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TAE is effective to control bleeding and reduces mortality rate especially in high risk and elderly patients.

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.

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.

Relevance. The Baker's cyst is the most numerous group of benign neoplasms of the popliteal region. The anatomical feature of the location, the vagueness of the etiology and pathogenesis leads to the lack of a single point of view on the tactics of treating popliteal cysts. In modern medical technologies, the method of local laser hyperthermia is often used, when the denaturing of collagen forming the basis of a tissue or an organ is based on surgical treatment. Since this technique does not have direct thermal control over the course of manipulation, it becomes necessary to strictly dosage controlled photocoagulation. Objectives of the study: to determine the optimal energy and time parameters of direct contact laser action on the wall of the Baker cyst in the simulation of its exo-vivo photocoagulation. Materials and methods of research. In the experiment we used a wall sample of Baker's cyst, obtained as a result of open extirpation of the cyst. The material was divided into 5 roughly equal in size and mass fragments. The first of them, without any physical effects, was immediately placed in a 10% formalin solution. For all other parts of the preparation, laser irradiation was carried out in a stationary manner with a surface contact of the optical fiber with the synovial layer of the samples. The effect on the fragment was carried out in a constant mode of the light flux with a wavelength of 1.47 μm. Results. The macroscopic and microscopic transformations that occur in the tissues of the wall of the Baker cyst were studied, with an output power of 5 and 10 W. Two series of experiments were conducted lasting 5 and 10 seconds. On the surface of the synovial membrane of the wall of Baker's cyst, the effect in the form of point carbonation was observed in all samples subjected to laser treatment. When a microscopic study of a drug not exposed to laser radiation, the synovial membrane was only loosened. In the fragment subjected to the contact action of 10 W laser radiation for 10 seconds, the focus of necrosis of the synovium and surface layers of collagen structures without a perifocal cell reaction is histologically determined. In all other samples, after laser photocoagulation, a focal destruction of the synovial membrane with a pronounced interstitial edema was determined in the histological study. Focal fragmentation of the surface fibers was detected near the loose loose collagen layers. Conclusions.The effect of high-energy laser radiation of 1.47 μm on the wall of the Baker cyst in all series of experiments did not lead to its total coagulation necrosis even in the direct irradiation zone. Considering the duration of the cyst of the energy exposure of the irradiation sufficient for the destruction of the wall, and also the small area of exposure of the laser irradiation to the face lightguide, it is evident that a considerable amount of time will be required for complete coagulation of the formation.