Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods. Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted. Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients. In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas. Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer.

The vein wall was investigated in the treatment of patients with varicose veins by endovenous laser and radiofrequency ablation. Fragments of removed veins with varicose veins served as material for pathomorphological research. The following histological staining methods were used: hematoxylin and eosin, van Gieson’s picrofuchsin with additional staining on elastica, according to Mallory. It has been shown, that with varicose veins of the lower extremities, pronounced irreversible morphological changes develop in the vein wall in the form of damage to endothelial cells, hypertrophy of all layers of the vein wall, total development of connective tissue in it with impaired collagen structure both in the basement membrane of endothelial cells and in muscle and elastic layers. Changes in the structure of collagen in the vein wall can be traced in all studied groups, which seems possible, since the treatment with minimally invasive methods is carried out against the background of already altered venous trunks. At the same time, injuries in the vein wall are most pronounced when using endovenous laser coagulation of veins and are accompanied by frequent pain in the postoperative period. The latter is confirmed by morphological changes in the form of total necrosis of the vein wall with necrosis and complete desquamation of the endothelium into the lumen of the vessel. Damage to the wall of the vein of the lower extremities, altered by a chronic current process with varicose veins, including its endothelium and all layers, is minimized when using radiofrequency ablation. Accordingly, cicatrization of surrounding fabrics in the zone of action of radiofrequency ablation will pass in more short spaces and with a favourable end for a patient, that it is confirmed by the less number of paresthesias and sickliness on motion a vein in a postoperative period.