Surgical treatment of varicosity-altered tributaries of saphenous veins

Chernookov A.I., Kotaev A.Yu., Vakhratyan P.E., Nikolaev A.M., Berezko M.P., Dolgov S.I., Matvienko E.P., Lapa L.A., Chernykh E.S.

Chair of hospital Surgery No 2, Therapeutic Faculty, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

A total of 469 patients presenting with lower-limb varicose disease were operated on at Municipal Clinical Hospital No 79 of the Chair of Hospital Surgery No 2 of the I.M. Sechenov First Moscow State Medical University over the period from 2008 to 2011. The tributaries of varicose veins were removed by means of miniphlebectomy according to the Muller technique, the Narat technique, with the use of a cryoprobe and an original-design vein extractor. The main method of removing tributaries is currently miniphlebectomy by the Muller technique. However, removal of the tributaries over 10 mm in diameter by the Muller’s technique was associated with a skin tear in the site of the puncture, which healed with the formation of a hypertrophic scar. Miniphlebectomy of tributaries measuring less than 10 mm in diameter with the signs of previously endured phlebitis is accompanied, as a rule, by a rupture of the venous wall in the form of phlebosclerosis and a commissural process with the underlying cellular tissue. Phlebectomy by the Narat’s technique was predominantly performed for removal of short tributaries from the altered paravasal cellular tissue. The method of cryophlebectomy was used by means of intravasal or paravasal insertion of the probe. A vein extractor was used to remove the tributaries form the altered cellular tissue at a distance of up to 20 cm. The choice of an optimal method of treatment for varicosity-altered tributaries makes it possible to decrease the complications rate and to obtain good cosmetic outcomes.

KEY WORDS: varicose disease, cryostripping, miniphlebectomy, varicose tributaries.

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