COMPRESSION THERAPY AFTER OPEN SURGERY OF VARICOSE VEINS OF THE LOWER EXTREMITIES
Introduction. Currently, the duration of compression therapy after open phlebectomy for varicose veins of the lower extremities has not yet been finally determined. There is no data on the need for prolonged use of compression hosiery for more than 1 week after open stripping or miniflebectomy to increase the treatment effect, as there is none on the uselessness of prolonged compression.
Purpose of the study. To conduct a study to determine the optimal duration of compression therapy after open phlebectomy.
Research Methods. To conduct the study, a scientific hypothesis was formed - wearing compression hosiery before resorption of hematomas and normalizing the color of the skin after an open phlebectomy is sufficient in terms for the frequency of local complications, swelling of the legs and disability. Two groups of patients were randomized. The first group of patients, or comparison group, consisted of patients whose compression therapy after open phlebectomy was 2 months. The second group of patients, or the study group, consisted of patients with a term of compression therapy before resorption of hematomas and normalization of skin color after open phlebectomy of the lower extremities. Criteria for inclusion in the study: C2 - C3 class according to CEAP chronic venous insufficiency (CVI) of the lower extremities; severe, multiple varicose veins of the great saphenous vein (GSV) or small saphenous vein (SSV) and their branches; previously transferred thrombophlebitis of GSV / SSV; crossectomy and stripping of GSV / SSV.
Results. The term of compression therapy in the 1st group of patients was 62.486 days (95% CI 62.099-62.873), in the 2nd group of patients 31.790 days (95% CI 31.559-32.021) (Log Rank = 5.005; p = 0.025). The period of disability in the 1st group of patients was 16.528 days (95% CI 16.169-16.888), in the 2nd group of patients 16.760 days (95% CI 16.508-17.012) (Log Rank = 1.083; p = 0.298).
Conclusions. Compression therapy after an open phlebectomy is enough to carry out during the resorption of subcutaneous hematomas, the visual disappearance of bruises and the normalization of the color of the skin for a period of, on average, up to 1 month.
Altay A. Dyussupov1, http://orcid.org/0000-0003-0875-1020
Yernur M. Kazymov1, http://orcid.org/0000-0002-4849-6549
Bekzhan S. Bulanov1, http://orcid.org/0000-0001-8091-9663
Merei N. Imanbaev1, http://orcid.org/0000-0002-7248-0440
Yerlan А. Salmenbayev1, https://orcid.org/0000-0001-6571-1645
Azhar A. Dyussupova1, http://orcid.org/0000-0002-8857-4118
Baktybala B. Dyussupova1, https://orcid.org/0000-0002-2658-4839
Kadylbek T. Abylkhairov1, http://orcid.org/0000-0001-6002-1020
1 NCJSC "Semey Medical University", Semey, Republic of Kazakhstan
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2. Beebe-Dimmer J., Pfeifer J., Engle J., Schottenfeld D. The Epidemiology of chronic venous insufficiency and varicose veins // Ann Epidemiol. 2005; 15(3). С.175-184. https://doi.org/10.1016/j.annepidem.2004.05.015
3. Eklof B., Rutherford R., Bergan J., Carpentier P.H., Gloviczki P., Kistner R.L., Meissner M.H., Moneta G.L., Myers K., Padberg F.T., Perrin M., Ruckley C.V., Smith P.C., Wakefield T.W. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: Consensus statement // J Vasc Surg. 2004; 40(6):1248-1252. https://doi.org/10.1016/j.jvs.2004.09.027
4. Huang T.W., Chen S.L., Bai C.H., et al. The optimal duration of compression therapy following varicose vein surgery: a meta-analysis of randomized controlled trials // Eur J Vasc Endovasc Surg 2013; 45:397.
5. Lawaetz M., Serup J., Lawaetz B., Bjoern L., Blemings A., Eklof B., Rasmussen L. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT // Int Angiol. 2017;36(3):281-288.
6. Rabe E., Pannier F. Clinical, aetiological, anatomical and pathological classification (CЕАР): «gold standard» and limits // Phlebology: The Journal of Venous Disease. 2012;27 (suppl 1) :114-118. https://doi.org/10.1258/ phleb.2012.012s19
7. Rabe E., Puskas A., Scuderi A., Fernandez Quesada F. VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program // Int. Angiol. 2012;31(2):105-115.
8. Rabe E., Partsch H., Hafner J., Lattimer C., Mosti G., Neumann M., Urbanek T., Huebner M., Gaillard S., Carpentier P. Indications for medical compression stockings in venous and lymphatic disorders: an evidence-based consensus statement // Phlebology: The Journal of Venous Disease. 2017; 33(3), С.163-184. https://doi.org/10.1177/0268355516689631
9. Rasmussen L., Lawaetz M., Bjoern L., Vennits B., Blemings A., Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins // British Journal of Surgery. 2011;98(8):1079-1087. https://doi.org/10.1002/bjs.7555
10. Reich-Schupke S., Feldhaus F., Altmeyer P., Mumme A. Stucker M. Efficacy and comfort of medical compression stockings with low and moderate pressure six weeks after vein surgery // Phlebology: The Journal of Venous Disease. 2014; 29(6):358-366.
11. Robertson L., Evans C., Fowkes F. Epidemiology of chronic venous disease // Phlebology: The Journal of Venous Disease. 2008; 23(3): 103-111. https://doi.org/10.1258/phleb.2007.007061
12. Schoenfeld D.A. Sample-Size Formula for the Proportional-Hazards Regression Model // Biometrics, 1983. - Volume 39, pages 499-503.
References:
1. Stojko Ju.M., Kirienko A.I., Zatevakhin I.I., Pokrovsky A.V., Karpenko A.A. s soavt. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniyu khronicheskikh zabolevanii ven [Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases]. Flebologiya [Phlebology]. 2018. №3. pp. 146-240. [in Russian]
2. Beebe-Dimmer J., Pfeifer J., Engle J., Schottenfeld D. The Epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005; 15(3) : 175-184. https://doi.org/10.1016/j.annepidem.2004.05.015
3. Eklof B., Rutherford R., Bergan J., Carpentier P.H., Gloviczki P., Kistner R.L., Meissner M.H., Moneta G.L., Myers K., Padberg F.T., Perrin M., Ruckley C.V., Smith P.C., Wakefield T.W. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: Consensus statement. J Vasc Surg. 2004; 40(6):1248-1252. https://doi.org/10.1016/j.jvs.2004.09.027
4. Huang T.W., Chen S.L., Bai C.H., et al. The optimal duration of compression therapy following varicose vein surgery: a meta-analysis of randomized controlled trials. Eur J Vasc Endovasc Surg. 2013; 45:397.
5. Lawaetz M., Serup J., Lawaetz B., Bjoern L., Blemings A., Eklof B., Rasmussen L. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol. 2017;36(3):281-288.
6. Rabe E., Pannier F. Clinical, aetiological, anatomical and pathological classification (CЕАР): «gold standard» and limits. Phlebology: The Journal of Venous Disease. 2012; 27 (suppl 1) : 114-118. https://doi.org/10.1258/ phleb.2012.012s19
7. Rabe E., Puskas A., Scuderi A., Fernandez Quesada F. VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int. Angiol. 2012;31(2):105-115.
8. Rabe E., Partsch H., Hafner J., Lattimer C., Mosti G., Neumann M., Urbanek T., Huebner M., Gaillard S., Carpentier P. Indications for medical compression stockings in venous and lymphatic disorders: an evidence-based consensus statement. Phlebology: The Journal of Venous Disease. 2017; 33(3) : 163-184. https://doi.org/10.1177/0268355516689631
9. Rasmussen L., Lawaetz M., Bjoern L., Vennits B., Blemings A., Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. British Journal of Surgery. 2011; 98(8): 1079-1087. https://doi.org/10.1002/bjs.7555
10. Reich-Schupke S., Feldhaus F., Altmeyer P., Mumme A. Stucker M. Efficacy and comfort of medical compression stockings with low and moderate pressure six weeks after vein surgery. Phlebology: The Journal of Venous Disease. 2014; 29(6):358-366.
11. Robertson L., Evans C., Fowkes F. Epidemiology of chronic venous disease. Phlebology: The Journal of Venous Disease. 2008; 23(3): 103-111. https://doi.org/10.1258/phleb.2007.007061
12. Schoenfeld D.A. Sample-Size Formula for the Proportional-Hazards Regression Model. Biometrics, 1983. - Volume 39, pages 499-503.
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Дюсупов А.А., Казымов Е.М., Буланов Б.С., Иманбаев М.Н., Сальменбаев Е.А., Дюсупова А.А., Дюсупова Б.Б., Абылхаиров К.Т. Компрессионная терапия после открытой хирургии варикоза нижних конечностей // Наука и Здравоохранение. 2020. 2(Т.22). С. 86-92. doi 10.34689/SH.2020.22.2.010Похожие публикации:
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