[Truncal mechanochemical versus thermal endovenous ablation for varicose vein disease: a systematic review and meta-analysis]. / Sistematicheskii obzor i metaanaliz rezul'tatov primeneniya stvolovoi mekhanokhimicheskoi i termal'noi obliteratsii u patsientov s varikoznoi bolezn'yu.

OBJECTIVE: To compare the outcomes of thermal and mechanochemical endovenous ablative techniques in patients with varicose veins. MATERIAL AND METHODS: We searched the PubMed, EMBASE and Cochrane Library databases for studies devoted to mechanochemical and thermal endovenous ablative techniques from inception until July 2021. The primary outcome was anatomical success. Secondary endpoints were intraoperative pain syndrome, complications, modification of disease severity and quality of life. RESULTS: This meta-analysis enrolled 10 comparative studies and 1.252 participants after truncal ablations. The follow-up period ranged from 4 weeks to 36 months. With regard to overall anatomical success, 245 out of 267 (91.8%) patients after mechanochemical ablation and 249 out of 266 (93.6%) patients after thermal ablation had favorable results after a month (low-quality evidence; odds ratio [OR] 0.79; 95% CI 0.40-1.55). No statistical heterogeneity was identified (χ2=1.48; df=2; p=0.48; I2=0%). Further analysis identified different incidence of total occlusion after 12 months or later (OR 0.36; 95% CI 0.11-1.21; p=0.05; I2=68%). Mechanochemical ablation resulted less intraoperative pain. Mean difference was -1.3 (95% CI -2.53- -0.07; p=0.00001). MOCA was followed by fewer incidence of nerve injury, hematoma, deep vein thrombosis and phlebitis. There were more cases of skin pigmentation compared to thermal ablation (low-quality evidence, p>0.05). Subsequent assessment of disease severity identified significant between-group difference of means (-0.64 (95% CI -1.82-0.53; p=0.004) and -0.16 (95% CI -0.43-0.11; p=0.005) after 6 and 12 months, respectively). Further assessment of quality of life revealed no between-group differences. These data were characterized by moderate methodological quality. CONCLUSION: Mechanochemical ablation is as effective as standard TA within the first postoperative month. However, this approach is associated with lesser anatomical success after 12 months. In most studies, pain syndrome was less severe in case of mechanochemical ablation. These data suggest that mechanochemical ablation is a safe alternative for varicose veins. However, further large-scale trials are required to define the role of MOCA.

Comprehensive overview of the venous disorder known as pelvic congestion syndrome.

Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.

A pilot study of preoperative heart rate variability predicting pain during local anesthetic varicose vein surgery.

OBJECTIVE: Local anesthetic endovenous procedures were shown to reduce recovery time, to decrease postoperative pain, and to more quickly return the patient to baseline activities. However, a substantial number of patients experience pain during these procedures. The autonomic nervous system modulates pain perception, and its influence on stress response can be noninvasively quantified using heart rate variability (HRV) indices. The aim of our study was to evaluate whether preoperative baseline HRV can predict intraoperative pain during local anesthetic varicose vein surgery. METHODS: Patients scheduled for radiofrequency ablation were included in the study. They had their electrocardiograms recorded from a single channel of a custom-made amplifier. Each patient preoperatively filled in forms Y-1 and Y-2 of Spielberger's State and Trait Anxiety Inventory, completed the Aberdeen Varicose Vein Questionnaire, and rated anxiety level on a numeric scale. Postoperatively, patients filled in the pain they felt during the procedure on the numeric pain intensity scale. MATLAB software (MathWorks, Natick, Mass) was used to extract R waves and to generate HRV signals, and a mathematical model was created to predict the pain score for each patient. RESULTS: In multivariable analysis, we looked into correlation between reported patient's pain score (rPPS) and Aberdeen Varicose Vein Questionnaire score, preoperative forms Y-1 and Y-2, preoperative anxiety level, and predicted patient's pain (pPPS) score. Multivariable analysis found association only between rPPS and pPPS. The pPPS was significantly correlated with rPPS (R = 0.807; P < .001) with accuracy of prediction of 65.2%, which was calculated from R2 on a linear regression model. CONCLUSIONS: This preliminary study shows that preoperative HRV can accurately predict patients' pain, allowing patients with higher predicted score to have the procedure under general anesthesia.

Nonthermal, Nontumescent Endovenous Treatment of Varicose Veins.

BACKGROUND: Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. A new technique for venous insufficiency is non-thermal ablation with vein sealing system which comprises the endovenous delivery of cyanoacrylate tissue adhesive to the vein causing fibrosis. METHODS: This is a single-center prospective study of treatment of great saphenous vein incompetence in 62 patients with vein sealing system (Biolas VariClose® FG Group, Turkey). All cases were implemented under local anesthesia. Tumescent anesthesia was not required. Patients were not given any nonsteroidal anti-inflammatory drug postoperatively; advised to wear elastic bandages for 1 day; and compression stockings were not offered. RESULTS: Treatment success was defined as complete occlusion of treated vein or recanalized segment shorter than 5 cm. Subtotal recanalization was defined as great saphenous vein flow containing 5-10 cm segment of treated vein. A recanalized great saphenous vein or treatment failure was defined as an open part of the treated vein segment more than 10 cm in length. At 1 week and 1 month control, duplex scans showed total occlusion for all patients (100%), total occlusion for 58 patients (93.5%), and subtotal occlusion for 4 patients (6.5%) at third month. At the end of 6 months, total occlusion 56 patients (90.3%) and subtotal occlusion for 2 patients (3.2%). For 4 (6.5%) patients, no occlusion was observed, and the diameter was >11 mm. Embolization of great saphenous vein with cyanoacrylate has been performed since the beginning of this decade. Combined chemical and physical mechanism of action results in permanent vein closure. In a recently published study, a 24-month occlusion rate of 92% was demonstrated. The most commonly reported complications of cyanoacrylate use for the treatment of varicose vein disease, so far, include ecchymosis and phlebitis. Almeida et al. reported that phlebitis is the most frequent side effect at a rate of 16%. In our study, phlebitis rate was not as high as reported. It may be caused due to shorter time of follow-up in the hospital. CONCLUSION: Endovenous ablation of incompetent great saphenous vein with cyanoacrylate-based glue is feasible. Operation time is short, and tumescent anesthesia is unnecessary as postprocedure compression stockings. Lack of significant side effects and an yearly success rate of 100% are benefits of the system.

Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia.

OBJECTIVE: The objective of this study was to compare the long-term results (groin-related recurrence, great saphenous vein [GSV] occlusion rate, Clinical class, Etiology, Anatomy, and Pathophysiology [CEAP] staging, and quality of life [QoL]) after the treatment of a GSV incompetence by saphenofemoral ligation and stripping (SFL/S) with endovenous laser ablation bare fiber, 980 nm (EVLA). METHODS: Patients with GSV insufficiency and varicose veins were randomized to either undergo SFL/S or EVLA, both of which were performed under tumescent anesthesia. The long-term results, which included the anatomic occlusion rate, varicose vein recurrence at the saphenofemoral junction (SFJ), relief of venous symptoms and QoL, were compared up to 5 years after treatment. RESULTS: A total of 130 legs of 121 patients were treated with either SFL/S (n = 68) or EVLA (n = 62). In the first 12 months, three recanalizations of the GSV were observed after EVLA. Up to 5 years later, more recurrent varicose veins caused by neoreflux in incompetent tributaries of the SFJ were observed in after EVLA (31%; 19/61) compared with SFL/S (7%; 4/60; P < .01). Neovascularization in the groin with clinically visible recurrence identified at 3 and 5 years post-treatment follow-up was only observed in the SFL/S group (n = 6). After 5 years, clinically visible recurrences originating from the SFJ region after EVLA were observed 33% (20/61) compared with 17% of patients (10/60) after SFL/S (P < .04). In both treatment groups, venous symptoms improved significantly. Patients in both groups reported a continuing significant cosmetic improvement measured on a visual analog scale of 1 to 10 (mean, 7.49; P < .01). There was no difference in the CEAP staging and a standardized, non-disease-specific instrument for describing and valuing health states (EuroQol-5D), between the groups up to 5 years after follow-up. CONCLUSIONS: At the 5-year follow-up, a significantly higher varicose vein recurrence rate originated at the SFJ region after EVLA compared with SFL/S. There were no differences in the relief of venous symptoms, CEAP staging, or general QoL between the groups.

Healthcare utilisation of pregnant women who experience sciatica, leg cramps and/or varicose veins: A cross-sectional survey of 1835 pregnant women.

BACKGROUND: Common discomforts of pregnancy experienced in the lower extremity include sciatica, leg cramps and varicose veins. Whilst research attention has focused on aetiology and outcomes, the health service utilisation of pregnant women suffering from these complaints has been largely overlooked. AIM: To examine the health status and health service utilisation profile of pregnant women experiencing sciatica, leg cramps or varicose veins. METHODS: Linear and logistic regression was applied to a cross-sectional survey of a pregnant women drawn from the 1973 to 1978 cohort (aged 31-36 years in 2009), of the Australian Longitudinal Study on Women's Health (n=1835). Participant's demographics, health status and health service utilisation were compared for all three complaints based upon three subgroups (yes, sought help; yes, did not seek help; no). FINDINGS: A number of women experienced sciatica (22.1%), leg cramps (18.2%) or varicose veins (9.4%). Of these, a greater proportion of women with sciatica (79.3%) or varicose veins (71.5%) sought help for their condition compared with women with leg cramps (46.7%). Comparisons between women with the conditions of interest who did seek help and those who did not only found that women with a university degree were 0.29 (95% CI: 0.10, 0.85) times less likely to seek help for their condition compared to women with a school only education. CONCLUSION: Further research examining all health seeking behaviour and treatment use of pregnant women who experience lower extremity problems is required in order to facilitate safe, effective and coordinated maternity care to further support these women during pregnancy.

Nitrous oxide/oxygen inhalation provides effective analgesia during the administration of tumescent local anaesthesia for endovenous laser ablation.

BACKGROUND: Tumescent anaesthesia (TA) is an important but sometimes very painful step during endovenous thermal ablation of incompetent veins. The aim of this study was to examine whether the use of fixed 50% nitrous oxide/oxygen mixture (N2O/O2), also called equimolar mixture of oxygen and nitrous oxide, reduces pain during the application of TA. PATIENTS AND METHODS: Patients undergoing endovenous laser ablation (EVLA) of incompetent saphenous veins were included. Thirty consecutive patients inhaled N2O/O2 during the application of TA. Thirty consecutive patients received TA alone (controls). Patients were asked to complete a questionnaire immediately after the intervention to assess satisfaction with the intervention and pain-levels during the different steps of the intervention (0=not at all, 10=very much). Adverse events during the treatment were monitored. RESULTS: 30 patients (14 men, mean age of 44 years) were included in the N2O/O2 group and 30 patients (9 men, mean age 48 years) were included in the control group. In the N2O/O2 group a significantly lower pain score was noted (mean 2.45 points, range 0-6) compared to the controls (mean 4.3 points, range 1-9, p<0.001). Overall, 64.5% of the patients were perfectly satisfied with the N2O/O2-Inhalation. Only 4 patients receiving N2O/O2 complained of adverse effects such as unpleasant loss of control (2 patients), headache (1 patient) and dizziness (1 patient). CONCLUSIONS: N2O/O2 is a safe and effective method to reduce pain during the application of tumescent anaesthesia for EVLA.

Prospective study of a single treatment strategy for local tumescent anesthesia in Muller phlebectomy.

BACKGROUND: Ambulatory Muller phlebectomy for varicose veins can be performed under local anesthesia. However, subcutaneous injection of local tumescent anesthetics may cause discomfort because of acidity of the solution. Addition of sodium bicarbonate lowers the acidity of anesthetic solutions, which might cause less pain. The objective of this study was to study whether alkalinization of the local anesthetic solution with sodium bicarbonate 1.4% decreases perioperative pain during Muller phlebectomies. METHODS: It is a double-blind single-center randomized controlled trial. In all, 101 patients scheduled for ambulatory Muller phlebectomy were randomized to receive either local anesthesia with alkalinized solution (lidocaine 1% and epinephrine in sodium bicarbonate 1.4%) or standard solution (lidocaine 1% and epinephrine in saline 0.9%). Primary outcome was pain during injection of local anesthetics with the use of the Visual Analogue Scale (VAS). Secondary outcomes were peroperative and postoperative pain, use of analgesics, patient satisfaction, return to function, and complications. RESULTS: Patients receiving subcutaneous injection of local anesthetics diluted in sodium bicarbonate 1.4% experienced significantly less pain during injection compared with patients treated with standard anesthetic solution (VAS, 1.75 ± 1.8 vs. 3.55 ± 2.2, P < 0.00). Peroperative and postoperative pain, complication rates, use of analgesics, patient satisfaction, return to function, and complications did not differ between the 2 groups (P > 0.10). CONCLUSIONS: Alkalinization of local anesthetic solution with sodium bicarbonate 1.4% significantly improves patient comfort during injection of local tumescent anesthesia.

Interim results on abolishing reflux alongside a randomized clinical trial on laser ablation with phlebectomies versus foam sclerotherapy.

AIM: The early results of a randomised clinical trial comparing local anaesthesia endovenous laser ablation (EVLA) with concurrent phlebectomies versus ultrasound-guided foam sclerotherapy (UGFS) into the great saphenous vein (GSV) revealed that laser was more expensive but the results on abolition of reflux were similar. The interim results at 15 month follow-up are reported. METHODS: Evaluations included ultrasound, the venous clinical severity score (VCSS), the Aberdeen varicose vein questionnaire (AVVQ) and the saphenous treatment score (STS). The global absence of reflux defined technical success. Adjuvant sclerotherapy to areas of reflux was administered on patient choice. RESULTS: Occlusion of the GSV was more effective with EVLA at 42/44 (95.5%) versus 31/46 (67.4%) for UGFS. However both techniques were equally effective at abolishing global venous reflux. The number of legs (N.=100) with total reflux abolition, above-knee, below-knee or combined reflux and loss to follow-up was 18, 6, 12, 8, 6 with EVLA and 20, 8, 11, 7, 4 with UGFS, respectively. The VCSS, AVVQ and STS reduced compared to baseline (P<0.0005), but there was no statistical difference between the groups. The AVVQ remained unchanged between 3-15 months (P=0.601). Also during this time, 19/46(41%) UGFS versus 9/44(20%) EVLA legs received adjuvant treatment (2.1 times increase). However, overall, adjuvant foam was given 4.7 times more frequently in the UGFS patients. CONCLUSION: EVLA and UGFS are equally effective at abolishing global venous reflux with overall success of 41% and 43%, respectively. The high reflux rate was not related to deterioration in quality of life indicating that this reflux was largely asymptomatic.

Sapheon: the solution?

Less invasive endovenous techniques have been shown to be as effective as open surgery in the treatment of varicose veins. Furthermore, they cause less postoperative bruising and pain and enable early return to normal activities and work. Tumescent anaesthesia is safe and obviates complications of general or spinal anaesthesia. Drawbacks are a steep learning curve and painful administration during treatment. Tumescentless techniques like Clarivein™ or VenaSeal™ Sapheon Closure System are recently under investigation. Short-term results of VenaSeal™ are comparable with thermal ablation. The procedure is safe without serious adverse events. Perioperative pain and patient discomfort with this tumescentless approach is minimal but postoperative recovery is temporarily hindered by thrombophlebitis in 14-15 % of patients. One-year results in a small feasibility study has demonstrated durable closure at this endpoint. No longer-term results are available. A randomized control trial between VenaSeal™ and Covidien ClosureFast™ is in a preparatory phase.

Treatment of primary varicose veins has changed with the introduction of new techniques.

New technologies have produced a revolution in primary varicose vein treatments. Duplex ultrasound is now used for preoperative diagnosis, postoperative surveillance, and during many procedures. Ultrasound has also altered our understanding of the pathophysiology of chronic venous disease. Laser and radiofrequency saphenous ablations are common. Classic techniques, such as sclerotherapy, high ligation, stripping, and phlebectomy, have been improved. Magnetic resonance venography, computed tomographic venography, and intravascular ultrasound have improved diagnostic capabilities. New strategies like ambulatory selective varices ablation under local anesthesia (ASVAL) and conservative hemodynamic treatment for chronic venous insufficiency (CHIVA) raise important questions about how to manage these patients.

Transilluminated powered phlebectomy in an office setting: procedural considerations and clinical outcomes.

PURPOSE: To report a series of non-sedated patients treated with transilluminated powered phlebectomy (TIPP) under tumescent anesthesia in an office setting. METHODS: Thirty-six patients (31 women; mean age 54.8±11.8 years) with a mean body mass index of 25 kg/m(2) were selected for the in-office TIPP procedure between January 2009 and September 2010. Medical conditions included hypertension, asthma, hypothyroidism, and gastrointestinal problems. Twenty-eight had prior surgical procedures, 10 of which were for vascular abnormalities. Symptom duration was a mean of 19 years. Twenty-five had a family history of venous disease. The CEAP classification ranged from 2 to 4, but the majority were class 2. Seven patients had conditions that made the TIPP procedures more challenging. Medical data, preoperative venous status, postoperative findings, and patient-reported satisfaction were reviewed. RESULTS: All procedures were completed as planned and without complications. The mean TIPP procedure time was 13.5±3.7 minutes. Thirty-three patients underwent concurrent endovenous ablation. Patient satisfaction measured on a scale from 0 to 10 ranged from a mean of 8.8 at 48 hours to 9.6 at 3 months. At the 3-month follow-up, there were no reports of hematoma, deep venous thrombosis, or extended paresthesia. CONCLUSION: Appropriately selected patients with a variety of clinical presentations can safely undergo the TIPP procedure in an office setting utilizing only local tumescent anesthesia.

Saphenofemoral junction ligation and disconnection for varicose veins-a longitudinal study of cosmesis and function.

BACKGROUND: Saphenofemoral junction ligation and disconnection (SFJLD) can be performed without exceeding the safe limits of local anesthetic if stripping of the long saphenous vein is not routine. We studied the early cosmetic and functional outcome of this procedure to identify the optimum time gap from SFJLD to multiple stab avulsions for varicose veins (VV). METHODS: A series of patients with primary VV underwent SFJLD under local anesthetic as day case procedures. The volume of VV was quantified with a cartograph wheel, whereas the extent and severity of VV was assessed with four validated questionnaires: (a) Clinical Etiology Anatomy Pathology Score, (b) Venous Clinical Severity Score, (c) Aberdeen Varicose Vein Severity Score, and (d) Short Form 36. Patients were assessed preoperatively, and at 1, 3, and 6 months postoperatively. The analysis of variance for repeated measures test was used; a p value <0.05 was found to be significant. RESULTS: There were 48 patients (15 men; mean age: 54 years; 95% CI: 29-79). In all, 91% (n = 44) of patients had cosmetic and symptomatic improvement. The volume of VV reduced significantly over the three postoperative time points when compared with preoperatively (112 [95% CI: 88-136] vs. 75 [95% CI: 55-97] vs. 65 [95% CI: 43-87] vs. 58 [95% CI: 31-86], p = 0.001). Using the Clinical Etiology Anatomy Pathology, Venous Clinical Severity Score, and Aberdeen Varicose Vein Severity Score questionnaires, severity of VV improved postoperatively when compared withpreoperatively (p = 0.001 respectively). Improvements in quality of life were also noted postoperatively with the Short Form 36 questionnaire (p = 0.032). At maximum follow-up of 3 years, 13% (n = 6) had recurrent VV. CONCLUSION: SFJLD confers cosmetic and symptomatic improvement at 1 month. Improvement is sustained on early follow-up, thereby allowing multiple stab avulsions to be performed as a staged procedure within 6 months. The rates of recurrent VV are acceptable on short-term follow-up.

[Complex treatment of patients with lympho-venous insufficiency of the lower limbs].

The article is concerned with the study of use of physical factors in the treatment of chronic lymphphleboid failure of lower limbs. As a result, it was able to show a significant positive dynamic under the complex approach of treating this disease. In patients with chronic lymphphleboid failure of lower limbs justified individual tactics, based on the use of a wide range of modern medicines, physical therapy techniques, therapeutic exercises, lymphatic massage of the lower limbs. This leads to early rehabilitation and improvement of quality of patients' life.

[Drug-mediated correction of negative phlebotropic effects of hormone replacement therapy in women].

OBJECTIVE OF THE STUDY: to specify a negative effect of hormone replacement therapy (HRT) on lower-limb veins in women and to assess feasibility of its correction with phleboprotectors. Examined were a total of thirty-seven 45-to-68-year-old (average age 55.4 +/- 13.7 years) women with the CEAP grade 0-2 chronic venous disease of the legs. Of these, grade C0 was diagnosed in 14 patients, grade C1 in 17, and grade C2 in the remaining six cases. Inclusion criterion: administration of oestrogen-progestin drugs with the replacement purposes. EXCLUSION CRITERIA: a history of previously sustained operations on the veins and venous sclerotherapy, as well as venous thrombosis. Of the 37 women receiving hormone replacement therapy for more than 4 months, 31 (66.7%) complained of uneasiness and a feeling of dilatation in the crural region, cramps, convulsions, pain, and leg heaviness. Eleven women reported to have had no such complaints prior to HRT, and twenty were found to have an apparent progression of the previously existing complaints. The comparative study using duplex scanning of limb veins before and 4 months after HRT revealed enlargement of the lumens of the common femoral, posterior tibial and great saphenous veins, as well as an increased incidence rate of reflux along the femoral and great saphenous veins. The women after 4 months of HRT were assigned to simultaneously undergo a therapeutic course with Phlebodia 600 taken at a dose of I tablet once a day for 2 months. On the background of this therapy, there was a decrease in and gradual disappearance of such symptoms as a feeling of heaviness, pain and dilatation in 31 patients, occurring 7 to 10 days after the beginning of treatment. Thirty (81.0%) women self-assessed the results of treatment with Phlebodia 600 as good, five (13.5%) as satisfactory, and two (5.4%) women reported no positive effect. Duplex scanning performed in women after 2 months of taking the bioflavonoid on the background of the continuing HRT revealed a decrease in the lumens of the common femoral, posterior tibial and great saphenous veins, as well as a decrease in the orthostatic gradient of the veins' diameter. Also observed was a decrease in the incidence rate of reflux along the femoral and great saphenous veins, with clinically diminished symptoms and improved well-being of the women. A conclusion was drawn that hormone replacement therapy in women for a period longer than 4 months leads to the development of orthostasis-dependent phlebopathy of the lower extremities, manifesting itself in decreased venous tonicity and the development of refluxes. The course of treatment with the phlebotonic notable for high compliance (a single morning administration) for two months was noted to have resulted in a significant decrease in the intensity of both subjective and objective signs and symptoms of phlebopathy secondary to long-term administration of oestrogen-gestagen-containing hormonal drugs.

[Venectomy under local tumescent anaesthesia].

The authors have analysed the findings of the examination and outcomes of surgical management of 142 patients with lower limb varicosity (a total of 160 lower extremities). Of theses, there were 52 (36.6%) men, and 90 (63.4%) women. The patients' age varied from 18 to 74 years old (mean age 44+/-11.1 years). The average duration of the disease amounted to 8.3+/-5.2 years. The distribution according to the CEAP clinical classes was as follows: C2 - 90 patients (63.4 %), C3 - 43 (30.3 %), C4 - 6 (4.2 %), C5 - 3 (2.1 %). The proportion of the patients with large varicose veins (more than 1 cm in diameter) amounted to 31.25%. Lesions of the bed of the great saphenous vein (GSV) were observed on 139 lower limbs (86.8%), of the small saphenous vein (SSV) - on 19 lower limbs (11.9%), and of both the GSV and SSV - on two lower extremities (1.3%). In all the cases, the operation was performed under local tumescent anaesthesia in outpatient conditions. The anaesthetic mixture was based on 0.2 - 0.5% ropivacain. The subjective score of the anaesthesia quality averaged 9.6 points. Immediate postoperative complications were observed in 1.4% of the patients (lymphorrhoea and wound process). Side effects of anaesthesia in the form of a vegetovascular reaction, transient cutaneous paresthesia, and a skin reaction were noted in 8.4% of the patients. Local postoperative haematomas were observed in 9.1% of cases. A total of 83.8% of the patients did not use tabletted analgetics in the postoperative period. The subjective assessment of the surgical intervention performed and postoperative outcomes achieved was excellent to good in 98.6% of the patients.

[Repeated surgical treatment of varicosity: the causes and specific features].

The paper is concerned with repeated surgical treatment for varicosity. The studies were carried out of the efficacy of surgical treatment at the specialized angio-surgical and general surgery hospitals. It has been discovered that after treatment at the specialized hospitals the patients applied for repeated surgical assistance 6 times less frequently. It is shown that the incompetent perforating veins provoke the recurrence of the symptoms of varicosity. An original technique for their obliteration is offered using highly intensive laser radiation (HILR) under permanent ultrasound guidance. The optimal parameters of HILR for venous obliteration were worked out in animal experiments. The experimental data were confirmed by microscopy and electron scanning microscopy. The clinical observations have demonstrated the high efficacy and safety of the treatment method offered.