The ways of optimization of laser and chemical vein ablation in varicose vein Disease with comorbid diabetes mellitus
DOI:
https://doi.org/10.11603/2414-4533.2019.4.10705Keywords:
veins, varicose veins, diabetes mellitus, treatment, vascular ablationAbstract
The aim of the work: to assess the effectiveness of endovascular laser and chemical ablation in varicose vein disease (VVD) with type 2 comorbid diabetes mellitus (DM), develop the most optimal technology of therapeutic measures in this category of patients.
Materials and Methods. Under the survey there were 162 patients with VVD (19 % of men and 81 % of women with the average age of 50 years) among whom the ratio of classes II, III, IV, V and VI of venous insufficiency was 1:1:3:1:2. DM occurred in 14 % of the cases while the distribution of mild, moderate and severe forms of the disease was 1:2:4 and the distribution of the phases of compensation, subcompensation and decompensation was 1:4:6. The content of glucose, glycosylated hemoglobin, insulin, C-peptide, fructosamine and microelements associated with carbohydrate metabolism (chromium, manganese, selenium, zinc) was studied in the blood from the cubital vein and the affected vein of the lower extremities. Laser vein ablation was performed using the device “Photonika-Lika-Surgeon” (Ukraine) and performing the paravasal “pillow” with Klein's solution using a pump for tuminascent anesthesia under ultrasound guidance and chemical (sclerotherapy) with a scleraine or fibrovascular solution. The first method was performed in 63 (39 %) patients, the second – in 99 (61 %).
Results and Discussion. The effectiveness of laser ablation depends on the class of venous insufficiency, previous phlebothrombosis, additional use of rivaroxaban and low-molecular-weight heparins in the complex of therapeutic measures, laser coagulation techniques, the presence and the severity of comorbid DM, the parameters of carbohydrate metabolism in the target vein besides the parameters of selenium and zincemia increase after the surgery, and the number of complications arising depends on the phase of DM and the level of chromium in the blood from a varicose vein. The results of sclerotherapy in women were better, the number of complications was less which depended on the level of venous insufficiency, previous phlebothrombosis and the lumen of the target vein of the leg, the parameters insulin, C-peptide and fructosamine in the blood from it. In a comparative assessment of various methods of surgical treatment of VVD laser ablation (coagulation) was characterized by a greater severity of comorbid DM, more frequent additional use of rivaroxaban and cyclo-3-fort, with the exception of patients with diabetic encephalopathy from the development, and sclerotherapy was not used in patients with nephropathy while the effectiveness of the activities carried out in both groups was about the same. In patients with VVD a therapeutic algorithm has been developed for applying the most optimal medical technology for laser and chemical ablation taking into account the nature of the flow of venous pathology and comorbid DM, systemic and local changes in carbohydrate metabolism, and background drug therapy.
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