Prospects and peculiarities of the procedure of ultrasound ablation of subcutaneous veins of the lower limbs

Savrasov G.V.¹, Gavrilenko A.V.^2,3, Borde A.S.¹, Ivanova A.G.², Fedorov D.N.², Arakelyan A.G.²

1) Department of Biomedical Engineering Systems, Moscow State Technical University named after N.E. Bauman (National Research University),
2) Department of Vascular Surgery, Russian Research Centre of Surgery named after Academician B.V. Petrovsky,
3) First Moscow State Medical University named after I.M Sechenov under the RF Ministry of Public Health, Moscow, Russia

The last decade has seen active development of minimally invasive (endovenous) methods of surgical removal of lower limb varicose veins (LLVV); however, the problem of increasing efficacy of these methods and improving long-term results still remains of current importance. The authors of this work propose a method of ultrasound ablation of subcutaneous veins of lower extremities.

Our experimental study was aimed at determining the pattern of venous wall damage after ultrasound exposure. Samples of segments of the trunk of the great saphenous vein (GSV) were divided into 5 groups: group 1 – the control group, group 2 – treatment with a sclerosant in the amount of 0.3 ml for 30 s, group 3 – treatment with ultrasound at a frequency of 26 kHz and amplitude 40 μm and 0.3-ml sclerosant for 30 s, group 4 – exposure to ultrasound at a frequency of 26 kHz and amplitude 40 μm and 0.3-ml sclerosant for 60 s, group 5 samples were exposed to ultrasound at 26 kHz and amplitude of 40 μm for 60 s.

The results of analysing the histological sections of the samples of the 2^nd and 3^rd groups demonstrated that the degree of alteration in the GSV wall on combined exposure to ultrasound and a sclerosant was 4.5-fold higher as compared with treatment with a sclerosant solution alone. During ultrasound exposure, the maximum temperature of the venous wall of group 5 samples was by 20°C higher than in samples of group 4. Analysing the histological sections demonstrated a similar pattern of structural alterations of the samples of group 4 and 5, thus suggesting a possibility of controlling the temperature of the venous wall during ultrasound ablation without changing quality of structural lesions.

The obtained findings showed a possibility of initiating irreversible dystrophic alterations in the venous wall on exposure to ultrasound by means of combining the mechanisms of chemical, mechanical, and thermal ablation.

KEY WORDS: lower limb varicose veins, endovenous ablation, ultrasound surgery, minimally invasive surgery.

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