IMPROVEMENT OF THE TREATMENT OF VARICOSE VEINS COMPLICATED BY VARICOTHROM-BOPHLEBITIS BASED ON THE STUDY OF D-DIMER

Abstract

Summary. Introduction. According to the European Society of Vascular Surgeons, surgery for varicose veins is possible 3 months after the first symptoms of varicothrombophlebitis. There is a certain category of patients who cannot wait for surgical intervention for the entire recommended period due to a number of social restrictions. We decided to investigate objective data that would allow us to assess the possibility of earlier surgical intervention. Aim: To study the terms of thrombosis recanalization and the level of D-dimer during treatment of varicothrombophlebitis, determination of their relationship, as well as dependence on the volume of thrombotic masses. Materials and methods. The study included 20 people with existing varicothrombophlebitis. In 15 patients, varicothrombophlebitis involved GSV, in 5 - SSV. The observation period lasted 60 days. All patients received 2.5 mg of fondaparinux 1 time per day and compression therapy with class II compression stockings for 45 days. Patients were conditionally divided into three clinical groups: Group I with a volume of thrombotic masses less than 4000 mm3 (n = 7), Group II with a volume of 4001-5999 mm3 (n = 7), Group III — more than 6000 mm3 (n = 6). The level of recanalization and quantitative D-dimer (the normal value of D-dimer was considered less than 500 ng/ml) were studied on the 30th, 45th and 60th day of observation, taking into account the initial volume of thrombotic masses, calculated on the basis of the diameter and extent of thrombosis. Results. In the I group, the average percentage of recanalization and the level of D-dimer on the 30th day was 55%/693 ng/ml, on the 45th day — 80%/651 ng/ml, on the 60th day — 100%/309 ng/ml, respec-tively. Group II had slower dynamics of recanalization, and a slight increase in the D-dimer level on day 45: on day 30 — 40%/723 ng/ml, on day 45 — 70%/794 ng/ml, on day 60 — 100 %/431 ng/ml, respectively. The data of the III group are similar to the II group: on the 30th day — 45%/729 ng/ml, on the 45th day — 65%/823 ng/ml, on the 60th day — 95%/482 ng/ml, respectively. Conclusions. Most patients have complete recanalization of saphenous vein thrombosis within 60 days. Recanalization and reduction of the D-dimer level largely depend on the extent of thrombosis and the diameter of the thrombosed vein. Moreover, normal levels of D-dimer correlate with complete recanalization, which in our opinion indicates the possibility of surgical intervention for varicose veins.