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CNAA / Theses / 2018 / July /

Long-term results of surgery for varicose veins of the lower limbs: clinical and hemodynamic aspects


Author: Maloghin Vasile
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2018
Scientific adviser: Eugen Guţu
doctor habilitat, professor, 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 5 July, 2018
Approved by NCAA on the 23 November, 2018

Abstract

Adobe PDF document – 1.09 Mb / in romanian

Thesis

CZU 616.147.3-007.64-089 (043.2)

Adobe PDF document 5.85 Mb / in romanian
158 pages

Keywords

varicose veins, chronic venous insufficiency, CEAP classification, crossectomy, phlebectomy, recurrent varicose, duplex sonography, abnormal venous reflux, neovascularization, quality of life

Summary

The research domain: 321.13 – surgery. Study aim: Identification of risk factors for the persistence or recurrence of clinical symptoms and venous hemodynamics disorders in patients in the late postoperative period after surgical treatment for varicose veins of lower limbs. The research objectives: To study the incidence, causes and variants of the varicose veins recurrence after surgery, the relationship between clinical symptoms and venous hemodynamics, the impact of recurrent venous reflux on the patients’ quality of life, the determination of measures which can improve the long-term results of surgery for varicose veins. The novelty and the scientific originality: Three types of long-term results after surgical varicose veins treatment have been established: no recurrent varices, „instrumental” and „clinical” recurrence. It was proved the limited influence of clinico-demographic factors on the postoperative incidence of recurrent varicose veins. There are identified the main sources of recurrent venous reflux after surgery. A number of intraoperative tactical and technical errors that lead to recurrence have been identified. Long-term postoperative elastic compression and phlebotonic drugs were ineffective for decresing of recurrent varicose veins. It was proved that the „instrumental” recurrence of varicose veins is significant both clinically and socially, and can worse the patients’ quality of life. The scientific solved problem: Has been identified a complex of reliable clinical, anamnestic and instrumental risk factors of persistent or recurrent haemodynamic disturbances and venous symptoms after surgery, was optimized the perioperative management in order to improve the long-term results after surgical treatment of varicose veins. The theoretical significance: There were determined the causes of postoperative recurrent varices, and the optimal perioperative management of varicose veins was justified. The applicative value of the work: It was improved assessment of the long-term results after surgical treatment of varicose veins, and measures which can improve the long-term results of surgery for varicose veins were outlined. The implementation of the scientific results: Results of research were introduced into didactic process of the Chair of General Surgery and Semiology nr.3, SUMF “Nicolae Testemitanu” and practice of surgical departments of Municipal Clinical Hospital nr.1, Municipal Clinical Hospital “Sf.Arhanghel Mihail”, Kishinev