Modern approaches to the comprehensive treatment of chronic venous insufficiency of the lower limbs in the stage of trophic disorders

Cover Page

Cite item

Full Text

Abstract

Objective. Evaluate the clinical effectiveness of minimally invasive treatment methods for chronic venous insufficiency (CVI) of the lower extremities at the stage of trophic disorders (C6 according to the CEAP classification).

Materials and methods. A prospective study included 80 patients, divided into two groups: the main group (n = 40) underwent endovenous laser coagulation (EVLC), radiofrequency ablation (RFA), and perforator vein correction, while the control group (n = 40) received conservative therapy.

Results. It was shown that in the main group, complete ulcer healing was achieved in 90 % of patients within 12 weeks, whereas in the control group this figure was 55 % (p < 0.01). The recurrence rate during the year was significantly lower with the use of minimally invasive surgery. Thus, minimally invasive treatment methods demonstrate high clinical effectiveness, promote faster ulcer healing and reduce recurrence rates, and may also be considered the preferred therapeutic approach for C6 stage chronic venous insufficiency.

Conclusions. The conducted prospective study confirmed the high clinical effectiveness of minimally invasive treatment methods for chronic venous insufficiency of the lower extremities at the stage of trophic disorders (C6 according to the CEAP classification). The use of endovenous laser coagulation and radiofrequency ablation in combination with correction of perforator reflux made it possible to achieve stable healing of trophic ulcers in 90 % of patients within 12 weeks, whereas with conservative therapy alone this indicator was 55 %.

Minimally invasive interventions not only accelerate epithelialization of the ulcerative defect, but also significantly reduce recurrence rates, decrease pain, improve venous hemodynamics, and enhance patients’ quality of life. Their safety and suitability for outpatient use make these methods preferable in clinical practice for managing patients with C6-stage chronic venous insufficiency.

About the authors

M. M. Abdurakhmonov

Bukhara State Medical Institute named after Abu Ali ibn Sinо

Author for correspondence.
Email: hur-surg@mail.ru
ORCID iD: 0000-0001-8394-5453

DSc (Medicibe), Professor of the Department of Surgical Diseases in Family Medicine

Uzbekistan, Bukhara

U. R. Khamdamov

Bukhara State Medical Institute named after Abu Ali ibn Sinо

Email: hur-surg@mail.ru
ORCID iD: 0009-0009-6511-0060

PhD (Medicibe), Doctoral Student of the Department of Surgical Diseases in Family Medicine

Uzbekistan, Bukhara

Z. M. Abdurakhmanov

Bukhara State Medical Institute named after Abu Ali ibn Sinо

Email: hur-surg@mail.ru
ORCID iD: 0000-0002-0444-9791

PhD (Medicine), Associate Professor of the Department of Surgical Diseases in Family Medicine

Uzbekistan, Bukhara

References

  1. Абдурахманов З.М., Умаров Б.Я., Абдурахманов М.М. Современные биомаркеры эндотелиальной дисфункции при сердечно-сосудистых заболеваниях. Рациональная фармакотерапия в Кардиологии 2021; 17 (4): 612–618. doi: 10.20996/1819-6446-2021-08-08 / Abdurakhmanov Z.M., Umarov B.Y., Abdurakhmanov M.M. Novel Biomarkers of Endothelial Dysfunction in Cardiovascular Diseases. Rational Pharmacotherapy in Cardiology 2021; 17 (4): 612–618. doi: 10.20996/1819-6446-2021-08-08 (in Russian).
  2. Andercou O., Stancu B., Noppeney T. Radiofrequency Thermal Ablation for the Treatment of Chronic Venous Insufficiency of the Saphenous Vein. Int J Environ Res Public Health 2023; 20 (4): 3308. doi: 10.3390/ijerph20043308
  3. Богачёв В.Ю., Каралкин А.В. Эндовенозная лазерная облитерация у пациентов с С6 по CEAP: результаты проспективного исследования. Флебология 2018; 12 (4): 215–223. doi: 10.17116/flebo201812041215 / Bogachyov V.Yu., Karalkin A.V. Endovenous laser obliteration in patients with C6 stage CEAP: results of a prospective study. Phlebology 2018; 12 (4): 215–223. doi: 10.17116/flebo201812041215 (in Russian).
  4. Cong L., Sun J., Wang L., et al. Hybrid endovenous laser ablation reduces recurrence in below-knee varicose veins: a real-world study. Arch Med Sci. 2023; 19 (6): 1739–1746. doi: 10.5114/aoms/163449
  5. Gohel M.S., Barwell J.R., Taylor M., et al. Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med. 2018; 378 (21): 2105–2114. doi: 10.1056/NEJMoa1801214
  6. Hamann S.A.S., Van den Bos R., et al. Randomized clinical trial of endovenous laser ablation versus radiofrequency ablation for great saphenous vein incompetence. Br J Surg. 2019; 106 (7): 998–1004. doi: 10.1002/bjs.11187
  7. Капустина В.А., Астафьева Н.Г. Компрессионная терапия при хронических венозных язвах: современные стандарты. Клиническая медицина 2018; 96 (3): 210–216. doi: 10.18821/0023-2149-2018-96-3-210-216 / Kapustina V.A., Astafieva N.G. Compression therapy for chronic venous ulcers: current standards. Klinicheskaya Meditsina (Clinical Medicine) 2018; 96 (3): 210–216. doi: 10.18821/0023-2149-2018-96-3-210-216 (in Russian).
  8. Кириенко А.И., Богачёв В.Ю., Калашникова М.С. Современные подходы к лечению трофических язв венозной этиологии. Флебология 2019; 13 (2): 102–112. doi: 10.17116/flebo201913021102 / Kirienko A.I., Bogachyov V.Yu., Kalashnikova M.S. Modern approaches to the treatment of venous trophic ulcers. Phlebology 2019; 13 (2): 102–112. doi: 10.17116/flebo201913021102 (in Russian).
  9. Reitz K.M., Salem K., Mohapatra A., et al. Complete Venous Ulceration Healing after Perforator Ablation Does Not Depend on Treatment Modality. Ann Vasc Surg. 2021; 70: 109–115. doi: 10.1016/j.avsg.2020.06.051
  10. Сапожников Ю.Г., Андрияшкин В.В., Лебедев М.В. Эндовазальные методы лечения варикозной болезни: сравнительная эффективность ЭВЛК и РЧА. Ангиология и сосудистая хирургия 2020; 26 (3): 45–51. / Sapozhnikov Y.G., Andriyashkin V.V., Lebedev M.V. Endovascular methods for the treatment of varicose veins: comparative effectiveness of EVLA and RFA. Angiology and Vascular Surgery 2020; 26 (3): 45–51 (in Russian).
  11. Савельев В.С., Гавриленко А.В., Козлов Ю.А. Минимально инвазивное лечение несостоятельных перфорантных вен при трофических язвах. Хирургия 2017; (9): 45–50. / Savelyev V.S., Gavrilenko A.V., Kozlov Y.A. Minimally invasive treatment of incompetent perforator veins in trophic ulcers. Surgery 2017; (9): 45–50 (in Russian).
  12. Трофимов А.Г., Поляков И.В. Радиочастотная абляция в лечении варикозной болезни с осложнённым течением. Вестник хирургии им. Грекова 2020; 179 (5): 12–17. doi: 10.24884/0042-4625-2020-179-5-12-17 / Trofimov A.G., Polyakov I.V. Radiofrequency ablation in the treatment of complicated varicose veins. Grekov’s Surgery Bulletin 2020; 179 (5): 12–17. doi: 10.24884/0042-4625-2020-179-5-12-17 (in Russian).
  13. Золотухин И.А., Кузнецов А.М., Чупин А.В. Сравнение эффективности ЭВЛК и РЧА у пациентов с трофическими расстройствами. Флебология 2021; 15 (1): 23–31. doi: 10.17116/flebo20211501123 / Zolotukhin I.A., Kuznetsov A.M., Chupin A.V. Comparison of EVLA and RFA effectiveness in patients with trophic disorders. Phlebology 2021; 15 (1): 23–31. doi: 10.17116/flebo20211501123 (in Russian).
  14. Ho V.T., Pannek J., Braithwaite B.D., et al. Evidence update on minimally invasive treatments for chronic venous disease: systematic review. J Vasc Surg Venous Lymphat Disord. 2022; 10 (2): 345–362. doi: 10.1016/j.jvsv.2021.12.090
  15. Шевченко Ю.Л., Стойко Ю.М., Черняго Т.Ю., Яшкин М.Н. Особенности функционального состояния эндотелия и микроциркуляции у пациентов с варикозной болезнью нижних конечностей класса С4 по СЕАР после эндовенозной лазерной облитерации и фармакотерапии сулодексидом. Флебология 2022; 16 (3): 213–219. doi: 10.17116/flebo202216031213 / Shevchenko Y.L., Stoyko Y.M., Chernyago T.Yu., Yashkin M.N. Features of endothelial function and microcirculation in patients with C4-class lower extremity varicose veins after endovenous laser ablation and sulodexide pharmacotherapy. Phlebology 2022; 16 (3): 213–219. doi: 10.17116/flebo202216031213 (in Russian).
  16. Шевченко Ю.Л., Стойко Ю.М., Гудымович В.Г., Никитина А.М. Эндотелиальная дисфункция в развитии варикозной болезни вен нижних конечностей и возможности ее коррекции. Медицинский вестник Юга России 2014; (4): 113–119. / Shevchenko Y.L., Stoyko Y.M., Gudymovich V.G., Nikitina A.M. Endothelial dysfunction in the development of lower extremity varicose veins and possibilities for its correction. Medical Bulletin of the South of Russia 2014; (4): 113–119 (in Russian).

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2025 Eco-Vector

License URL: https://eco-vector.com/for_authors.php#07
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).