RU2212917C2 - Method for varicose veins obliteration - Google Patents

Abstract

FIELD: medicine; surgical treatment of varicose veins. SUBSTANCE: laser radiation source is inserted through vascular wall directly into varix. The latter is irradiated from inside many times, each time in different directions, with aid of diode laser at wavelength of 805 nm in quasi-continuous mode and at radiation power of 2-20 W. In the process single-action time is 2 to 20 s. EFFECT: complete obliteration of varicose veins at varix point proper. 1 cl, 1 dwg, 2 ex

Description

 The invention relates to medicine, in particular to laser surgery, and can be widely used in the surgical treatment of varicose veins.

 There are various methods of surgical treatment of varicose veins, for example, excision of veins along with a skin flap, the saphenous veins intersected with this are tied, the flap is returned and sutured (see book by A. F. Kharkhut, “Expansion of the veins of the lower extremities”, publ. "Medicine", 1996, pp. 77-83), or the removal of dilated veins and individual conglomerates from small incisions along the main trunk of a large saphenous vein, or the removal of saphenous veins using special probes (see ibid., P. 77 -83).

 However, all known methods are quite traumatic, require pain relief.

 There is a method of treating varicose veins, which involves introducing a source of radiation into the vein through the conductor of the radiation source until it encounters an obstacle and the subsequent thermal exposure of the vein during the reverse movement of the radiation source, accompanied by manual compression (see ibid., P. 83) .

 This method relates to electrocoagulation. As a radiation source in this method, a bipolar electrode is used, fed from the diathermy apparatus.

 Coagulation of the inner layer of the vein occurs when the wall is in close contact with the electrode, which is achieved by moderate external pressure of the moving mono-channel bipolar electrode with the hand of the operator.

 According to the authors of this method, he established himself on the positive side.

 However, this method is not without drawbacks, in particular, there is a danger of the spread of a coagulating effect on the blood in perforating veins with the transition of blood clots to deep veins. In addition, the known method has limited use, it cannot be used in patients with an implanted stimulator or in nodal formations.

 The use of this method requires the use of general anesthesia, and also has a significantly more damaging effect on the surrounding tissue.

 A known method of laser coagulation of saphenous veins in the treatment of varicose veins of the lower extremities, selected as the closest analogue, involving the introduction of a probe into the lumen of the vein at the required distance of the fiber and subsequent irradiation of the inner surface of the varicose vein with laser radiation with an output power of 20 W, carried out at its movement in the proximal direction at a speed of 0.8-1.2 cm / s with elastic bandaging of the limb on the gauze roller along the vein, which directly venous contact of the vein wall with the working end of the fiber (see patent RU 2147849. Ml. A 61 B 18/20, publ. 04/27/2000).

The impact is carried out in a continuous mode, the laser radiation energy is 120-150 J / cm ² .

 This technique is quite complex and a large length of the vein section is subject to destruction, which increases not only the damaging effect on the patient’s body, but significantly increases the duration of the operation.

 Thus, the technical result to which this invention is directed is to create a simpler, less long-term method for treating varicose veins, which allows for complete obliteration of varicose veins locally, on a smaller section of the vein, namely at the location of the nodular formation.

 The specified technical result is achieved by the fact that in the method of laser obliteration of varicose veins, punctured using a conductor, introducing the laser radiation source to the site of exposure and then irradiating it for a time sufficient for complete obliteration, according to the invention, the source is introduced directly through the vessel wall into the venous node, irradiation is carried out from the inside of the node repeatedly, each time in different directions using a diode laser with a wavelength of 80 5 nm in quasi-continuous mode and a radiation power of 2-20 W, while the time of a single exposure is from 2 to 20 seconds.

 The implementation of the introduction of a laser radiation source through the vessel wall directly into the venous node and its subsequent irradiation from the inside of the node can significantly simplify the operation and reduce its duration.

 This is due to the fact that additional transitions are excluded and the surgical field is reduced, access to the site of exposure is greatly simplified.

 The implementation of the irradiation from the inside of the site repeatedly and each time in different directions ensures local complete obliteration of the veins in the minimum section of the veins, which also simplifies the method and reduces its duration.

 At the same time, it was experimentally established that the desired effect is facilitated by the use of a diode laser with a wavelength of 805 nm in quasi-continuous mode for irradiation with a radiation power of 2 to 20 W and a single exposure time of 2 to 20 seconds.

 The method is as follows.

 Aseptic processing of the surgical field is performed. With superficial anesthesia with a needle (conductor) with a diameter of 1.5 mm for intravenous administration, a varicose vein is punctured in the region of the venous node on the lower limb.

 A quartz fiber with a diameter of 0.6 mm is inserted into the venous node through a needle (conductor). From the inside of the node, the surface of the venous node is irradiated in the direction in which the light guide is inserted. After the first irradiation, the position of the fiber is changed, shifting its tip, for example, to the right at an angle to the original direction of introduction. Carry out the irradiation of the venous node, but in a different direction (see drawing). Thus, irradiation of the venous node from the inside is carried out repeatedly, each time in different directions, thereby achieving complete obliteration of the vein at a given location.

 For irradiation, a diode laser with a wavelength of 805 nm is used, the regime is quasi-continuous, and the radiation power is from 2 to 20 W. The time of a single exposure is from 2 to 20 seconds.

 Before removing the fiber, the laser source is turned off.

 After removing the fiber, a compression dressing is applied to the limb for about 4 days, after which it is removed. During this time, a complete obliteration of the varicose vein takes place.

 The method is confirmed by examples of specific performance.

 Example 1. Patient K. Age 62 years. Diagnosis: chronic venous insufficiency, class 6 according to CEAP. Varicose disease.

 Puncture of the saphenous vein is punctured at the medial ankle. A light guide was inserted through the lumen of the needle into the venous node. Using a diode laser with a wavelength of 805 nm in quasi-continuous mode with a radiation power of 20 W, the venous node was twice irradiated from the inside, each time in a different direction. A single exposure time is 20 seconds.

 After removing the fiber, a compression bandage is applied to the lower limb for a period of 4 days.

 From the second day there is a decrease in induction and edema. Healing of an ulcer occurred after 15 days. Before this ulcer existed for more than a year.

 Example 2. Patient X. Age 75 years. Diagnosis: chronic venous insufficiency, class 4 according to CEAP. Varicose disease with severe comorbidity, arterial hypertension, insulin-dependent diabetes mellitus.

 The patient has a punctured venous node of the lower limb of the large saphenous vein. A fiber guide was punctured into the cavity of the venous node using a conductor. Using a diode laser with a wavelength of 805 nm, a radiation power of 2 W, a 10-fold irradiation of the venous node from the inside is performed, each time changing the position of the fiber, which provides the most complete obliteration of the vein. Single exposure time 2 seconds.

 After surgery, a compression dressing is applied to the lower limb.

 From 2 days the feeling of heaviness and swelling decreased. Reduced induction. Reduction of hyperpigmentation from 5-7 days.

Claims (1)

 A method of laser obliteration of varicose veins, involving punctured using a conductor, introducing a laser radiation source to the site of exposure and then irradiating it for a time sufficient for complete obliteration, characterized in that the source is introduced directly through the vessel wall into the venous node, irradiation is carried out from the inside node repeatedly, each time in different directions using a diode laser with a wavelength of 805 nm in quasi-continuous mode and a radiation power of 2-20 V , With a single exposure time is from 2 to 20 seconds.