RU2466687C1 - Method for curative treatment of acute varicothrombophlebitis of lower extremities with use of laser and plasma technologies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: there are conducted crossectomy, direct and/or indirect thrombectomy, ligation of inadequate perforating veins and varicose flows of subcutaneous vein stems. A pathological venous bed is eliminated by endovasal laser coagulation (EVLC) of the inadequate subcutaneous vein stems. The surgical procedure is performed under tumescent anaesthesia of the EVLC region by physiologic saline cooled to 6-7°C at ozone concentration 4-5 mcg/ml. It is assisted by continuous ultrasonic navigation. The EVLC region involved in varicothrombophlebitis and the incisional wound are processed by argon-plasma flow followed by elastic compression of the operated extremity.

EFFECT: method extends the range of product for treating acute varicothrombophlebitis of the lower extremities.

Description

Acute varicothrombophlebitis (AFVF), which develops in 30% of patients with varicose veins of the lower extremities (VBNK), is one of the urgent problems of general surgical practice. Treatment of this group of patients is a difficult social task, given the high prevalence of background nosology among the adult population and the risk of thromboembolic complications. As you know, with severe paravasal inflammation, radical interventions based on classical phlebectomy are traumatic, increase the risk of wound complications, and are not always acceptable from an aesthetic point of view. On the other hand, routine conservative therapy is also not able to quickly stop the local thrombus-inflammatory process, delaying it for a long time. All these points dictate the need to develop more advanced therapeutic techniques in which the effective methods of traditional surgery would be rationally combined with fundamentally different energies, which include plasma technology, endovasal laser coagulation (EVLK).

Our developed method for the radical treatment of AFP is as follows. Under spinal anesthesia, as the first stage of combined phlebectomy (CF), ligation of failed perforating veins and varicose dilated inflows of the ventricular arteries (MPV) is performed on the foot and lower leg from small epiphasial accesses, local thrombectomy according to the K.Sigg technique (1976), as well as ligationectomy all estuarine tributaries of the BPV (MPV). In the presence of a floating thrombus with prolapse of its apex from the BPV (MPV) into the deep veins of the lower extremity, crossectomy is combined with the removal of the floating “head” of the thrombus from the safeno-femoral (safeno-popliteal) anastomosis. The stump of the vein is not more than 0.5-0.6 cm.The distal end of the trunk of the BPV (MPV) is opened at the clamps, soft thrombotic masses are determined in its lumen, which are then removed as far as possible using an electric suction pump or Fogarty balloon angiocatheter. After that, we proceed to the second stage of CF - endovasal laser coagulation (EVLK) of the BPV trunk (MPV), which will consist of several sequentially performed:

1. The introduction of an optical fiber (fiber) into the main saphenous vein freed from thrombotic masses. This is carried out in a retrograde direction to the lower third of the leg. The position of the working body in the distal segment of the BPV (MPV) is controlled by palpation, visually (by the glow of the pilot laser), as well as by the method of intraoperative ultrasound navigation.

2. Infiltration tumescent anesthesia. Its purpose is to protect paravasal tissues and anatomical structures (lymphatic collectors, nerves) located in the projection of the coagulated BPV trunk (MPV) from damaging thermal effects. We offer for this a cooled ozonized physiological solution (temperature 6-7 ° C, ozone concentration 4-5 μg / ml, source - Medozon installation). Infiltration of the solution is carried out under continuous ultrasonic navigation strictly into the fascial sheath of the vein (additional compression and spasm), and also above them into the subcutaneous tissue above the superficial fascia (additional skin protection). The total volume of the solution does not exceed 500 ml: approximately 350 ml is calculated per thigh and 150 ml per shin.

3. Laser coagulation of insolvent BPV trunks (MPV). The source is a pulse-periodic apparatus "Lazermed-1-25" (wavelength 1.06 μm, LLC "RIK", Tula), the exposure mode is only constant. The radiation power varies with the diameter of the barrel BPV (MPV) in the range from 20 to 25 watts. The fiber is extracted from the saphenous vein in increments of 2-4 mm / sec.

Before suturing, all surgical wounds, the EVLK zone, as well as the varicothrombophlebitis region are successively treated with argon-plasma flow in the therapeutic regime (source - Plasma Scalpel - CPT unit). Irradiation with a defocused plasma jet is carried out daily, at the rate of 10 seconds per focal field with an area of 1 cm ² , the distance from the manipulator nozzle to the surface is 3-4 cm, the temperature of the cooled ionized stream in the contact zone is 37-38 ° С, the duration of the procedures is from 4 to 7 minutes . Plasma stimulation of all areas of surgical intervention continues during the first week of the postoperative period daily. At the end of CF, plastic compression of the operated limb is carried out using medical knitwear of class II. The latter is permanent and is enhanced by additional compression of the BPV (MPV) using latex rollers installed along the coagulated vessel. Anti-inflammatory, phlebotropic and symptomatic therapy is carried out in combination with the application of heparin-containing ointments. Dynamic ultrasound control of the EVLK area was carried out on the 2nd, 7th and 14th day of the postoperative period.

The above method of radical treatment of AFP using "high" energies was used in 4 patients with a prescription of the pathological process from 2 to 7 days. No features of the course of the postoperative period were noted. The severity of the pain syndrome differed from that in individuals operated on by the generally accepted technique (classical CF) towards a significant decrease. In no case was the development of paresthesia, inflammatory-purulent complications and thrombosis of the main veins noted. Local thrombectomy in combination with regular plasma treatment in the stimulation mode markedly accelerated the resolution of AFP (peripheral beat, pain).

COMMON ACCEPTED TECHNIQUE OF RADICAL SURGICAL TREATMENT OF ACUTE VARICOTROMBOMPHLEBITIS OF LOWER EXTREMITIES

Classical CF-type radical interventions usually include crossectomy, mechanical extraction of the affected defective BPV (MPV) trunks, as well as their tributaries on the lower leg and thigh using traditional surgical techniques (Babcock, Narat operation), epiphasic ligation of the incompetent perforating veins (IVC) on the lower leg (Coquette operation), as well as multiple local thrombectomy (phlebocentesis) from the subcutaneous inflows of the small intestine lesions (MPV) using the K.Sigg method (1979).

List of abbreviations

BPV - large saphenous vein

VBNK - varicose veins of the lower extremities

CF - combined phlebectomy

MPV - small saphenous vein

OVTF - acute varicothrombophlebitis

Information sources

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Claims (4)

1. A method for the radical treatment of acute varicothrombophlebitis of the saphenous veins of the lower extremities, including crossectomy, direct and / or indirect thrombectomy, ligation of failed perforating veins and varicose dilated inflows of the saphenous veins with subsequent elimination of the pathological venous channel using endovasal laser coagulation trunks of saphenous veins under tumescent anesthesia of the EVLK zone, cooled to 6-7 ° C by ozonized physiological solution at an ozone concentration of 4-5 μg / m l, performed under continuous ultrasonic navigation and subsequent treatment with argon-plasma flow in the therapeutic mode of the EVLK zones, varicothrombophlebitis, together with surgical wounds and elastic compression of the operated limb. 2. The method according to claim 1, characterized in that the endovasal laser coagulation is carried out at a constant healing power of 20-25. 3. The method according to claim 1, characterized in that the argon-plasma flow treatment is carried out at a temperature in the contact zone of 37-38 ° C. 4. The method according to claim 1, characterized in that the elastic compression of the operated limb is carried out using medical hosiery with stockings of compression class II and latex semi-cylindrical rollers fixed to the skin along the coagulated vein with the plane up.