Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins
Authors:   Russian Biotechnological University, Moscow, Russian Federation, Zubritskiy V.F. , Chernookov A.I. ,   Russian Biotechnological University, Moscow, Russian Federation, Kuznetsov M.R. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Kandyba S.I. ,   Branch No. 5 of the N.N. Burdenko Main Military Clinical Hospital, Moscow, Russian Federation, Dolgov S.I. ,   Phlebology Center CJSC, Moscow, Russian Federation, Atayan A.A. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Ramazanov A.A. ,   Clinical Center for Restorative Medicine and Rehabilitation, Moscow, Russian Federation, Shadyzheva T.I. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Published: June 2023

Aim: to justify the choice of the most optimal treatment method depending on the cause, and clinical and anatomical patterns of the varicose veins relapse. Patients and Methods: treatment results of 157 patients with varicose vein relapses were analyzed. The mean age of patients was 39,8±0,3 years. 3 years after surgery, relapse occurred in 23 (14.7%) patients, in terms of 3 to 5 years — in 95 (60.5%), after 5 years or more — in 39 (24.8%). Different treatment methods were used depending on the individual clinical and anatomical relapse form of varicose veins. Anesthesia choice depended on the type and extent of surgical intervention. Of the open access, 94 (59.9%) surgical interventions were performed, minimally invasive methods of treatment were used in 63 (40.1%) cases. The life quality was assessed at the patient's admission to the clinic and 1–2 years after the end of treatment using the CIVIQ-2 questionnaire. Results and Discussion: after the use of minimally invasive techniques, the average pain intensity on the VAS was 3.1±0.2, in patients who underwent open resurgeries — 5.4±0.3. Early postoperative complications were noted in 3 (1,9%) patients. Long-term treatment results were examined in 129 (82.2%) patients out of 157 included in the study within 12 to 24 months after discharge from the clinic. After performing open surgeries, the average value of the cosmesis index on a ten-point scale was 6.1±0.3 points, after minimally invasive interventions — 7.9±0.5. In the long-term period, the disease repeatedly recurred in 2 (1.6%) patients. It was also found that the use of the developed treatment tactics for patients with relapses of varicose veins leads to an improvement in the life quality parameters by 1,2–1,5 times. Conclusion: eliminating the causes of varicose disease relapse, minimizing the invasiveness of interventions improves immediate and long- term treatment results and the life quality of patients. The use of preoperative duplex angioscanning and modern high-tech treatment methods helps to reduce the relapse number of varicose veins associated with technical and tactical errors of surgeons. KEYWORDS: varicose vein relapses, minimally invasive interventions, open surgeries, life quality. FOR CITATION: Zubritskiy V.F., Chernookov A.I., Kuznetsov M.R. et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231 (in Russ.). DOI: 10.32364/2587-6821-2023-7-4-225-231.