Ендоваскулярна нейрорентгенохірургія (Mar 2017)
Theoretical, experimental and clinical aspects of endovenous electric welding in varicose vein treatment
Abstract
Objective – to study experimentally a possibility of using the technology of living tissue electric welding in the treatment of varicose veins by endovenous electric welding (EVEW) of v. saphena magna (VSM) and to determine its optimum parameters for clinical use; to obtain results of EVEW clinical application. Materials and methods. A device for electric welding of living tissues EC-300M (Ukraine), was used as a current source. To supply the current into the vein lumen, specialized endovenous bipolar instruments of various sizes have been designed. EVEW impact was studied on experimental stand equipped with the contact thermal sensors, registration device for recording the electric welding parameters to monitor current and voltage, and video recording device. The object of the study was previously extracted segments of VSM with fatty tissue. EVEW method was used in the treatment of 82 patients with different VV severity classes. Surgery was performed on 104 limbs. Results. Efficiency of EVEW impact on VSM segments was defined as a series of structural changes that depended on the electric influence power and exposure. A characteristic dependence of electrical welding parameters from tissue impedance at different stages of structural vein changes was noted. The optimal parameters of EVEW were determined in the experiment. Satisfactory results of treatment in terms of stable VSM occlusion were obtained in 97 (93.3 %) cases. According to the available scientific sources, a structure, number and severity of complications did not vary significantly from the results of endovenous laser coagulation and radiofrequency ablation. Conclusions. EVEW with certain parameters defined in the experiment creates safe and effective influence on the venous vessel providing reliable VSM occlusion. The relatively low welding temperature mode and lack of EVEW adverse thermal effect spreading beyond the vein allow to perform an intervention without tumescent anesthesia. Saline solution adding in the area of welding extends a zone of electric influence and allows to apple EVEW on a vein with diameter significantly greater than the caliber of the tool working part. Results of clinical EVEW application within an observation period of 1 year demonstrate no significant differences from the results of the use of other thermal obliteration methods.
