MANAGEMENT OF MINIINVASIVE TREATMENT OF PRIMARY VARICOSE SUPERFICIAL VEINS.

OBJECTIVE: The aim: Determination of the optimal method for surgical correction of stages C2-C6s varicose superficial veins. PATIENTS AND METHODS: Materials and methods: The treatment results of 228 patients with stages C2-C6 of primary varicose according to the CEAP classification using thermal and non-thermal treatment methods were analyzed. RESULTS: Results: All patients underwent operations under the control of ultrasound scanning. In patients after EVLA, total trunk obliteration was detected in 148 patients (98.7%) after 1 week, and in 100% after a year. In 2 patients, reflux was diagnosed in the PDSV and in the ZDSV after 1 week. In patients after RFA, inflow reflux on the leg was in 1 patient (5.2%), in others - complete obliteration (18 patients - 94.7%). In patients after MOCA, recanalization was performed in 5 patients (19.2%) with a control ultrasound investigation after 1 month. In patients after cyanoacrylate obliteration, inflow reflux on the leg after 1 month was in 2 patients (14.2%). In patients who underwent UGS of the GSV trunk, 5 patients (33.3%) had persistence of pathological reflux after 1 month with control ultrasound. All corrections were performed using Foam form sclerotherapy. CONCLUSION: Conclusions: EVLA is the most effective method of treating varicose veins and gives the best long-term results. The advantage of non-thermal methods is the lack of influence on paravenous structures and no need for tumescent anesthesia, which is important in case of an allergic history. After applying cyanoacry¬late, there is no need for mandatory compression. The advantage of foam scleroobliteration is its lowest cost among all methods. Foam sclerotherapy was the method of choice for correction of postoperative treatment.

LATE RESULTS OF TREATING PATIENTS WITH OCCLUSIVE-STENOTIC LESIONS OF THE AORTA INFRARENAL SEGMENT'S MAIN ARTERIES.

OBJECTIVE: The aim: To analyze the results of surgical treatment in the late postoperative period after using modern types of surgical technologies for occlusive-stenotic atherosclerotic lesions of the infrarenal aorta's main arteries. PATIENTS AND METHODS: Materials and methods: The total of 420 patients were operated on. The patient's age ranged from 45 to 87 years (in the mean, 66.7±2.3 years). Men pre¬dominated - 375 (89.29%), and women were 45 (10.71%). According to the ischemia classification by Rutherford - 324 (77%) patients fell under categories 4, 5, 6 of the classification. 98 patients were operated on by the open method, 243 by the endovascular method, and 79 by the hybrid method. We assessed such indices as: postoperative thrombosis, limb amputations, mortality, and repeated operations performed due to complications or unsuccessful results of the primary operation. RESULTS: Results: It was ascertained, a decrease in the number of postoperative complications from 7.87% to 4.39% (t=2,11, p=0,035), repeated operations - from 7.87% to 4.39% (t=2,11, p=0,035), amputations - from 3.63% to 2.19% (t=1,24, p=0,214) and mortality - from 3.03% to 1.09% (t=2,03, p=0,042) in the group where in-depth examination methods were applied, a treatment algorithm based on individual anatomical and hemodynamic features was implemented, techniques for performing operations were improved. CONCLUSION: Conclusions: The analysis of late results of surgical interventions showed that the largest number of complications was found in the group of patients with multistory occlusive-stenotic lesions of arteries.

CLINICAL OUTCOMES AND COMPLICATIONS OF ENDOVASCULAR SURGERY IN PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA.

OBJECTIVE: The aim: To review the results of endovascular treatment in patients with chronic threatening ischemia of lower extremities as well as to assess the level of complications developed after the use of modern endovascular technologies. PATIENTS AND METHODS: Materials and methods: 243 patients with occlusive-stenotic lesions of major arteries of infrarenal aorta, operated on by various endovascular techniques, were studied. 51 of them (20.98%) had multi-level lesions. All experimental group patients (83) were thoroughly evaluated preoperatively including assessment of probable development of arterial thrombosis of affected extremity after the surgery. Besides, endovascular treatment algorithm developed and introduced by the authors on the basis of individual anatomical and hemodynamic parameters was used. RESULTS: Results: Thrombosis was the major early postoperative complication in both study groups, being registered in 21 patients (10.6%). The incidence of thrombosis was statistically higher in the control group as compared to experimental group - 11.53% and 7.14%, respectively (p<0.05). 15 patients of both groups underwent amputations - 12 patients (7.5%) in the control group, and 3 patients (3.6%) in experimental group. Early postoperative mortality rate was 2.56% in the control group, while there were no deaths in experimental group in early postoperative period. CONCLUSION: Conclusions: Continuous ultrasound monitoring, avoidance of subintimal positioning of endovascular devices, use of rotary-mechanical thromboaspiration, drug-coated balloons and stents, regional thrombolytic therapy, as well as the concept of angiosome-directed therapy used in the study for restoration of artery patency, made it possible to improve treatment outcomes and decrease complications.