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2010 | 82 | 3 | 159-165
Tytuł artykułu

The Association of Surgery and Sclerotherapy in the Treatment of Severe Chronic Venous Insufficiency

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
The aim of the study was to evaluate the efficacy of surgery in combination with sclerotherapy in the treatment of severe chronic venous insufficiency.Material and methods. During the period between 2007 and 2009, 38 patients with symptoms of advanced chronic venous insufficiency - C4, C5 and C6, according to the CEAP classification- were subject to surgery in combination with sclerotherapy. The study group comprised 24 (63%) female and 14 (37%) male patients, aged between 42 and 95 years. Twenty-three patients were diagnosed with saphenous vein insufficiency, 14 with small saphenous vein insufficiency, and one with femoro-popliteal venous insufficiency. Based on the VCSS scale, disease symptoms were evaluated before the operation and six months after the surgical intervention. In cases of saphenous or small saphenous vein insufficiency, the patients underwent crossectomy, followed by ligation of the saphenous-femoral and small saphenous-popliteal ostia. The distal segment of the vein was obliterated using a 3% polidocanol foam solution. Control ultrasonography was performed 1, 3, 6 and 12 months after the procedure. Patients with crural ulcerations that did not heal by three months postoperatively were subject to additional epidermal grafts.Results. Statistical analysis of the VSCC point scale before and after the operation demonstrated a significant reduction in the following parameters: pain, presence of varices, edema, ulcerations, and use of compression therapy. Analysis showed an effective elimination of the main venous trunks. Among patients with venous ulcerations, spontaneous healing was observed during the nine months after the procedure was observed in 17 (94%) patients. In one patient, the ulceration was reduced by 30-40%. Neurological, ophthalmological and thromboembolic complications of the deep venous system were not observed.Conclusions. 1. The combination of surgery and sclerotherapy in the treatment of advanced chronic venous insufficiency is a method worthy of recommendation. 2. The method is effective with a low risk of complications, thus significantly shortening hospitalization and absence from work. 3. An evaluation of the disease stage based on the VCSS scale, before and after the operation, demonstrated a significant improvement.
Wydawca

Rocznik
Tom
82
Numer
3
Strony
159-165
Opis fizyczny
Daty
wydano
2010-03-01
online
2010-09-15
Twórcy
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Department of Ultrasound Diagnostics and Mammography, Warsaw Medical University
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
  • Department of General and Vascular Surgery, 2 Medical Faculty, Warsaw Medical University
Bibliografia
  • Kielar M, Porzycki P, Myrcha P i wsp.: Występowanie przewlekłej niewydolności żylnej kończyn dolnych w wybranej losowo populacji miejskiej. Pol Przegl Chir 2002; 74: 1229-42.
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  • Nelzén O, Bergqvist D, Lindhagen A et al.: Chronic leg ulcers: an underestimated problem in primary health care among elderly patients. J Epidemiol Community Health 1991; 45:184-87.[Crossref]
  • Belcaro G, Christopoulos D, Vasdekis S: Treatment of superficial venous incompetence with the SAVAS technique-(Section Ambulatoire des Varices avec Sclérothérapie). A 4 year randomised, controlled trial comparing venous hemodynamic and costing after SAVAS, sclerotherapy and the dentist's technique. J Mal Vasc 1991; 16:23-27.
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  • Proebstle TM, Moehler T, Gül D et al.: Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg 2005; 31: 1678-83
  • Milleret R: Innovations in the treatment of saphenous trunks. W: Wittens C (red) Innovative treatment of venous disorders. Wyd. 1Turyn: Edizioni Minerva; 2009; s. 159-170.
  • Pascarella L, Bergan JJ, Mekenas LV: Severe chronic venous insufficiency treated by foamed sclerosant. Ann Vasc Surg 2006; 20: 83-91.[PubMed][Crossref]
  • Tessari L, Cavezzi A, Frullini A: Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58-60.[PubMed][Crossref]
  • Hach-Wunderle V, Hach W: Invasive therapeutic options in truncal varicosity of the great saphenous vein. Vasa 2006; 35: 157-66.[Crossref][PubMed]
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  • Kalra M, Gloviczki P: Fifteen years ago laser was supposed to open arteries, now it is supposed to close veins: what is the reality behind the tool? Perspect Vasc Surg Endovasc Ther 2006; 18: 3-8.[PubMed]
  • Agus GB, Mancini S, Magi G et al.: The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the 1999-2003 period. Int Angiol 2006; 25: 209-15.
  • Mayers KA, Jolley D, Clough A et al.: Outcome of ultrasound-guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg 2007; 33: 116-21.[Crossref][WoS]
  • Baron HC, Wayne MG, Santiago C et al.: Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure. Surg Endosc 2005; 19: 126-29.[Crossref]
  • Ciostek P, Myrcha P, Noszczyk W: Ten years experience with subfascial endoscopic perforator vein surgery. Ann Vasc Surg 2002; 16: 480-87.[PubMed][Crossref]
  • Hamera T, Modrzejewski a, Dmytrzak A i wsp.: Techniki endoskopowe w leczeniu zaawansowanej przewlekłej niewydolności żylnej - ocena wyników. Przegl Flebologiczny 2008; 16: 73-80.
  • Gloviczki P, Bergan JJ, Rhodes JM et al.: Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group. J Vasc Surg 1999; 29: 489-502.[Crossref]
  • Illig KA, Shortell CK, Ouriel K et al.: Photople-thysmography and calf muscle pump function after subfascial endoscopic perforator ligation. J Vasc Surg 1999; 30: 1067-76.[Crossref]
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Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_v10035-010-0021-1
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