Methods of operative interventions in postthrombotic disease of the crus

Sultanov D.D., Azizov A.A., Kamolov A.N.
Department of Vascular Surgery Republican Scientific Centre for Cardiovascular and Thoracic Surgery
Dushanbe, Tajikistan

Analysed herein are the findings of examination and outcomes of surgical management of 43 patients presenting with crural postthrombotic disease. Of these, eighteen patients were diagnosed as having stage II chronic venous insufficiency (CVI) and the remaining 25 had stage III CVI. All the patients had previously experienced acute thrombosis of deep crural veins. Eight patients had developed thrombosis during or in the immediate terms after typhoid fever, seven women in the postpartum period, and a further four women after endured operations on the organs of the abdominal cavity or small pelvis. Twelve patients had developed thrombosis after a blunt injury of the limb. In a further 12 cases, the causes of thrombosis coujinot be revealed or traced properly, thus having remained unknown. The disease duration varied form twelve months to nine years.

Venous haemodynamics was studied by means of duplex scanning and phlebography, with the latter used if indicated. The prevailing role in making appropriate diagnosis was found to belong duplex scanning. Thirty-one patients were subjected to combined surgical procedures.

Twelve subjects underwent single-stage operations. The main stage of the intervention in combined surgery consisted in resection of the anterior tibial vein and dissection of communicating veins of the medial surface of the crus according to the Savelyev-Konstantinova's technique; phlebectomy was performed on the crus only.

The remote period was marked by a decrease in the CVI's severity, i.e., transition to a lesser-severity degree in eighteen patients (41.9%), while in twenty-five cases (58.1%) CVI remained at the baseline level. Totally, positive results were obtained in forty patients (93.0%). Three patients (7.0%) initially presenting with grade C5-6 CVI and subjected to single-component operations were found to have poor outcomes.

Surgical correction of the venous blood flow does by no means cure the patient but appears to result in persistent remission of the disease, with adequate rehabilitation after surgery leading to considerable regression of CVI.

KEY WORDS: chronic venous insufficiency (CVI), postthrombotic disease, diagnosis, surgical management.

P. 93

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