ELABORATION AND FIRST APPLICATION OF ENDOVENOUS ELECTRIC WELDING DURING VARICOSE VEIN DISEASES TREATMENT

The endovenous laser coagulation (EVLK) and radiofrequency ablation (RFA) are leading methods of venous reflux elimination during the treatment of lower extremity varicose vein disease (VVD). Nevertheless, the experts had to search for a new method of endovenous obliteration due to the number of unresolved methodological issues related to the choice of operative measure and optimal parameters of energy impact, the high prime cost of equipment and materials. We have proposed the endovenous electric welding (EVEW), as the best solution. It was developed based on electric welding of living tissues. The experts, having conducted the experimental and clinic-based studies during 2015 – 2017 years at the Department of Surgery and Vascular Surgery of the Shupyk National Medical Academy of Postgraduate Education, determined that the EVEW provides the controlled impact resulting in electro-thermal occlusion and further fibrous transformation (FT) of the great saphenous vein (GSV). It has been established that, EVEW in manual mode is no less effective, than EVLK, but has a perfect control algorithm, which is accompanied by much lower heating of tissues and fewer complications. The further improvement of the specialized purpose-built endovenous tool has determined the chances of EVEW application in automatic mode. Objective. To study the effectiveness of EVEW in au-tomatic mode and determine the early and distant results of the clinical use of this method in the treatment of VVD. Results. The impact of EVEW in automatic mode caused the occlusion of GSV because of spasm and connection of denatured protein elements of the venous wall and blood. The experts made a note of interrelation between the electrical pa-rameters of welding and the impedance of the venous wall tissue at different stages of structural changes. The venous wall tem-perature was 55 – 75°C during the working cycle (5 – 12 se-conds). The working cycle ended automatically at the time of development of the initial signs of the venous wall coagulation. There was no carbonization. According to the morphological analysis, the alteration of the venous wall was extending to the endothelial layer and subendothelial layer without damage of paravasal fatty tissue. During the surgical interference, all the patients had the occlusion development of target parts of GSV. There were no burns of the skin. The postoperative pain of majority patients (%) did not exceed 3 points (moderate pain). 35 (97,2%) patients had satisfactory final anatomical results in the form of FT of target parts of GSV. Only 1 (2,8%) patient had recanalization of GSV of hip. The ecchymosis and paresthesia occurred in 13 (36.1%) and in 7 (19.4%) patients, and their regression was noted in the period between 7 and 14 days respectively. There were no burn, thrombophlebitis and inflammatory infiltrates in any cases. Conclusions. The application of EVEW in automatic mode has an effective impact, resulting in electro-thermal occlu-sion of GSV. The control algorithm, based on interrelation between the electrical parameters of welding and the impedance of the venous wall tissue provides a low level of paravasal tissues heating, reduces the incidence of complications and excludes the negative impacts of human factors on treatment outcomes.