PREVENTION OF RECURRENT VARICOSE VEINS OF THE SMALL PELVIS IN WOMEN

Objective. To improve the results of treatment for small pelvic varicose veins (SPVV) in women and to prevent a recurrence of the disease. Subjects and methods. 67 patients, in whom spectral Doppler revealed varicose transformation of veins in the small pelvic, were divided into 3 groups according to the grade of dilation of the ovarian varicose vein: grade I (n = 35), grade II (n = 23), and grade III (n = 9). The treatment of SPVV depended on the degree of phlebectasia. The patients with grades I and II SPVV (Group 1 (n = 58)) received conventional therapy that included vasoprotective (phlebodia and antistax) and antiplatelet (trental, curantil) agents for 2 months twice a year. Those with grade III SPVV (Group 2 (n = 9)) underwent bilateral ovarian vein sclerosurgery using Fibro-Vein 30 mg/ml under laparoscopic guidance. To explore the pathogenetic mechanisms of SPVV, the investigators studied the indicators of lipid peroxidation (LPO) and antioxidant defense, as well as the immune system of patients with this disease. Results. Over the 3-year follow-up period, 18 of the 58 women in Group 1 were observed to have SPVVprogression accompanied by increased dilatation of the ovarian vein (>10 mm). In Group 2, SPVV progression was found in 5 cases (the ovarian vein diameter was 13-15 mm). The findings were indicative of intensified LPO, reduced antioxidant reserves, and an activated nonspecific immune response. The found laboratory changes suggest that the etiopathogenetic mechanisms for the development of SPVV are polyvalent, which must be considered when treating the disease, by complementing its conventional treatment regimen with antioxidants and immunoprotectors. Conclusion. To prevent recurrent SPVV, in addition to conventional therapy for varicose veins, the package of therapeutic measures should include drugs that correct oxidative stress and secondary immunodeficiency. Recurrent SPVV after scleroobliteration of the ovarian veins is caused by their recanalization or incomplete obliteration of the appendages, the treatment of which is achieved by compression sclerotherapy under intraoperative quality control using functional tests.

small pelvic varicose veins, duplex angioscanning, lipid peroxidation, immune status, phlebosclerosing and thermocompression of the ovarian veins