Surgical treatment of varicose disease of the lower extremities. Evolution of the 5 problem - past and present
The way of development and formation of diagnostics and treatment of the varicose veins (VV) of veins of the lower extremities is presented in the review, starting with the description of anatomy of vessels, studying of anatomy and physiology of venous system of veins of the lower extremities, including their valvate structures in historical aspect. Pathophysiological justification of surgical treatment of VV of the lower extremities is connected with the names F. Trendelenburg (1890), A.A. Troyanov (1910), to J. Homans (1916) which offered to built doping and bandaging of all trunks and inflows of the big hypodermic vein (BHV). The basic principles of surgical treatment of VV were created at the beginning of the XX century and the applied more sparing methods of removal of BHV are connected with the names Madelung (1884), to BHV which offered radical operation of removal, the perforating veins and varicose expanded inflows through a long skin section from a groin to a medial anklebone, and also W Keller (1905) and W Babcock (1907). The phlebectomy method on the W. Babcock method with various improvements was adopted by most of surgeons of the world, being the standard of treatment of a VV. The W Babcock method the inversion equipment of a saphenectomy that is provided with application of olives of small diameter and a cryotrapping succeeded. In the middle of the XX century the concept of the isolated impact on varicose veins as a way of switching off from blood circulation of the varicose changed veins developed. Instead of removal of a vein in 1959 the method of its endovascular electrocoagulation was introduced. Instead of it broad development was gained by a sclerotherapy method thanks to that effective and safe sclerosing drugs were synthesized. Wide popularity was received by the technique of a miniphlebectomy of varicose inflows developed by R. Muller (1966) and Z. Varady (1977) which allows to carry out treatment of a varicose veins in out-patient conditions, with high esthetic result. In the XXI century broad development was gained by technologies of an endovenous thermal ablation (EVTA) - a radio-frequency ablation (RChA), an endovenous laser obliteration (EVLO), the endovenous steam ablation (ESA). The listed technologies - minimum invasive out-patient methods which are carried out under local tumescent anesthesia with the frequency of relapses, comparable with a traditional phlebotomy. Authors of article in detail stopped on EVLO technique, having shown stages of its development, advantage before other techniques, and also its role and a place in complex treatment of sick VV of the lower extremities.