Comparative Characteristics of Endothelial Dysfunction After Endovascular Laser Vein Ablation and Classical Saphenectomy for Varicose Veins of the Lower Extremities

The objective: to assess the endothelial dysfunction after classical saphenectomy and endovenous laser ablation. Materials and methods. 100 patients (68 women and 32 men) who were operated on for varicose veins of the lower extremities C2-C4 according to the CEAP classification were under observation. According to the age classification of the World Health Organization, the age of the patients was from 25 to 44 years (young age). Patients with diseases that could affect the level of endothelial dysfunction were excluded from the study, in particular: coronary heart disease, metabolic cardiomyopathy, cerebrovascular diseases, diffuse connective tissue diseases, diabetes, rheumatoid arthritis. Depending on the type of operation, all patients were divided into two groups: 1st group – 60 patients who underwent endovenous laser ablation (EVLA), 2nd group – 40 patients who underwent classic saphenectomy. 30 healthy persons are included in the control group. By age and clinical classification the patients in the groups were comparable. Dysfunction was evaluated by determining the level of markers of endothelial dysfunction: P selectin, E-selectin, tissue plasminogen activator, endothelin-1, vascular endothelium type 1 adhesion molecule, circulating endothelial cells. These indicators were studied in 100 patients (1 day before surgery, 10 and 60 days after surgery). Results. According to the results of the study, in the early postoperative period (the 10th day) the levels of markers of endothelial dysfunction, namely P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, sVCAM, circulating endothelial cells were higher than before surgery. In the late postoperative period (the 60th day) the levels of the above-mentioned markers decrease, but remain somewhat higher than before the operation. The fact of an increased markers of endothelial dysfunction in different periods of the postoperative period after classic saphenectomy compared to EVLA was established. Conclusions. 1. The level of endothelial dysfunction is higher after classic saphenectomy, and the inflammatory response after EVLA was less compared to classic saphenectomy, which is also evidenced by statistically significant lower values of sVCAM-1. 2. Existing endothelial dysfunction in the postoperative period requires correction with the help of multicomponent drug therapy.