein disease. However, there are a number of specific complications that reduce efficiency of its usage.The objective of the research was to decrease specific postoperative complications after endovenous laser coagulation due to the introduction of its mathematical design.Materials and methods. The study included 168 patients with lower limb varicose vein disease. Prior to surgery the mathematical calculation of the basic parameters of laser coagulation such as density of laser irradiation and rate of reverse movement of the light pipe depending on the diameter of varicose veins was made. The control group consisted of 146 patients with varicose vein disease; the aforementioned parameters were established according to the instruction of using a laser device.Results.  The analysis of complications such as induration of skin over coagulase great or small saphenous vein, phlebitis in the projection of the great or small saphenous vein, ecchymosis or dermatomelasma in the early postoperative period, pain syndrome showed the reduction in the number of complications while applying the mathematical model of calculation of linear density of laser radiation and the speed of reverse traction of the light pipe with its transfer to the graphic image.Conclusions.  The application of the mathematical model of calculation of linear density of laser radiation and the speed of reverse traction of the light pipe with its transfer to the graphic image allows us to improve the results of endovenous laser coagulation for varicose veins due to the reduction in specific complications.

scholarly journals Investigation of the Utility of Web-Based Videos About Varicose Veins

2021 ◽  
Keyword(s):  
Data Analysis ◽  
Varicose Vein ◽  
Medical Staff ◽  
Varicose Veins ◽  
Lower Extremities ◽  
Accurate Information ◽  
Scientific Content ◽  
Web Based

Background and Objectives: Very few investigations and studies have been conducted on the provided information about varicose veins in web-based media worldwide. The present study aimed to investigate the categorization, characteristics, scientificity, and accuracy of such videos uploaded to YouTube. Materials and Methods: YouTube was searched during November 2019, and the search keywords were "varicose vein", "varicose veins", and "varicose veins of lower extremities". The videos collected by retrieval were classified as useful, partially useful, and completely useless based on their scientific content, contemporariness, and accuracy. The analysis was mainly performed on the data collected from videos that were categorized as useful. Results: In total, 635 (75.6%) out of 840 collected videos were excluded. Most videos on the website were uploaded by medical staff (31%, n=64). Based on the results, among the videos included in the data analysis, videos uploaded by official agencies were viewed more times than those uploaded by others. In addition, most of the useful videos were uploaded by official institutions. Conclusions: Official institutions should provide more web-based videos with up-to-date, complete, and accurate information about varicose veins. Furthermore, effective search tools are needed for the identification of the videos uploaded by academic sources and institutions.

Varicose veins: A critical review of the definition and the therapeutical options

VASA ◽  
2011 ◽  
Vol 40 (5) ◽  
pp. 344-358 ◽  
Author(s):  
Jeanneret ◽  
Karatolios
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
New Techniques ◽  
Definition Of ◽  
Vein Disease ◽  
Therapeutical Options ◽  
Long Term Studies

This review intends to give an overview of the present therapeutic options for varicose vein disease. The definition of varicose vein disease and its recurrence are made and discussed with new aspects including duplexsonography assessment. All therapeutic approaches have developed and refined their treatment modalities, the open surgical as well as the endovenous techniques. In particular the “new” endovenous techniques are described with regard to safety and outcome, the published literature in this respect is summarized. The studies comparing the different techniques are listed, the prospective long term studies comparing the new techniques with the so called gold standard (open surgery) shall decide on the fate of the different techniques.

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