Prospective comparative study of remote results of surgical treatment of patients with varicothrombophlebitis

Tsarev O.A., Anisimov A.Yu., Prokin F.G., Mashchenko Yu.V., Lobanov A.V.

Saratov State Medical University named after V.I. Razumovsky under the Ministry of Public Health of the Russian Federation, Saratov, Russia

The authors examined the effect of the presence of undifferentiated connective tissue dysplasia (UCTD) on the clinical course of lower-limb varicose veins (LLVV) and acute varicothrombophlebitis (AVTP) in patients after the Troyanov-Trendelenburg operation.

We carried out a prospective comparative study of the remote results during three years after the Troyanov-Trendelenburg operation in a total of 132 patients suffering from AVTP. The Study Group included 67 patients found to have more than four phenotypic traits of UCTD, thus suggesting the presence of UCTD. The Comparison Group consisted of 65 patients with no signs of UCTD.

During three-year follow up, relapses of AVTP were diagnosed in 22 (32.8%) patients of the Study Group and in 5 (7.7%) patients of the Comparison Group (p<0.01). In four (6.0%) patients with UCTD, the thrombus propagated to the perforating veins of the crus, new danger of pulmonary embolism arose, and emergency phlebectomy was required. Thrombosis of the femoral vein was revealed in eight (11.9%) patients of the Study Group, and being free-floating in two (3.0%) of them, it was the cause of pulmonary embolism. They were subjected to plication of the external iliac vein. No thromboses of deep veins were revealed in the Comparison Group patients.

Phlebectomy was performed in 57 (85.1%) patients of the Study Group and in 14 (21.5%) patients of the Comparison Group (p<0.01) due to remaining vertical and horizontal pathological venous reflux. Fifty-one (78.5%) patients of the Comparison Group six months after the Troyanov-Trendelenburg operation were found to have spontaneous restoration of the functional competence of the valvular apparatus of the perforating veins with elimination of the horizontal venous reflux, which predetermined regression of clinical manifestations of varicose veins, with no phlebectomy required.

A conclusion drawn is that the clinical course of LLVV on the background of UCTD after the Troyanov-Trendelenburg operation is distinguished by predisposition to progression of chronic venous insufficiency and is characterised by a relapsing pattern of AVTP. Therefore, surgical policy, as well as medicamentous treatment after disconnection of the saphenofemoral junction in patients with AVTP should be decided upon with due regard for the phenotypic signs characterising UCTD.

KEY WORDS: varicose veins, varicothrombophlebitis, Troyanov-Trendelenburg operation, surgical policy, undifferentiated connective tissue dysplasia.

P. 85

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