DETERMINATION OF THE FORM OF VENOUS HYPERTENSION IN PATIENTS WITH DECOMPENSATED CHRONIC VENOUS INSUFFICIENCY WITH VARICOSE DISEASE AND POSTTHROMBOTIC SYNDROME
Aim. Improve the results of treatment of patients with decompensated forms of chronic venous insufficiency by determining the main forms of venous hypertension inherent in varicose veins and postthrombotic syndrome.
Materials and methods. From 2018 to 2022, 147 patients with chronic venous insufficiency (CVI) C6 according to CEAP, aged from 38 to 69 years (on average, 55±5.3 years), were treated in the surgical clinic of the Communal non-commercial enterprise «Transcarpathian Regional Hospital» of the Transcarpathian Regional Council from 2018 to 2022. According to the etiopathogenesis of decompensated CVI, 76 (51.7%) patients were diagnosed with varicose veins of the lower extremities, and 71 (48.3%) patients with postthrombotic syndrome (PTS). Research of venous hemodynamics began with the determination of vertical reflux in the system of the large saphenous vein, then in the system of the small saphenous vein, then the presence of vertical reflux in the system of deep veins of the lower extremities and horizontal reflux in the thigh and lower leg. At the same time, isolated and combined forms of horizontal and vertical refluxes were distinguished.
Research results. Based on the complex ultrasonographic examination (USG) and the etiopathogenesis of chronic venous insufficiency, 76 (51.7%) patients with varicose veins (VC) had superficial venous hypertension. In decompensated forms of PTPS, 71 (48.3%) in 68 (95.8%) patients had deep venous hypertension, and in 3 (4.2%) a mixed form of venous hypertension. According to USG studies, the diameter of the large saphenous vein (LSV) in patients of the 1st group was on average 10.3±0.2 mm, the small saphenous vein (SSV) was 5.3±0.1 mm. In patients of the second group, the diameter of the LSV was 11.1±0.5 mm, the SSV was 6.5±0.2 mm. Failure of penetrating veins in the first group was found in 14 (18.4%), and only in 12 (15.8%) cases horizontal reflux was single. The average diameter of penetrating veins was 5.1±0.5 mm
In the second group of patients, horizontal reflux in penetrating veins was found in all patients, and in 56 (78.9%) of them, it was multiple. At the same time, the average diameter of penetrating veins was 5.8±0.9 mm.
The size of trophic ulcers was larger in the second group of patients. With a diameter of a trophic ulcer up to 10 cm in patients with superficial hypertension, 42.1% had the IIst depth of the lesion, and with deep venous hypertension, the IIIst depth of the lesion was observed in 51.4% of cases. 34.2% of patients with superficial hypertension had trophic ulcers with a diameter of up to 5 cm and a depth of lesions of the IIst, then patients with deep venous hypertension had trophic ulcers of up to 5 cm in diameter with a depth of lesions of the IIst in only 5.8% of cases. IV st. of lesion depth was observed only in three patients with a mixed form of venous hypertension.
Conclusions. In decompensated forms of varicose veins, superficial venous hypertension is observed in almost all patients. With PTS in the stage of decompensation, 95.8% of patients have a deep form of venous hypertension, and 4.2% of patients have a mixed form of hypertension. In 68 (95.8%) patients of the second group, blood refluxes in deep, penetrating and superficial veins were interconnected with each other, where their pathological effect was mutually reinforcing. In 61 (81.5%) patients with a superficial form of venous hypertension, each of the refluxes had an independent character and was hemodynamically unrelated to each other.
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