ULTRASOUND NAVIGATION IN THE SURGICAL CORRECTION OF PATHOLOGICAL VENOUS REFLUXES IN CHRONIC VENOUS INSUFFICIENCY OF THE LOWER EXTREMITIES

Abstract. Introduction. Chronic venous insufficiency (CVI) of the extremities is an extremely important current problem from a medical, social and economic point of view due to the high prevalence of this pathology. In the pathogenesis of CVI, 4 main mechanisms play the greatest role: proximal obstruction in deep veins, valve failure in superficial veins, valve failure in deep veins, and perforating vein valve failure (PV). Current understanding of the pathogenesis of CVI indicates that the presence of pathological horizontal and vertical venous refluxes is one of the most important links in the complex chain of venous insufficiency. Despite the improvement of methods for diagnosing and treating chronic venous insufficiency of the lower extremities, this problem remains relevant and has not been fully resolved. Until recently, X-ray contrast phlebography was central to the diagnosis of valvular insufficiency of the venous system and its topical localization. its topical localization. The current standard examination of patients with chronic venous disease is ultrasound duplex examination. Aim. Improving the results of treatment of patients with chronic lower extremity vein diseases with signs of post-thrombophlebitic syndrome by developing a modern diagnostic algorithm and new treatment technologies. Materials and methods. The study was based on the results of surgical treatment of 102 patients with PTFD of the lower extremities in the decompensated stage of CVI who had not been operated on before. Common to all patients was the presence of trophic disorders of the soft tissues of the lower leg of varying severity (C4-6 class according to the SEAR) and insufficiency of the perforating veins of the lower leg, detected during the examination. Depending on the method of eliminating low horizontal veno-venous discharge, patients were divided into two groups: the main group and the comparison group. A prerequisite was an ultrasound comprehensive examination of the veins of both lower extremities. The diagnostic algorithm necessarily included an assessment of changes in blood flow under the influence of functional tests to evaluate the patency of the segment under study, the functional capacity of the valve apparatus. The presence of complications in the early and late postoperative period, the length of hospital stay, and the duration of surgery were also assessed. Research results and discussion. According to the results of ultrasound duplex scanning with color Doppler mapping (CDM), the most frequently failed perforating veins were found in the Cockett zone and in the middle third of the lower leg. The nature of the combined venectomy in the system of the great saphenous vein (GSV) and the small saphenous vein (SSV), performed in combination with dissection of perforating veins (PV), was determined individually in each case. The choice of surgical access was determined depending on the localization of failed PVs and the prevalence of soft tissue DVT, which were determined on the basis of ultrasound duplex angioscopy (USDA) of the lower extremity veins. All stages of surgical treatment in both groups were performed under ultrasound navigation in the “4-hand” mode, which frees the surgeon’s hands during surgery. The surgical treatment of patients in the comparison group was combined and consisted of simultaneous endoscopic dissection of failed PVs and various modifications of phlebectomy and sclerotherapy. Conclusions. The paper presents data on the solution of an urgent scientific and practical problem of modern surgery – improvement of treatment outcomes in patients with decompensated forms of chronic venous insufficiency in post-thrombophlebitic disease through the use of differentiated pathogenetically based surgical tactics based on ultrasound navigation data in the preoperative, intraoperative and postoperative stages of patient management.