A method for the treatment of initial stages of varicose disease of lower extremities


(57) Abstract:

The invention relates to medicine, namely to vascular surgery, and can be used for the treatment of varicose disease of the lower extremities. Cross and tie a large subcutaneous vein in the initial section. Antegrade catheter into a vein to stilnovo valve. The position of the catheter in Vienna under ultrasound control duplex angiocardiogram. Produce manual compression of the abdomen. Simultaneously with manual compression of the abdomen is filled vein phlebosclerosis solution. The method allows to reduce the invasiveness of surgery and the number of intraoperative complications.

The invention relates to medicine, namely to vascular surgery.

The known method of intraoperative catheter stem sclerotherapy (Saveliev B. C., D. Konstantinov, Bogachev C. Y., Ignatenko, C. M. a Modern view of the sclerotherapy of varicose veins of the lower extremities. Thoracic and cardiovascular surgery. 1992, 7-8, 4-8), which is resection of pre-estuarial Department of a large or small saphenous vein with a mandatory audit of the sapheno-femoral anastomosis and legirovaniem all tributaries of Magistralnaya introduces a flexible catheter with perforations at one end, which is held to the level of the medial malleolus. Here also is cut, highlighted and Perevoznaya the initial division main saphenous vein. The catheter simultaneously with reverse traction it is injected sclerosing solution.

The method has several disadvantages. First, the ligation of the great saphenous vein at the mouth must be accompanied by the allocation of the anterior wall of the femoral vein in this Department and the intersection and ligation of all the numerous mouth of tributaries. When performing these manipulations, there is always a real threat of damage or crossing the femoral vein with the development of massive bleeding. Secondly, the ligation of the great saphenous vein at the mouth must be performed under endotracheal or intravenous anesthesia, which increases the duration of interference for 25 - 30 minutes, third, wellhead resection of the great saphenous vein requires a skin incision in the groin area, which reduces the cosmetic result of the intervention, especially since the bulk of the patients are women of young age.

The objective of the invention is to reduce the trauma reducing the risk intraoper the/P> In the proposed method under local anesthesia is allocated and intersects the initial division of the great saphenous vein at the medial ankle. Then its proximal end is inserted a flexible catheter with perforations on the end. The catheter is held in Vienna in an antegrade direction to the mouth. Concurrent with the catheter is made of ultrasonic duplex scanning of the area sapheno-femoral anastomosis. After a clear visualization on the screen of the device pre-estuarial Department of the great saphenous vein with Vienna catheter, the latter is set immediately under ostalnym valve. Then the assistant performs manual compression of the abdomen of the patient in order to increase the pressure in the deep veins of the limbs and to prevent possible contact with them sclerotiorum solution, and the operator removes the catheter, at the same time imposing on him phlebosclerosis. As far as the retrieval catheter from the vein of its lumen is compressed gauze rolls, with full compression of the veins is controlled by ultrasonic duplex scanning. The wound is then sutured, the limb bandaged elastic bandage. The patient begins to walk immediately after surgery. Elastic bandaging of the limb must preseparation complications and trauma intervention for the expense of surgical procedures in the area of the sapheno-femoral anastomosis. The operation time is compared with the known method is reduced to 3 to 4 times. Disabled patients recovered after 2 to 3 days. In the proposed method takes only one small (1 cm) incision, which allows to achieve high cosmetic result.

A specific example of the way:

Patient A. , aged 22. When viewed diagnosed with varicose veins of the right lower extremity at the stage of subcompensation.

When pre-operative duplex ultrasound scanning revealed the failure of the valves of the trunk of the great saphenous vein. During the physical examination revealed varicose tributaries of the great saphenous vein at lower leg.

Final diagnosis: Varicose veins of right lower extremity at the stage of subcompensation, failure of the valves of the great saphenous vein. The patient underwent an operation - stem catheter sclerotherapy under ultrasound control. The sequence of operations was as follows: under local anaesthesia, incision 1 cm from the medial malleolus selected initial division of the great saphenous vein, the vein is crossed, the distal end tied, the proximal end is inserted catheter. Under ultrasound contravene with simultaneous filling her phlebosclerosis solution. Along the great saphenous vein imposed gauze swabs produced ultrasonic testing of the adequacy of compression. Tight elastic bandaging.

The duration of 15 minutes. Immediately after elastic bandaging the patient independently went through 6 hours and was discharged for outpatient follow-up care. To work began on day 2. When the control ultrasonic studies on 3, 7 and 11 days showed complete obliteration of the trunk of the great saphenous vein. After 2 weeks made puncture sclerotherapy of varicose tributaries of the great saphenous vein. For dynamic monitoring of physical complaints and beauty of character is not present.

During the application of the proposed method treated 38 patients with varicose disease, which is 45% of the total number of patients with this pathology is operated for a given period. The remaining 55% of the proposed method of treatment has not been demonstrated due to the presence of decompensated stage due to late referral. With increasing medical activity of the population the number of patients to be treated this way, may be increased to 90%.

A method for the treatment of initial stages of varicose illness the catheter with perforations on the end phlebosclerosis solution characterized in that the intersection and the ligation of the great saphenous vein perform in her home Department, antegrade catheter to stilnovo valve and fill the veins phlebosclerosis solution with simultaneous manual compression of the abdomen, the position of the catheter in Vienna are controlled by ultrasonic duplex angiotenzinovye.


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