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Neovascularization in the Region of Saphenofemoral Junction Following Babcock Excision of Great Saphenous Vein

100%
Mikusek W., Waniczek D., Arendt J., Buda K., Rudzki M.
Polish Journal of Surgery
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2009
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vol. 81
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issue 9
383-391
EN
Recurrent varicose veins are an important problem in the surgical practice. They can be caused by neovascularization. New venous anastomoses, formed at the site of primary surgical intervention, can result in venous reflux and then recurrence of the disease.The aim of the study was to investigate whether there is a neovascularization at the site of saphenofemoral junction and if so, how common it is, in patients undergoing surgical treatment for varicose veins of the lower limbs.Material and methods. The study enrolled 60 patients: 43 women and 17 men. In all study subjects the region of saphenofemoral junctions was dissected, visualized collateral vessels and great saphenous vein were ligated and cut; the latter was dissected using Babcock method. Ultrasound imaging of the saphenofemoral junction was performed twice: 30 days and 6 months after the surgical procedure. We sough vessels that persisted after the primary procedure as well as vessels formed in the process of neovascularization.Results. Thirty days after the surgical procedure, we did not find any blood vessels in the study group that would suggest that the process of neovascularization took place. In 10 (16.7%) patients we found collaterals left in the region of saphenofemoral junction. Six months after the surgical procedure, small newly formed venules were found in 17 (28.3%) patients in the region of previous surgical intervention. Certain neovascularization was found in 12 (20%) patients and probable neovascularization in 5 (8.3%) of the study group.Conclusions. Six months after the surgical procedure small, tortuous veins appeared at the site of saphenofemoral junction. Their formation is inevitable and occurs irrespectively of completeness of the primary surgical procedure. Throughout six months of follow-up we did not find any evidence to support the assumption that neovascularization could be the cause of recurrent varicose veins.
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The “biological chamber” method – use of autologous platelet-rich plasma (PRP) in the treatment of poorly healing lower-leg ulcers of venous origin

86%
Waniczek D., Mikusek W., Kamiński T., Wesecki M., Lorenc Z., Cieślik-Bielecka A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 6
283-289
EN
Wound healing is a complex pathophysiological process, in which platelets play a crucial role. Platelet alpha-granules release growth factors to the wound bed; the factors are necessary in the healing process. In chronic wounds, such as poorly healing lower-leg ulcers of venous origin, there is decreased activity of multiple growth factors, so the concept of exogenous delivery of such factors seems a logical strategy. Platelet-rich plasma therapy in patients with lower-leg ulcers of venous origin combined with conventional treatment methods (previously ineffective in these patients) seems, based on our observation, an important adjunct leading to recovery. The aim of the study was to present an original method of autologous platelet-rich plasma application through the creation of a sort of “biological chamber” containing a concentrate of growth factors. Material and methods. The described therapy was implemented in 10 patients, who had been ineffectively treated for more than one year in the outpatient setting. Patients with exacerbation of inflammatory process, signs of wound infection and ankle brachial pressure index < 0.8 were excluded from the study. After the application of platelet-rich plasma, further treatment was continued with the use of moist therapy and compression therapy according to a uniform regimen. Results. Complete healing was achieved within 4-10 weeks from the beginning of the product administration in all patients. Conclusion. The presented method seems technically simple, effective and relatively inexpensive
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The Usefulness of Preoperative Doppler Ultrasonographic Evaluation of Saphenofemoral Complex For Improving Lower Limb Varicose Veins Surgery

86%
Mikusek W., Arendt J., Waniczek D., Rudzki M., Buda K., Orkisz W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
594-603
EN
The aim of the study was to determine whether detailed preoperative Doppler ultrasonographic examination of saphenofemoral complex can improve the results of the lower limb varicose veins surgery.Two groups of patients (30 people each) were operated due to lower limbs primary varicose veins caused by saphenous vein insufficiency. All patients had a routine duplex examination performed. Group B had additional ultrasound examination before the operation to evaluate the number, diameter, and localization of the tributary vessels in the area of saphenofemoral junction. 30 days after the operation, in both groups control duplex examination was performed to evaluate the sparingness of the surgical procedure. The control ultrasonography showed 8 and 2 tributary vessels overlooked in groups A and B, respectively. The differences were statistically significant. The conformity of the preoperative ultrasound and the scene found during the operation in group B was 83.3%. The chance of overlooking peripheral vessels in group A increased 5.1 times.Preoperative Doppler ultrasound estimates localization of tributary vessels within the saphenofemoral junction, which makes detecting vessels during the operation much easier. It allows to minimize the number of technical mistakes and improve the lower limb varicose veins surgery results.
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