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CNAA / Theses / 2009 / June /

The possibilities of subfascial endoscopic perforator surgery for the treatment of severe chronic venous insufficiency


Author: Culiuc Vasile
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2009
Scientific adviser: Eugen Guţu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 24 June, 2009
Approved by NCAA on the 1 October, 2009

Abstract

Adobe PDF document – 2.50 Mb / in romanian

Keywords

Chronic venous insufficiency – incompetent leg perforating veins –venous ulcer – duplex scanning – subfascial endoscopic perforator surgery

Summary

„The possibilities of subfascial endoscopic perforator surgery for the treatment of severe chronic venous insufficiency" The aim of the study was to improve the treatment results of the patients with severe chronic venous insufficiency (CVI) by means of inclusion of subfascial endoscopic perforator surgery (SEPS) in the range of routine methods of surgical correction of pathological venous reflux. Study is based on clinical, ultrasound, functional, bacteriological and cytological data analysis, as well as on the results of complex surgical treatment including SEPS in 65 patients (82 extremities) with severe CVI (C4-C6 CEAP) of lower limbs. Etiology of CVI was varicose disease in 57 (69.51%) and postthrombotic syndrome – in 25 (30.49%) cases. It was demonstrated, that indications for SEPS and volume of operation should be based on the results of preoperative duplex scanning. Using an original diagnostic method the irreversible nature of the incompetence of perforator veins situated in the area of trophic changes was demonstrated. There was established, that SEPS allows performing of reliable, safe and visually controlled disconnection of incompetent perforators in the region of active venous ulcer. The study proved that preoperative sterilization of highly contaminated ulcer prior to SEPS is not required. There were elaborated objective criteria for selection of method of disconnection of incompetent perforators based on data regarding its diameter and localization revealed during duplex scanning and SEPS. It was demonstrated, that in the case of severe CVI and perforator incompetence the adequate decrease of venous hypertension can be achieved after disconnection of perforators only. By means of updated computed method used for calculation of venous ulcer area was established that the initial healing rate may serves as an additional criterion for skin grafting.