[Errors in examination and management of patients with lower limb varicosity and their role in development of a relapse of the disease]

Abstract

Analyzing the literature of the recent years and own clinical experience gained in management of patients diagnosed with recurrent varicose disease indicate that along with the progression of the disease one of the main causes of its relapses are certain medical errors leading to the development of relapsing varicosity of the lower limb veins. Moreover, the number of medical errors often appears to considerably exceed the total number of the patients in whom they were revealed, i. e., several and more medical errors would have been made sequentially in one and the same patient at various stages of the examination. The present work is based on the findings obtained from a comprehensive examination and comparative analysis of the condition of the patients presenting with recurrent varicosity of the veins of the lower extremities, and the errors we revealed to have been made during the prior examination and surgical treatment of the latter. The errors were subdivided into diagnostic, tactical, technical and organizational ones as follows: Diagnostic errors: missed in 195 (90%) patients at the moment of the primary examination turned out to have been incompetent perforating veins, in 82 (38 %) -saphenopopliteal reflux, and in 12 (5.5 %) patients not revealed turned out to have been the signs of postthrombotic disease, dysplasia of venous valves and arteriovenous fistulas. Tactical errors: in 61 (28 %) patients exceeded had been the indications for sclerotherapy, in 39 (18 %) - the indications for ligature methods, and 95 (44 %) patients were found to have had the trunk of the smaller saphenous vein not removed during the primary intervention. Technical errors: in 115 (53 %) patients we revealed a long stump of the greater saphenous vein and in 156 (72 %) that of the smaller saphenous vein, also left had been the trunk of the GSV in 43 (20 %) patients, and in 141 (65 %) subjects revealed were errors in treatment of the perforating veins of the crus and femur or a complete absence thereof. Our experience and the literature data indicate that the greatest number of complications, unfavourable therapeutic outcomes, and relapses of varicose disease occur during the management of phlebological patients in general surgical departments, with the attending physicians having insufficient training in phlebology. In our opinion, this quite delicate intervention should be performed by vascular surgeons, or surgeons duly trained in this specific modality.