RU2741694C1 - Method for sparing surgical treatment of varicose veins of lower extremities - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to vascular surgery. Great saphenous vein in the inguinal region is transected and dressed. Sensor for direct intraoperative pressure determination is introduced into the vein lumen into a ligation point. Sensor is shifted distally along the vein at pitch of 5 mm to determine pressure in the vein at each point. If pressure exceeds 8 mm Hg, the vessel is ligatured from the percutaneous approach in the projection of the previous pressure measurement point. Pressure measurement and vascular ligation are continued until complete removal of the sensor through the distal incision.EFFECT: method enables reducing intraoperative injuries, reducing a risk of recurrent varicosity of the superficial veins of the lower extremities.1 cl, 1 tbl, 6 ex

Description

The technical field to which the invention relates

The invention relates to medicine, namely to surgery.

State of the art

Varicose veins of the superficial veins of the lower extremities is a fairly common surgical pathology caused by age-related dysplastic changes in the connective tissue. The main method of treatment for this pathology is the surgical removal of the altered section of the vein by pulling it out through the incision. The operation is traumatic, associated with significant blood loss, long-term pain syndrome and a high likelihood of developing cosmetic defects.

An example of the classical approach to the surgical treatment of varicose veins of the superficial veins of the lower extremities is the "Method for the surgical treatment of varicose veins of the lower extremities" proposed by V. I. Kolga and D. V. Chikishev. The method includes "antiseptic treatment of the operating field, allocation with a linear 1.0 cm cut with a large saphenous vein in the inguinal region in the sapheno-femoral anastomosis, transection of the great saphenous vein at the clamps, ligation of the stump of the great saphenous vein at the confluence with the femoral vein with an additional sutured ligature, transection and ligation of the tributaries of the great saphenous vein, characterized by the fact that in the lower third of the medial the surface of the leg with a linear 1.0 cm incision, the distal part of the great saphenous vein is isolated, transected, tied with an additional stitching ligature, a probe is inserted into the trunk of the great saphenous vein, the proximal section of the trunk of the great saphenous vein is fixed to the end of the probe, varicose dilated tributaries of the great saphenous The sore vein on the thigh and tibia is removed with a venextractor from a separate surgical access of 1.0 cm in the upper third of the tibia by tunneling the subcutaneous fat and detachment from the main trunk of the great saphenous vein, stopping bleeding by temporary pressure on the affected area, monitoring hemostasis and foreign bodies , layered suturing of wounds, in the projection of the distant veins and the main trunk of the great saphenous vein, gauze pads are applied, cosmetic sutures are applied to the skin surface, followed by elastic intraoperative bandaging from the groin to the proximal incision in the medial ankle, after the extraction of the main trunk of the great saphenous vein with a probe on the skin the distal wound is applied with cosmetic sutures with elastic bandaging of the ankle joint and foot "(patent for invention No. 2594979 RU dated 05/08/2015).

This technique is traumatic and associated with significant damage to the surrounding tissues during vein extraction.

The known "Method for the surgical treatment of varicose veins of the lower extremities", proposed by Sedov Yu. I. and Korchagina V.Yu. The proposed method includes the transection of the great saphenous vein at the place of its confluence with the femoral vein and its isolation at the inner ankle, removal of the great saphenous vein on the thigh and lower leg, varicose veins and associated communicating veins, characterized in that the removal of veins is performed after endovasal electrocoagulation fragments, while holding a needle with a thread under the vein and withdrawing it diametrically opposite to the outside, then through the puncture hole, pass a needle with a thread over the vein with output to the outside through the injection, pull a fragment of the vein with a thread and remove it, after which the varicose enlarged fragments are sequentially removed in the same way in fragments and lateral inflows of veins and communicating veins in the area of varicose veins revealed during tension of the thread, while a pressure bandage is immediately applied to the remote area (patent for invention No. 2281039 RU dated 08/10/2006).

Fragmentation of the removed vein reduces the trauma of the operation.

As a prototype, we adopted the description "Method for the treatment of the initial stage of varicose veins of the lower extremities" proposed by VS Saveliev, AI Kirienko, V.Yu. Bogachev. and Zolotukhin I.A. (RF patent for invention No. 2142741 dated 20.12.1999).

The authors propose to carry out "transection and ligation of the great saphenous vein, filling it through a flexible catheter with perforations at the end with a phlebosclerosing solution, characterized in that the transection and ligation of the great saphenous vein is performed in its initial section, the catheter is inserted antegradely up to the ostial valve and the vein is filled with phlebosclerosing solution. with simultaneous manual compression of the abdomen, the position of the catheter in the vein is controlled using ultrasonic duplex angioscanning "(RF patent for invention No. 2142741 from 20.12.1999).

The advantage of this technique is the removal of the vein from the circulatory system without traumatizing it.

However, this method has the following disadvantages:

1) preparations for sclerosing veins can cause an allergic reaction or local aseptic inflammation;

2) the entire vein is subject to sclerosis, regardless of the state of blood flow in it;

3) the state of blood flow in the sclerosed vessel is not taken into account, which can lead to a relapse of the disease due to vein recanalization or expansion of collateral veins.

Thus, it is required to develop a new method of sparing surgical treatment of varicose veins of the superficial veins of the lower extremities. In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to reduce the trauma of the operation and reduce the risk of recurrence in the surgical treatment of varicose veins of the superficial veins of the lower extremities.

The technical result of the method is to ensure ligation of veins in areas with unchanged blood pressure and dividing the superficial vein into several fragments without high blood pressure.

Implementation of the invention

The claimed technical result can be achieved as follows:

- After antiseptic treatment of the operating field, according to the method adopted in the hospital, an incision of the skin is performed, the isolation, intersection and ligation of the great saphenous vein in the groin area.

- After antiseptic treatment of the operating field, according to the method adopted in the hospital, the skin is incised and the distal part of the great saphenous vein (in the ankle) is isolated.

- From the distal incision, a flexible wire is inserted into the lumen of the great saphenous vein, equipped with a transducer for direct intraoperative pressure determination.

- The sensor is advanced antegrade to the site of ligation of the great saphenous vein, then it is slowly removed along the vein with a step of 5 mm and the pressure in the vein is determined at each point.

- If an increase in pressure of more than 8 mm Hg is detected, the vessel is ligated from the percutaneous access in the projection of the previous pressure measurement point.

- Pressure measurement and vessel ligation are continued until the transducer is completely removed through the distal incision. Skin wounds are sutured in layers.

The novelty of the proposed method lies in the fact that:

- for the first time used direct intraoperative measurement of pressure in the saphenous vein;

- for the first time, the varicosely changed large saphenous vein is divided into areas with normal venous pressure, which prevents the development of recurrence of varicose veins of the lower extremities due to the development of collaterals with increased pressure in the ligated section of the vein;

Distinctive features of the method:

- a transducer is inserted into the lumen of the vein antegradely to the ligation site for direct intraoperative pressure determination,

- the sensor is shifted distally along the vein with a step of 5 mm and the pressure in the vein is determined at each point,

- when the pressure increases over 8 mm Hg, the vessel is ligated from the percutaneous access in the projection of the previous pressure measurement point,

- measurement of pressure and ligation of the vessel is continued until the transducer is completely removed through the distal incision.

The proposed method is illustrated by the following examples.

Experimental implementation of the proposed technique was carried out on the basis of a surgical hospital - Clinic and polyclinic of the Tver State Medical University of the Ministry of Health of Russia, Tver (license No. FS-69-01-000780 dated April 23, 2015). The study plan was approved at a meeting of the ethics committee of the Tver State Medical University of the Ministry of Health of Russia. The study included 36 patients with varicose veins of the superficial veins of the lower extremities. All patients signed voluntary informed consent.

Table 1. Clinical examples of using the proposed technique

Example number Sensor shift step Pressure at the point of pressure rise Pressure at the previous measuring point Identified patterns one 3 mm It is impossible to determine the exact place of vessel ligation, because positioning error when puncturing the skin and subcutaneous tissue (thickness at least 2 mm) is at least 2-3 mm. 2 5 mm The ligation site is determined with an error of 2-3 mm, which is not critical with a sensor movement step of 5 mm 3 10 mm The pressure drop between adjacent points is 2-3 mm Hg, which reduces the accuracy of choosing a vein ligation site 4 8 mm Hg 8 mm Hg Normal vein pressure is 6-8 mm Hg five 9 mm Hg 8 mm Hg Ligation of the vessel takes place in the zone of normal pressure - there is no intensification of the development of collaterals 6 10 mm Hg 9 mm Hg Excessive pressure in the vein at the time of ligation leads to the intensive development of collateral circulation and the formation of a relapse of the disease. Complete removal of the vein is required.

Claims (1)

A method for the sparing surgical treatment of varicose veins of the superficial veins of the lower extremities, including the transection and ligation of the great saphenous vein in the groin region, the introduction of a flexible guide through the distal incision and ligation of the vein sections through the percutaneous approach, characterized in that a sensor is inserted into the lumen of the vein antegrade to the ligation site to direct intraoperative pressure determination, the transducer is shifted distally along the vein with a step of 5 mm and the pressure in the vein is determined at each point, with an increase in pressure of more than 8 mm Hg, the vessel is ligated from the percutaneous access in the projection of the previous pressure measurement point, pressure measurement and vessel ligation are continued until the transducer is completely removed through the distal incision.