CHOICE OF TACTICS OF SURGICAL TREATMENT OF VARICOSE DISEASE DEPENDING ON THE VARIANT OF THE ANATOMICAL STRUCTURE OF SAPHENO-POPLITEAL ANASTOMOSIS IN DOPPLEROMETRY OF THE VENES OF THE LOWER LIMBS
Summary. The aim of the study is to determine the variants of the anatomical structure of the saphenopliteal anastomosis in ultrasound Doppler of the veins of the lower extremities, including as sources of pathological blood reflux in varicose veins of the small saphenous vein basin, and the importance of insolvent veins in the formation of insufficiency in the small saphenous vein basin to clarify the further protocol treatment.
Materials and methods. The venous system of 2348 patients was studied, including both patients with various pathologies of the venous system, including those with varicose veins, and those in whom the pathology of the veins was not detected by USDG.
Results and discussion. In patients with USDG, various anatomical variants of the structure of the sapheno-popliteal anastomosis were found. The anastomosis may look like a perforating vein and have a fairly sharp angle of deviation from the trunk. In these cases, it is recommended to conduct an open surgical intervention, namely: crossectomy — ligation and transection of the small saphenous vein, striping — removal of the trunk of the small saphenous vein, ligation of insolvent communicative veins, miniflebectomy - removal of varicose nodes through punctures. The smooth course of the sapheno-popliteal anastomosis was found in 58.0 % of the subjects and did not depend on the level of the anastomosis. In such cases, the option of choice for surgical intervention was minimally invasive technologies: laser coagulation, radiofrequency ablation, as well as combined phlebectomy, which includes the following stages - removal of varicose inflows of the small saphenous vein and elimination of incompetent perforating veins. Indirect variants of the anastomosis turned out to be frequent, for example, through the sural or nonsaphenic vein with the presence of additional venous vessels (up to 18.0 % of those studied). In these cases, the level of the anastomosis was also formed below the knee joint gap. According to the USDG data, the anatomical absence of the sapheno-popliteal anastomosis was found only in 142 patients, which is less than 1.0 %. In such patients, a search and elimination of pathological reflux is performed, which leads to the development of varicose veins in the system of the small saphenous vein. Its varicose inflows are removed and insolvent perforating veins are eliminated.
Conclusion. The specialists’ understanding of the variants of the structure of the saphenopliteal anastomosis in normal and pathological conditions, as well as the observance of the full examination protocol for venous ultrasonography, allows providing detailed information in order to determine the most effective treatment tactics and prevention of disease recurrence.
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