COMPREHENSIVE APPROACHES TO THE TREATMENT OF VARICOSE VEINS WITH SEVERE FORMS OF VENOUS INSUFFICIENCY

Abstract. Introduction. Venous ulcers, C6 according to the CEAR classification, affect approximately 1-2% of the population, with the prevalence increasing to 4% in people over 65 years of age. Conversely, milder forms such as C0s (symptoms only) are seen in approximately 9% of people, C1 (telangiectasias/reticular veins) in 26%, and C2 (varicose veins) in 19%. Given the low grade and level of evidence of the above recommendations, we decided to conduct our own small study to clearly demonstrate the significance of horizontal reflux, which should not be neglected in patients with terminal forms of venous insufficiency. Aim. Search for optimal approaches to the diagnosis and treatment of patients with severe forms of venous insufficiency using minimally invasive techniques and involving specialists of various profiles. Materials and methods. The study included 46 people. Patients were randomly divided into two groups: Group I (n=22) underwent only endovenous laser ablation (EVLA) of the ERW/MPV trunk, Group II (n=24) underwent the same endovenous laser ablation (EVLA) of the ERW/MPV trunk in combination with foam sclerosis with ethoxysclerol of 3% of the perforating veins or tributary network in the area of the ulcer bed. The frequency of healing after 24 weeks and the frequency of relapses after 12 months were studied. Results. Significantly better indicators for the healing rate (68.2% vs. 82.6%, HR -2.22; p=0.436) and relapse rate (13.6% vs. 8.7%, HR-0.6; p=0.958) in Group II. The dynamics of healing in both groups were approximately the same. It is worth noting that in patients of both groups who did not have complete healing of the ulcer, a significant decrease in its area was observed. Conclusions. Better results can be observed in terms of healing frequency in Group II, which indicates a large effect of horizontal reflux on the formation of trophic skin changes in patients with venous insufficiency. Also, foam sclerosis with ethoxysclerol 3% is a fairly effective method in the fight against horizontal reflux. In addition, the problem of venous trophic ulcers requires a comprehensive approach and the involvement of specialists from various fields.