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CNAA / Theses / 2018 / July /

Surgical options for treatment of varicose veins of lower limbs


Author: Casian Dumitru
Degree:doctor habilitat of medicine
Speciality: 14.00.27 - Surgery
Year:2018
Scientific advisers: Eugen Guţu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

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Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 4 July, 2018
Approved by NCAA on the 23 November, 2018

Abstract

Adobe PDF document – 1.38 Mb / in romanian

Thesis

CZU 616.147.3-007.64-073-089

Adobe PDF document 10.89 Mb / in romanian
280 pages

Keywords

varicose veins, chronic venous insufficiency, venous reflux, duplex ultrasound scanning, phenomenon of neovascularization, surgical treatment, endovenous ablation, phlebectomy.

Summary

Field of research: medical sciences, clinical medicine, surgery (321.13)

The purpose of study. Optimization of surgical management of the patients with varicose veins (VV) of lower limbs basing on complex evaluation of clinical and hemodynamic features of various forms of the disease and analysis of tactical and technical characteristics of surgical interventions.

Objectives of the study. Analysis of the pattern of venous reflux in case of VV, relation of clinical manifestations with various types of hemodynamic disturbances and estimation of the risk of development of severe chronic venous insufficiency (CVB). Determination of the optimal volume of surgery and preferential techniques of realization of the main steps of surgical interventions in function of the clinical and hemodynamic context. Identification of the basic mechanisms of VV recurrence after surgical treatment and of the methods of its correction. Study of peculiarities of natural history, diagnosis and surgical treatment of the rare and complicated forms of VV. Comparative evaluation and analysis of intercorrelation between technical, clinical and patient reported outcomes of surgical treatment of VV. Identification of risk factors associated with unfavourable long-term results of surgical treatment of VV.

Scientific originality and novelty. It was demonstrated that modification of Carpentier score by addition of the test with preoperative elastic compression increases the accuracy of prediction of clinical outcome of surgery. The prognostic model for estimation of risk of development of severe CVI was elaborated. The data of duplex ultrasound scanning with operator-dependent character were identified. The rationality of differentiated approach to the selection of volume of surgery was demonstrated and original classification of hemodynamic disturbances in VV was proposed. The efficacy of modified techniques of sapheno-femoral disconnection for prevention of recurrent VV caused by phenomenon of neovascularization was proved. The techniques of saphenous stripping associated with the lowest rate of complications were determined. The validity of the PREST score in prediction of recovery of saphenous vein competence after isolated phlebectomy of varicose tributaries was demonstrated. The futility of the routine disconnection of the leg perforating veins during surgery for VV was shown. The dominating role of tactical and technical errors in the development of recurrent VV was demonstrated. The efficiency and safety of minimally-invasive surgery for treatment of the pulsatile VV were shown. The risk factors associated with unfavourable outcome of surgical treatment of VV were identified.

The main applied-scientific problemsolved in the thesis consist in reconceptualization of curative and diagnostic options for management of VV of lower limbs that resulted in determination and implementation in medical practice of optimal tactical and technical variants of conventional and minimally-invasive surgical interventions.

Theoretical significance and applicative value. Results of the study demonstrated large variability of clinical manifestations and patterns of venous reflux in patients with VV. The proposed systematization of pathological disturbances of venous circulation allows optimization of surgical tactics. Construction of prognostic system for development of severe CVI will contribute to the refinement of indications for surgery. Obtained data allow identification of the optimal techniques of realization of surgical interventions for VV. Definition of clinical and paraclinical peculiarities of rare forms of VV will result in decreased rate of diagnostic and curative errors. Identification of factors with negative impact upon the results of surgical treatment substantiates the main directions for further improvements in the medical care of patients with VV.

Implementation of scientific results. Obtained scientific results were implemented in the clinical activity of the departments of surgery of the Municipal Clinical Hospital nr. 1, Chisinau, Institute of Emergency Medicine and in the didactic activity of Department of general surgery and semiotics nr.3 at the State University of Medicine and Pharmacy „Nicolae Testemitanu”. Seven acts of implementation of the results were registered.