Novosti
Khirurgii

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Year 2023 Vol. 31 No 5

SCIENTIFIC PUBLICATIONS

E.P. BURLEVA, A.V. PESHKOV, S.A. TYURIN, S.M. BELENTSOV, M.A. MATVEEVA, M.E. ONOKHINA, I.O. OSEEV

LOWER LIMB VARICOSE VEIN RECURRENCES: STRUCTURE AND TACTICAL DECISIONS (A START-UP STUDY)

Federal State Budgetary Educational Institution of Higher Professional Education
"Ural State Medical University", Ministry of Health of the Russian Federation 1,
"Olmed" 2,
"AngioLine" 3, Ekaterinburg,
Russian Federation

Objective. Analysis of the structure of recurrences of varicose veins (VV) of the lower extremities and surgical tactics of their treatment.
Material and Methods. A retrospective analysis of the medical documentation of two phlebological centers during the period from 2020 to 2013 was carried out. 566 cases of recurrent VV in 504 patients were detected (78.8% of women; 21.2% of men; average age – 44.5 years). 2 groups were formed. In the 1st group - 285 cases, the first intervention in the GSV basin was phlebectomy (FE)\stripping; in the 2nd group – 245 – endovasal thermal ablation interventions (EVTI) (RFQ-103, EVLC – 142). The analysis of the material was based on a new classification of VV recurrences (ESVS guidelines, 2022).
Results. The recurrences of the disease after EVTI were detected in 271 cases (7.4%): 159 cases after EVLC (9.5%), 112 cases after RFQ (5.6%). The percentage of recurrences after phlebectomies was 10.4%. According to the analysis of the structure of recurrences, the percentage of technical and tactical errors after EVTI was 2.2%, after FE – 1.6%. The main part of recurrences was associated with the progression of VV and neovascularization on the high. New vertical overflows on the thigh were registered in 169 cases (57.3%) after FE and in 77 cases after EVTI (28.4%). In the EVTI group, a significant part of recurrences accrues to horizontal reflux – 102 cases (37.6%), in the FE group – 65 cases (22.0%). Recurrences associated with changes in the SSV basin: after EVTI – 11.8%, after FE – 10.4%. In a comparative analysis of the results of EVLC and RFQ, the difference was only in the percentage of medical errors (2.5% vs. 1.6%, respectively). Reinterventions (n=370) were performed in patients with venospecific complaints, recurrence of varicose syndrome, the presence of new refluxes in large tributaries with drainage into recanalized GSV or into another venous structures. EVLC and different variants of sclerotherapy were used. During 1-year observation, there were no complications or additional interventions, occlusion of the target veins was achieved.
Conclusion. Regardless of the type of surgical intervention on the stem of GSV, VV recurs in about 10% of patients. The pathological mechanisms of restructuring of the venous bed of the limb after phlebectomy \ stripping and EVTI were different. The use of minimally invasive endovasal interventions was a justified tactic for the treatment of recurrent VV.

Keywords: varicose veins of the lower extremities, endovasal laser coagulation, radiofrequency ablation, phlebectomy\stripping, reñurrences, classification, tactics
p. 374-382 of the original issue
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Address for correspondence:
620102, Russian Federation,
Ekaterinburg, Volgogradskaya st, 189,
MAU GKB No. 40
Tel: 8 912 600 300 8.
e-mail: e.p.burleva@gmail.com
Burleva Elena Pavlovna
Information about the authors:
Burleva Elena P., MD, Professor of the Department of Surgery, Endoscopy and Coloproctology of the Ural State Medical University, Cardiovascular Surgeon, Professor, Honored Doctor of the Russian Federation, Yekaterinburg, Russian Federation.
http://orcid.org/ 0000-0003-1817-9937
Peshkov Andrey V., PhD, Cardiovascular Surgeon, Chief Physician of the Olmed Network of Medical Centers, Yekaterinburg, Russian Federation.
http://orcid.org/ 0000-0002-9246-0463
Tyurin Sergey A., PhD, Cardiovascular Surgeon, Chief Physician of the Olmed MC, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0001-5125-4295
Belentsov Sergey M., MD, Professor, Cardiovascular Surgeon at the AngioLine MC, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0002-3742-8954
Matveeva Marina A., Cardiovascular Surgeon MC «Olmed», Ekaterinburg, Russian Federation.
https://orcid.org/0009-0009-6184-872Õ
Onokhina Margarita E., Clinical Resident of the Department of Surgery, Endoscopy and Coloproctology, Ural State Medical University.
https://orcid.org/0000-0003-4912-7996
Oseev Ilya O., Student of the Faculty of Treatment and Prevention of the Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University”, Ekaterinburg, Russian Federation.
https://orcid.org/0009-0000-1720-4649
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