PREVENTION OF LOCAL POSTOPERATIVE COMPLICATIONS IN THE SURGICAL TREATMENT OF CHRONIC VENOUS INSUFFICIENCY OF THE LOWER EXTREMITIES (CEAP C3-C5).

Abstract

Introduction: Chronic venous insufficiency of the lower extremities remains one of the most significant problems of modern vascular surgery and angiology because of its high prevalence, progressive course, and association with edema, trophic skin changes, and impaired quality of life. In patients with CEAP C3-C5 disease, the outcome of surgical treatment depends not only on elimination of pathological venous reflux, but also on the degree of surgical trauma and the risk of local postoperative complications.

Aim: To evaluate the effect of a modified dissection technique for incompetent perforating veins with preservation of the accompanying artery on the incidence of local postoperative complications in patients with CEAP C3-C5 chronic venous insufficiency of the lower extremities.

Materials and methods: A single-center prospective non-randomized comparative clinical study was conducted at the Department of Cardiovascular Surgery of the Medical Hospital of Semey State Medical University in 2018-2021. The study included 62 patients aged 22 to 48 years with clinically significant chronic venous insufficiency of the lower extremities CEAP C3-C5 who required surgical treatment. The main group consisted of 32 patients who underwent modified dissection of incompetent perforating veins with preservation of the accompanying artery, whereas the comparison group included 30 patients operated on using the conventional technique. Preoperative assessment included clinical examination, duplex ultrasound scanning, CEAP classification, and VCSS scoring. The primary endpoint was the overall incidence of local postoperative complications; the secondary endpoint was the change in VCSS over follow-up. Statistical analysis was performed using Fisher's exact test and the Mann-Whitney U test; p<0.05 was considered statistically significant.

Results: The groups were comparable at baseline in age, CEAP clinical class distribution, and initial VCSS values. In the comparison group, local postoperative complications occurred substantially more often than in the main group. Subcutaneous hematomas were observed in 26.7% versus 6.3% of patients (p=0.040), postoperative limb edema in 40.0% versus 3.1% (p<0.001), ecchymosis in 10.0% versus 0, and skin necrosis in 6.7% versus 0, respectively. The overall incidence of at least one local postoperative complication was 53.3% in the conventional surgery group and 9.4% in the modified surgery group (p=0.00024). Absolute risk reduction was 43.9%, relative risk was 0.18, relative risk reduction was 82.4%, and the number needed to treat was 2.3. VCSS dynamics also favored the modified technique: at 6 months the score was 5 [4;6] versus 6 [5;8] (p=0.028), and at 12 months it was 4 [3;5] versus 6 [5;7] (p=0.011) in the main and comparison groups, respectively.

Conclusions: The modified dissection of incompetent perforating veins with preservation of the accompanying artery was associated with a significant reduction in the incidence of local postoperative complications in patients with chronic venous insufficiency of the lower extremities CEAP C3-C5 compared with the conventional technique. The method is associated with a more favorable early postoperative course and better subsequent clinical improvement according to VCSS, which supports its use as a tissue-sparing and pathogenetically justified surgical approach.