UA126617U - A METHOD FOR A Seamless obliteration of a large subcutaneous vein in case of varicose veins - Google Patents

Abstract

The method of seamless obliteration of the large subcutaneous vein in its varicose veins involves the introduction into the lumen of the subcutaneous vein of the probe with a gradual traction and step-by-step welding of the affected section of the vein. Surgical access at the level of the knee joint is performed, probes are introduced with a diameter and length according to the size of the affected vein section in the anti- and retrograde directions, welding is performed under tumescent anesthesia with a Klein solution.

Description

The useful model belongs to the field of medicine, in particular to surgery and can be used in the treatment of patients with insufficient venous circulation and deformed deep veins of the lower extremities.

Most often, in the treatment of varicose veins of the lower extremities, forced obliteration of these veins is used to stop blood flow through the affected veins. Previously, only surgical techniques were used for this, which involve removal or obliteration of the affected part of the vein.

In recent years, a well-known method for this procedure is the use of laser radiation, primarily in the infrared range of the spectrum (11). The principle of the method consists in the thermal effect on the inner surface of the veins. Absorption of laser thermal energy leads to local heating and destruction of vein walls, as a result of which certain zones of veins are obliterated, while blood circulation is partially or completely eliminated.

A classic diode laser for such laser coagulation (obliteration) has a wavelength of 0.96 μm. The laser radiation is absorbed directly by the blood, which quickly heats up and boils. Steam bubbles are created from the water fraction of the blood, which thermally affect the walls of the vessels and thus boil the walls of the veins throughout their thickness. But the temperature regimes significantly exceed those required for obliteration of blood vessels. A temperature above 100 "C leads to necrosis of all layers of the surgical wound. The international name of this operation is epadodepoiy Yazeg ariaiop (EMIA), i.e. endovenous laser ablation (EVLA) or endovenous laser coagulation (EVLK) or obliteration (EVLO).

To increase the efficiency of the EVLK method for irradiation, in recent years lasers on a niodymium crystal with a wavelength of 1.04 μm have been used. The maximum energy absorption of such a laser is also associated with blood. Under the influence of a light pulse, steam bubbles are formed in the blood. The thermal effect on the vein wall occurs due to the contact of the wall with the indicated bubbles. The disadvantage of this effect is damage to the endothelium and coagulation of proteins in the layers of the veins.

The latest generation of neodymium lasers for EVLK has a wavelength of 1.47 μm. At this wavelength, laser radiation acts directly on the vein wall, but not on the blood, so this wavelength is suitable for the largest venous trunks with a diameter of more than 10 mm.

Since the appearance of the EVLKUEVLO technique, there has been a tendency to increase the power of radiation energy. Early work was done with 10-15 W lasers. After establishing a direct relationship between the volume of created steam bubbles and the energy of laser radiation, the EVLK/EVLO operation is considered expedient to perform with a laser radiation power of up to 30-40 W (21.

Thus, EVLK/EVLO is a very high-tech operation that requires special expensive equipment and is performed under constant ultrasound control. In addition, there are certain contraindications to such laser coagulation, the electrodes used in EVLK are quite expensive. Therefore, a method of obliteration of blood vessels using radiation and oscillations in other spectral ranges was developed.

A well-known method of obliteration of veins using a generator of electrical oscillations of the EK type

ZOOM'1, developed by the Institute of Electric Welding named after E. 0. Paton IZ). The connection of tissues takes place without the use of suture material with minimal damage to organs on the basis of dosed modulated current, which is automatically generated depending on the impedance of the welded tissues. Usually, when using this method, for obliteration of blood vessels, the frequency of the EKV3-300 type generator is 66 or 440 kHz, the oscillation power is smoothly adjusted to the maximum, which is about 300 W. Generators with an operating frequency of 20-35 kHz are used for high-frequency dissection of living tissues.

There is a known method of obliteration of the great saphenous vein, which is chosen as the closest analogue, by high-frequency welding (|4|. The method includes ligation of the sapheno-femoral joint and the origins of the great saphenous vein, followed by the introduction of a probe into the lumen of the great saphenous vein along its entire length. Obliteration of the great saphenous vein of a subcutaneous vein is performed by high-frequency electric welding with the help of a probe of the original design, which contains an electrode device of a bipolar configuration. Obliteration of veins does not occur due to coagulation, but due to welding of the venous wall. The welding process on a separate segment of the vein takes place at a temperature of 55-65 "С during 1-2 seconds, the depth of heat exposure does not exceed 1 mm, which allows to minimize thermal damage to the surrounding tissues.

As a source of high-frequency current in the prototype (4), a multifunctional device for high-frequency electric welding of soft fabrics, type EKVZ-300, developed at the E.O. Paton Institute of Electric Welding of the National Academy of Sciences of Ukraine, was used. bipolar configuration for supplying high-frequency current to the electrodes located at its end. The method was developed in the process of experiments on individual removed large subcutaneous veins. In particular, the nature and optimal parameters of the effect of high-frequency current on the venous wall were studied. The clinical approbation of the method was performed on the basis of the Department of Surgery and vascular surgery

National Medical Academy of Postgraduate Education named after P.L. Shupyk and on patients of the department of phlebology of the Mo 8 city clinical hospital.

When using this method, there is a reliable obliteration of the large saphenous vein, a reduction in the trauma of surgical intervention, a reduction in the number of postoperative complications, and an improvement in the cosmetic effect of the treatment.

But the disadvantages of the prototype are the appearance in the lumen of the subcutaneous vein of a large amount of remnants of congealed blood in the form of layers of dark color, which causes inflammation at the site of the operation and increases the risk of thromboembolic complications. The probe is inserted into the lumen of the vein filled with blood, the skin is close to the vein wall, therefore the proposed method is not very convenient and there is a danger of thermal damage to it. A large surgical wound. The time of the operation increases, the healing of the wound slows down significantly, the cosmetic effect worsens, and the postoperative period is prolonged.

The useful model is based on the task of creating a method of seamless obliteration of a large saphenous vein in varicose veins by welding in the anti- and retrograde directions with probes of the appropriate size for the vein under tumescent anesthesia with a solution

Klein.

The method provides optimization of endovenous obliteration of the large saphenous vein due to more accurate positioning of the probes in the vein, reduction of the influence of the oil temperature on the surrounding tissues, which are not injured at the same time, the surgical wound is small and heals quickly, the indications for this intervention are expanded, the operation time is reduced, which gives positive cosmetic effect.

The task is solved by the fact that the method of seamless obliteration of the large saphenous vein in its varicose disease includes the introduction of a probe into the lumen of the saphenous vein with gradual traction and stepwise welding of the affected part of the vein and, according to a useful model, surgical access is performed at the level of the knee joint, probes with a diameter of and length

Depending on the size of the affected area of the vein in the anti- and retrograde directions, welding is performed under tumescent anesthesia with Klein's solution.

The method is carried out as follows.

Surgical access is performed at the level of the knee joint, probes are inserted into the lumen of the subcutaneous vein, the diameter and length of which correspond to the size of the affected area of the vein in anti- and retrograde directions under ultrasound control, with gradual traction and gradual welding of the vein along its entire length. Welding is performed under tumescent anesthesia with Klein's solution. The method is recommended for the loose type of structure of superficial veins in the stage of development of varicose veins, in which it is impractical to use a limited number of incisions (2-

From stage or uncompensated forms according to Saveliev).

A specific implementation example.

Patient N., 49 years old. She was admitted for examination with a diagnosis of "varicose disease of the subcutaneous veins" with a pronounced lesion of the left limb - stage 2.

After analysis of examination and examination data, a seamless obliteration operation of the large saphenous vein using high-frequency endovenous welding was recommended.

Under local infiltration anesthesia with Klein's solution, at the level of the knee joint on the anteromedial surface of the thigh, a longitudinal typical method (3 cm long) was isolated. After the crossing between the clamps, an electric welding button probe is inserted into the lumen of the vein proximal to the extremity. Control of the probe level is performed by palpating its oil. The proximal end of the probe is connected to the "Patonmed" device. Under ultrasound control, insufflation of the perivenous space with Klein's solution was performed with a special pump. In the mode of the "welding" device, the traction of the probe-electrode on itself at a speed of 5 mm per second performed ablation of a segment of the large subcutaneous vein, which was confirmed by ultrasound control. After removing the probe and directing it into the lumen of the segment of the vein distal to the limb, the electric welding button probe is inserted along the entire length of the lower leg to the level of the medial bone. Probe level control, high-frequency electric welding, Klein's solution insufflation, ultrasound control of vein ablation were performed in the same sequence as for the proximal segment. The wound is sutured in layers with 3 sutures. The necessary elastic compression of the hip, lower leg, and foot was performed.

The method was developed in the course of experiments on sections of the large subcutaneous vein. The optimal parameters of the high-frequency current were selected and analyzed, and its effect on the venous wall was studied.

Clinical approbation of the method was performed on 5 patients.

Reduced trauma, simplicity, efficiency and safety, by implementing the proposed method, create an opportunity for the wide implementation of this useful model in clinical practice.

Sources of information: 1. Sokolov A.L., Lyadov K.V., Stoyko Yu.M. Intravenous laser coagulation in the treatment of varicose veins. - M.: Medpraktika, 2007. - IZVM 978-5-98803-082-9. 2. Rioerziie TM, Moenpieg T, Si! 0, Negayeptapp 5. Epdomepoits igeaiitepi oi pe dgeai zarpepoiv5 meiip ivipd a 1,320 pt Ma:mAs |Iazeg saizev5 Ioueg vzide-eNesiv Shtap ivipd a 940 pt aiiode Iazeg.

I'm grumbling! 5th 2005, Oes.; 31 (12): 1678-83.

Z. Paton B.E. etc. The method of connecting soft biological tissues and the device for its implementation. Patent Mo 44805 C2 Ukraine, IPC AbЕ18В 17/00, publ. 16.09.2002, Bull. Mo. 9. 4. Palamarchuk V.I., Horbovets V.S., Khodos V.A., Balatskyi R.O., Bondarenko Yu.I. Method of obliteration of the great saphenous vein. Patent of Ukraine Mo 100169, IPC Ab1B 17/12, publ. 10.07.2015 Bull. Mo 13.

Claims (1)

- USEFUL MODEL FORMULA The method of seamless obliteration of a large saphenous vein in its varicose disease, which includes the introduction of a probe into the lumen of the saphenous vein with gradual traction and stepwise welding of the affected part of the vein, which is distinguished by the fact that surgical access is performed at the level of the knee joint, probes are inserted with a diameter and in length according to the size of the affected area of the vein in anti- and retrograde directions, welding is performed under tumescent anesthesia with Klein's solution. Zo