Journal «Angiology and Vascular Surgery» • 

2008 • VOLUME 14 • №2

COMPREHENSIVE OUTPATIENT TREATMENT OF VARICOSE DISEASE OF THE LOWER LIMBS

Gavrilov V.A., Chabbarov R.G., Pyatnitsky A.G., Khvorostukhin V.S.
Medical Centre "Axon",
Saratov, Russia

The article deals with the findings obtained in examining a total of 8,000 people presenting with varicose disease of the lower extremities. The examination included a clinical (physical) examination and coloured duplex scanning of the lowerlimb veins. The examination was carried out in outpatient conditions, whereas surgical treatment was performed either outpatiently, or at a "oneday" hospital. Revealing complete valvular insufficiency of the great saphenous vein was followed by surgical treatment – intraoperative stem catheter scleroobliteration (SSO) or shortterm screening and postoperative puncture sclerotherapy. Detecting partial valvular insufficiency of the greater saphenous vein (pathological saphenofemoral reflux only in the vertical position) was managed by applying the principle of the socalled "incremental radicalism": i.e. the patients were subjected to the procedure of puncture sclerotherapy of varicose veins on the crus in ambulatory conditions to be followed by secondary ultrasonographic scanning with permanent dynamic followup. The cases of preserved reflux along the greater saphenous vein were subjected to sclerosurgical management. Valvular insufficiency of perforating veins was coped with by minimally invasive surgical interventions: subtotal endoscopic dissection of incompetent perforating veins, suprafascial ligation from a miniaccess and echosclerotherapy of the perforating veins. Also performed were histological and histochemical studies of the portions the greater saphenous vein and surrounding tissues procured during crossectomy of the saphenofemoral anastomosis in 43 patients, who had endured preliminary puncture sclerotherapy on the crus. Good functional and cosmetically pleasing outcomes were achieved in the majority of cases. In 75% of the patients with partial valvular insufficiency of the greater saphenous vein, we managed to avoid operations since repeat ultrasonographic study revealed no pathological venovenous shunts.

KEY WORDS: varicose disease of the lower extremities, outpatient treatment, clinical study, coloured duplex scanning, sclerotherapy.

P. 94

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