ORIGINAL RESEARCH

Cardiovascular Surgery

doi: 10.25005/2074-0581-2023-25-4-488-498
COMBINED MINIMALLY INVASIVE PHLEBECTOMY WITH PRP THERAPY FOR THE TREATMENT OF CHRONIC VENOUS INSUFFICIENCY AND KNEE OSTEOARTHRITIS

O. NEMATZODA1, S.KH. KURBANOV2, KH.A. YUNUSOV1, A.S. EKHSONOV2, S.G. ALI-ZADE2, KH.A. TOSHPULOTOV2

1Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
2Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To analyze the results of combined minimally invasive phlebectomy (CMIP) with platelet-rich plasma (PRP) therapy for the treatment of chronic venous insufficiency (CVI) and knee osteoarthritis (KOA).

Methods: The study analyzed the treatment results of 26 patients (11 men, 15 women, average age of 49.3±4.6 years) with CVI and KOA who underwent CMIP with PRP therapy. The patients' average body mass index (BMI) was 28.9±2.1 kg/m². It was observed that patients with CVI exhibited different grades of severity according to the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. Out of 26 patients, 7 (27%) were classified as CEAP class 2, 15 (58%) as class 3, and 4 (15%) as class 4. Isolated insufficiency of the great saphenous vein (GSV) and its tributaries was noted in 9 (35%) patients and the small saphenous vein (SSV) – in 2 (8%) patients. Of the 26 patients, 15 (58%) had combined insufficient GSV and SSV trunks and tributaries. All patients presented with bilateral saphenous vein insufficiency, predominantly on the left side in 19 (73%) cases and on the right side in 7 (27%) cases. Of 26 patients, 17 (65%) had insufficient tibial perforators. According to the Kellgren JH & Lawrence JS classification of osteoarthritis (OA), 4 (15%) of the patients had grade I KOA, 14 (54%) had grade II, and 8 (31%) had grade III. Phlebological status was assessed visually and with duplex scanning (DS) of the venous system in the lower extremities. The knee joints were evaluated using the WOMAC Osteoarthritis Index.

Results: The median total index on the WOMAC scale before treatment was 65.5 (61.0-74.0) points, including pain index – 14.0 (13.0-16.0) points, knee joint stiffness – 6.0 (5.0-6.0) points and joint functioning – 47.0 (45.0-49.0) points. All patients underwent CMIP as the first stage, followed by four sessions of PRP therapy, one per week as the second stage. The average duration of surgical procedures was 115.5±35.5 minutes, and patients stayed an average of 2.8±0.4 days in the hospital. There were no significant complications in any case. After the treatment, there was a substantial decrease in pain and stiffness and an improvement in knee joint function. Therapy was ineffective in 4 (15%) cases. The effectiveness of PRP therapy is lower when certain factors are present. These factors include an advanced stage of KOA with a longer duration of the degenerative process in the joint, chronic use of painkillers, and the combined insufficiency of the GSV and SSV trunks. There is a direct correlation between these factors and the low effectiveness of platelet-rich autologous plasma.

Conclusion: In patients with CVI and KOA, performing CMIP and PRP therapy can significantly decrease pain and improve daily knee joint function.

Keywords: Varicose veins, knee osteoarthritis, microphlebectomy, stripping, PRP therapy.

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References
  1. Zubareva EV, Lesnyak OM. Vliyaet li varikoznaya bolezn' nizhnikh konechnostey na proyavleniya osteoartroza kolennykh sustavov? [Does lower extremity varicose disease influence manifestations of knee osteoarthritis?]. Lechashiy vrach. 2016;12:64-8.
  2. Ageeva AI, Kulikov AG, Volovets SA, Gerasimenko MYu, Yarustovskaya OV. Gonartroz v sochetanii s khronicheskoy venoznoy nedostatochnost'yu: novyy vzglyad na terapiyu [Gonarthrosis concurrent with chronic venous insufficiency: A new look at therapy]. Voprosy kurortologii, fizioterapii, i lechebnoy fizicheskoy kul’tury. 2019;96(5):29-35. https://doi.org/10.17116/kurort20199605129
  3. Nematzoda O, Gaibov AD, Kurbanov SKh, Toshpulotov KhA, Ali-Zade SG, Baratov AK. Znachenie gonartroza v razvitii varikoznoy bolezni nizhnikh konechnostey [The role of knee osteoarthritis in the development of varicose veins in the lower extremities]. Vestnik Avitsenny [Avicenna Bulletin]. 2022;24(2):193-203. https://doi.org/10.25005/2074-0581-2022-24-2-193-203
  4. Shcheglov EA, Vezikova NN. Ehffektivnost' khirurgicheskogo lecheniya varikoznoy bolezni u patsientov c khronicheskoy venoznoy nedostatochnost'yu v sochetanii s gonartrozom [Effectiveness of varicose disease surgical treatment in patients with chronic venous deficiency in combination with knee osteoarthritis]. Uchyonye zapiski Petrozavodskogo gosudarstvennogo universiteta. 2012;6:55-8.
  5. Oga Y, Sugiyama S, Matsubara S, Inaki Y, Matsunaga M, Shindo A. The effectiveness of endovenous thermal ablation for the knee symptoms of the osteoarthritis with varicose veins. Ann Vasc Dis. 2021;14(2):108-11. https://doi. org/10.3400/avd.oa.21-00016
  6. Nematzoda O, Gaibov AD, Soliev OF, Toshpulotov KhA, Ali-Zade SG, Baratov AK. Rezul'taty pervogo opyta simul'tannykh operatsiy pri varikoznoy bolezni i gonartroze [Evaluation of results of the first experience of combined surgery for varicose veins and knee osteoarthritis]. Vestnik Avitsenny [Avicenna Bulletin]. 2022;24(3):331-43. https://doi.org/10.25005/2074-0581-2022-24-3-331-343
  7. Alrithwany MHI, Manaa HZH, Al-Omari WRS. Knee osteoarthritis: Measurement of disability and associations with chronic venous insufficiency of the legs and osteoporosis. International Journal of Development Research. 2019;9(03):26185-204.
  8. Teplov OV, Teplova YuS, Plakseychuk YuA1, Masgutov RF, Masgutova GA, Salikhov RZ, i dr. Primenenie autologichnoy bogatoy trombocitami plazmy v lechenii patsientov starshey vozrastnoy gruppy s osteoartrozom kolennogo sustava II-III st [The use of autologous PRP in the treatment of patients of the older age group with II-III stage osteoarthritis of the knee joint]. Prakticheskaya meditsina. 2017;8:130-2.
  9. Sinyachenko YuO, Samoylenko GE, Sinyachenko OV. Vliyanie gonartroza na techenie i effektivnost' lecheniya varikoznoy bolezni ven nizhnikh konechnostey [Influence of gonarthrosis on the clinical course and treatment efficiency of varicose vein of lower limb]. Travma. 2017;18(1):63-7. https://doi. org/10.22141/1608-1706.1.18.2017.95591
  10. Sadriev ON, Kalmykov EL, Gaibov AD, Inoyatov MS. Retsidiv varikoznoy bolezni posle flebektomii [Recurrent varices after phlebectomy]. Rossiiskiy mediko-biologicheskiy vestnik imeni akademika I.P. Pavlova. 2016;24(1):86-90.
  11. Kotelnikov GP, Losev II, Sizonenko YaV, Katorkin SE. Osobennosti diagnostiki i taktiki lecheniya patsientov s sochetannym porazheniem oporno-dvigatel'noy i venoznoy sistem nizhnikh konechnostey [Peculiarities of diagnostics and treatment tactics of patients with combined lesion of the musculoskeletal and venous systems of the lower limbs]. Novosti khirurgii. 2013;21(3):42-53. https:// doi.org/10.18484/2305-0047.2013.3.42
  12. Classification and grading of chronic venous disease in the lower limbs. A consensus statements. Ad Hoc Committee, American Venous Forum. J Cardiovasc Surg (Torino). 1997;38(5):437-41.
  13. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. https://doi.org/10.1136/ard.16.4.494
  14. Potapnev MP, Krivenko SI, Bogdan VG, Kosmachyova SM, Shlyaga OL, Karpenko FN. Plazma krovi, obogashchyonnaya rastvorimymi faktorami trombotsitov: poluchenie, standartizatsiya, meditsinskoe primenenie [Platelet-rich derived plasma: Manufacture and medical application]. Zdravookhranenie. 2018;10:38-44.
  15. Roos EM, Klässbo M, Lohmander LS. WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and MacMaster Universities. Scand J Rheumatol. 1999;28(4):210-5. https://doi.org/10.1080/03009749950155562
  16. Sultanov DD, Kalmykov EL, Gaibov AD, Soliev OF, Dodkhoev DS, Nematzoda O. Epidemiologiya khronicheskikh zabolevaniy ven sredi sel’skikh zhiteley Tadzhikistana [Epidemiology of chronic venous diseases among rural residents of Tajikistan]. Flebologiya. 2019;13(4):303-9. https://doi.org/10.17116/flebo201913041303
  17. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220-33. https://doi.org/10.1002/art.41142
  18. Potapnev MP, Zagorodniy GM, Krivenko SI, Bogdan VG, Svirskiy AO, Yasyukevich AS, i dr. Sovremennye aspekty primeneniya plazmy, obogashchyonnoy rastvorimymi faktorami trombotsitov, v lechenii travm i zabolevaniy oporno-dvigatel'nogo apparata [Modern aspects of the use of plasma enriched in soluble platelet factors in the treatment of injuries and diseases of the musculoskeletal system]. Sportivnaya meditsina: nauka i praktika. 2019;9(4):33-45. https://doi. org/10.17238/ISSN2223-2524.2019.4.33
  19. De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267. https://doi. org/10.1016/j.ejvs.2021.12.024

Author information:


Nematzoda Okildzhon,
Candidate of Medical Sciences, Leading Researcher of the Republican Scientific Center for Cardiovascular Surgery
Researcher ID: F-8729-2018
Scopus ID: 56469644700
ORCID ID: 0000-0001-7602-7611
SPIN: 2408-9107
Author ID: 929575
E-mail: sadriev_o_n@mail.ru

Kurbanov Saybilol Khushvakhtovich,
Doctor of Medical Sciences, Professor of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
Researcher ID: ABЕ-2853-2020
ORCID ID: 0000-0002-2853-2020
Author ID: 584471
E-mail: 9282718@mail.ru

Yunusov Khuseyn Abdulkhakovich,
Junior Researcher of the Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0001-8569-3384
SPIN: 1001-4435
Author ID: 1020861
E-mail: husein-yunusov89@mail.ru

Ekhsonov Abdushokir Safarmatovich,
Candidate of Medical Sciences, Applicant of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
Researcher ID: G-4743-2019
ORCID ID: 0000-0002-4592-2629
E-mail: ehsonov28@gmail.com

Ali-Zade Sukhrob Gaffarovich,
Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-2456-7509
SPIN: 6854-5343
Author ID: 258253
E-mail: suhrob_a@mail.ru

Toshpulotov Khurshed Abdumutalibovich,
Applicant of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-1735-795X
E-mail: rncssh@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Nematzoda Okildzhon
Candidate of Medical Sciences, Leading Researcher of the Republican Scientific Center for Cardiovascular Surgery

734003, Republic of Tajikistan, Dushanbe, Sanoi str., 33

Tel.: +992 (915) 250055

E-mail: sadriev_o_n@mail.ru

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