INTRAOPERATIVE ULTRASOUND NAVIGATION IN THE COMBINED SURGICAL TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES

Abstract

Summary. Introduction. Varicose veins of the lower extremities are an urgent medical and social problem, which leads to the continuous modernisation of diagnostic and treatment technologies. Surgical treatment of varicose veins has been and will remain the main method of treating varicose veins for a long time [1]. At the turn of the 20th and 21st centuries, a tremendous breakthrough occurred in the treatment of varicose veins. The classical varicose vein removal surgery (phlebectomy, safenectomy) with its disfiguring skin incisions, pain after surgery, long hospital stays and prolonged rehabilitation was replaced by laser surgery, the so-called endovenous laser vein coagulation (EVLC). According to international studies, the laser method (EVLK, EVLT, EVLO) surpasses all known methods of treating varicose veins in terms of therapeutic and cosmetic results and can be used in most cases. The best wavelength for venous laser is 1470 nm, and the effectiveness of the procedure depends on the method of laser coagulation. Aim. To analyse the effectiveness of combined surgical treatment of varicose veins of the lower extremities using ultrasound intraoperative navigation during the procedure. Materials and methods. The study included 246 patients with varicose veins of the lower extremities of class C2-C5. In 172 patients, varicose veins were detected in the basin of the IVC, in 49 patients - in the basin of the MPS, 25 patients had varicose lesions in the basin of the MPS and IVC, in 66% of patients, saphenous varicose veins (IVC and/or MPS) were combined with varicose veins in the basin of non-saphenous veins and reticular varicose veins. In 31% of patients, varicose veins had complications in the form of varicothrombophlebitis and/or saphenous vein phlebitis. Patients with signs of acute thrombosis (up to 1 month old) were not included in the study. The observation period lasted 1.5 years for each patient. All patients underwent a combined surgical intervention - EVLK and miniphlebectomy under ultrasound Doppler monitoring, in combination with sclerotherapy. Research results and discussion. The assessment of treatment results was based on the presence of patient complaints, analysis of clinical symptoms by a vascular surgeon, presence or absence of complications during the observation period, recurrence of the disease during the observation period, and analysis of ultrasound assessment of the veins by an ultrasound diagnostician. Ultrasound Doppler was performed on a mandatory basis in patients of all groups before surgical treatment, ultrasound intraoperative navigation during surgical correction and as a control within 1 to 3 days after surgery. Dynamic follow-up (including ultrasound Doppler) was performed in all patients at 1, 3, 6 and 12-18 months after surgical treatment. Conclusions. Most patients have a complete recovery after surgical treatment. Careful history taking in patients of this group and performing ultrasound Doppler ultrasound of the veins of the lower extremities allowed for effective surgical treatment. Specialists’ understanding of the capabilities of ultrasound Doppler ultrasound of the veins of the lower extremities, as well as compliance with the full examination protocol for ultrasound Doppler veins, allows us to provide detailed information to determine the most effective treatment tactics and prevent complications of the disease.