Development of Obliteration in the Great Saphenous Vein After Influence of High-Frequency Endovenous Welding by Data of Morphological and Ultrasonic Studies

Abstract

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.