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Background. Acute ascending thrombophlebitis of the great saphenous vein (GSV) is an adverse complication of varicose veins of the lower extremities. Conventional surgical treatment comprises traumatic removal of thrombotic vein trunk by means of a Babcock probe. Endovascular welding is a promising, minimally invasive treatment for varicose veins, which may also be applied for hemodynamic correction of impaired venous blood flow of the lower extremities in urgent conditions. Material and methods. Thirty-six patients diagnosed with acute ascending thrombophlebitis type III and IV, stage C2-C6 (CEAP) were treated using an EK300M electric welding device (LLC Svarmed, Ukraine) for high-frequency electric welding of living tissues guided by endovenous probes. Changes in the treated venous trunks were analyzed by ultrasound, and quality of life before and after surgical treatment was evaluated using a chronic insufficiency venous international questionnaire (CIVIQ). Results. Twelve months after high-frequency endovenous electric welding 33 patients (91.41%) had complete occlusion and fibrous transformation in areas of the thrombus segments of the GSV. Two patients (5.54%) had hemodynamically insignificant partial recanalization of separate vein segments, and one patient (2.77%) had complete recanalization of the GSV trunk. Conclusions. Endoscopic welding is an effective, minimally traumatic alternative method for the surgical treatment of acute ascending thrombophlebitis III and VI type of the GSV.
Despite numerous theories, the etiology and pathogenesis of primary varicose veins remain unclear. The etiology of chronic venous diseases (CVDs) known as chronic venous insufficiency (CVI) is related to leukocyte trapping. Leukocyte trapping involves trapping of white cells in vessel walls followed by their activation and translocation outside the vessel. Release of reactive oxygen species (ROS) from trapped white cells has been documented. Superoxide dismutase (SOD) directly inhibits the generation of free radicals and compounds that are produced during oxidation by ROS, such as malonyldialdehyde (MDA). The aim of this study was to determine the involvement of free radicals in the etiology of venous changes. The following material was used for the study: fragments of sufficient or insufficient venous system and varices from 31 patients diagnosed with chronic venous disease in the 2nd or 3rd degree, according to clinical state, etiology, anatomy and pathophysiology (CEAP), which were qualified for surgical procedure. The levels of oxidative stress markers strongly correlated with lesions observed by USG in insufficient and varicose veins. In both a higher concentration of MDA was observed, which is a sign of lipid peroxidation. Antioxidative mechanisms, SOD activity and total antioxidative power expressed as FRAP were inversely proportional to MDA concentration. In insufficient and varicose veins both FRAP and SOD activities were significantly lower than in normal veins. The severity of clinical changes was inversely dependent on the efficiency of scavenging of ROS, which additionally proves the participation of free radicals in pathogenesis of CVDs.
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