Justification of the surgical approach in treatment of patients with lower limb various vein disease considering the supplement to the ceap clinical classification

Abstract

Varicose disease of the lower limbs nowadays remains an actual medical problem, due to the widespread prevalence of this disease, as well as an increase in the number of complicated cases. Identification of the peculiarities of the functioning of the venous system in patients with varicose disease of the lower limbs will justify the need to modify the CEAP clinical classification, change and standardize the volume of low-trauma surgery, create the best conditions for stabilizing the course and prompt healing of the trophic ulcer. The results of examination and surgical treatment of 132 patients with lower limbs varicose vein disease of type C2-C6 according to CEAP who were on treatment in the surgical department on the basis of the Department of Surgery and Minimally Invasive Technologies of the State Institution “Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine” were analyzed. Supplements to clinical CEAP classification are suggested with the aim to adapt it to the surgical approach with identification of three clinical variants of stage C6: С6а, С6в and С6с as well as verification of competent perforating veins of “re-entry” and incompetent perforating tibia veins marked with the symbols “Apc” and “Apin”, respectively. A combined method for diagnosing the inconsistency of perforating corneal veins in case of varicose veins of lower limbs is developed (Declaration patent of Ukraine No. 70282). The method allows differential diagnostics between a well-founded and inconsistent perforating vein of the tibia, which makes it possible to determine surgical tactics and choose the mode of operation in patients with leg varicose veins. A method of low-traumatic surgical treatment of varicose disease of the lower limbs has been developed, which consists of performing a crossectomy, short stripping of the great saphenous vein trunk with removal of Boyd’s perforator, mini collection of collaterals according to Muller. The developed method of surgical treatment of varicose veins of the lower limbs is radical, allows to reduce the traumatism and duration of the operation, to achieve the best cosmetic results. In the postoperative period after 12 months or more, all (100%) patients had complete disappearance of the pain syndrome, edema of the shin, healing of the trophic ulcer in all cases.