Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins
DOI: 10.32364/2587-6821-2023-7-4-225-231
V.F. Zubritskiy1, A.I. Chernookov1, M.R. Kuznetsov2, S.I. Kandyba3, S.I. Dolgov4, A.A. Atayan2, A.A. Ramazanov5, T.I. Shadyzheva2
1Russian Biotechnological University, Moscow, Russian Federation
2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
3Branch No. 5 of the N.N. Burdenko Main Military Clinical Hospital, Moscow, Russian Federation
4Phlebology Center CJSC, Moscow, Russian Federation
5Clinical Center for Restorative Medicine and Rehabilitation, Moscow, Russian Federation
Aim: to justify the choice of the most optimal treatment method depending on the cause, and clinical and anatomical patterns of the varicose veins relapse.
Patients and Methods: treatment results of 157 patients with varicose vein relapses were analyzed. The mean age of patients was 39,8±0,3 years. 3 years after surgery, relapse occurred in 23 (14.7%) patients, in terms of 3 to 5 years — in 95 (60.5%), after 5 years or more — in 39 (24.8%). Different treatment methods were used depending on the individual clinical and anatomical relapse form of varicose veins. Anesthesia choice depended on the type and extent of surgical intervention. Of the open access, 94 (59.9%) surgical interventions were performed, minimally invasive methods of treatment were used in 63 (40.1%) cases. The life quality was assessed at the patient's admission to the clinic and 1–2 years after the end of treatment using the CIVIQ-2 questionnaire.
Results and Discussion: after the use of minimally invasive techniques, the average pain intensity on the VAS was 3.1±0.2, in patients who underwent open resurgeries — 5.4±0.3. Early postoperative complications were noted in 3 (1,9%) patients. Long-term treatment results were examined in 129 (82.2%) patients out of 157 included in the study within 12 to 24 months after discharge from the clinic. After performing open surgeries, the average value of the cosmesis index on a ten-point scale was 6.1±0.3 points, after minimally invasive interventions — 7.9±0.5. In the long-term period, the disease repeatedly recurred in 2 (1.6%) patients. It was also found that the use of the developed treatment tactics for patients with relapses of varicose veins leads to an improvement in the life quality parameters by 1,2–1,5 times.
Conclusion: eliminating the causes of varicose disease relapse, minimizing the invasiveness of interventions improves immediate and long-term treatment results and the life quality of patients. The use of preoperative duplex angioscanning and modern high-tech treatment methods helps to reduce the relapse number of varicose veins associated with technical and tactical errors of surgeons.
Keywords: varicose vein relapses, minimally invasive interventions, open surgeries, life quality.
For citation: Zubritskiy V.F., Chernookov A.I., Kuznetsov M.R. et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231 (in Russ.). DOI: 10.32364/2587-6821-2023-7-4-225-231.
About the authors:
Vladislav F. Zubritskiy — Dr. Sc. (Med.), Professor, Head of the Department of Trauma Surgery, Russian Biotechnological University; 11, Volokolamskoe highway, Moscow, 125080, Russian Federation; ORCID iD 0000-0003-4894-2796.
Alexander I. Chernookov — Dr. Sc. (Med.), Professor of the Department of Trauma Surgery, Russian Biotechnological University; 11, Volokolamskoe highway, Moscow, 125080, Russian Federation; ORCID iD 0000-0003-3124-4860.
Maxim R. Kuznetsov — Dr. Sc. (Med.), Professor, Deputy Director of the Institute of Cluster Oncology named after L.L. Levshin, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, bldn. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0001-6926-6809.
Sergey I. Kandyba — C. Sc. (Med.), Head of the Surgical Department of the Branch No. 5 of the N.N. Burdenko Main Military Clinical Hospital; 8A, Yakovoapostolsky lane, Moscow, 105064, Russian Federation; ORCID iD 0000-0002-3479-9880.
Sergey I. Dolgov — Head of the Surgical Department, Phlebology Center CJSC; 9, 10-letiya Oktyabrya str., Moscow, 117036, Russian Federation; ORCID iD 0000-0003-1595-9321.
Andrey A. Atayan — C. Sc. (Med.), Associate Professor of the Department of Hospital Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, bldn. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0001-8914-7735.
Artur A. Ramazanov — surgeon, Clinical Center for Restorative Medicine and Rehabilitation; 2, Klinskaya str., Moscow, 125414, Russian Federation; ORCID iD 0000-0002-7158-8652.
Tanzila I. Shadyzheva — Associate Professor of the Department of Hospital Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, bldn. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0009-0000-2767-1208.
Contact information: Alexander I. Chernookov, e-mail: chernookov01@rambler.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 10.03.2023.
Revised 04.04.2023.
Accepted 27.04.2023.
2. Raskin V.V., Semenov A.Yu., Kurginyan H.M. Endovenous laser obliteration in the prevention of recurrence of varicose veins in the anterior saphenous vein pool. Profilakticheskaya Meditsina. 2020;3(23):98–103 (in Russ.). DOI: 10.17116/profmed20202303198.
3. Chernookov A.I., Kandyba S.I., Silchuk E.S. et al. Endovascular laser coagulation in varicose vein relapses in the lower extremities. Laser Medicine. 2022;26(2):8–14 (in Russ.). DOI: 10.37895/2071-8004-2022-26-2-8-14.
4. Robertson L., Evans C., Fowkes F.G.R. Epidemiology of chronic venous disease. Phlebology. 2008;23(3):103–111. DOI: 10.1258/phleb.2007.007061.
5. Kim E. Minimally invasive interventions in the treatment of relapse of varicose veins: thesis. M.; 2011 (in Russ.).
6. Park H.S., Kwon Y., Eom B.W., Lee T. Prospective nonrandomized comparison of quality of life and recurrence between high ligation and stripping and radiofrequency ablation for varicose veins. J Korean Surg Soc. 2013;84(1):48–56. DOI: 10.4174/jkss.2013.84.1.48.
7. Kostas T., Ioannou C.V., Touloupakis E. et al. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004;27(3):275–282. DOI: 10.1016/j.ejvs.2003.12.006.
8. Matvienko E.P. The choice of the method of treatment of relapse of varicose veins after surgical interventions: thesis. M.; 2017 (in Russ.).
9. Kulakova A.L. Modern methods of treatment of varicose veins of the lower extremities. Health and education in the XXI century. 2017;12(19):47–51 (in Russ.). DOI: 10.26787/nidha-2226-7425-2017-19-12-47-51.
10. Sabelnikov V.V., Kalashnikova O.I., Prokopets A.I., Zlobin A.V. Causes and possibilities of prevention and treatment of relapse of varicose veins of the lower extremities. Collection of abstracts of the 14th St. Petersburg Venous Forum "Topical issues of phlebology". 2021:61–62 (in Russ.).
11. Abud B., Kunt A.G. Midterm varicose vein recurrence rates after endovenous laser ablation: comparison of radial fibre and bare fibre tips. Interact Cardiovasc Thorac Surg. 2021;32(1):77–82. DOI: 10.1093/icvts/ivaa219.
12. Whiteley M.S., O'Donnell T.F. Debate: whether venous perforator surgery reduces recurrences. J Vasc Surg. 2014;60(3):796–803. DOI: 10.1016/j.jvs.2014.06.102.
13. Murzina E.L., Popov I.B., Barganjia A.B. et al. Med-term Results of Cyanocrylate Embolization of Saphenous Veins. Flebologiya. 2020;14(4):311–321 (in Russ., in Engl.). DOI: 10.17116/flebo202014041311.
14. Shirinbek O., Mnatsakanyan G.V., Odinikova S.N. Cyanoacrylate Adhesive Closure in the Real-World Practice: 2-Year Results of Varicose Vein Treatment. Outpatient Surgery 2022;1(19):125–132 (in Russ.). DOI: 10.21518/1995-1477-2022-19-1-132-139.
15. Lawson J.A., Gauw S.A., van Vlijmen C.J. et al. Prospective comparative cohort study evaluating incompetent great saphenous vein closure using radiofrequency-powered segmental ablation or 1470-nm endovenous laser ablation with radial-tip fibers (Varico 2 study). J Vasc Surg Venous Lymphat Disord. 2018;6(1):31–40. DOI: 10.1016/j.jvsv.2017.06.016.
16. Sushkov S.A. Postoperative recurrence of varicose veins of the lower extremities. Surgery news. 2008;4(16):163–177 (in Russ.).
17. Potapov M.P., Staver V.E., Dyakiv A.D., Parshchenko A.F. Features of phlebohemodynamics in relapse of varicose veins of the lower extremities. Health and education in the XXI century. 2017;1(19):43–46 (in Russ.).
18. Bush R.G., Bush P., Flanagan J. et al. Factors associated with recurrence of varicose veins after thermal ablation: results of the recurrent veins after thermal ablation study. ScientificWorldJournal. 2014;2014:505843. DOI: 10.1155/2014/505843.
19. Potapov M.P., Staver V.E., Sokolova E.I., Parashenko A.F. Analysis of factors determining the quality of laser crossectomy. Phlebology. 2021;2(15), issue 2:31 (in Russ.).
20. Zollmann M., Zollmann C., Zollmann P. et al. Recurrence types 3 years after endovenous thermal ablation in insufficient saphenofemoral junctions. J Vasc Surg Venous Lymphat Disord. 2021;9(1):137–145. DOI: 10.1016/j.jvsv.2020.04.021.
21. Golovina V.I., Selivestrov E.I., Efremova O.I. Possibilities and prospects of hemodynamic surgery of varicose veins in the era of endovasal thermal obliteration. Novosti Khirurgii. 2020;6(28):702–713 (in Russ.). DOI: 10.18484/2305-0047.2020.6.702.
22. An E.S., Seliverstov E.I., Soldatsky E.Y. et al. The radical and vein-sparing strategies in varicose vein surgery. 2016;10(4):190–198 (in Russ.). DOI: 10.17116/flebo2016104190-198.
23. Theivacumar N.S., Darwood R., Gough M.J. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg. 2009;38(2):203–207. DOI: 10.1016/j.ejvs.2009.03.031.
24. Khryshchanovich V.I., Tret'iak S.I., Romaanovich A.V. Recurrent varicosis: does inadequate surgical treatment remain a problem? Flebologiya. 2010;4(3):71–73 (in Russ.).
25. Cavallini A., Marcer D., Ferrari Ruffino S. Endovenous laser treatment of groin and popliteal varicose veins recurrence. Phlebology. 2018;33(3):195–205. DOI: 10.1177/0268355516687865.
26. Bushnin S.S., Bushnin A.S., Zubkov D.Yu., Mansvetova E.F. Treatment of recurrent varicose veins of the great saphenous vein using endovenous laser obliteration. Flebologiya. 2014;2(8):33 (in Russ.).
27. Gaibov A.D., Nematzoda O., Burieva Sh.M., Kalmykov E.L. Experience in the use of mechanochemical scleroobliteration in the treatment of relapse of varicose veins of the lower extremities. I.P. Pavlov Russian Medical Biological Herald. 2020;28(1):57–66 (in Russ.). DOI: 10.23888/PAVLOVJ202028157-66.
28. Darvall K.A., Bate G.R., Adam D.J. et al. Duplex ultrasound outcomes following ultrasound-guided foam sclerotherapy of symptomatic recurrent great saphenous varicose veins. Eur J Vasc Endovasc Surg. 2011;42(1):107–114. DOI: 10.1016/j.ejvs.2011.03.010.
29. Pavei P., Ferini M., Spreafico G., Nosadini A. Ultrasound guided foam sclerotherapy of recurrent varices of the great and small saphenous vein: 5-year follow up. Veins and Lymphatics. 2014;3(2):46–55. DOI: 10.4081/vl.2014.4655.
30. Theivacumar N.S., Gough M.J. Endovenous laser ablation (EVLA) to treat recurrent varicose veins. Eur J Vasc Endovasc Surg. 2011;41(5):691–696. DOI: 10.1016/j.ejvs.2011.01.018.
31. Van Groenendael L., van der Vliet J.A., Flinkenflögel L. et al. Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation. J Vasc Surg. 2009;50(5):1106–1113. DOI: 10.1016/j.jvs.2009.06.057.
32. Chernookov A.I., Ramishvili V.Sh., Dolgov S.I. et al. Modern strategy of treatment of patients with relapses of varicose veins after endovasal interventions. Georgian Medical News. 2021;(4):26–33 (in Russ.).
This work is licensed under a Creative Commons «Attribution» 4.0 License.
