Hybrid therapy of variceal disease: A retrospective clinical study

Abstract

The chronic venous disease presents a wide range of morphological and functional abnormalities of the venous system starting with telangiectasia up to venous ulcers. The authors describe possibilities of modern treatment procedures of variceal disease (combination of thermoablation techniques with sclerotherapy and local vein extirpation). Present study aimed to evaluate the results of treatment of variceal disease using thermoablation techniques combined with sclerotherapy and miniflebectomy of collateral varices. At our outpatient department and operating room, 457 performances in the venous system of the lower extremities were performed during a year and a half. From thermoablation options available the main venous trunk radio frequency was performed (VNUS closure fast) in 192 cases, and laser ablation (ELVES - 1470 nm) of the main venous trunk in 265 cases. After a comparison of both thermal ablation techniques for insufficiency treatment of the main venous trunk, the difference was not found. In the group of patients with sclerotherapy, the pain score was higher, mainly in sclerotherapy of great varicocele. In a group of patients with local varices extirpation, a higher number of hematomas was observed. Thermoablation techniques treatment for superficial venous insufficiency combined with sclerotherapy and miniflebectomy of collateral varices are safe and can be carried out under local anesthesia in an outpatient setting with good patient satisfaction and low complication rates. There are three main indications dominating in the treatment of varicosities of lower extremities. Firstly, the treatment is directed to the prevention of possible complications such as thromboses and prevention of ulcerations in lower limbs in the final stage. The second indication is to relieve the patient from ‘heavy legs’ feeling, swelling and convulsions. The third and no less important is the indication to procedure due to cosmetic reasons.