Savrasov G V, Gavrilenko A V, Borde A S, Ivanova A G, Fedorov D N, Arakelian A G
Department of Biomedical Engineering Systems, Moscow State Technical University named after N.E. Bauman (National Research University), Moscow, Russia.
Department of Vascular Surgery, Russian Research Centre of Surgery named after Academician B.V. Petrovsky, Moscow, Russia; First Moscow State Medical University named after I.M Sechenov under the RF Ministry of Public Health, Moscow, Russia.
Angiol Sosud Khir. 2019;25(1):59-65. doi: 10.33529/angio2019108.
The last decade has seen active development of minimally invasive (endovenous) methods of surgical removal of lower limb varicose veins (LLVV); however, the problem of increasing efficacy of these methods and improving long-term results still remains of current importance. The authors of this work propose a method of ultrasound ablation of subcutaneous veins of lower extremities. Our experimental study was aimed at determining the pattern of venous wall damage after ultrasound exposure. Samples of segments of the trunk of the great saphenous vein (GSV) were divided into 5 groups: group 1 - the control group, group 2 - treatment with a sclerosant in the amount of 0.3 ml for 30 s, group 3 - treatment with ultrasound at a frequency of 26 kHz and amplitude 40 μm and 0.3-ml sclerosant for 30 s, group 4 - exposure to ultrasound at a frequency of 26 kHz and amplitude 40 μm and 0.3-ml sclerosant for 60 s, group 5 samples were exposed to ultrasound at 26 kHz and amplitude of 40 μm for 60 s. The results of analysing the histological sections of the samples of the 2nd and 3rd groups demonstrated that the degree of alteration in the GSV wall on combined exposure to ultrasound and a sclerosant was 4.5-fold higher as compared with treatment with a sclerosant solution alone. During ultrasound exposure, the maximum temperature of the venous wall of group 5 samples was by 20 °C higher than in samples of group 4. Analysing the histological sections demonstrated a similar pattern of structural alterations of the samples of group 4 and 5, thus suggesting a possibility of controlling the temperature of the venous wall during ultrasound ablation without changing quality of structural lesions. The obtained findings showed a possibility of initiating irreversible dystrophic alterations in the venous wall on exposure to ultrasound by means of combining the mechanisms of chemical, mechanical, and thermal ablation.
过去十年见证了下肢静脉曲张（LLVV）手术切除的微创（静脉内）方法的积极发展；然而，提高这些方法的疗效并改善长期效果的问题仍然具有当前的重要性。这项工作的作者提出了一种超声消融下肢皮下静脉的方法。我们的实验研究旨在确定超声暴露后静脉壁损伤的模式。大隐静脉（GSV）主干段样本分为5组：第1组为对照组，第2组用0.3 ml硬化剂治疗30秒，第3组用频率26 kHz、振幅40μm的超声和0.3 ml硬化剂治疗30秒，第4组用频率26 kHz、振幅40μm的超声和0.3 ml硬化剂治疗60秒，第5组样本用26 kHz、振幅40μm的超声治疗60秒。对第2组和第3组样本的组织学切片分析结果表明，与单独使用硬化剂溶液治疗相比，联合超声和硬化剂暴露时GSV壁的改变程度高4.5倍。在超声暴露期间，第5组样本静脉壁的最高温度比第4组样本高20℃。对组织学切片的分析表明，第4组和第5组样本的结构改变模式相似，因此表明在不改变结构损伤质量的情况下，在超声消融过程中控制静脉壁温度是可能的。获得的研究结果表明，通过结合化学、机械和热消融机制，在超声暴露时静脉壁有可能引发不可逆的营养不良性改变。
