“Mechanochemical obliteration: results and prospects”, online colloquium with interactive discussion 12.05.2020/XNUMX/XNUMX

On May 12, 2020, a colloquium on the topic: “Mechanochemical obliteration: results and prospects” was held in the format of an online conference. The event was led by a phlebologist, professor, Konstantin Vitalievich Mazayshvili (Surgut, Russia).

Speakers of the event were: phlebologist, professor of the department, clinic of vascular surgery and angiology, Lublin, Tomasz Zubilevich (Lublin, Poland), phlebologist, candidate of medical sciences, Sergey Mikhailovich Markin (St. Petersburg, Russia), phlebologist, candidate of medical sciences , Evgeny Arkadevich Ilyukhin (St. Petersburg, Russia). The conference was attended online by 175 phlebologists from Russia and neighboring countries, including an employee of the Moscow City Phlebology Center, Alexei Mikhailovich Malakhov.

Professor Konstantin Vitalievich Mazayshvili opened the event with a welcoming speech.

Professor Mazayshvili K.V.

Professor Mazayshvili K.V.

The first message was delivered by the leading Polish phlebologist Tomasz Zubilevich (Lublin, Poland) on the topic: “My experience of using Flebogrif is 48 months of observation after the procedures.”

Phlebologist Tomasz Zubilevich reports (Lublin, Poland)

Phlebologist Tomasz Zubilevich reports (Lublin, Poland)

Dr. Zubilevich shared the experience of treatment and observation for 4 years of patients who underwent varicose vein removal using the Flebogrif mechanochemical obliteration technique. The procedure is described in detail and step by step. Tomasz revealed in sufficient detail the main nuances of the method. The technology has a clear limitation on the maximum trunk diameter of the target vein, 26 mm. This is due to the dimensions of the working part of the Flebogrif, it is 28 mm. The addition of the procedure with tumescence, as a way out of this situation (at D> 26 mm), can already be regarded as an unacceptable compromise. The main feature of the technique is the rejection of tumescent anesthesia. The technology also has a minimum threshold diameter of the vein - 4 mm. The developing spasm of the vein does not allow you to remove the device after the procedure without damaging the soft tissue. A doctor from Poland presented statistics on a 4-year follow-up of 200 venous pools where the Flebogrif procedure was performed.

Results of the mechanochemical obliteration of Flebogrif

Results of the mechanochemical obliteration of Flebogrif

Obliteration in the final stage of observation was 92,5%. This figure is comparable with the results of thermobliteration, which is somewhat strange. Perhaps some of the details of patient monitoring over the past 4 years were left overs. Regarding complications: 17,5% of thrombophlebitis in the postoperative period are completely correlated with similar figures for stem thermobliteration. This fact is understandable, Tomas does not practice the simultaneous removal of tributaries. Dr. Zubilevich presented the results of practical activities in the form of photo documentation.

Results of the mechanochemical obliteration of Flebogrif

Results of the mechanochemical obliteration of Flebogrif

In the photo, it can be clearly noted that after 6 months, varicose inflows remain, although in a reduced form. Again, the analogy with stem thermobliteration suggests itself. 3 and 6 month results are very similar. In this case, we do not use tumescence, which is an obvious plus of mechanochemistry in a comparative aspect with isolated laser or radio-frequency thermobliteration. So, the main advantages of mechanochemical obliteration over thermal (EVLO, RFO):

  • Lack of tumescent anesthesia (fewer injections, more comfortable for the patient and less time spent on the procedure).
  • The cost of Flebogrif consumables in Poland is lower than for thermobliteration.

The subject was continued by a phlebologist, candidate of medical sciences, Sergei Mikhailovich Markin, (St. Petersburg, Russia). Message: “MOCA: results, opportunities, prospects” was no less informative than the previous one from a Polish colleague. Sergei Mikhailovich presented a series of randomized clinical trials comparing mechanochemical obliteration with thermal obliteration. As previously mentioned, mechanochemistry is in a better position in terms of the time of the procedure and pain for the patient. But to the statistics of recanalization of target veins in various procedures, frankly, there are questions.

Also, the interpretation of the data is not entirely clear. In the future, how recanalized vein behaves in the future, I think, is not a secret for professionals. After crossectomy with stem sclerotherapy, patients still visit their doctors. And far from all of them have complaints, and sometimes even complaints. Dr. Markin well revealed to the audience some of the practical aspects of technology. A number of limitations were indicated for mechanochemical technology. In the work, we will take into account not only the diameter of the target vein, but also its length, as well as the number of simultaneously operated venous pools. In this situation, the maximum volume of the foam form of the sclerosant that we can use matters. Nevertheless, in the face of the mechanochemical obliteration of Flebogrif, we have a pretty good technology for a fairly budgetary treatment of varicose veins. The indisputable advantages of the technique can also be considered the lack of the need to purchase expensive laser equipment with a bunch of necessary additions and consumables. Part of the lecture on experimental science was very interesting. Sergei Mikhailovich shared research data on the mechanochemical obliteration technique performed on animals (sheep). Subsequent histological analysis gives a good understanding of what is happening in the wall of the operated vein. Now green, nature and animal lovers are indignant. But in serious science, there is no other way, no matter how much we would like to. Perhaps, moving along the path of basic research, even on animals, we really get a new “gold standard” for the treatment of varicose veins.

Evgeny Arkadyevich Ilyukhin, phlebologist, member of the Association of Phlebologists of Russia (AFR), member of the European Venous Forum (EVF), (St. Petersburg, Russia), presented the message: “From promising surgery to promising therapy: announcement of Allegro research.”

Reported by Ilyukhin E.A.

Reported by Ilyukhin E.A.

Evgeny Arkadievich, a recognized authority in the world of phlebology, and not only in Russia, apparently tired of fighting laser dinosaurs in the jungle, decided to devote time to the conservative treatment of varicose veins. Dr. Ilyukhin shared the results of an observational clinical trial of Allegro. The effect of the drug Sulodexide on the symptoms of chronic venous insufficiency (CVI) was studied. The results of using the drug were evaluated on a visual-analogue scale and the key symptoms of the disease after 2-2,5 months and 4 months of using therapy. In this study, Sulodexide showed very good performance and patient adherence.

Messages about the new Flebogrif methodology caused a lively reaction from the audience and, as a result, the speakers were bombarded with questions from online event participants. Should mechanochemistry, in particular Flebogrif, be considered the new "gold standard" for the treatment of varicose veins? Both Sergei Mikhailovich and the Polish doctor were unanimous in their opinion that endovenous laser obliteration (EVLK) remains the leading technique. The event was expected, because we finally heard the opinion of a specialist with significant clinical experience in the mechanochemical obliteration of Flebogrif. The theme of the event was very relevant and, as it turned out, quite topical in spite of global circumstances. Probably, each participant in the online conference had his own opinion about the Flebogrif method, its capabilities, prospects and disadvantages. You can voice the main points, with many of them, I think you will agree.

Key findings from the reports of the colloquium: "Mechanochemical obliteration: results and prospects."

1. Will the Flebogrif mechanochemical obliteration technique take its place in the modern treatment of varicose veins? Of course. The professional community has a clear request for a good, non-expensive, and yet not very expensive, method for removing varicose veins. The same can be said about the part of modern patients to whom this technology will suit perfectly.

2. What will this niche be? When will the application of the mechanochemical obliteration technique be most optimal and justified? These questions have yet to be answered. At the moment, both practical observations and good randomized clinical trials are not enough.

The audience did not even get a clear answer from the leading Polish phlebologist, who has more than 1000 procedures carried out. It can be assumed that this technology can be offered to the following categories of patients:

  • The stem form of varicose veins with minimal damage to the tributaries and a trunk diameter of up to 12 mm.
  • Patients configured for minimalism of a single intervention and ready to return to treatment after 2 or more months in the form of a 2nd stage (sclerotherapy or miniflelectomy).
  • Patients of advanced age with serious concomitant diseases.

3. Prospects for technology in the domestic, Russian, medical services market. They are. But do not extrapolate the Polish experience to domestic realities. In the phlebological community of our East European neighbor, stem sclerotherapy is still very popular. By the way, the situation with the mass use of the latter is similar to Russia in the “dolaser” era. Today, both domestic phlebologists and patients attach great importance to the radical nature of the method. Here, the psychology of the Russian consumer of medical services can be safely put at the forefront.

4. Can mechanochemistry become the new “gold standard” in the treatment of varicose veins? In the version that we have now, definitely not.

In any case, until the mass introduction of technology into domestic clinical practice, testing and testing mechanochemistry in the conditions of my own operating room, the foregoing will remain unfounded statements and hypotheses. And many thanks to the speakers for the job well done, and the audience appreciated it.

In conclusion, I want to add a few words regarding the modern "gold standard", thermobliteration. Despite the data from a series of meta-analyzes (we are all familiar with the notorious 92-94% occlusion during thermobliteration), an experienced specialist knows that occlusion and subsequent obliteration of the target vein should occur in 100% of cases. And the duration of the observation does not affect this indicator. But if suddenly the target obliteration after EVLK is suddenly not achieved, and this is not 100%, it means that somewhere somewhere clearly done wrong.