RU2734090C1 - Method of one-stage treatment of surface thrombophlebitis in recurrent varicose vein by means of endovasal laser obliteration (versions) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely cardiovascular surgery. Endovasal laser obliteration is performed under ultrasonic control using an ultrasonic device with a linear sensor. Thrombotic masses are localized both in transverse and longitudinal scanning. That is followed by loc puncture with an introducer of a target vein under ultrasonic control at an upper border of the thrombus. A J-guide is inserted, an angiographic catheter is inserted to guide the laser obliteration light guide, wherein the light guide is carried over the entire length of the recurrent vein and is localized 1-2 cm from falling into deep veins. It is followed by hydropreparation with the help of a cooled physical solution or 0.25 % novocaine in an amount of not more than 500 ml along the entire recurrent vein under ultrasonic control. Thereafter, laser power of 10 W is fed into the light guide and traction is performed in manual or automatic mode at rate of 1 mm per second. That is followed by closing the puncture point with an aseptic sticker and applying compression jersey to the surgical site. In another version, endovasal laser obliteration is performed under ultrasonic control using an ultrasonic device with a linear sensor. Thrombotic masses are localized both in transverse and longitudinal scanning. Local anesthesia is followed by puncture with an introducer of a target vein under ultrasonic control in an inguinal fold. Then J-conductor is introduced either directly into sapheno-femoral fistula, or directly into proximal segment of vein. An angiographic catheter is inserted to insert a light guide for laser obliteration to an upper thrombone boundary. That is followed by hydropreparation with the help of a cooled physical solution or 0.25 % novocaine in an amount of not more than 500 ml along the entire recurrent vein under ultrasonic control. Then, laser power of 10 W is supplied to the light guide and traction is performed in manual or automatic mode at rate of 1 mm per second. That is followed by closing the puncture site with an aseptic sticker and applying compression jersey to the surgical site.

EFFECT: group of inventions enables preventing recurrence of disease, performing one-stage treatment with achieving a high therapeutic effect.

2 cl, 2 ex, 2 dwg

Description

FIELD OF TECHNOLOGY

The invention relates to medicine, surgery, and can be used to eliminate (treat) superficial thrombophlebitis in recurrent varicose veins.

LEVEL OF TECHNOLOGY

The most common complication after the treatment of varicose veins is relapse of varicose veins. At the same time, the patient is often dissatisfied with the result of treatment and turns to the doctor only if there are complications - in particular, thrombophlebitis of the superficial veins of the lower extremities. The most dangerous in this case is the separation of thrombotic masses from the source and transportation to the pulmonary artery through the blood stream, which ends with pulmonary embolism. Accordingly, this disease requires careful and, most importantly, timely intervention to prevent a fatal complication, which is achieved by emergency measures. But given that the patient has already undergone previous treatment for varicose veins, the process of access and exposure of the affected varicose vein can be seriously difficult, due to the presence of a pronounced adhesion process and the possibility of using serious anesthesia.

Prevention of pulmonary embolism in such cases is carried out with the help of surgery (Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases // Phlebology. - 2018. - No. 3. - P. 146-240). Currently, endovasal laser obliteration is used for the main treatment of varicose veins (Diagnosis and treatment of thrombophlebitis of the superficial veins of the extremities. Recommendations of the Association of Phlebologists of Russia // Phlebology. - 2019. - No. 2. - P. 78-97). Surgical treatment in the standard case is an open, repeated, traumatic access, which not only qualitatively reduces the patient's ability to work for a period of up to 3-4 weeks, but also does not always lead to an improvement in their well-being. Considering that the treatment of the disease itself, which caused the complication, does not occur, the standard method does not always cause the desired effect.

Endovenous laser obliteration has become widespread in the treatment of patients with varicose veins in a planned manner and is not used in acute cases.

The closest in meaning to the claimed invention is the method of endovasal laser obliteration of the insolvent great saphenous vein with post-thrombophlebitic changes and the anatomically complex structure of its mouth (RF patent No. 2653639, 05/11/2018). The known method consists in the fact that laser obliteration is carried out in two stages, following continuously one after the other and carried out under constant ultrasound scanning, the first of which includes puncturing the great saphenous vein at the border of the middle and upper third of the leg or in the lower third of the thigh, introduction through an intraducer into the lumen of the great saphenous vein of a laser light guide with a spherical emitter, moving it to the place of increased resistance to the propagation of the waveguide along the trunk of the great saphenous vein and subsequent laser obliteration of the area of the great saphenous vein from the place of increased resistance to the advancement of the laser light guide to the place of its puncture when the operating laser light guide moves along the trunk the great saphenous vein from top to bottom, and the second stage includes puncturing the great saphenous vein in the region of its mouth, directly into the subvalvular space, inserting a laser light guide with a spherical emitter through an introducer into the lumen of the great saphenous vein, placing it to the place from which the trunk of the great saphenous vein has already been obliterated at the first stage and, the implementation of laser obliteration of the trunk of the great saphenous vein from the place of obliteration, performed at the first stage, to the mouth and subvalvular space, when the operating laser light guide moves along the trunk of the great saphenous veins in the direction from bottom to top, while infiltration anesthesia along the trunk of the great saphenous vein is carried out separately at the sites of the first and second stages of laser obliteration, and as laser radiation, radiation with a wavelength of 1550 nm with a constant frequency, with a radiation power of 10 W and a density radiation power 60-80 J / cm2.

при этом при его применении не обеспечивается одномоментного лечения острого заболевания, что может приводить к последующим рецидивным последствиям.The disadvantages of the known method are the factors that this technique is used precisely during planned operations, on the existing large saphenous vein, which is a common surgical intervention performed since 1991, when it was first used

at the same time, when using it, no one-step treatment of an acute disease is provided, which can lead to subsequent recurrent consequences.

SUMMARY OF THE INVENTION

The purpose of the invention and the technical problem to be solved is to create an effective method for eliminating the development of complications of varicose veins in an emergency with simultaneous treatment of the disease itself, achieved using minimally invasive technology under close ultrasound control.

The technical result is to provide an effective one-step treatment of thrombophlebitis in recurrent varicose veins.

The claimed technical result is achieved due to the implementation of the method of one-step treatment of superficial thrombophlebitis in recurrent varicose veins, which includes the implementation of endovasal laser obliteration performed under ultrasound control using an ultrasound apparatus with a linear sensor, while localizing thrombotic masses both in the transverse and longitudinal scanning, under local anesthesia, the intraducer puncture of the desired vein is carried out under ultrasound control above the upper border of the thrombus, a J-guide is inserted, an angiographic catheter is inserted, through which a light guide for laser obliteration is inserted, and the light guide is guided over the entire length of the recurrent vein and is localized in 1-2 cm from falling into deep veins, hydropreparation is performed using a cooled physical solution or 0.25% novocaine solution in a volume of not more than 500 ml along the entire recurrent vein under ultrasound control, 10 Watt laser energy is supplied to the light guide, and traction is performed, in manual or automatic mode at a speed of 1 mm per second, after which the puncture site is closed with an aseptic adhesive and compression hosiery is put on at the surgical site. The claimed technical result is also achieved by performing a method for the simultaneous treatment of superficial thrombophlebitis in recurrent varicose veins, which includes the implementation of endovasal laser obliteration performed under ultrasound guidance using an ultrasound apparatus with a linear transducer, while localizing thrombotic masses both transversely and in longitudinal scanning, under local anesthesia, the intraducer puncture of the desired vein is carried out under ultrasound guidance at the inguinal fold, directly into the sapheno-femoral junction, or directly into the proximal part of the vein, a J-guide is inserted, an angiographic catheter is inserted through which a fiber is inserted for laser obliteration to the upper the boundaries of the thrombus, hydropreparation is performed using a cooled physical solution or 0.25% solution of novocaine in a volume of not more than 500 ml along the entire recurrent vein under ultrasound control, Laser energy with a power of 10 watts is supplied to the light guide, and traction is performed, in manual or automatic mode at a speed of 1 mm per second, after which the puncture site is closed with an aseptic adhesive and compression hosiery is put on at the surgical site.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 illustrates an embodiment of the invention with antegrade access.

FIG. 2 illustrates an embodiment of the invention in a retrograde approach.

CARRYING OUT THE INVENTION

The claimed method is carried out with the implementation of the corresponding options, depending on the placement of the thrombus in the vein.

In the first embodiment of the method (10) shown in FIG. 1, the following sequence of actions is carried out. Endovasal laser obliteration is performed under ultrasound guidance using an ultrasound device with a linear transducer, during which thrombotic masses are localized (104) in both transverse and longitudinal scanning. The inflows (101) of the recurrent vein (102) are determined.

Then, under local anesthesia, the skin puncture (100) is performed with an Intraducer of the desired (recurrent) vein (102), performed under ultrasound guidance. Above the upper border of the thrombus (103), a J-guide is inserted, after which an angiographic catheter is inserted, through which a light guide (105) is inserted for laser obliteration. The light guide (105) is held along the entire length of the recurrent vein (102) and is localized 1-2 cm from the confluence of the deep veins (106), after which hydropreparation is performed using a cooled physical solution or 0.25% novocaine solution in a volume of no more than 500 ml along the entire recurrent vein (102). Hydroprocessing is also carried out under ultrasound control.

After that, laser energy with a power of 10 W is supplied to the light guide (105) using a laser device that generates a wave with a length of 1470 nm, and then traction is performed, in manual or automatic mode at a speed of 1 mm per second (for example, using an automatic tractor SPDS 04).

Laser action on the vein wall (102) leads to its obliteration and eliminates the possibility of blood flow through it.

After performing the surgical intervention, the puncture site (103) is closed with an aseptic sticker and the compression hosiery is put on at the site of the surgical treatment.

This technique is suitable for more distal localization of the thrombus.

FIG. 2 shows the second version (20) of the method, in particular, retrograde access to the site of thrombus formation (204). When implementing the method (20) according to the second option, as well as in the first case, endovasal laser obliteration is performed, carried out under ultrasound guidance using an ultrasound apparatus with a linear sensor, during which thrombotic masses (204) are localized both in transverse and longitudinal scanning veins to determine the inflows (201) of the recurrent (desired) vein (202) and, accordingly, the vein itself (202).

Under local anesthesia, puncture (203) of the skin (201) is performed with an introducer to access the desired vein (202), while the puncture (203) is performed under ultrasound guidance. Puncture (203) is performed at the inguinal fold, directly into the saphenofemoral junction, or directly into the proximal section of the vein (202) for insertion of the J-guide and subsequent installation of an angiographic catheter, through which a light guide (205) is inserted for laser obliteration to the upper border of the thrombus (204).

The light guide (205) is held along the entire length of the recurrent vein (202) and is localized 1-2 cm from the confluence of the deep veins (206), after which hydropreparation is performed using a cooled physical solution or 0.25% novocaine solution in a volume of no more than 500 ml along the entire recurrent vein (202). Hydroprocessing is also carried out under ultrasound control.

After that, laser energy with a power of 10 W is supplied to the light guide (205) using a laser device that generates a wavelength of 1470 nm, and then traction is performed, in manual or automatic mode at a speed of 1 mm per second (for example, using an automatic tractor SPDS 04). Laser action on the vein wall (202) leads to its obliteration and the elimination of the possibility of blood flow through it.

After performing the surgical intervention, the puncture site (203) is closed with an aseptic sticker and the compression hosiery is put on at the site of the surgical treatment.

This technique is suitable for more proximal localization of the thrombus.

Further, the data obtained during the practical application of the claimed options (10, 20) of the method will be presented.

Example 1.

Patient K., 84 years old, was consulted by a surgeon in a polyclinic at the place of residence. In anamnesis, he was operated on the right leg 2 times in different hospitals. There is a relapse at once along 2 tributaries - the medial and lateral tributaries of the great saphenous vein, inconsistent SPS on the right. The patient has 2 scars in the groin area on the right, a lot of scars on the lower leg and thigh with a pronounced adhesive process, which complicates open surgery. According to the ultrasound scan of the veins of the lower extremities - thrombi in the projection of the middle third of the thigh with visible flotation. Clinically - the presence of sharp pain, hyperemia and edema in the area of thrombophlebitis. Concomitant pathology: ischemic heart disease, postinfarction cardiosclerosis, hypertension 3 tbsp., Angina pectoris 3 functional class, obesity 2 tbsp. Taking into account the patient's categorical refusal to be admitted to the hospital and the possibility of a thrombus rupture with the development of fatal complications, endovasal laser obliteration of the medial and lateral inflows was performed up to the incompetent SPS on the right. When performing control immediately after surgical treatment, and on the 2nd day, 7th day, 30th day, 3 months, 6 months, 1 year and 2 years, data for a relapse were not obtained.

Example 2.

Patient P. 56 years old, was admitted by ambulance to the hospital after consultation in a private medical center, from where she was sent to the hospital. History of surgical treatment of varicose veins at the age of 7, when phlebectomy was performed for varicose veins. In the projection of the upper third of the right thigh there is hyperemia, a sharp soreness that appeared during the last week, was treated independently, without a significant effect. In the groin area on the right, there is a pronounced scar with signs of keloid. According to the ultrasound scan data, thrombosis of a rather large medial inflow to the right (3 cm in diameter), 6 cm apart from the incompetent and preserved saphenofemoral anastomosis.The thrombus and anastomosis are in the projection of the postoperative scar; according to the ultrasound scan data, there is a pronounced adhesive process in the subcutaneous tissue. A retrograde puncture access was performed through the SPS on the right, a laser light guide was inserted, which was localized in the thrombus projection. Hydroprocessing of the tissues surrounding the vein was performed along the entire length. Produced by laser obliteration of the medial inflow, up to the SPS on the right. When performing control immediately after surgical treatment, and on the 2nd day, 7th day, 30th day, 3 months, 6 months, 1 year and 2 years, data for a relapse were not obtained.

Claims (2)

1. A method for the simultaneous treatment of superficial thrombophlebitis in recurrent varicose veins, including the implementation of endovasal laser obliteration, performed under ultrasound guidance using an ultrasound machine with a linear sensor, while localizing thrombotic masses both in transverse and longitudinal scanning, under local anesthesia is performed by puncture of the desired vein with an introducer under ultrasound control at the upper border of the thrombus, a J-guide is inserted, an angiographic catheter is inserted through which a light guide for laser obliteration is inserted, and the light guide is guided over the entire length of the recurrent vein and is localized 1-2 cm from the confluence of the deep veins, hydropreparation is performed using a cooled physical solution or 0.25% novocaine solution in a volume of not more than 500 ml along the entire recurrent vein under ultrasound control, 10 W laser energy is supplied to the fiber and traction is performed, either in manual or automatic mode at a speed of 1 mm per second, after which the puncture site is closed with an aseptic adhesive and compression hosiery is put on at the site of surgical treatment. 2. A method for the simultaneous treatment of superficial thrombophlebitis in recurrent varicose veins, including the implementation of endovasal laser obliteration, performed under ultrasound guidance using an ultrasound apparatus with a linear sensor, while localizing thrombotic masses both in transverse and longitudinal scanning, under local anesthesia is performed by puncture of the desired vein with an Intraducer under ultrasound control at the inguinal fold, directly into the saphenofemoral junction, or directly into the proximal part of the vein, a J-guide is inserted, an angiographic catheter is inserted, through which a light guide is inserted for laser obliteration to the upper border of the thrombus, hydro-preparation using a cooled physical solution or 0.25% novocaine solution in a volume of not more than 500 ml along the entire recurrent vein under ultrasound control, 10 W laser energy is fed into the fiber, and traction is performed in manual or automatic mode at a speed of 1 mm per second, after which the puncture site is closed with an aseptic adhesive and compression hosiery is put on at the site of surgical treatment.

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