FACTORS INFLUENCING THE EFFECTIVENESS OF ENDOVASAL CHEMICAL ABLATION OF VEINS IN VARICOSE VEINS DISEASE WITH COMORBID DIABETES MELLITUS TYPE 2
DOI:
https://doi.org/10.11603/2414-4533.2024.1.14641Keywords:
varicose veins, diabetes mellitus, microelements, carbohydrates, chemical ablationAbstract
The aim of the work: to evaluate the effectiveness of endovasal chemical vein ablation in the treatment of VVD with comorbid DM-2; determine the factors likely to affect the effectiveness of treatment; to determine the dynamics of the microelements (ME) level, which take part in carbohydrate metabolism in this category of patients; identify prognostic criteries.
Material and Methods. An analysis of the treatment of 99 patients with VVD was carried out (17.2 % men and 82.8 %, average age 48 years). C4-C6 classes (CEAP) were observed in 67.7 % of cases. Comorbid DM-2 was diagnosed in 12.1 % of patients. The ratio of mild, moderate, and severe diabetes was 1:3:2, and the phases of compensation, subcompensation, and decompensation were 1:6:5. Polidocanol (Lauromacrogol 400) in a concentration of 1-3% in the form of a foam was used for EVCA.
Results. One month after endovasal chemical ablation (EVCA), significant improvement was noted in 11.8 % of cases in men and 41.5 % of women. Also, the effectiveness of the treatment after 1 month is influenced by the age of the patients, initial blood pressure values, systolic volume, peripheral vascular resistance and vascular autonomic index, degree of venous insufficiency, past phlebothrombosis, use of rivaroxaban, vein diameter (DV). Simultaneous direct variance-correlation relationships of treatment effectiveness at the first follow-up stage relate to baseline INSl/s, and negative relationships to CPl/s and FAl/s. An unfavorable factor is a high initial value of CPl/s (where INS-insulin, CP-C-peptide, FA-fructosamine, l/s is the ratio of the indicator in the varicose and ulnar veins). 6 months after the performed EVCA, compared to the control group and initial concentrations, chromium content increases (by 8 %) in patients, and in comparison with the initial values, Se and Zn levels increase by 2 % and 9 % in patients with VVD.
The results of EVCA in female patients are better, there are fewer complications, which depend on the state of systemic hemodynamics, the degree of venous insufficiency, past phlebothrombosis and the diameter of the varicose vein, parameters in the blood from it INS, CP and FA, and from the ulnar vein – associated with carbohydrate metabolism of trace elements (Cr, Mn, Zn). Prognostic criteria were identified, while an increase in the levels of Cr, Se, and Zn was recorded in patients who underwent EVCA.
References
DePopas E, Brown M. Varicose Veins and Lower Extremity Venous Insufficiency. Semin Intervent Radiol. 2018;35(1): 56-1. DOI:10.1055/s-0038-1636522
Robertson LA, Evans CJ, Lee AJ, Allan PL, Ruckley CV, Fowkes FG. Incidence and risk factors for venous reflux in the general population: Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2014;48(2): 208-14. DOI:10.1016/j.ejvs.2014.05.017
Syniachenko YuO, Pylypenko RV, Syniachenko OV. Effectiveness of endovenous laser coagulation against the background of sclerotherapy of varicose veins of the lower extremities. Pivdennoukr med nauk zhurn. 2017;18: 78-80. Ukrainian.
Mallick R, Raju A, Campbell C. Treatment Patterns and Outcomes in Patients with Varicose Veins. Am Health Drug Benefits. 2016;9(8): 455-65.
Serizawa F, Tanaka M, Shimizu T, Akamatsu D, Ohara M, Goto H The epidemiology of micro-arteriovenous fistulas in the lower legs. Ann Vasc Surg. 2019;56(11): 29-35.
Regulski MJ, MacEwan MR. Implantable Nanomedical Scaffold Facilitates Healing of Chronic Lower Extremity Wounds. Wounds. 2018;30(8): E77-80.
Shao M, Hussain Z, Thu HE. Emerging Trends in Therapeutic Algorithm of Chronic Wound Healers: Recent Advances in Drug Delivery Systems, Concepts-to-Clinical Application and Future Prospects. Crit Rev Ther Drug Carrier Syst. 2017;34(5): 387-452. DOI:10.1615/CritRevTherDrugCarrierSyst.2017016957
Tavares DMDS, Bolina AF, Dias FA, Ferreira PCDS, Santos NMF. Overweight in rural elderly: association with health conditions and quality of life. Cien Saude Colet. 2018;23(3): 913-22. DOI: 10.1590/1413-81232018233.25492015
Rusak A, Karuga-Kuźniewska E, Wiatrak B et al. Venous insufficiency: Differences in the content of trace elements. A preliminary report. Adv Clin Exp Med. 2018;27(5): 695-701. DOI:10.17219/acem/68902
Palamarchuk VI, Odnorog SI, Gvozdyak MM, Vilgash AM Clinical course and effective treatment of varicose vein of lower limb in diabetic patients. Klinichna khirurhiia. 2015;(6): 44-5.
Kaspar S. Flebologické problémy a diabetes [Veins and diabetes]. Vnitrni lekarstvi. 2010;56(4): 329-32.
Ziegler UE, Schmidt K, Keller HP, Thiede A. Behandlung chronischer Wunden mit einer Kalzium-Zink-Mangan-Alginatauflage [Treatment of chronic wounds with an alginate dressing containing calcium zinc and manganese]. Fortschr Med Orig. 2003;121(1): 19-26.
Ortega MA, Romero B, Asúnsolo Á. Behavior of Smooth Muscle Cells under Hypoxic Conditions: Possible Implications on the Varicose Vein Endothelium. Biomed Res Int. 2018;2018: 7156150. Published 2018 Oct 18. DOI:10.1155/2018/7156150
Trapani G, Satriano C, La Mendola D. Peptides and their Metal Complexes in Neurodegenerative Diseases: from Structural Studies to Nanomedicine Prospects. Curr Med Chem. 2018;25(6): 715-47. DOI:10.2174/0929867324666171026163144.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 В. О. ШАПРИНСЬКИЙ, С. О. ЖАРІКОВ, Р. В. ПИЛИПЕНКО, В. Р. ТАГЕЄВ
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
