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CNAA / Theses / 2022 / /

Diagnosis and treatment of varicose veins complicated with acute superficial vein thrombosis


Author: Bzovîi Florin
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2023
Scientific adviser: Dumitru Casian
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 20 September, 2022
Approved by NCAA on the 24 February, 2023

Abstract

Adobe PDF document – 1.21 Mb / in romanian
Adobe PDF document – 1.08 Mb / in english

Thesis

CZU 616.147.3-007.64-005.6-08(043.2)

Adobe PDF document 11.37 Mb / in romanian
190 pages

Keywords

superficial vein thrombosis, acute varicothrombophlebitis, venous thromboembolism, duplex ultrasound, anticoagulation, surgical treatment.

Summary

Structure of the thesis. The thesis includes 142 pages of the main text: introduction, five chapters, general conclusions and practical recommendations, 22 figures and 23 tables. The bibliography includes 241 references. The principal results of the study were published in 20 scientific papers. Key words: superficial vein thrombosis, acute varicothrombophlebitis, venous thromboembolism, duplex ultrasound, anticoagulation, surgical treatment. The aim of study. Improvement of the results of treatment of acute varicothrombophlebitis (VTPh) of lower limbs basing on identification of risk factors associated with venous thromboembolism and determination of the criteria for selection of optimal curative approach. Objectives of the study. Study of current patterns in the management of patients with acute VTPh in Republic of Moldova and its comparison to international practice. Analysis of correlations between clinical manifestations, imaging data and results of laboratory tests in patients with various types of acute VTPh. Assessment of efficacy and safety of various protocols of medical treatment used in patients with acute VTPh and determination of factors with an impact upon the results of conservative treatment. Evaluation of the risks associated with surgical treatment of VTPh in acute phase and determination of possibilities for reduction of the rate of postoperative complications. Comparison of the results of surgical and medical treatment of acute VTPh basing on clinical and patient reported outcomes. Scientific originality and novelty. Significant variability of local patterns in the management of acute VTPh was demonstrated using an online questionnaire. The predictive value of local clinical signs of VTPh in initial differentiation of the forms with and without involvement of the saphenous trunk was established. The value of the markers of systemic inflammation in patients with acute VTPh was studied. The disbalance of hemostasis with a tendency towards hypercoagulability was demonstrated in patients with acute VTPh, especially in those with periosteal form of thrombosis. A significant difference in estimated values of blood viscosity during the hot and cold period of the year was found in patients with acute VTPh, which may explain the seasonal variations in the incidence of disease. The low risk of postoperative venous thromboembolic events in patients with non-truncal VTPh was demonstrated and risk factors for complications of surgical wound were identified. Using Cox regression statistical model, the significant impact of individual level of the risk of thromboembolic complications (estimated basing on the Caprini score) upon the outcomes of anticoagulant treatment of acute VTPh was demonstrated. The scientific problem solved in the thesis consist in identification of risk factors associated with negative outcomes of treatment of acute VTPh, allowing modification of treatment paradigm and scientifically argued selection of the optimal curative approach in each individual case. Theoretical significance and applicative value. The present study demonstrated the association of extensive, periosteal forms of thrombosis with disequilibrium of hemostatic balance and systemic inflammatory reaction, arguing the need for anticoagulant treatment. The comparable efficacy of surgical and conservative approach in the treatment of acute VTPh demonstrated in the study and determination of risk factors associated with treatment failure serve as a basis for optimization of curative approach. Basing on the results of study, the diagnostic value of local clinical signs of acute VTPh was determined and the importance of duplex ultrasound examination and laboratory tests (platelet-lymphocyte ratio, C-reactive protein and D-dimers) in the elaboration of treatment strategy was demonstrated. Implementation of scientific results. The results of study were implemented in the clinical activity of the departments of surgery at Municipal Clinical Hospital „Gheorghe Paladi” from Chisinau, Institute of Emergency Medicine from Republic of Moldova and Department of general surgery – semiotics nr.3 at the State University of Medicine and Pharmacy „Nicolae Testemițanu”. Four acts of implementation of the results were registered. 8