During last years, ultrasound duplex angioscanning (USD) gives opportunity to get the most complete information respecting the venous pathology and is used as a method of navigation during conducting of endovascular manipulations. Purpose of research — to study the ultrasound changes in the thrombosed vein before and after the influence of endovascular high-frequency electric welding and to evaluate the effectiveness of the method in the complex surgical service of acute ascending thrombophlebitis of the GSV. During the period from 2015 to 2017 in the surgical departments of the city clinical hospital №8 in Kyiv there were 38 patients with acute ascending thrombophlebitis of the great saphenous vein (AATGSV), who were treated with endovascular electric welding (EVEW). The age ranged from 19 to 78 years (average age 51.28±2.63 years). According to the international classification of CEAR (Clinical Etiological Anatomical Pathophysiological), C2 was noted in 6 (15.8%) patients, C3 — in 13(34.2%), C4 — in 7(18.4%), C5 — in 9(23.7%), C6 — in 3 (7.9%). All patients was treated with ultrasound duplex angiography (USD) using TOSHIBA Nemio XG (Japan), equipped with a convex sensor with an operating frequency of 3.5–5 MHz and a linear sensor with the range of 7.5–12 MHz. Domestically produced electric welder “Swarmed” EK-300М1 were used as a feeding device “Swarmed” EK-300М1. In manual mode, 15 sec. Parametric methods were used for statistical processing of the received results. Average arithmetic meanings (M), standard error of arithmetic mean (m) were calculated. The authenticity of the differences were evaluated using the Student`s criterion. Differences were recognized as statistically significant in p <0,05. Electric welding of the thrombosed vein segment was performed using an endovascular electric welding catheter (EC). With ultrasound examination of the thrombosed vein segment with acute ascending thrombophlebitis of the GSV the average diameter of the vein to effect by EVEW was 9.6±0.4 mm. Multiple hyperechogenicity thrombotic masses were visualized in the vein lumen. On the first day after the EVEW, the diameter of the GSV was increased by 1.3 times and averaged was 12.2±0.4 mm (p<005). The diameter of the vein increased due to the edema of the venous wall after the EVEW. After 1 month, the vein decreased in diameter significantly compared to the previous indicator and its average diameter was 7.4±0.5 mm (p<005), the vein lumen had a hypoechogenic character. After the 3 months period, compared to the 1 month after the EVEW, the vein diameter continued to decrease to 4.7±0.5 mm (p<005). After 6 months from the moment of the EVEW, the diameter of the vein was even more reduced compared to the period of 3 months — 2.4±0.4 mm (p<005). After the period of 1 year or more duplex ultrasound picture showed the completion of the process of obliteration with total vein ablation. In the observation period of 3-6 months, the occurrence of GSV repatency was observed for 3 (7,89%) patients. The ultrasound picture in the thrombosed vein after the endovascular high-frequency electric welding undergoes changes from anechogenic, hypoechogenic to echogenic character, reflects the occlusion process, obliteration and total ablation of the vein.

The aim of the study was to conduct a comparative evaluation of the effectiveness of surgical treatment of acute ascending thrombophlebitis of the great saphenous vein using the endovascular high-frequency welding technique and traditional phlebectomy. Materials and methods: Two groups were formed in the conducted study. Group I included patients (n=42) with the acute ascending thrombophlebitis of the great saphenous vein, in whom their thrombosed great saphenous vein was removed using the endovascular high-frequency welding technique. As a source of current, an EK300M1 Svarmed electric welding machine (Ukraine) was used. Electric welding of a thrombosed vein segment was carried out using the endovenous electric welding catheter. Group II included patients (n=31) with the acute ascending thrombophlebitis of the great saphenous vein, who underwent the traditional phlebectomy of the thrombosed great saphenous vein according to Babcock’s technique. Results: In group I no patient revealed presence of pain syndrome with significant intensity during the postoperative period. An infiltrate along the coagulated segments of the great saphenous vein, postoperative oedema and paresthesiae were observed in considerably fewer cases from group I versus group II (р=0.0005, р=0.0001, р=0.0018). During their follow-up for more than 12 months, 2 (4.76 %) of 42 patients from group I revealed partial recanalization of the great saphenous vein (р=0.632). In group I the postoperative inpatient period was 1.3±0.1 days. In group II the above period averaged 4.8±0.8 days (p<0.001). Absence of an intense pain syndrome in group I was caused by a gentle effect of high-frequency electric current itself on the venous wall and paravasal structures. A significant reduction of side effects and complications with a shorter stay of patients in hospital versus the traditional phlebectomy was achieved owing to reduction in the extent of injury of the surgical operation itself with the use of endovascular high-frequency welding. Conclusions: The technique of endovascular high-frequency welding in treatment of acute ascending thrombophlebitis of the great saphenous vein makes it possible to reduce the extent of injury of the surgical operation versus the traditional phlebectomy, results in a significant decrease in the number of side effects and complications and shortens the period of the patient’s stay in hospital.

The aim — to study morphological and ultra‑sonic changes in the thrombosed magistral vein after the high‑frequency endovascular electric welding and to determine the effectiveness of the method for the acute ascending thrombophlebitis treatment.Materials and methods. Surgical treatment of 52 male and female patients with acute ascending thrombophlebitis of the great subcutaneous vein was performed in the surgical departments during the period from 2016 to 2018, in which the endovenous high‑frequency electro welding with the EK300M Svarmed (Ukraine) apparatus was done. Their age ranged from 19 to 78 years old (average age — 51.28 ± 2.63 years). С2 stage was registered for 4 patients, С3 — for 19, С4 — for 13, С5 — for 9, С6 — for 7 according to the international CEAR (Clinical Etiological Anatomical Pathophysiological) classification. The morphological study of sections was carried out. Photos were archived with the light optical microscope Zeiss (Germany) and the Axio Imager. A2 data processing system. Ultrasonic duplex angioscanning was carried out by the Toshiba Nemio XG (Japan) device with a curvilinear transducer with at working frequency of 3.5 — 5 MHz and a linear transducer in the range of 7.5 — 12 MHz. The ultrasound examination was performed in 2 — 7 days after the surgery, the remote results were evaluated in 3.6.12 months.Results and discussion. A morphological study of vein preparations revealed homogenization of thrombotic masses in the vein’s lumen, a close connection of the latter with the treated vessel wall. In most cases, the thrombotic masses totally obstructed the lumen of the vein. All layers of the vein wall merged into a single homogeneous complex. With specific coloring on elastic fibers, their total destruction in the inner and middle layers, thinning and fragmentation of adventitia elastic fibers were revealed. Ultrasound examination showed complete occlusion of the great saphenous vein on the 2nd — 7th day in 49 (94.24 %) cases. Partial recanalization was detected after 3 — 6 months in 3 (5.76 %) cases, after 9 — 12 months in 2 (3.84 %) cases the partial hemodynamically insignificant recanalization was preserved according to color mapping. In 1 case (1.92 %) there was a complete, hemodynamically significant recanalization of the whole welded segment of the great subcutaneous vein. The analysis of ultrasonic testing showed that, despite the complete destruction of the entire vein wall, during the first days after the endovascular electric welding in 5.76 % of the welded great subcutaneous vein, areas of the wall blood flow were detected.Conclusions. Endovascular high‑frequency electrical welding of the thrombosed great subcutaneous vein for acute ascending thrombophlebitis causes complete destruction of the thrombotic masses and all layers of the vein wall; and in 94.24 % of cases it allows achieving a complete obliteration of the welded vein.

Introduction: Acute ascending thrombophlebitis (AAT) of the great saphenous vein (GSV) is one of the problems in modern surgery. The aim: Study of morphological and ultrasonic changes in a thrombosed vein following the influence of high-frequency endovenous electrical welding and assessment of the efficacy of application of this method to treatment of acute ascending thrombophlebitis. Materials and methods: During the period of 2016-2018, surgery departments of Kyiv City Hospital No. 8 provided surgical treatment for 52 male and female patients with AAT of the GSV, who underwent high-frequency endovenous electrical welding (EVEW) with help of an EK300M Svarmed apparatus. The patients’ age ranged from 19 to 78 years (their mean age was 51±2.63 years). According to the international CEAP (сlinical-etiological-anatomical-pathophysiological) classification, C2 was revealed in 4 cases, C3 in 19, C4 in 13, C5 in 9 and C6 in 7. Sections, prepared in compliance with standard methods, were morphologically examined. Photo archiving was made with use of a ZEISS light optical microscope (Germany) and «Axio Imager. A2» data processing system. Duplex ultrasonography (DUS) was performed with help of a TOSHIBA Nemio XG (Japan) device, equipped with a convex transducer having the working frequency of 3.5-5 MC and a linear transducer at a range of 7.5-12 MC. Ultrasonic studies were carried out 2-7 days after the operation. Remote results were assessed after 3, 6 and 12 months. Results: Morphological examinations of vein preparations after EVEW with standard haematoxylin-eosin staining revealed homogenization of thrombotic masses in the venous lumen and a close relationship of the veins with the treated vascular wall; in the majority of examined cases, thrombotic masses totally obliterated the venous lumen. All the layers of the venous wall – internal, middle and external – coalesced into a single homogenous complex. Specific staining on elastic fibers revealed their total destruction in the internal and middle coats, thinning and fragmentation of elastic fibers in the adventitia. Total occlusion of the GSV was observed sonographically in 49 of 52 cases (94.24%) on days 2-7 after the influence of EVEW. Within 3-6 months, 3 cases (5.76%) developed some partial recanalization. During 9-12 months, colour mapping revealed preservation of some partial and haemodynamically insignificant recanalization in 2 cases (3.84%). One case (1.92%) developed the complete and haemodynamically significant recanalization of the whole welded segment of GSV. Conclusion: Analysis of ultrasonic studies showed that despite the total destruction of the whole venous wall during the first days after the influence of EVEW there were areas of parietal blood flow in 5.76% of cases. During a remote period of follow-up from 3 to 6 months the above changes could develop partial and haemodynamically insignificant recanalization in 3.84% of cases. Within the period of follow-up from 9 to 12 months those areas of blood flow could lead to the complete and haemodynamically significant recanalization of the welded GSV in 1.92% of cases. High-frequency EVEW of the thrombosed GSV in AAT caused the total destruction of thrombotic masses and all layers of the venous wall and made it possible to achieve the total obliteration of the welded vein in 94.24 % of cases.

The aim: To analyze and evaluate the efficacy of CDLLV treatment, using high-frequency endovascular welding (EVW), endovenous laser coagulation (EVLC) and catheter microfoam echosclerotherapy. Materials and methods: We have treated 329 patients with CDLLV C2-C6 functional classes according to the Clinical Etiological Anatomical Pathophysiology. Of these, 102 patients had vertical reflux eliminated by EVW, in 112 – by EVLC, and in 115 – by catheter microfoam echosclerotherapy. Results: In the EVW group 3 patients (2.94%) had a partial recanalization of coagulated veins 3 months after the procedure. In EVLC group 2 patients (1.79%) also had partial recanalization group after 6 months. In the group of catheter microfoam echosclerotherapy partial recanalization occurred in 3 patients during 3 months of observation, in the period of 6 months – in 2, in the period of 12 months – in 9, in total – in 14 patients (12.17%). The EVW and EVLC methods showed high efficacy of vertical reflux elimination on the great and small subcutaneous veins (GSV/SSV) in CDLLV and have no fundamental differences in the immediate and long-term results of treatment. Microfoam catheter echosclerotherapy leads to a greater number of recanalisations, compared with EVW and EVLC. Conclusions: High-frequency endovenous welding results in complete fibrotic GSV/SSV transformation in 97.06% of patients. Endovascular laser coagulation results in complete fibrotic GSV/SSV transformation in 98.21% of patients. Elimination of vertical reflux by microfoam echosclerotherapy results in complete fibrotic GSV/SSV transformation in 87.83% of patients.