Mini-invasive treatment of acute superficial varicothrombophlebitis of the lower extremities

Abstract

BACKGROUND: Conservative treatment of acute varicothrombophlebitis of superficial veins does not allow to achieve a significant reduction of venous thromboembolic complications. The discussion regarding the choice of method and method of treatment of these patients is constantly ongoing. The aim of the study was to improve the results of treatment of patients with acute superficial varicothrombophlebitis by introducing minimally invasive treatment methods. METHODS: The results of examination and minimally invasive surgical treatment of 53 patients with acute superficial varicothrombophlebitis treated between 2020 and January 2023 were analyzed. All surgical interventions were performed under constant ultrasound control. RESULTS: Acute superficial varicothrombophlebitis in the basin of the large saphenous vein was found in 48 (90.6%) patients, in the system of the small saphenous vein – in 2 (3.7%) and in the intersaphenous veins – in 3 (5.7%) patients. The length of the thrombotic lesion according to ultrasound data was from 3 to 12.5 cm, on average 5.7±1.7 cm. The surgical intervention consisted in the elimination of the thrombotic process in varicose superficial veins, endovasal laser coagulation (N.=35) or radiofrequency ablation (N.=18) femoral and upper third tibial segments, miniphlebectomy. During 1-2 years of observation, signs of recanalization of the femoral segment of the great saphenous vein, recurrence of varicose veins, venous thromboembolic complications and complications of a general nature were not detected in any patient. In the postoperative period, 41 (77.4%) patients had no signs of chronic venous insufficiency, and 12 (22.6%) patients had a significant regression of clinical symptoms. CONCLUSIONS: The implementation of minimally invasive methods of surgical treatment of acute superficial varicothrombophlebitis allows to effectively prevent venous thromboembolic complications, eliminate manifestations and prevent recurrence of varicose disease, completely eliminate or cause a significant regression of clinical manifestations of chronic venous insufficiency, and expand the indications for surgical intervention in patients with severe concomitant pathology.