Background: The surgical stripping with phlebectomy is still a widely accepted successful way of varicose vein treatment. Due to the often symptomatic course of the disease, the role of phlebotropic agents in patients with chronic venous disease was previously investigated, however, there are limited data concerning their usefulness in the perioperative pharmacological treatment in patients undergoing varicose vein surgery.
Material and methods: In the paper the efficacy of the complex treatment including Great Saphenous Vein (GSV) stripping, phlebectomy and perioperative administration of the micronized purified flavonoid fraction (MPPF, micronized purified fraction, Detralex, Servier) in patients with primary varicose veins and GSV incompetence were assessed. In the study 90 patients qualified to the GSV stripping and phlebectomy were evaluated. The patients were treated with MPFF within two weeks before surgery and the pharmacological treatment was continued up to the first postoperative visit between the 7th and 14th day after stripping. The severity of the complaints related to the chronic venous disease was assessed by the means of the Visual Analoque Scale (VAS). For the quality of life assessment the value of GIS (Global Index Score) based on the 20 question CIVIQ form was implemented (before and after surgery and medical treatment). The level of postoperative pain was evaluated by means of the VAS and by the assessment of the necessity of analgetic agents consumption. The severity of the postoperative pain, as well the size of postoperative subcutaneous haematoma after saphenous vein stripping was evaluated in relation to the kind of the performed surgery (conventional stripping vs. stripping by invagination).
Results: Prior to the initial pharmacological treatment, more than 90% of the varicose vein patients included into the study reported subjective complaints (pain and/or leg heaviness or tiredness) related to the chronic venous disease. Other ailments including sensation of swelling, night cramps and itching were present in 69%, 67% and 42% of the patients respectively. In 23% of the cases the coexistence of all and in 38% the coexistence of 5 of above mentioned complaints was noticed. After the 14 day treatment with MPFF (before surgery) a statistically significant reduction of the frequency of all the previously reported ailments was seen - the most commonly occurring leg heaviness, tiredness and pain were present in 42%, 38% and 36% of the patients respectively. In the final evaluation (after pharmacological and surgical treatment) the further reduction of the patient’s complaints related to chronic venous disease was reported (pain - 23%, leg heaviness 23%, sensation of swelling - 11%, leg heaviness - 10% itching 8%, and night cramps - 2%). In the quantitative assessment a significant reduction in the severity of these complaints was also noticed. The implementation of the phlebotropic treatment (MPFF) in association with surgical procedure resulted also in a significant final quality of life improvement at the end of the study. In the whole group, the mean increase of the GIS value achieved 16.65 points. In 25% of the patients GIS increase of 23.8 points or more from the initial values was noticed. The patients who underwent stripping by invagination reported the shorter use of paracetamol after surgery in comparison with the group underwent conventional stripping. In the patients underwent conventional stripping a higher rate of large subcutaneous haematoma was reported, especially if general or spinal anesthesia were used. A significant increase of final GIS in the patients who underwent stripping by invagination was seen at the end of the treatment.
Conclusions: 1. Due to the high rate of symptomatic cases among the patients qualified for varicose veins surgery, the use of complex treatment (including MPFF pharmacotherapy) is often justified. 2. The perioperative treatment with MPFF in patients qualified for saphenous vein stripping has a positive influence on the reduction of the complaints related to the chronic venous disease as well as on the patient’s quality of life improvement. 3. The use of stripping by invagination together with local anaesthesia, limits the number of local haemorrhagic complications as well as reduces the level of postoperative pain in comparison with the conventional stripping procedure.