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Objective — to assess the feasibility of superficial vein surgery in patients with post-thrombotic syndrome (PTS) of lower limbs. Material and methods. We performed a systematic review in the PubMed database using the following criteria: 1) enrolled patients with PTS of lower limbs and/or previous deep vein thrombosis (DVT) and/or venous obstruction and/or deep venous reflux; 2) superficial vein surgery; 3) available data on clinical and/or functional outcomes. Results. Searching for literature data was finished in December 2022 and included 2741 references. Final analysis enrolled 19 articles summarizing the results of superficial vein in 10 879 patients (15% with PTS and/or previous DVT). Treatment of superficial reflux and secondary varicose veins included open surgery (high ligation, stripping, phlebectomy, mini-phlebectomy), endovenous laser ablation, radiofrequency ablation, cyanoacrylate embolization, mechano-chemical obliteration, sclerotherapy with simultaneous elimination of perforator veins by thermal ablation, sclerotherapy and subfascial dissection in some cases. The only study demonstrated functional improvements after isolated superficial vein surgery in patients with persistent venous obstruction. Three studies revealed the possibility of superficial reflux treatment in addition to venous stenting, while the contribution of superficial vein surgery to total improvement was ambiguous. Most patients with combined superficial and deep reflux demonstrated functional (abolition of deep reflux in 41-94% of cases) and clinical (decrease in severity of chronic venous disease, healing of trophic ulcer) improvement after superficial vein surgery predominantly in primary venous insufficiency. Several trials of minimally invasive interventions on superficial veins in patients with PTS did not reveal any signs of insufficient efficiency and safety. Conclusion. There is no convincing evidence of advisable superficial vein surgery in patients with PTS of lower limbs and persistent venous obstruction. There is a limited and primarily extrapolated evidence of functional and clinical efficacy of superficial vein surgery in patients with PTS and deep venous reflux. Data of single studies with a few participants suggest the efficacy and safety of modern minimally invasive interventions on superficial veins in some patients with PTS of lower extremities.
Pikhanova et al. (Sun,) studied this question.