Effectiveness of treatment of patients with superficial vein thrombosis associated with varicose veins in real clinical practice

Abstract

Introduction. Approaches to the treatment of superficial vein thrombosis associated with varicose veins (V-SVT) has undergone significant changes in the last decade as a result of randomized clinical studies on the effectiveness of anticoagulant therapy in V-SVT. At the same time, there is still not enough specific clinical data covering the results of treatment of patients with V-SVT and reflecting the willingness of doctors to abandon active surgical tactics in this variant of thrombophlebitis.Aim – study the effectiveness of treatment of patients with superficial vein thrombosis associated with varicose veins (V-SVT) in real clinical practice.Materials and methods. A retrospective non-comparative study of the results of treatment of 82 patients with V-SVT (w/m – 49/33, mean age – 55.5 years) who underwent of treatment in two departments of vascular surgery in 2019. A retrospective analysis of outpatient records of 81 patients with V-SVT discharged from the hospital was performed. Clinical and ultrasound parameters were highlighted to summarize the results. The methods of standard statistics applied using the program MS Excel 2016.Results. The localization of thrombus in the system of the great saphenous vein (GSV) in 68 cases (82.9%), in system of the small saphenous vein (SSV) in 8 cases (9.8%), in both systems – 6 cases (7.3%). Localization of the top of the thrombus 20–80 mm from the sapheno-femoral (SFJ)/sapheno-popliteal junctions (SPJ) – 60 (67.5%), passage into deep veins – 12 (13.4%), localization of the top of the thrombus to the level of the middle third of the thigh – 8 (9.0%), in the tributaries and trunk of the GSV/SSV on the leg below knee – 9 (10.1%). The type of the thrombus proximal part: occlusal – 61 (68.5%), non-occlusal – 6 (6.7%), floating – 22 (24.7%). Surgical interventions: high ligation of SFJ – 49 (55.1%), dissection of the SPJ – 8 (9.0%), high ligation + thrombectomy – 12 (13.4%). Conservative treatment at vascular surgery department – 20 (22.5%). Recovery – 81 (98.7%). Death – 1 (massive pulmonary embolism upon admission). After 1 month in the outpatient period, a complete relief of the inflammatory process was registered in 76 patients (93.8%), partial in 5 patients (6.2%). Regression of the thrombotic process: complete in 7 patients (8.7%), partial in 74 patients (91.3%). A case of successful treatment of a patient with V-SVT using parnaparin sodium given in this article.Conclusion. It is necessary to revise the drug therapy of V-SVT with increasing dose of anticoagulants and prolongation of anticoagulant therapy to achieve effective results in regression of thrombotic process in superficial veins of the lower extremities.

Keywords

• поверхностный варикотромбофлебит
• тактика
• хирургическое лечение
• парнапарин натрия