Kochmar O. Treatment of acute varicotromboflebitis in patients with decompensated venous insufficiency

Thesis for the degree of a candidate of medical sciences in specialty 14.01.03 – surgery. State Higher Educational Institution "Uzhgorod National University" Uzhhorod, 2019. The dissertation presents a theoretical generalization and a new solution to the scientific problem of complex treatment of patients with chronic venous insufficiency (CVI) of the lower extremities, complicated by acute varicotromboflebitis (АVTF) and open trophic ulcers, by surgical treatment of АVTF for the prevention of pulmonary embolism, correction of venous hypertension and autodermoplasty of ulcers under the cover of vacuum therapy. The results of complex examination and surgical treatment of 97 patients with AVTF in the system of large and small subcutaneous veins with chronic venous insufficiency in the stage of decompensation (stage C6 according to the CEAP classification) in the department of vessel surgery of Transcarpathian Regional Clinical Hospital named after Andriy Novak, Uzhhorod, since 2010 year to July 2018, have been analyzed. The transition of the thrombotic process to the deep venous system was observed in 24.7% of the total number of patients with acute varicotrombophlebitis and trophic ulcers, where the floating nature of the thrombus in the system of small subcutaneous vein in patients with thrombophlebitis in the context of posttromboflebitis syndrome occurs almost 4.3 times more often than with varicose veins (22.5% vs. 5.3%). Scientifically proved that changes in coagulation hemostasis in patients with AVTF with CVI in the stage of decompensation are mainly local, where the most stable and the only indicator of both regional and central flow is the international normalized ratio (INR) (p = 0, 0063). On the basis of the received data, the algorithm of diagnostics and complex treatment of patients with thrombotic complications at CVI in the stage of decompensation is proposed and implemented, that including methods of surgical and minimally invasive correction of hemodynamics and local treatment of trophic ulcers, including methods of sclerooblitiration under covering of vacuum therapy. The dynamics of healing of trophic ulcers in patients with acute varicotrombophlebitis in the background of varicose veins was better than in patients with acute varicotrombophlebitis in the context of posttrombophlebitis syndrome.