Online ISSN: 3007-0244,
Print ISSN:  2410-4280
THE ANALYSIS OF THE EFFECTIVENESS OF THE MODERN SURGICAL TREATMENT OF VARICOSE VEINS OF LOWER EXTREMITIES. REVIEW

The study of approaches to the treatment of varicose veins of lower extremities is an important task that allows assessing the immediate and long-term results of the operation, determining the probability of complications or recurrence of the disease, as well as personalizing treatment and improving the prophylaxis of the disease. Despite the fact that at present there is a significant amount of literature data on studies devoted to the treatment of varicose disease of lower extremities, both with the use of traditional phlebectomy, and with the use of modern minimally invasive surgical interventions (endovenous thermal ablation, ultrasound controlled foam sclerotherapy), the authors' views on approaches to the treatment of this category of patients remain controversial.

The purpose of this systematic review is to analyze research data on the types of surgical treatment of varicose veins of lower limbs, to determine its effectiveness and the probability of relapse of the disease.

Materials and methods. The study included full text publications in English and Russian on the treatment of varicose veins of lower extremities, over the past 15 years as well as publications with fundamental statements.

Results. As a result of the search, 576 sources were identified in the databases PubMed, Google Scholar, e-Library. After the screening 54 full-text scientific works were selected and included in the study.

Conclusions. The main types of surgical treatment of varicose veins are traditional phlebectomy (TF), endovenous thermal ablation (EVTA), ultrasound-guided foam sclerotherapy (UGST). Despite the availability of many techniques in the surgery of varicose veins of lower extremities, the specialists still do not have consistency and unified tactics. Works devoted to the hybrid treatment of varicose veins focus more on the combination of only two techniques while the range of the modern phlebology’s capabilities are much broader as well as the technology develops every day. Most importantly, the role of hybrid treatment in the planning and prevention of recurrence of the disease is not defined. In our opinion, the study of traditional methods should be continued and new approaches in the treatment of varicose veins should be developed. Particular attention should be given to the use of hybrid treatment as well as to the comparison of results of traditional types of operations.

Farkhad T. Adylkhanov, http://orcid.org/0000-0002-4806-9408

Aleksandr B. Fursov, http:// orcid.org/0000-0002-6992-8646

JSC “Astana Medical University”,

Department of General Surgery,

Astana, Kazakhstan,

1.         Andriyashkin A. V. Diagnostika i lechenie retsidiva varikoznoi bolezni nizhnikh konechnostei (Kand.Diss.) [Diagnosis and treatment of varicose veins of lower extremities. Cand Diss.]. Moskva, 2007, 137 p. [in Russian]

2.         Zhukembaeva A.M., Abdrazakov S., Amerkulova A., Anasova Zh., Mukai R., Sarsenova M., Tleubergenov A., Beisembekov K., Sadyrbaeva A., Sultan B. KhVN Pri varikoznoi bolezni nizhnikh konechnostei. Patogenez. Lechenie [Chronic venous insufficiency at varicose veins of lower extremities]. Vestnik Kaz NMU [Kaz NMU messenger], 2015, №1, pp. 170-172 [in Russian]

3.         Ignat'ev I.M., Bredikhin R.A. Posleoperatsionnye retsidivy varikoznoi bolezni [Postoperative recurrence of varicose veins]. Angiologiya i sosudistaya khirurgiya (prilozhenie). [Angiology and vascular surgery (attachment)] 2003, № 3, pp. 120-122. [in Russian]

4.         Kirgizbaev S.Zh. Vybor optimal'nogo sposoba khirurgicheskogo lecheniya varikoznoi bolezni nizhnikh konechnostei (Kand. Diss.) [Selection of optimal treatment of varicose veins of lower extremities. Cand. Diss.]. Almaty, 2010, 290 p. [in Russian]

5.         Lyzikov A.N., Skuratov A.G., Osipov B.B. Sovremennaya khirurgiya varikoznoi bolezni nizhnikh konechnostei [Modern surgery of varicose veins of lower extremities]. Problemy zdorov'ya i ekologii [Problems of health and ecology], 2009. №1. pp. 7. [in Russian]

6.         Nurakhmanov B.D., Izbasarov R.Zh., Karataev N.T. kompleksnoe lechenie varikoznogo rasshireniya ven nizhnikh konechnostei [Combined treatment of varicose veins of lower extremeties]. Vestnik KazNMU [Kaz NMU messenger]. 2015, №1, pp. 203-204. [in Russian]

7.         Pokrovskii A.V., Saplekin S.V. Khronicheskaya venoznaya nedostatochnost' nizhnikh konechnostei sovremennye problemy diagnostiki, klassifikatsii, lecheniya [Current problems of diagnosis, classification and treatment of chronic venous insufficiency of lower extremities]. Angiologiya i sosudistaya khirurgiya. [Angiology and vascular surgery], 2003, № 1, pp. 53-58. [in Russian]

8.         Chernukha L.M., Guch A. A. Khirurgiya neoslozhnennykh form varikoznoi bolezni — udel innovatsionnykh tekhnologii ili patogeneticheski obosnovannogo podkhoda? [Surgery of uncomplicated forms of varicose veins -matter of innovative technologies or a pathogenetically grounded approach]. Klіnіchna flebologіya. [Clinical phlebology]. 2008, 1, pp. 42-45. [in Russian]

9.         Chernukha L.M., Guch A.A., Nikul'nikov P.I., Vlaikov G.G. Innovatsionnye tekhnologii v lechenii varikoznoi bolezni nizhnikh konechnostei [Innovative technologies in the treatment of varicose veins of lower extremities]. Klіnіchna khіrurgіya [Clinical surgery], 2007, № 2-3, pp. 123- 124. [in Russian]

10.     Shevchenko Yu.L., Stoiko Yu.M., Mazaishvili K.V. Lazernaya khirurgiya varikoznoi bolezni: monografiya. [Laser surgery of varicose veins: monograph]. Moskva, 2010. pp. 120-121. [in Russian]

11.     Baraldi C., Carelli M., Rinaldi F. Hybrid techniques for treatment of varicose veins: combined new and conventional technologies. International journal of cardiology. 2011, N 147, pp. 56

12.     Biemans A.A., Kockaert M., Akkersdijk G.P., van den Bos R.R., de Maeseneer M.G., Cuypers P., Stijnen T., Neumann M.H., Nijsten T. Comparing endovenous laser ablation, fo am sclerotherapy, and conventional surgery for great saphenousvaricoseveins. Journal of vascular surgery. 2013, N. 58(3). pp. 727-34.

13.     Bootun R., Davies A.H. Long-term follow-up for differentvaricose veintherapies: is surgery still the best? Phlebology. 2016, N 31(1 Suppl), pp.125-9.

14.     Cavallini A., Marcer D., Ferrari Ruffino S. Endovenous laser treatment of groin and popliteal varicose veins recurrence. Phlebology. 2017. Jan 1:268355516687865. [E-pub ahead of print]. Accessed 29.01.2017 URL: http://journals.sagepub.com/doi/pdf/10.1177/0268355516687865

15.     Christenson J.T., Gueddi S., Gemayel G., Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. Journal of Vascular Surgery. 2010, N 52(5), pp. 1234-1241.

16.     Chen C.H., Chiu C.S., Yang C.H. Ultrasound-guided foam sclerotherapy for treating incompetent great saphenous veins--results of 5 years of analysis and morphologic evolvement study. Dermatologic Surgery. 2012, N 38(6), pp. 851-7.

17.     Department of Health and Social Security. Hospital episode statistics 2002/2003. London: DHSS, 2003. 12 p.

18.     Flessenkämper I.H., Stenger D., Hartmann M., Hartmann K., Roll S. Two-year results of a prospective randomised controlled multicenter trial to compare open operative therapy vs. endoluminal venous laser therapy with and without high ligation for the therapy of varicose greater saphenous vein. Zentralblatt Fur Chirurgie. 2015, Feb. N 140(1), pp. 27-34.

19.     Gauw S.A., Lawson J.A., van Vlijmen-van Keulen C.J., Pronk P., Gaastra M.T., Mooij M.C. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. Journal of vascular surgery. 2016. N 63(2), pp. 420-8.

20.     Gloviczki P., Comerota A.J., Dalsing M.C., Eklof B.G., Gillespie D.L., Gloviczki M.L., Lohr J.M., McLafferty R.B., Meissner M.H., Murad M.H., Padberg F.T., Pappas P.J., Passman M.A., Raffetto J.D., Vasquez M.A., Wakefield T.W., The care of patients with varicose veins and associated chronic venous diseases: clinical practice guideline of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery. 2011, N 53. pp. 2-48.

21.     Hayden A., Holdsworth J. Complications following reexploration of the groin for recurrent varicoseveins. Annals of The Royal College of Surgeons of England. 2001, N 83, P. 272–273.

22.     Harlander-Locke M., Jimenez J.C., Lawrence P.F., Derubertis B.G., Rigberg D.A., Gelabert H.A. Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries. Journal of Vascular surgery. 2013. N58. pp. 166-172.

23.     Izumi M., Ikeda Y., Yamashita H., Asaoka Y., Fujishiro M., Shin M., Abo Y. Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe SaphenousVaricose Veinsin Japanese Patients. International heart journal. 2016. N 57(1). pp. 87-90.

24.     Jibiki M., Miyata T., Futatsugi S., Iso M., Sakanushi Y. Effect of the wide-spread use of endovenous laser ablation on the treatment ofvaricose veinsin Japan: a large-scale, single institute study. Laser Therapy. 2016, N 25(3). pp. 171-177.

25.     Kalteis M., Adelsgruber P., Messie-Werndl S., Gangl O., Berger I. Five-year results of a randomized controlled trial comparing high ligation combined with endovenous laser ablation and stripping of the great saphenous vein. Dermatologic surgery. 2015, N 41(5), pp. 579-586.

26.     Lynch N.P., Clarke M., Fulton G.J. Surgical management of great saphenous vein varicose veins: A meta-analysis. Vascular. 2015, N 23(3), pp. 285-296.

27.     Liu Y., Yang W.B., Cao G. Endovenous laser ablation versus conventional surgery for great saphenous varicose veins:meta-analysis of randomized trials. Zhonghua Yi Xue Za Zhi. 2013, N 18;93(23), pp. 1822-1826.

28.     Mallick R., Raju A., Campbell C., Carlton R., Wright D., Boswell K., Eaddy M. Treatment Patterns and Outcomes in Patients with Varicose Veins. American Health & Drug Benefits. 2016, N 9(8), pp. 455-465.

29.     Mozafar M., Atqiaee K., Haghighatkhah H., Taheri M.S., Tabatabaey A., Lotfollahzadeh S. Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results. Lasers in medical science. 2014, N29(2). pp. 765-71.

30.     Mendes C.A., Martins A.A., Fukuda J.M., Parente J.B., Munia M.A., Fioranelli A., Teivelis M.P., Varella A.Y., Caffaro R.A., Kuzniec S., Wolosker N. Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don’t tell, they won’t know. Clinics (Sao Paulo). 2016, N71(11), pp. 650–656.

31.     Murad M.H., Coto-Yglesias F., Zumaeta-Garcia M., Elamin M. B., Duggirala M. K., Erwin P.J., Montori V.M., Gloviczki P. A systematic review and meta-analysis of the treatments of varicose veins. Journal of Vascular Surgery. 2011, May. N53(5 Suppl), pp. 49S-65S.

32.     Nandhra S., El-sheikha J., Carradice D., Wallace T., Souroullas P., Samuel N., Smith G., Chetter I.C. A randomized clinical trial ofen do venous laser ablation versus conventional surgery for small saphenous varicose veins. Journal of vascular surgery. 2015, N. 61(3), pp. 741-6.

33.     Nesbitt C., Eifell R.K., Coyne P., Badri H., Bhattacharya V., Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. The Cochrane Database of Systematic Reviews. 2011, Oct. N5(10), CD005624.

34.     Nesbitt C., Bedenis R., Bhattacharya V., Stansby G., Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices (Review). The Cochrane Database of Systematic Reviews - Cochrane Library. 2014, N 30, (7) CD005624.

35.     Oğuzkurt L. Endovenous laser ablation for the treatment of varicose veins. Diagnostic and interventional radiology. 2012, N 18(4). pp.417-22.

36.     O'Donnell T.F., Balk E.M., Dermody M., Tangney E., Iafrati M.D. Recurrence ofvaricose veinsafter endovenous ablation of the great saphenousveinin randomized trials. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2016, N 4(1), pp. 97-105.

37.     Pan Y., Zhao J., Mei J., Shao M., Zhang J. Comparison of endovenouslaserablation and high ligation andstrippingforvaricosevein treatment: a meta-analysis. Phlebology. 2014, N 29(2), pp.109-19.

38.     Pittaluga P., Chastanet S., Rea B., Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein.Journal of Vascular surgery. 2009, N 1, pp. 107–118.

39.     Rass K., Frings N., Glowacki P., Hamsch C., Gräber S., Vogt T., Tilgen W. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study). Archives of dermatology. N 148(1), pp. 49-58.

40.     Rabe E., Guex J.J, Puskas A., Scuderi A., Fernandez Quesada F. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. International Angiology. 2012, N 31, pp. 105-115.

41.     Ran F., Shi Y., Qiao T., Shang T., Liu Z., Liu C. J. Comparison of foam sclerotherapy alone or combined with stripping of the great saphenous vein for treating varicose veins. Dermatologic surgery. 2017, N. 43, pp. 541-547

42.     Robertson L., Evans C., Fowkes F.G. Epidemiology of chronic venous disease. Phlebology. 2008, N 23(3), pp. 103-111.

43.     Rustempasic N., Cvorak A., Agincic A. Outcome of endovenous laser ablation of varicose veins. Acta Informatica Medica. 2014, N22(5), pp. 329-32.

44.     Samuel N., Carradice D., Wallace T., Mekako A., Hatfield J. Randomized clinical trial of endovenouslaserablation versus conventional surgery for small saphenous varicose veins. Annals of surgery. 2013, N 257(3), pp.419-26.

45.     Sharad Sawant, Bhosale Dattatray, Anil Keskar Comparative Study of Endovenous Laser Ablation over Conventional Surgery of Varicose Veins of Lower Limbs. International Journal of Science and Research (IJSR). N4(11). 2015, pp. 552-554

46.     Siribumrungwong B., Noorit P., Wilasrusmee C., Attia J., Thakkinstian A. A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. European Journal of Vascular and Endovascular Surgery. 2012, N44(2). pp. 214–223.

47.     Tabuchi A., Masaki H., Yunoki Y., Watanabe Y., Furukawa H., Yamasawa T., Takiuchi H., Honda T., Kuwada N., Kojima K., Tanemoto K. Positioning for Endovenous Laser Ablation: Comparative Study with ThighStripping. Annals of vascular deseases. 2016. N 9(3). P. 154-159.

48.     Tellings S.S., Ceulen R.P., Sommer A. Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature. Phlebology. 2011, N 26(5). pp. 179–184.

49.     Uruski P., Aniukiewicz K., Mikuła-Pietrasik J., Sosińska P., Tykarski A., Książek K., Krasiński Z. Endovenous Laser Ablation ofVaricose VeinsPreserves Biological Properties of Vascular Endothelium and Modulates Proinflammatory Agent Profile More Favorably Than Classic Vein Stripping. Bio Med Research International. 2017, 6, pp. 167-480.

50.     Van Den Bos R., Arends L., Kockaert M., Neumann M., Nijsten T. Endovenous therapies of lower extremity varicosities: A meta-analysis. Journal of Vascular Surgery. 2009. N 49, pp. 230–239.

51.     Van DerVelden S.K., Pichot O., Van Den Bos R. R., Nijsten T. E., De Maeseneer M. G. Management strategies for patients with varicose veins (C2-C6): results of a worldwide survey. European journal of vascular and endovascular surgery. 2015, N49(2), pp. 213-220.

52.     Winterborn R.J., Earnshaw J.J. Crossectomy and great saphenous vein stripping. The journal of cardiovascular surgery (Torino). 2006, N 47(1), pp, 19-33.

53.     Yin H., He H., Wang M., Li Z., Hu Z., Yao C., Wang J., Wang S., Chang G. Prospective Randomized Study of Ultrasound-Guided Foam Sclerotherapy Combined with Great Saphenous Vein High Ligation in the Treatment of Severe Lower Extremity Varicosis.Annals of vascular surgery. 2017, N 39, pp. 256-263.

54.     Zi-Yuan Zhao, Xiu-Jun Zhang, Jun-Hai Li, Mei Huang Comparison of high ligation and stripping of the great saphenous vein combined with foam sclerotherapy versus conventional surgery for the treatment of superficial venous varicosities of the lower extremity. International Journal of Clinical and Experimental Medicine. 2015, N 8(5), pp. 7843–7848.

Number of Views: 1312


Category of articles: Reviews

Bibliography link

Adylkhanov F.T., Fursov A.B. The analysis of the effectiveness of the modern surgical treatment of varicose veins of lower extremities. Review. Nauka i Zdravookhranenie [Science & Healthcare]. 2017, 2, pp. 128-143.

Авторизируйтесь для отправки комментариев