Tactics of treatment of varicose disease, complicated by thrombosis, using miniinvasive methods

Abstract

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.

A Case of Surgical Treatment of a Gunshot Wound to the Left Scapular Region With Damage to the Distal Axillary and Proximal Brachial Arteries

“…Such injuries are often characterized by the serious condition of the victim, the variability of the clinical course, the unpredictability of the wound canal, and the need for urgent surgery [4]. The severity of a gunshot wound, its consequences, complications, surgical tactics, and treatment outcome depend on the ballistic, anatomical, and morphological characteristics of the wound [5, 6].…”

“…Of the 950 revascularizations performed with autologous vein, one‐third of patients developed complications, of which 64% were thrombosis. This resulted in a high frequency of amputations (27.1–31.5%), significant disability in those wounded (45.0%), and fatalities in 12.0% of cases [1, 6, 7].…”