RU2217059C2 - Surgical method for treating the cases of varicose large saphenous veins - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: method involves ligating and transecting the saphenofemoral anastomosis via a 1.5 cm long incision in suprainguinal area. Vein lumen is exposed and a conductor is introduced via a 0.5 cm long incision near medial malleoulus in retrograde way. The transected proximal end of the large saphenous vein is attached to the conductor. Then it is invaginated into the lower one third of the femoral subcutaneous vein lumen and into crural subcutaneous vein lumen by means of conductor traction. EFFECT: reduced risk of traumatic complications; improved cosmetic effectiveness. 2 dwg

Description

 The invention relates to medicine, namely to vascular surgery, and can be used in the surgical treatment of varicose veins.

 Among the many methods of surgical treatment of varicose veins of the lower extremities, the most common is the removal of Beccoccus's large saphenous vein.

 Recently, a number of authors (Sannikov A.B. Endovasal autovenous occlusion of varicose veins of the lower extremities (diss.), Kursk, 1997) began to apply the method of obliteration of the saphenous vein by introducing strips from the removed saphenous vein into its lumen. Other authors (Polubudkin M.S. Method for surgical treatment of varicose veins of the lower extremities, A.S. 730351 from 04.30.80), after removing the large saphenous vein on the thigh and lower leg according to Beccoccus, in the lumen of the expanded branches of the large saphenous vein of the lower leg after a longitudinal skin incision, exposure and opening of vessels introduce a transplant from a distant vein. Still others (Vedensky A.N. A new method for correcting pathological blood flow in the veins of the lower leg, 1988) retrogradely insert strips from the removed large saphenous vein into the lumen of the posterior tibial vein after exposing it at the ankle from a 3 cm section.

 Comparison of technical solutions with an analogue (Sannikov AB, Endovasal autovenous occlusion of varicose veins of the lower extremities (diss.), Kursk, 1997) established compliance with the “novelty” criterion, since the proposed method turns off the large saphenous vein of the lower third of the thigh and lower leg from the blood circulation without removing it. This achieves the goal of reducing the invasiveness of the operation without reducing radicalism with an improvement in the cosmetic effect (only 2 skin incisions - 1.5 and 0.5 cm).

 Comparing the claimed solution with other methods, significant differences were identified.

 In the Bebcoccus method with pulling out a large saphenous vein along the entire thigh and lower leg, there is a clear trauma to the tissues around the vessels, with the formation of extensive hematomas; damage to the lymphatic vessels and sensory nerves on the lower leg subsequently leads to lymphatic edema, parasthesia, a long-term recovery of disability occurs.

 When obliteration of the saphenous vein of the lower leg, within only the lower 2/3, with the removed stripe of the autogenous femur, as suggested by A. Sannikov Endovasal autovenous occlusion of varicose veins of the lower extremities (diss.), Kursk, 1997, there are hematomas on the thigh, since the large saphenous vein is removed using the Beccoccus probe, and incomplete occlusion occurs, which can lead to relapse of the disease. In addition, for the implementation of this method, three incisions are made: in the inguinal region, in the upper third of the leg and distal to the ankle. The possibility of infection increases with the allocation of a flap of a removed vein and its introduction into the lumen of the veins of the leg.

 In the claimed technical solution, occlusion of the large saphenous vein in the lower third of the thigh and lower leg is performed by invagination of the large saphenous vein in the distal direction directly during reduction during surgery using a conductor wire with a loop, using only two small cuts at the source of the large saphenous vein and its mouth. into the femoral vein. The duration of the operation is reduced by 3 times compared with the prototype and analogue. The invaginated large saphenous vein of the femur into the large saphenous vein of the lower leg completely occludes it, leaving no free space between the walls of the lumen, thereby ensuring a tight fit of the walls to each other for better germination of fibroblasts. The whole operation is carried out in a "closed" way under aseptic conditions.

 All this allows us to conclude that the technical solution meets the criterion of "significant difference".

 The aim of the invention is to improve the immediate and long-term results of venectomy by improving the technique of surgery and increase the cosmetic effect while maintaining its radicality.

 This goal is achieved by occlusion of the large saphenous vein in the lower third of the thigh and lower leg by invagination of the upper 2/3 of the large saphenous vein of the thigh in the distal direction using a conductor with a loop.

 The invention is illustrated using the drawings.

 FIG. 1 - technique of invagination venectomy: A - large saphenous vein, B - incision in the supra-inguinal region, C - skin incision in the medial ankle. G - conductor wire, D - traction of the conductor with invagination of the vein.

 FIG. 2 - invagination venectomy: A - the invaginated large saphenous vein of the femur into the vein of the leg, B - the length of the invaginated area with the dilated and convoluted saphenous vein on the thigh.

 The method is as follows.

 From the supra-inguinal vertical access at the pubic tubercle up to 1.5 cm long, the mouth of the large saphenous vein is exposed and a support thread is held under it (Fig. 1 - A, B). Then, with a vertical incision up to 0.5 cm long (Fig. 1 - B), the source of the medial ankle is distinguished, the lumen of the vein is opened with the ligation of its distal part. Then a conductor is introduced retrogradely - a wire with a loop to which the proximal end of the saphenous vein is fixed after ligation and intersection v. saphena maqna and its tributaries (Fig. 1 - D). The diameter of the conductor-wire is 0.8-1 mm, the diameter of the loop is 3-4 mm.

 Subsequently, the traction of the conductor is carried out with invagination of the saphenous vein of the femur into the saphenous vein of the leg and excretion of the proximal part of the vein through the wound into the distal end with ligation of these veins at the ankle. In this case, occlusion of the great saphenous vein of the lower leg with the saphenous vein of the thigh occurs (Fig. 1 - D, Fig. 2 - A), which is determined visually and by palpation thickening of the large saphenous vein of the leg in the form of a strand.

 If the large saphenous vein on the thigh is significantly widened and convoluted, then during invagination it lengthens, which allows the saphenous vein to be occluded in the lower third of the thigh (Fig. 2 - B).

 Depending on the diameter of the trunk of the saphenous vein, for carrying out such an operation, there is a set of conductors-wires of different diameters and with different sizes of loops.

 In the immediate postoperative period, complications were not observed, there were no suppurations, as well as phlebotrombosis of deep veins. There were minor hemorrhages on the thigh.

 Within 2 days in the area of the occluded saphenous vein of the leg, a somewhat painful cord-like compaction was noted, without hyperemia and edema of the skin over the vein.

 On day 3, compaction became less painful.

 On the 5th day in the area of the occluded vein, the pain and compaction practically disappeared.

 All these manifestations were moderate and did not affect the course of the disease and the length of hospital stay.

 After the operation, patients moved the same evening or the next day, were discharged on average 3-4 days, and when performing the operation in the classical way - not earlier than 8-12 days.

 Compression therapy was carried out for 1.5 months in the form of wearing an elastic bandage on the lower leg.

 Of the 25 operated, long-term periods from 6 months to 1 year were traced in 16. No relapse of the disease was noted. The therapeutic and cosmetic effect is good.

 We give a clinical observation.

 Patient M-va 55 years old, medical history 1250.

 Diagnosis at admission (09.21.99) to the hospital: varicose veins of the right lower limb, stage of decompensation.

 Complaints about the presence of "large" veins on the thigh and lower leg on the right, a feeling of expansion and burning, heaviness in the right lower leg. In the afternoon notes edema and cyanosis. Varicose veins over 15 years.

 The condition is satisfactory. Objectively: from the side of internal organs pathology is not revealed. Locally: the right lower leg is slightly larger than the left, on the inner surface of the thigh and the antero-medial-posterior surface of the lower leg, are packages of varicose saphenous veins that collapse when placed horizontally. Skin in the lower third of the leg with cyanosis. Hemodynamic tests indicate deep vein patency and the presence of retrograde blood flow through a large saphenous vein.

 Operation 09/22/99. A typical invagination venectomy was performed on the thigh with occlusion of the saphenous vein trunk of the leg using the above-described method under anesthesia. The postoperative course is smooth.

 Discharged on the 4th day.

 Examined after 4 months: no complaints, edema on the limbs and soreness was not detected, the tissues on the lower leg are soft. Cyanosis is absent. He works in the specialty. Pleased with the operation.

The conformity of the claimed method to the criterion of "novelty" is due to the presence of the following features that are absent in the prototypes:
1. Invaginative venectomy leads to complete occlusion of the lower third of the great saphenous vein of the thigh and entire leg.

 2. The duration of this operation compared with analogues and prototype is reduced by 3 times.

 3. Cosmetically (inconspicuous) minimum accesses: to expose a large saphenous vein, only two skin incisions are made 1.5 cm long above the inguinal fold and 0.5 cm at the medial ankle.

 4. Minimized and trauma to the tissues on the thigh, hematomas are rare.

 5. The operation is carried out in a “closed” version under aseptic conditions.

 6. Tissue damage on the lower leg is completely eliminated and, most importantly, there is no trauma to nerves and lymph vessels.

 7. There are no severe pains in the operated limb; disability is restored 10-14 days earlier than after typical operations; which is beneficial to practical health care (reduction of bed days).

 8. Relapses are excluded.

 9. The therapeutic and cosmetic effect of the proposed method of operation surpasses all previously known venectomy techniques.

Sources of information
1. Polubudkin M.S. The method of surgical treatment of varicose veins of the lower extremities // Vinnitsa Medical Institute. N.I. Pirogova. Publ. 04/30/80.

 2. Vedensky A. N. A new method for correcting pathological blood flow in the veins of the lower leg // Herald of Surgery, 1988, 4. - P. 143-144.

 3. Vedensky A. N., Stoyko Yu.M. Remote occlusion of perforating vein mouths // Bulletin of Surgery, 1990, 10. - P. 124-128.

 4. Sannikov A. B. Endovasal autovenous occlusion of varicose veins of the lower extremities (diss.), Kursk, 1997 - analogue.

 5. Sukovatykh B.S., Nazarenko P.M., Belikov L.N., Rodionov O.A., Abramova S. A. Importance of disorders of the muscular-venous pump and venectomy for lymphatic drainage of the lower extremities in patients with varicose disease // Angiology and vascular surgery. T. 4, 1998, 4. - S. 38-43.

 6. Shevchenko Yu.A. Occlusion of the posterior tibial veins according to A. Vedensky // Errors, dangers and complications in vein surgery. St. Petersburg, 1999 .-- S. 79-81, 124-127.

 7. Belikov L.N., Sukovatykh B.S., Rodionov O.A. The method of surgical treatment of varicose veins // Kursk Medical University. Publ. 07/01/92.

Claims (1)

A method for surgical treatment of varicose veins of the saphenous vein, including ligation and intersection of the safeno-femoral anastomosis, ligation of the saphenous vein at the medial ankle, retrograde insertion of the conductor into the lumen of the saphenous vein, fixation of the saphenous vein to the proximal end, conductor traction and large saphenous occlusion veins of the lower leg using autologous veins, characterized in that the ligation and intersection of the safeno-femoral anastomosis is made through a 1.5 cm incision in nadp of the howling region, open the lumen of the vein and introduce the conductor through a 0.5 cm incision at the medial ankle, and, after fixing the crossed proximal end of the saphenous vein to the conductor, invaginate it into the lumen of the lower third of the saphenous vein of the femur and into the saphenous vein by traction .

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