Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study

Objective. To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities. Methods. Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups. Results. There were no significant differences in baseline characteristics between the two groups ( P > 0.05 ). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group ( P > 0.05 ). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group ( P < 0.05 ). There were no significant differences in recurrent varicose vein incidences ( P > 0.05 ). After surgery, the venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation ( P < 0.05 ). There was no significant difference in VCSS score or CIVIQ-14 scores between the two groups postoperation ( P > 0.05 ). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively. Conclusion. The modified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modified above-knee technique is worthy of clinical application.

Blood Flow Analysis of the Great Saphenous Vein in the Su-Pine Position in Clinical Manifestations of Varicose Veins of Different Severities: Application of Phase-Contrast Magnetic Resonance Imaging Data

The progression of clinical manifestations of lower-limb varicose veins remains unclear. This study investigated changes in lower-limb venous blood flow using phase-contrast magnetic resonance angiography. Data were collected on veins from 141 legs. We compared legs with and without varicose veins and related symptoms and examined varying levels of varicose vein symptom severity. Legs without varicose veins exhibited a lower absolute stroke volume (ASV, p < 0.01) and mean flux (MF, p = 0.03) for the great saphenous vein (GSV) compared with legs with symptomatic varicose veins. Legs with asymptomatic varicose veins exhibited lower MF for the GSV (p = 0.02) compared with legs with symptomatic varicose veins. Among legs with varicose veins, asymptomatic legs exhibited lower ASV (p = 0.03) and MF (p = 0.046) for the GSV compared with legs that exhibited skin changes or ulcers; however, no significant differences were observed between legs presenting with discomfort or edema and legs with skin changes or ulcers, and between legs presenting with discomfort or edema and asymptomatic legs. In conclusion, in the supine position, increased blood flow rate and blood flow volume in the GSV were associated with symptomatic varicose veins and increased symptom severity.

Estimation of a minimum laser power with wavelengths of 1.47, 1.56, and 1.68 μm for efficient obliteration of varicose veins

Experiments modelling endovenous laser obliteration (EVLO) are performed. As a result, laser radiation powers Pc at which collagen denaturation, tissue necrosis, and vasa vasorum destruction occur throughout the entire venous-wall thickness and, at the same time, the surrounding tissues are not subjected to unnecessary heating, are found. The main criterion for determining Pc is the achievement of 100% denaturation of venous-wall proteins, confirmed by morphological and calorimetric analysis. The Pc values for laser wavelengths of 1.47, 1.56, and 1.68 mm are found to be 6.0 ± 0.2, 5.0 ± 0.2, and 6.0 ± 0.2 W, respectively. It is established for all wavelengths in use that the temperature of the external venous-wall surface reaches 91 plusmn; 2 deg;C at the corresponding power Pc. We relate the dependence of Pc on the radiation wavelength to the formation of a coagulum on the optical fibre tip moving through a blood-filled vessel. The achievement of temperature necessary for coagulum formation is determined by the simultaneously occurring processes of energy absorption and its dissipation in the form of heat. These processes become more intense with an increase in the absorption coefficient of the medium. A mechanism is proposed to explain the relationship between the Pc value and laser wavelength, based on the influence of the absorption coefficient of medium (blood) on the temperature near the fibre tip.

MEDICAL-SOCIAL PECULIARITIES OF CHRONIC INFLAMMATORY PROCESSES OF THE INTERNAL GENITAL ORGANS IN WOMEN AGAINST THE BACKGROUND OF VARICOSITY OF PELVIS MINOR

Aim of the research. Study the peculiarities of chronic inflammatory processes of the internal genital organs in women against the background of varicose veins of the pelvis minor. Materials and methods. In the comparative aspect, the main points of the clinical characteristics of 30 women of the control and 120 patients of the main groups (with chronic inflammatory processes of the internal genital organs against the background of varicose veins of the pelvis, isolated chronic inflammatory processes of the internal genital organs) are represented in the work. Results. Performed researches have shown that the vast majority of women in the group 1 were engaged in manual labor, of which 32 were workers ((47,1±6,1) %), 13 – were housewives ((19,1±4,8) %). The proportion of unemployed among patients of the group 2 was 1.2-fold higher than of the group 1, prolonged static load in a standing or sitting position was observed in 38 ((55,9±6,0) %) and in 7 ((10,5±3,7) %) cases, respectively; excessive physical activity, especially related to the lifting of loads – in 12 (23,1±4,6) %) and in 6 (11,05±4,4) %) cases, respectively; and this definitely made the negative impact on the venous hemodynamics. Statistical calculations showed that the risk of VPM (varicosity of pelvis minor) in female workers was significantly higher compared to the control group (OR 3,56; 95 % CI 1,29-9,80; p=0,02) and group 2 (OR 2,67; 95 % CI 1,21-5,86; p=0,02). Analysis of the peculiarities of genital function has shown that the early sexual activity (up to 18 years) was started by 19 ((27,9±5,4) %) women of the group 1, by 22 women ((42,3±6,9) %) – of the group 2, that was 1,8-fold more than in patients of the control group (7; (23,3±4,7) %). The women of the group 1 were found to have a significantly higher risk of sexual dysfunction compared to the group 2: dyspareunia (OR 2,39; 95 % CI 1,14-5,04; p=0,03) and anorgasmia (OR 2,60; 95 % CI 1,12-6,06; p=0,04). Regarding the use of contraceptives, it was found that almost half of the patients of the first group resorted to interrupted sexual intercourse, which adversely affects the venous hemodynamics of the pelvis and significantly increases the risk of VPM against the background of CIPIGO (chronic inflammatory processes of the internal genital organs) (OR 2,41; 95 % CI 1,11-5,24; p=0,04). Studying the reproductive history of patients, it was determined that women in the group 1 have had 3,4-fold higher birth parity compared to the group 2 (p<0,05), which can also be considered a leading risk factor for VPM. In addition, in the research groups there was a significant proportion of miscarriages (4,7-fold more in the group 1; p<0,05) and stillbirths, which may be a consequence of the past acute inflammatory diseases of specific etiology. Conclusions. Anamnestic data (static lifestyle and physical activity, miscarriages, high parity of childbirth), as well as peculiarities of the clinical course of chronic inflammatory processes of the internal genital organs in women against the background of varicose veins of the pelvis minor (severe chronic pelvic pain, swelling and aching fornices, dyspareunia, sexual dysfunction) should be the leading factors in the selection of patients for the use of an advanced diagnostic algorithm (ultrasound examination of the lesser pelvic veins in combination with color Doppler examination).