[Comprehensive outpatient treatment of varicose disease of the lower limbs].Angiol Sosud Khir. 2008; 14(2):91-4.AS
The article deals with the findings obtained in examining a total of 8,000 people presenting with varicose disease of the lower extremities. The examination included a clinical (physical) examination and coloured duplex scanning of the lower-limb veins. The examination was carried out in outpatient conditions, whereas surgical treatment was performed either out-patiently, or at a <<one-day>> hospital. Revealing complete valvular insufficiency of the great saphenous vein was followed by surgical treatment - intraoperative stem catheter scleroobliteration (SSO) or short-term screening and postoperative puncture sclerotherapy. Detecting partial valvular insufficiency of the greater saphenous vein (pathological sapheno-femoral reflux only in the vertical position) was managed by applying the principle of the so-called <<incremental radicalism>>: i. e. the patients were subjected to the procedure of puncture sclerotherapy of varicose veins on the crus in ambulatory conditions to be followed by secondary ultrasonographic scanning with permanent dynamic follow-up. The cases of preserved reflux along the greater saphenous vein were subjected to sclerosurgical management. Valvular insufficiency of perforating veins was coped with by minimally invasive surgical interventions: subtotal endoscopic dissection of incompetent perforating veins, suprafascial ligation from a miniaccess and echosclerotherapy of the perforating veins. Also performed were histological and histochemical studies of the portions the greater saphenous vein and surrounding tissues procured during cross-ectomy of the sapheno-femoral anastomosis in 43 patients, who had endured preliminary puncture sclerotherapy on the crus. Good functional and cosmetically pleasing outcomes were achieved in the majority of cases. In 75% of the patients with partial valvular insufficiency of the greater saphenous vein, we managed to avoid operations since repeat ultrasonographic study revealed no pathological veno-venous shunts.