Thrombosis of muscle veins of the crus in patients operated on for varicose disease

Bukina O.V., Golovlev V.V.

Regional Clinical Hospital named after V.D. Babenko, Tambov, Russia

The necessity of preventing venous thromboembolic complications in patients after endured surgical interventions for varicose disease remains a debatable problem. The study was aimed at assessing the incidence of deep vein thrombosis after phlebectomy and determining its clinical significance.

Materials and methods. The authors carried out a prospective cohort study comprising a total of 86 patients (73 women and 13 men, aged from 16 to 64 years, the mean age 39.1±11.8 years) presenting with class C2–C4 varicose disease. All patients under conduction and tumescent anaesthesia were subjected to crossectomy, stripping, and miniphlebectomy. The operations lasted from 60 minutes to 3 hours 30 min (average duration – 123±23 min). According to the Caprini score, in 58 patients the risk of thromboembolic complications was assessed as moderate (3–4 points), and in 28 patients as high (5 points and greater). In the postoperative period elastic compression was used in all patients, the activation began 1–2 hours after the operation. Anticoagulants in preventive doses were indicated in 6 patients due to the presence of additional risk factors.

Results. Ultrasonographic examination in the postoperative period revealed 3 (3.5%) cases of crural muscle vein thrombosis. Anticoagulation therapy was not indicated in these patients. Detecting thrombosis was followed by dynamic follow up. Ultrasonographic study revealed complete recanalization of thrombosed veins by the end of the second month of follow up. The incidence rate of thrombosis in the group with the moderate baseline risk of thrombosis amounted to 1.7% and in the group with high risk of thrombosis to 9.1% (p>0.1).

Conclusion. Crossectomy, stripping of subcutaneous veins, and miniphlebectomy carried out under conduction and local anaesthesia are not significant risk factors for the development of thromboembolic complications.

KEY WORDS: varicose disease, phlebectomy, crural vein thrombosis, venous thromboembolic complications, miniphlebectomy, anticoagulant therapy.

P. 92

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