Completing sclerotherapy of recurrent and residual varicosely changed veins of the lower extremities after surgical and endovenous methods of treatment


Keywords: chronic venous insufficiency; varicose nodes; color ultrasound dopplerography; stripping; endovenous laser ablation; radio-frequency ablation; sclerotherapy

Abstract

Objective. Improvement of the treatment results in patients, suffering recurrent and residual varicosely changed veins and varicose nodes of the lower extremities, developed after surgical and endovenous laser methods of treatment.

Materials and methods. In 32 patients (21 women and 11 men) ageing from 28 to 71 yrs old, a miniinvasive definitive sclerotherapy of recurrent and residual varicosely changed veins and varicose nodes of the lower extremities, which have developed after surgical and endovenous laser methods of treatment in 45 patients, were performed.

Results. Complete occlusion of subcutaneous veins and varicose nodes of the lower extremities without their recanalization were revealed in 45 patients in accordance to data of the control color ultrasound dopplerography. Transitory thrombophlebitis have developed in 3 patients. There were following symptoms: a foreign body feeling like of a small chords - in 3 patients, paresthesia and feeling of numbness - in 2, and ecchimosis - in 2. These complications did not demand special medicinal and physiotherapeutic methods of treatment and spontaneously resolved during 1 - 6 mo. Serious complications were absent.

Complications. In patients with unsatisfactory results of surgical treatment of chronic venous insufficiency and varicose nodes (the recurrence rate constitutes 48.1%, and in the residual pathology of subcutaneous veins - 25.0%) the alternative miniinvasive methods of treatment must be applied. Complex approach and correct choice of endovenous laser methods of treatment permits to achieve a complete occlusion of subcutaneous veins in 97.37% of this patients, to reduce the rate of the disease recurrence and serious complications occurrence down to minimum. Conduction of a definitive sclerotherapy under local infiltrative anesthesia in ambulatory or stationary conditions is expedient in patients with the subcutaneous veins recanalization, development of recurrence and residual disease in the lower extremities.

References

1. Fokin AA, Borsuk DA. Vozmojnosti endovenoznoy lazernoy obliteracii krupnyx pritokov bolshoy podkojnoy veny na bedre. Flebologiya (Russian). 2018;12(1):4-11 doi:10.17116/flebo20181214-11.

2. Agus GB, Mancini S, Magi G. The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the 1999-2003 period. Int Angiol. 2006 Jun;25(2).209-5. PMID:16763541.

3. Myers KA, Fris R, Jolley D. Treatment of varicouse veins by endovenouse laser therapy: assessment of results by ultrasound surveillance. Med J Aust. 2006 Aug 21;185(4).199-202. PMID:16922664 https://www.mja.com.au/system/files/issues/185_04_210806/mye10280_fm.pdf.

4. Ozkan U. Endovenous Laser Ablation of Incompetent Perforator Veins: A New Technique in Treatment of Chronic Venaous Disease. Cardiovascular and
Interventional Radiology 2009;32:1067. PMID:19609603; doi:10.1007/s00270-009-9646-z.

5. Proebstle TM, Sandhofer M, Kargl A, Gül D, Rother W, Knop J, et al. Thermal damage of the iner vein wall during endovenous treatment: key role of energy absorption by intravascular blood. Dermatol Surg. 2002;28(7):596. doi:10.1046/j.1524-4725.2002.01309.x

6. Theivacumar N, Beale RJ, Mavor AI, Gough MJ. Factors influencing the effectiveness of Endovenous Laser Treatment (EVLT) for varicose veins due to saphenofemoral (SF) and long saphenous (LSV) reflux. Ireland TVSoGBa, editor. In The Vascular Society Yearbook London, UK; 2005:40. PMID:17936037. doi: 10.1016/j.ejvs. 2007.08.010

7. Goldman MP. Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxysclerol and sotradecol. Dermatol Surg. 2002;28:52-5. PMID:11991271.

8. King T, Coulomb G, Goldman A, Sheen V, McWilliams S, Guptan RC. Experience with concomitant ultrasound-guided
foam sclerotherapy and endovenous laser treatment in chronic venous disorder and its influence on Healt Related Quality of Life: interim analysis of more than 1000 consecutive procedures. Int Angiol. 2009;28:289-7. PMID: 19648872.

9. Tessari L, Cavezzi A, Frullini A. Preliminary Experience with a New Sclerosing Foam in the Treatment of Varicose Veins. Dermatol Surg. 2001;27:58. technique.PMID: 11231246. doi:10.1111/j.1524-4725.2001.00192.x

10. Dunst KM, Huemer GM, Wayand W, Shamiyeh A. Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein. J Vasc Surg. 2006;43:1056-8. doi:10.1016/j.jvs.2006.01.030.

11. Sichlau MJ, Ryu RK. Cutaneous thermal injury after endovenous laser ablation of the great saphenous vein. J Vasc Interv Radiol. 2004;15:865-7. PMID:15297592. doi:10.1097/01.RVI.0000136968.64870.07

12. Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg. 1999;29:589-2. PMID- 10194484.

13. Sarin S, Securr JH, Coleridge Smith PD. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 1992;79:889-3. doi:10.1002/bjs.1800790911.

14. Navarro L, Min RJ. Endovenous laser: a new minimally invasive method of treatment for varicose veins-preliminary observations using an 810 nm diode laser. Dermat Surg. 2001;27:117-2.

15. Van den Bos RR, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49:230-9. PMID: 18692348 doi: 10.1016/j.jvs.2008.06.030.

Author Biography


V. A. Musayev, Medical Faculty of University of Gazi, Ankara

Vugar Alishir oglu Musayev

Gazi University Medical Faculty Hospital.

Emniyet Mahallesi, Mevlana Blv. No: 89, Yeni mahalle /Ankara, Turkey.

Tel. +90 312 202 40 00 / +90 4440212. Mobil - + 90 5415241350

https://orcid.org/0000-0003-0885-2382.

Published
2018-11-01
How to Cite
Musayev, V. A. (2018). Completing sclerotherapy of recurrent and residual varicosely changed veins of the lower extremities after surgical and endovenous methods of treatment. Klinicheskaia Khirurgiia, 85(11), 40-43. https://doi.org/10.26779/2522-1396.2018.11.40
Section
General Problems of Surgery