Radiotekhnika
Publishing house Radiotekhnika

"Publishing house Radiotekhnika":
scientific and technical literature.
Books and journals of publishing houses: IPRZHR, RS-PRESS, SCIENCE-PRESS


Тел.: +7 (495) 625-9241

 

A review of modern methods in surgical treatment of lower limb varicose veins

Keywords:

G.V. Savrasov - Dr. Sc. (Eng.), Professor, Department of Biomedical Engineering Systems, Bauman Moscow State Technical University
E-mail: savrasov2000@mail.ru
A.S. Borde - Post-graduate Student, Department of Biomedical Engineering Systems, Bauman Moscow State Technical University
E-mail: aenea.doerb@mail.ru


Lower limb varicose veins (LLVV) is a common pathology of peripheral blood vessels, which treatment may require long time and high financial expenses. In industrially developed countries 26-38% of women and 10-20% of men suffers of LLVV. The medical and social significance of LLVV is caused by the prevalence among the population of working age; a prolonged, often recurrent treatment leading to a decrease in the quality of life, social activity and work capacity of patients; high level of subsequent disability of patients and significant economic cost for their treatment. In industrially developed countries, the cost of treating patients with LLVV achieves from 1% to 3% of the total health budget annually.
Today in the surgical treatment of LLVV there are two main directions. It is traditional surgery and minimally invasive surgery, which includes techniques such as chemical ablation or sclerotherapy and thermal ablation presented by endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). Each of these methods has its advantages and disadvantages and is not universal.
For decades, surgical resection of the large saphenous vein trunk - stripping, was the gold standard in the LLVV treatment. Although the effectiveness of eliminating LLVV pathological reflux using traditional surgery is currently unlikely to be compared to any alternative method, the operation scares its high level of trauma and a change in the habitual way of life due to the requirement on the inpatient and outpatient patient treatment.
Since 2006, there have been significant changes in the approach to the LLVV uncomplicated forms treatment. The desire to optimize the treatment, improve its results and reduce the operational trauma led to the development of endovenous (intravascular) methods. Today modern minimally invasive and low-traumatic methods have already been successful, such as chemical ablation or sclerotherapy and thermal ablation, represented by endovenous laser ablation (ELA) and radiofrequency ablation (RFA). The common problems of existing minimally invasive methods for LLVV treating are:
a) lack of a clear understanding of the impact mechanisms;
b) lack of standardization of intravascular procedures and, as a result, their inefficiency and high frequency of reinterventions.
In addition, in the literature there is too little information that can help to make a choice in favor of one or another LLVV treatment method. All this leads to the problem of the relevance of the standardization of various LLVV patients groups treatment, search for the optimal timing, volume, and the most effective methods of their complex treatment.

References:
  1. Klinika obshhej hirurgii lechebnogo fakul'teta RNIMU im. N.I. Pirogova: [Jelektronnyj resurs]. M. URL: http: //www.phlebosurgery.ru/ (Data obrashhenija: 01.05.2017).
  2. Savel'ev V.S., Gologorskij V.A., Kirienko A.I. Flebologija: Rukovodstvo dlja vrachej. M.: Medicina. 2001. 664 s.
  3. Sokolov A.L., Ljadov K.V., Stojko Ju.M. Jendovenoznaja lazernaja koaguljacija v lechenii varikoznoj bolezni. M.: MEDPRAKTIKA-M. 2007. 223 s.
  4. Berjozko M.P. Varianty krioflebjektomii v lechenii varikoznoj bolezni nizhnih konechnostej: Diss. … kand. med. nauk: 14.01.17. M. 2014. 163 s.
  5. Brittenden J., Cotton S.C., Elders A., Tassie E., Scotland G., Ramsay C.R., Norrie J., Burr J., Francis J., Wileman S., Campbell B., Bachoo P., Chetter I., Gough M., Earnshaw J., Lees T., Scott J., Baker S.A., MacLennan G., Prior M., Bolsover D., Campbell M.K. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of Laser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial // Health Technol. Assess. 2015. V. 19. № 27. P. 1–342.
  6. van Eekeren R.R., Boersma D., de Vries J.P., Zeebregts C.J., Reijnen M.M. Update of endovenous treatment modalities of insufficient saphenous veins. A review of literature // Journal of Vascular Surgery. 01/2005. № 40(6). P. 1248–1252.
  7. Carroll C., Hummel S., Leaviss J., Ren S., Stevens J.W., Cantrell A., Michaels J. Systematic review, network meta-analysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins // British Journal of Surgery. 2014. V. 101. № 9. P. 1040–1052.
  8. Gloviczki P., Comerota A.J., Dalsing M.C., Eklof B.G., Gillespie D.L., Gloviczki M.L., Lohr J.M., McLafferty R.B., Meissner M.H., Murad M.H., Padberg F.T., Pappas P.J., Passman M.A., Raffetto J.D., Vasquez M.A., Wakefield T.W. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum // J. Vasc. Surg. 2011. № 53. P. 1–48.
  9. Iljuhin E.A. Obosnovanie rezhimov primenenija jendovaskuljarnyh metodov v hirurgicheskom lechenii varikoznoj bolezni: Diss. … kand. med. nauk: 14.01.17. SPb. 2014. 123 s.
  10. Albanese G., Kondo K.L. Pharmacology of sclerotherapy // Seminars in interventional radiology. 2010. V. 27. № 4. P. 391–399.
  11. Pokrovskij A.V., Ignat'ev I.M., Bredihin R.A., Gradusov E.G. Posleoperacionnye recidivy varikoznoj bolezni // Angiologija i sosudistaja hirurgija. 2015. T. 21. № 4. S. 118–125.
  12. Rasmussen L.H., Lawaetz M., Bjoern L., Vennits B., Blemings A., Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with a 3-year follow-up // J. Vasc. Surg: Venous and Lym Dis. 2013. № 1. P. 349–356.
  13. Mueller R.L., Raines J.K. ClariVein Mechanochemical Ablation: Background and Procedural Details // Vasc Endovascular Surg. 2013 Apr. V. 47, № 3. P. 195–206.
  14. Davies M. G., Dalen H., Svendsen E., Hagen P.O. The functional and morphological consequences of balloon catheter injury in veins // J. Surg. Res. 1994. № 57. P. 122–132.
  15. Proebstle T.M., Alm J., Dimitri S., Rasmussen L., Whiteley M., Lawson J., Cher D., Davies A. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins // J. Vasc. Surg.: Venous and Lym. Dis. 2014. P. 1–6.
  16. Shajdakov E.V., Porembskaja O.Ja. Pjatyj EVF HOW. Master-klass Evropejskogo Venoznogo Foruma (Limassol, Kipr) // Angiologija i sosudistaja hirurgija. 2015. T. 21. № 2. S. 101–105.
  17. Mlosek R.K., Wozniak W., Gruszecki L., Stapa R.Z. The use of a novel method of endovenous steam ablation in treatment of great saphenous vein insufficiency: own experiences // Phlebology. 2014. № 29. P. 58–65.
  18. Krylov A.Ju. Kompleksnoe lechenie osnovnyh zabolevanij poverhnostnoj venoznoj sistemy nizhnih konechnostej: Diss. … dokt. med. nauk: 14.01.17. M. 2010. 264 s.
  19. Skleroterapija pri varikoze ven – «Centr Flebologii»: [Jelektronnyj resurs]. M. URL: ¬http://www.va-rikoz.ru/price/moscow/ (Data obrashhenija: 01.05.2017).
  20. Flebjektomija pri varikoze – «Innovacionnyj sosudistyj centr»: [Jelektronnyj resurs]. M. URL: http://varicoz.net/sugery/?yclid=5441118577227992257 (Data obrashhenija: 01.05.2017).
  21. Jendovazal'naja lazernaja koaguljacija varikoznyh ven – ceny v Moskve: [Jelektronnyj resurs]. M. URL: http://www.krasotaimedicina.ru/treatment/varicose-Isola¬ted/laser-coagulation (Data obrashhenija: 01.05.2017).
  22. Jendovenoznaja RChO varikoznyh ven nizhnej konechnosti – ceny v Moskve: [Jelektronnyj resurs]. M. URL: http://www.krasotaimedicina.ru/treatment/varicose-Isolated/radiofrequency-ablation?PAGEN_2=9#proc (Data obrashhenija: 01.05.2017).
June 24, 2020
May 29, 2020

© Издательство «РАДИОТЕХНИКА», 2004-2017            Тел.: (495) 625-9241                   Designed by [SWAP]Studio