Year 2014 Vol. 22 No 5

GENERAL AND SPECIAL SURGERY

B.S. SUKOVATUKH, M.B. SUKOVATUKH

THE APPROACH TO THE TREATMENT OF INCOMPETENT PERFORATING VEINS IN PATIENTS WIH THE LOWER LIMB VARICOSE VEINS

SBEE HPE “Kursk State Medical University”,
The Russian Federation

Objectives. To study the correlation of the blood refluxes and on its basis to substantiate the approaches in treatment of incompetent perforating veins in patients with the lower limb varicose disease.
Methods. The analysis of the integrated examination and treatment of 181 patients suffering from varicose veins (CEAP class C3-C6) has been conducted. All patients were divided into two groups. 106 (58,6%) patients with class C3 were enrolled into the first group. The second group included 75 (41,4%) patients with class C4-C6. Duplex ultrasound is being performed to determine localization, intensity and extension of blood refluxes in the venous system of the affected limb.
Results. In 75,5% of patients with class C3 (the 1st group) the moderate intensive superficial blood reflux along the great saphenous vein in the thigh and upper third of the leg resulted to the incompetence of solitary perforating veins has been revealed. In 88% of patients with class C4-C6 (the 2nd group) a superficial blood reflux of high intensity extended from the groin until the malleolus. The reflux was considered to be responsible for the multiple perforating incompetence. Deep venous reflux in the 1st group of patients was noticed only in 10,4%.
It was of low intensity without any negative impact on perforating veins. Incompetence of deep vein valves in the 2nd group was detected in 36% of patients. It was clear that in 22,7% of patients a deep reflux was of high intensity caused the multiple incompetence of perforating veins.
Conclusion. The incidence of the venous reflux in perforating veins is considered to be directly depended on the intensity of blood reflux in superficial and deep veins. The higher occurrence of reflux expression, the more incidences of incompetent perforating veins has revealed.

Keywords: varicose veins, blood refluxes, perforating incompetence, surgical treatment
p. 553-559 of the original issue
References
  1. Launois R, Le Moine JG, Lozano FS, Mansilha A.Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res. 2012 Aug;21(6):1051–8.
  2. Savel'ev VS, Gologorskii VA, Kirienko AI. Flebologiia [Phlebology]. Moscow, RF: Meditsina, 2001. 664 p.
  3. Ignat'ev IM, Bredikhin RA. Varikoznaia bolezn'. Sovremennye aspekty problemy [Varicose veins. Current aspects of the problem]. Vestn Khirurgii im Grekova. 2004;163(4):105–109.
  4. Zolotukhin IA, Bogachev VIu, Kuznetsov AN, Kirienko AI. Nedostatochnost' perforantnykh ven goleni: kriterii i chastota vyiavleniia [Insufficiency of the perforating veins tibia: criteria and incidence of detection rate]. Flebologiia 2008;(1):21–26.
  5. Vincent JR, Jones GT, Hill GB, van Rij AM.Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency. J Vasc Surg. 2011 Dec;54(6 Suppl):62S–9S.e1-3.
  6. Kirienko AI, Zolotukhin IA, Bogachev VIu, Andriiashkin AV, Kuznetsov AN. Otdalennye rezul'taty endoskopicheskoi disektsii perforantnykh ven goleni pri khronicheskoi venoznoi nedostatochnosti [Long-term results of endoscopic dissection of perforating leg veins in chronic venous insufficiency]. Angiologiia i Sosud Khirurgiia.2007;13(2):68–72.
  7. Sukovatykh BS, Sukovatykh MB, Belikov LN, Rodionov OA. Vybor sposoba miniinvazivnogo lecheniia vysokogo veno-venoznogo refliuksa krovi po bol'shoi podkozhnoi vene u bol'nykh s varikoznoi bolezn'iu ven nizhnikh konechnostei [Option of minimally invasive treatment method of high veno-venous blood reflux in the great saphenous vein in patients with varicose disease of the lower extremities]. Vestn Khirurgii. 2012;171(2):29–33.
  8. Iarich AN, Briushkov AIu, Karalkin AV, Zolotukhin IA. Nedostatochnost' perforantnykh ven pri varikoznoi bolezni: patogeneticheskoe znachenie i metody korrektsii [Insufficiency of the perforating varicose veins: pathogenetic role and methods of correction]. Flebologiia. 2010;(4):29–36.
  9. Zolotukhin IA, Karalkin AV, Iarich AN, Seliverstov II, Kirienko AI. Otkaz ot dissektsii perforantnykh ven ne vliiaet na rezul'tat flebektomii u patsientov varikoznoi bolezn'iu [Refusal of dissection of perforating veins not affect the result of phlebectomy in patients with varicose disease]. Flebologiia. 2012;(3):16–19.
  10. Al-Mulhim AS, El-Hoseiny H, Al-Mulhim FM, Bayameen O, Sami MM, Abdulaziz K, Raslan M, Al-Shewy A, Al-Malt M.Surgical correction of main stem reflux in the superficial venous system: does it improve the blood flow of incompetent perforating veins? World J Surg. 2003 Jul;27(7):793–96.
  11. Mendes RR, Marston WA, Farber MA, Keagy BA.Treatment of superficial and perforator venous incompetence without deep venous insufficiency: is routine perforator ligation necessary? J Vasc Surg. 2003 Nov;38(5):891–95.
  12. Zolotukhin IA, Karalkin AV, Iarich AN, Kirienko AI. Otsenka funktsii perforantnykh ven goleni pri varikoznoi bolezni s pomoshch'iu metodiki radionuklidnoi flebografii [The estimation of the leg perforating veinsfunction with varicose disease using the of radionuclide venography]. Flebologiia. 2011;(2):14–17.
  13. Sukovatykh BS, Sukovatykh MB, Belikov LN, Rodionov OA. Miniinvazivnoe lechenie vysokogo venovenoznogo refliuksa krovi po bol'shoi podkozhnoi vene u bol'nykh varikoznoi bolezn'iu ven nizhnikh konechnostei [Minimally invasive treatment of high blood of veno-venous reflux of the great saphenous vein in patients with varicose disease of the lower extremities]. Annaly Khirurgii. 2010;(4):60–65.
  14. Rossiiskie klinicheskie rekomendatsiipo diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical guidelines for the diagnosis and treatment of chronic venous disease]. Flebologiia. 2013;(2):6–47.
  15. Pokrovskii AV, Gradusov EG, Ignat'ev IM, Akhmetzianov RV. Vosstanovlenie klapannoi funktsii glubokikh ven pri varikoznoi bolezni nizhnikh konechnostei [Restoration of valve function of deep veins with varicose disease of the lower extremities]. Angiologiia i Sosud Khirurgiia. 2014;20(2):80–89.
Address for correspondence:
305041, Rossiyskaya Federatsiya,
g. Kursk ul. K. Marksa 3,
GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet»,
kafedra obschey khirurgii,
tel.: (4712) 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE “Kursk State Medical University”.
Sukovatykh B.S. PhD, an associate professor of the general surgery chair of SBEE HPE “Kursk State Medical University”.
Contacts | ©Vitebsk State Medical University, 2007-2023