Endovenous obliteration in the combined treatment of chronic venous diseases

The modern approach to the treatment of chronic venous insufficiency and varicose veins utilizes physical techniques for endovasal obliteration. It is characterized by significantly fewer side effects and opens new possibilities for the treatment of patients with varicose disease. Purpose: To evaluate the effectiveness of radiofrequency obliteration of varicose veins and puncture laser obliteration of perforant veins in the combined treatment of patients with varicose disease (VD). Material and methods. Outcomes of treatment of 528 patients with VD in the pool of the great saphenous vein (GSV) or small saphenous vein (SSV) have been analyzed. These patients had the combined treatment, which included radiofrequency obliteration of GSV and SSV trunk and / or Giacomini vein. Of these, 335 patients had also ECHO Foam-Form sclero-obliteration of GSV and SSV inflows and perforant veins on the thigh and / or ankle. In 266 patients, their treatment was combined with miniphlebectomy of GSV and SSV inflows and perforant veins on the thigh and / or ankle; and in 55 patients – with puncture laser obliteration of perforant veins. Results. The assessment of curative outcomes have has shown that postoperative pain intensity (VAS) was 3.1 + 0.5. Transient paresthesias were seen in 14 (3.4%) cases. Local ecchymoses – in 18 (4.3%) cases. Consequences of tumescent anesthesia: local ecchymoses and hyposthesia passed after 3–5 days. Skin pigmentation was noted in 1 case and lasted up to 3 months. Thrombosis was registered in 2 cases as a parietal thrombus in the great saphenous vein at the level of the middle third of the thigh; and in 2 cases as a thrombotic clot prolapse.

1. Duvansky V.A. Photodynamic therapy and NO-therapy in the complex treatment of patients with trophic ulcers of venous genesis. Lazernaya medicina. 2004; 8 (1–2): 5–8. [In Russ.].

2. Duvansky V.A., Azizov G.A. Features of regional microcirculation in patients with chronic venous insufficiency stage С6. Lazernaya medicina. 2011; 15 (1): 12–15. [In Russ.].

3. Halepo O.V., Molotkov O.V., Zinchuk V.V. et al. Microcirculation and endothelial function: theoretical foundations, principles of diagnostics of disorders, significance for clinical practice: scientific and methodological guide. Smolensk, 2015: 111. [In Russ.].

4. Gavrilenko A.V. Diagnostics and treatment of chronic venous insufficiency of lower extremities. M.: Medicine, 1999: 152. [In Russ.].

5. Sokolov A.L., Lyadov K.V., Lutsenko M.M. et al. Laser light irradiation of 1.56 microns for endovasal vein obliteration in the treatment of varicose disease. Angiologiya i sosudistaya khirurgiya. 2009; 15 (1): 68–76. [In Russ.].

6. Kirienko A.I., Bogachev V. Yu., Zolotukhin I.A. et al. Endovasal obliteration of the great subcutaneous vein in varicose disease. Angiologiya i sosudistaya khirurgiya. 2004; 10 (1): 53–61. [In Russ.].

7. Beale R.J., Gough M.J. A review of current Treatment options for primary varicose veins – A review. Eur. J. Endovasc Surg. 2005; 30: 83–95.

8. Goode S.D., Chowdhury A., Crockett M. et al. Laser and radiofrequency ablation study (LARA study): a randomised study comparing radiofrequency ablation and endovenous laser ablation (810 nm). Eur. J. Vasc. Endovasc. Surg. 2010; 40 (2): 246–253.

9. Shepherd A.C., Manj Gohel, Brown L.C. et al. Randomized clinical trial of VNUS Closure FAST radiofrequency ablation versus laser for varicose veins. Br. J. Surg. 2010; 97 (6): 810–818.

10. Shaidakov E.V., Ilyukhin U.A., Petukhov A.V. Radiofrequency obliteration with catheters Closure FAST in the treatment of chronic venous disease. Novosti khirugii. 2011; 19 (6): 129–133. [In Russ.].