International Medical Journal, Vol. 22., Iss. 2, 2016, P. 26−30.
METHODS OF TREATMENT OF SAPHENOUS TRIBUTARIES OF VARICOSE VEINS BY ULTRASOUND GUIDED ENDOVENOUS LASER ABLATION
V. T. Zaytsev Institute of General and Urgent Surgery NAMS of Ukraine, Kharkiv, Ukraine
Endovenous laser ablation (EVLA) as mini−invasive analogue of saphenous stripping is one of priority methods of surgical treatment of varicose disease. It can be performed for the interfascial segments of veins (saphenous veins). But recommendation for treatment of tributaries are still debated. In all described cases, tunnel anesthesia of tributaries (own technique), aimed at reduction of vein diameter, and as a result to free location of the tributary in the with liquid tunnel. No significant difference was found between groups of combination of EVLA with phlebectomies and EVLA with sclerotherapy. No significant complications were found in both groups. Few small esthetic complications without significant difference between groups were observed except pigmentations which had significantly higher incidence in EVLA plus sclerotherapy group. The study showed that one or another supplementing method can be more suitable in different patients depending on configuration of tributaries, severity of chronic venous insufficiency etc. As a result the algorithm of supplementing treatment of venous tributaries was created. Finally the study showed that in 94.7±1.6 % of cases of EVLA performance supplementing treatment of venous tributaries is needed. Tunnel anesthesia eases and optimizes treatment of tributaries. The choice of supplementing treatment can be made based on clinical manifestations of varicose disease, results of duplex investigations (tributaries number, configuration, location data). Efficacy of EVLA is 98.4±0.9 % and does not depend on kind of supplementing treatment of tributaries.
Key words: varicose disease, endovenous laser ablation, miniphlebectomy, foam sclerotherapy.