Objective. To study the effectiveness of endovascular laser coagulation in patients with recurrent varicose veins in their lower extremities.Material and methods. Outcomes after the treatment of 54 patients with varicose vein relapses in the lower extremities were analyzed. Under the tumescent anesthesia, endovascular laser coagulation was made: in 5 patients – stump of the great saphenous vein; in 22 patients – recanalized, residual and preserved subcutaneous venous trunks; in 27 patients – insufficient communicating veins of the thigh and lower leg.Results and discussion. In average, surgery lasted for 31 ± 0.6 minutes; intensity of the postoperative pain syndrome was 3.4 ± 0.4 points. Early postoperative complications were registered in 1 (1.8 %) patient, side effects in the form of hyperpigmentation and paraesthesia – in 4 (7.4 %). In 12 months, all operated patients demonstrated an improvement in all parameters of their quality of life by 29.2– 40 %; cosmetic outcome after surgery was 7.8 points out of a ten-point scale. The long-term observation revealed the relapse in varicose veins only in 1 (1.8 %) patient.Conclusion. The justified use of endovasal laser coagulation in patients with relapses of varicose veins in the lower extremities allows to avoid manipulations in the area of scar-altered tissues, to reduce tissue damage and duration of surgery, to improve patients’ quality of life, to avoid additional incisions as well as to improve cosmetic outcomes after surgery.

РезюмеВведение. В настоящее время, несмотря на применение современных и высокотехнологичных методов оперативного лечения больных с варикозной болезнью и грыжами передней брюшной стенки, в отдаленном периоде рецидивы заболевания встречаются в 1,7-14% случаев. Сочетание послеоперационных рецидивов паховой грыжи и варикозной болезни является нечастой разновидностью множественной хирургической патологии. Клинический случай. В статье приводится клиническое наблюдение пациента с рецидивом варикозной болезни и паховой грыжи, перенесшего до поступления в клинику в общей сложности три оперативных вмешательства. Проведение детальной ультразвуковой диагностики позволило установить причину развития рецидива и разработать оптимальную хирургическую тактику с учетом индивидуальных особенностей заболевания и характера ранее перенесенных операций. Учитывая анатомическую близость и одностороннюю локализацию патологических процессов, пациенту выполнена симультанная операция из одного доступа. Через сутки уровень послеоперационной боли по визуально-аналоговой шкале составил 4,2 балла, в течение 2 послеоперационных суток больной для купирования болевого синдрома принимал анальгетики. Компрессионная терапия осуществлялась чулками второго функционального класса. Пациент покинул клинику на следующий день после вмешательства в удовлетворительном состоянии, предъявлял жалобы на незначительные боли в области операционной раны. Послеоперационный период протекал гладко, без осложнений. Боли, ограничение движения наблюдались в течение 4 дней после оперативного вмешательства. Шов снят на 7-е сутки после операции, рана зажила первичным натяжением. Заключение. Применение симультанной операции позволяет провести радикальную коррекцию обеих болезней, уменьшить психологическую нагрузку на больного, улучшить эстетический результат вмешательства, избежать тромботических осложнений и ущемления грыжи в послеоперационном периоде.

Aim: to justify the choice of the most optimal treatment method depending on the cause, and clinical and anatomical patterns of the varicose veins relapse. Patients and Methods: treatment results of 157 patients with varicose vein relapses were analyzed. The mean age of patients was 39,8±0,3 years. 3 years after surgery, relapse occurred in 23 (14.7%) patients, in terms of 3 to 5 years — in 95 (60.5%), after 5 years or more — in 39 (24.8%). Different treatment methods were used depending on the individual clinical and anatomical relapse form of varicose veins. Anesthesia choice depended on the type and extent of surgical intervention. Of the open access, 94 (59.9%) surgical interventions were performed, minimally invasive methods of treatment were used in 63 (40.1%) cases. The life quality was assessed at the patient's admission to the clinic and 1–2 years after the end of treatment using the CIVIQ-2 questionnaire. Results and Discussion: after the use of minimally invasive techniques, the average pain intensity on the VAS was 3.1±0.2, in patients who underwent open resurgeries — 5.4±0.3. Early postoperative complications were noted in 3 (1,9%) patients. Long-term treatment results were examined in 129 (82.2%) patients out of 157 included in the study within 12 to 24 months after discharge from the clinic. After performing open surgeries, the average value of the cosmesis index on a ten-point scale was 6.1±0.3 points, after minimally invasive interventions — 7.9±0.5. In the long-term period, the disease repeatedly recurred in 2 (1.6%) patients. It was also found that the use of the developed treatment tactics for patients with relapses of varicose veins leads to an improvement in the life quality parameters by 1,2–1,5 times. Conclusion: eliminating the causes of varicose disease relapse, minimizing the invasiveness of interventions improves immediate and long- term treatment results and the life quality of patients. The use of preoperative duplex angioscanning and modern high-tech treatment methods helps to reduce the relapse number of varicose veins associated with technical and tactical errors of surgeons. KEYWORDS: varicose vein relapses, minimally invasive interventions, open surgeries, life quality. FOR CITATION: Zubritskiy V.F., Chernookov A.I., Kuznetsov M.R. et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231 (in Russ.). DOI: 10.32364/2587-6821-2023-7-4-225-231.

Introduction. True doubling of great saphenous vein is observed in 1.6–2.1% of patients with varicose veins and may be one of the reasons for the development of postoperative relapse of the disease. Performing endovasal laser coagulation (EVLC) of both great saphenous vein trunks makes it possible to increase the radicality of the intervention and reduce the likelihood of a recurrence of varicose veins.Aim. Based on the study of immediate and long-term results, to substantiate the expediency of using EVLC of the main and true additional stem of great saphenous vein in patients with varicose veins.Materials and methods. From 2014 to 2020, 24 patients with a true doubling of great saphenous vein were treated. Among the applicants there were 12 women and 12 men aged 23 to 62 years with clinical class C2–C4 according to the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification. All patients under tumescent anesthesia underwent simultaneous EVLC of the main and accessory trunk of the BPV, followed by miniflebectomy or sclerobliteration of varicose tributaries.Results and discussion. The use of simultaneous coagulation of both trunks was performed by all patients, thus the technical success of the operation was observed in 100% of cases. There were no intraoperative complications. The use of such a volume of intervention is accompanied by an increase in the duration of the operation by 29.3%. Hyperpigmentation in the projection of the coagulated trunk was observed in 2 (8.3%) patients, neurological disorders – in 1 (4.2%) patient. During the examination of patients 1–2 years after the operation, no relapses of the disease were detected, and the cosmetic result of the intervention on a ten-point scale, patients on average estimated at 7.6 points.Conclusions. True doubling of the great saphenous vein is rare and may increase the likelihood of relapses of the disease. EVLC of the main and additional BPV trunks is accompanied by an increase in the duration of surgery by an average of 29.3%, and the number of patients with hyperpigmentation by 1.5 times. Simultaneous EVLC of both tables with true duplication of BPV makes it possible to reliably block a potential source of varicose disease recurrence and reduce the likelihood of recurrent veins.

A clinical case of simultaneous laser obliteration in a patient with recurrent varicose veins and a Baker’s cyst is presented. As has been demonstrated, simultaneous laser obliteration of varicose veins and a Baker’s cyst is a safe and effective technique which allows to improve outcomes after treatment, to reduce rehabilitation period and to avoid complications.