According to statistics, the disorder of venous circulation of the lower extremities is one of the most common diseases in the world. Although treatment of Varicose Veins the lower extremities (VV) advanced with the use of non-invasive-endovenous procedures, the prognosis in the short term is not satisfactory.

The aim of this paper was to examine the results of treatment of VV on the occurrence of complications and to improve the Quality of Life (QoL) 1 year after the Operative (OP) treatment or Endovenous Laser Ablation (EVLA).

Method: Patients with VV that were operated with the classical surgical method were OP group (n-36) and who are treated EVLA were EVLA group (n-36). We examined patients clinically after 1 year of treatment, while their QoL examined with the Venous Clinical Severity Score (VCSS) questionnaire in which clinical features were estimated by 9 characteristics clinical weight of : 0-absence, 1-easy, 2-moderate, 3-difficult.

Results: The number of absences from work significantly differed (4.500 ± 5.531 in the EVLA group / 22.944 ± 11.363 in the OP group) (p < 0.000). After interventions, complications were rare, except for hematoma, and there was no difference between groups. QoL after 1 year showed that the VCSS was significantly improved (6.20 ± 2.3 / 1.53 ± 1.88) (p < 0.000). Symptomatology of patients from both groups improved after 1 year of interventions, pain decreased in the OP group by 61%, in the EVLA group by 87% (p < 0.017).

Conclusion: Patients after OP or EVLA treatment of varicose veins had few minor complications and after 1 year of interventions and a better QoL.

Abbreviations

OP: Operative Surgical Ligation of Vein Saphena Magna and Stripping; EVLA: Endovenous Laser Ablation; BMI: Body Mass Index; CEAP classification: Clinical (C), Ethiological (E), Anatomical (A) Pathophysiological (P) [C0-6]; VCSS: Venous Clinical Severity Score; QoL: The Quality of Life; CVI: Chronic Venous Insufficiency; DVT: Deep Vein Thrombosis

Introduction

Venous system may be due to venous wall degeneration, post-thrombotic damage of the valvular apparatus, chronic vein obstruction or disorders of the muscular pump function [1]. All signs and symptoms occurring in CVI are the result. The importance of treating Varicose Veins (vv) is not only for cosmetic reasons, but rather a widespread disease which in the later stage can be difficult. Additionally, vv are disease known for centuries and they are mentioned in Ebers Papirus in ancient Egypt (1580 BC), where it is clearly recommended that they do not work well [2].

The review that collected the results of many English-language studies since 1941 has, as so far shown, a prevalence of Chronic Venous Insufficiency (CVI) that varies, but is most common in Western countries in women > 1% to 40%, and in males > 1% to 17%, depending on the geographic region and risk factors [3].

Dysfunction of the venous hypertension [4]. Histological studies have found in the wall of varicose vein of Vein Saphena Magna (VSM) hypertrophy with increased collagen content and a disorientation of the correct orientation of smooth muscle and elastic fibers [5,6].

Symptoms are mainly, non-specific and depend on the stage in which the disease is located. Patients are most likely to complain about “heavy legs,” pain, swelling, anxiety, night cramps and itching [7]. However, the examination of patients with vv is reduced to four symptoms based on which were made and questionnaires for investigating the success of treatment in pain, edema, changes of the skin and changes in the joints of the feet and as a result disturbed functional ability -Venous Clinical Severity Score (VCSS) questionnaire. These symptoms are the consequence of damage to the veins of the lower extremities.

The weight of the venous disease is classified according to the so-called CEAP classification. This classification is based on certain criteria: 1. Clinical (C), 2. Ethiological (E), 3 Anatomical (A) 4. Pathophysiological (P) [6,7].

Seven clinical categories are defined. C0-C6 which may be symptomatic (S) and asymptomatic (A) [7,8].

The importance of preventing the development of CVI and the timely initiation of treatment for patients, especially in the COs stage, when patients have symptoms despite the lack of visible signs of CVI is that it can normalize venous physiology and delay the further development of the disease [9].

The goals of the treatment of diseased veins are: preventing progression of the disease, alleviation of symptoms, improving, the look of the leg and prevention of complications: thrombophlebitis, Deep Vein Thrombosis (DVT) and lung embolism.

Conventional surgery of varicose veins is based on the physical elimination of the diseased segment, and for the past 20 years the idea has come to that the occlusion of the diseased venous segment (thanks to highly sophisticated duplex scanning, as well as radiofrequency and laser devices) can achieve the same effect, but with less invasive mode [10]. Today, in most developed countries, conventional surgery is slowly replaced by the thermal ablation of the VSM and the Vein Safena Parva (VSP).

The aim of this paper was to examine that the results of treatment of vv on the occurrence of complications and to improve the quality of life 1 year after the Operative (OP) treatment or Endovenous Laser Ablation (EVLA) are better.

Methodology

Patients with vv who were operated with the classical surgical method (OP) were OP group (n-36) and who were treated EVLA were EVLA group (n-36). We examined the patients clinically after 15 days of surgery and after 1 year of treatment for the quality of life with VCSS questionnaire.

The inclusion criteria were: diagnosis of varicose veins prior to the intervention. The exclusion criterion was: patients with other diseases: heart diseases, cancer or some other advanced stage disease. The diagnosis was postulated by clinical inspection and duplex scanning. The severity of the disease was assessed using the VCSS and CEAP classification C0-C6.

Conventional surgery

In all 36 patients, the usual surgical technique was applied. After marking the veins in a standing position, preparation of a safeno-femoral mouth, ligating VSM at the junction, simultaneously with the ligation of lateral branches (crossectomia), then cut in the level of the medial malleolus. After the venotomy a flexible endoluminal catheter is placed, which after the intersection of the vein in the distal part of the ligatures is fixed to the blood vessel in the proximal part. The terminal portion is ligated by the end after the catheter fixation in the groin is accessed by pulling out the entire venous stable (stripping).

Endovenous laser ablation

For the EVLA procedure, we used Biolitek Ceralas TM E laser according to the predicted protocol (Model 980nm / 15w / 200 µm (photo number). Patients were treated with energy (depending on the diameter of the diseased vein) 70-100 J / cm and with a power of 14W continuously at 200 μm fiber diameter across the entire length of the vein.

We used local (tumescent) anesthesia. Puncture a vein was at the predetermined position with the aid of ultrasound, J placing the flexible wire is made hardly visible incision and placing a dilator (sheath). Placing the laser probe (pre-connection to a apparat) through a catheter in which the previously extracted in the dilator position below the saphenous-femoral junction.

Statistical Methods

The statistical analysis were used the descriptive statistics methods. To calculate the difference between the continuous variables of both groups, the hi²-test and t-test were used. The unpaired t-test was used to calculate the effect of improving symptoms before the undertaken intervention and 1 year after interventions in both groups.

Results

The study group consisted of 72 patients who had interventions divided into two groups: Group I-OP (n-36) -patients who operated in Group II-EVLA (n-36) patients who were treated with EVLA Table 1 shows the characteristics of both groups of the patients who did not differ by gender, age, BMI, BMI > 25, CEAP classification-C0-6 and VCSS. A significant difference existed in the number of absent days from work after treatment, so with the patients treated ambulatory EVLA method returns to work faster (group II- 4.500 ± 5.531 days versus group I- 22.944 ± 11.363, p < 0.000).

Figure 1: Symptoms before the intervention and after one year from intervention Figure 1 shows the difference in symptomatology in both groups: after 1 year. The pain decreased by 61%, while in the EVLA group the pain decreased by 87%, which was statistically significant (p < 0.017). The difference between patients with edema before and after 1 year. In both groups it was also expressed, the edema decreased in the OP group by 58%, the islets in the EVLA group decreased by more than 77%, the difference was not significant (p < 0.91). Skin changes in both groups have worsened in the OP by 50%, in the EVLA group by 50%, also. Failure in daily activities decreased in both groups in the OP group by 46% in the EVLA group by 40%.

Figure 2: VCSS 1 Histogram in both groups of patients prior to interventions. Histogram VCSS1 prior interventions which was 6.20 ± 2.3 (Figure 2).

Figure 3: VCSS 2 Histogram in both groups of patients after 1 year of interventions Figure 3 shows the histogram VCSS 2 after 1 year of interventions that was 1.53 ± 1.88 significantly lower than VCSS1 before interventions. (P < 0.000).

Discussion

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