Justification of the Need for Changing the CEAP Clinical Classification of Varicose Disease of the Lower Extremities and Adapting it to the Surgical Approach and the Selection of the Extent of the Operation

Abstract

Abstract.The results of the examination and surgical treatment of 132 patients with CEAP class C2-C6 varicose disease of the lower extremities have been analyzed. A combined diagnostic method that allows detecting the peculiarities of the functioning of the perforating vein venous system of the shin, namely, allows establishing the uncompetency of the perforating veins of the shin objectively, has been developed. In view of the examination results obtained, a method of radical surgical treatment has been developed that allows individualizing, standardizing and synchronizing the extent of the surgical intervention depending on the stage of the disease, which results in a decrease in the injury rate and the duration of the operative intervention, ensuring the best results in the near and remote postoperative periods. A change in the CEAP classification has been proposed in order to adapt it to the surgical approach with a need to single out three clinical variants of stage С6: С6a, С6b and С6c, as well as the need to verify the competent "re-entry" perforating veins and the uncompetent perforating veins of the shin while designating them with "Apc" and "Apun" symbols respectively. In view of the innovations proposed an algorithm of the approach and selection of the extent of the surgical treatment of varicose disease depending on its clinical course has been developed.