DEFINITION OF THE VOLUME OF MINIMALLY INVASIVE SURGERY IN PATIENTS WITH VARI-COSE VEINS OF THE LOWER EXTREMITIES IN STAGE C4-C6 (CEAP) WITH AFFECTION OF SA-PHENIC VEINS

Currently duplex ultrasound vessels scanning is a “gold standard” of diagnostics of varicose veins. At the same time, the other methods of diagnostics lose their importance gradually. In our opinion duplex ultrasound vessels, scanning could be prospective for differential approach in choosing of the volume of minimally invasive surgery in this kind of patients. The aim of study was to work out a way for measure-ment of the volume of minimally invasive surgery in patients with varicose veins of the low extremities in stage C4-C6 according to CEAP with affection of saphenic veins by performing of ultrasound diagnostics before operation. Materials and methods. The 56 patients were enrolled into study. There were 36 (64.3%) women and 20 (35.7%) men. Their average age was 47.3±2.4 years. Inclusion criteria were follow: varicose veins of the low extremities in stage C4-C6 CEAP with affection of the saphenic veins which was confirmed by instrumental methods; absence of thrombosis of deep veins of the low extremities; absence of obliterating diseases of aorta, pelvic and the low extremities arteries; concomitant chronic pathology without significant manifestation; coagulation system without any pathological deviation. Complete clinical and laboratory examination was per-formed to all the enrolled patients. Duplex ultrasound vessels scanning of low extremities veins was conducted to them. It was performed with using of device Philips EnVisor HD (USA) equipped by linear sensor 7-10 MHz and by convex sensor 3.5-5 MHz. The volume of minimally invasive surgery was measured in accordance to author's method (Patent of Ukraine Nr. 102115). Ultrasound control was made in 1, 3, 6 and 12 months after surgery. Results. Among examined patients C4 stage was de-tected in 24 (42.9%) cases, C5 – in 18 (32.1%) cases, C6 – in 14 (25%) cases. All the patients had expressed lipodermatosclerosis in the middle and lower third of tibia. During the ultrasound examination, before surgery re-flux flow was absent in 23 (41.1%) patients. Absence of the reflux in tributary veins pointed that reflux is located mostly on saphenic vein. Because of these data, volume of minimally invasive surgery was limited by radiofrequency ablation of great saphenous vein trunk. Other 33 (58.9%) patients had independent reflux on tributaries veins of great saphenous vein. It pointed on necessity to combine radiofrequency ablation of great saphenous vein trunk and miniphlebectomy. During control ultrasound examinations that were per-formed in 1, 3, 6 and 12 months recurrence of the disease was found out in one (1.8%) patient on 6th month after performing of radiofrequency ablation without miniphlebectomy. Recurrence manifested by appearance of solitary varicose node. It was decided to remove it by foam scleroobliteration. Conclusions. The proposed way of measurement of minimally invasive surgery volume in patients with varicose veins low extremities in stage C4-C6 CEAP with affection of saphenic veins permits to avoid traumatic miniphlebectomy without rising of recurrent varicose disease frequency.