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To date, modern outpatient minimally invasive interventions for varicose veins, such as endovenous laser or radiofrequency ablation, microphlebectomy, sclerotherapy, non-thermal non-tumescent methods (NTNT), are widely introduced into clinical practice in the Russia. In the approved by the Ministry of Health of the Russian Federation in 2021 clinical guidelines "Varicose veins of the lower extremities" they are recommended as preferred over open surgery. At the same time, there are no federal regulations of preoperative examination of patients before these minimally invasive procedures for varicose veins. That is why the medical community is often forced to prescribe unnecessary diagnostic tests on the "just-in-case" principle, in order to protect itself for cases of complications and subsequent checks. This undoubtedly harms both the patients and the medical service, which has an additional useless and inappropriate burden. The purpose of the round table held on September 28, 2021 under the auspices of the Self-Regulatory Organization “The National College of Phlebology” together with the legal partner “The Faculty of Medical Law LLC” (Moscow), was to review the existing legislation on this issue and then to prepare a resolution regarding the justified preoperative examination of patients before minimally invasive interventions for varicose veins of the lower extremities. The prepared document consists of two parts. The first part presents the legal regulation of the diagnostic tests before interventions in phlebology. The second part contains the opinion of the professional community regarding the appropriateness or inexpediency of different pre-procedural examinations. In addition, based on the conclusions of legal analytics, a form of order of the chief physician has been developed, which regulates the diagnostic tests before the considered phlebological interventions in the clinic.

Introduction. Chronic venous disease significantly reduces quality of life and often leads to complications. The only way to eliminate hemodynamically significant blood flow disorders is the surgical method, incl. its latest modification is the VenaSeal.Objective of the study. To study the immediate and long-term results of the use of VenaSeal adhesive technology to obliterate the incompetent major saphenous veins, as well as the potential benefits in special groups of patients based on three-year experience in using VenaSeal Glue Procedure.Materials and methods. Over a 3-year period, we have treated 104 patients with VenaSeal. The average age was 59.6 ± 14.97 years, the CEAP class was 3.2 ± 1.09. 101 patients had varicose veins, in three cases - post-thrombotic. The intervention was performed on 117 incompetent main veins: GSV – 107, SSV – 10.Results and discussion. Clinical evaluation and ultrasound imaging of veins immediately after the intervention of vein occlusion throughout the intervention. There was no pronounced pain syndrome after surgery. Complications occurred in 3 patients in the form of chemical phlebitis. Long-term results up to 3 years were studied clinically and using ultrasound in 72 patients (76 veins): recanalization was noted in 2 GSV (2.6%), which in one case was accompanied by the formation of a recurrent varicose veins. To study the effect of VenaSeal on the quality of life in a comparative aspect, a non-randomized, single-center, open-label study was carried out; it included patients, incl. with GSV occlusion using RFA and EVLT. In the group of patients after VenaSeal, the quality of life indicators were better values. In addition, the absence of the need for elastic compression made the surgical treatment of patients with chronic venous disease and concomitant lesions of the peripheral arterial bed. In groups of elderly and senile patients, patients with weeping eczema, with obesity, additional advantages were found in the form of a decrease in the invasiveness of the intervention and the possibility of correcting reflux as a hemodynamic basis for the development of trophic disorders with the aim of their faster and more effective relief.Conclusions. Non-thermal obliteration of incompetent major saphenous veins using VenaSeal in varicose veins and post-thrombotic disease is highly effective: the immediate results assessed with clinical methods and using ultrasound duplex scanning confirmed the occlusion of the target vein in all cases. The study of long-term results revealed recanalization of two veins out of 76, which accounted for 2.6%.

Recently collated scientific data on the management of C1 clinical class of chronic venous disorders; wide prevalence of the disease and high variability amongst medical practitioners in relation to managing this category of patients and absence of any regulatory documents has prompted the development of clinical guidelines for the treatment of patients with reticular varicose veins and telangiectasias of the lower extremities and various parts of the body. These guidelines have been developed by a self-regulated organization Association “The National College of Phlebology”. The purpose of the de novo guidelines is to systematize the existing evidence and offer minimal standards of care for chronic venous disorders in C1 patients.

The authors describe herein a clinical case report regarding a 70-year-old woman presenting with lower-limb varicosity in the system of the great and small saphenous veins, aneurysmal dilatation of the proximal portion of the great saphenous vein, and an open trophic ulcer of the crus with concomitant hypertension and coronary artery disease. Given these factors, she was subjected to endovenous laser coagulation of the great and small saphenous veins, microfoam echosclerotherapy of the distal portion of the trunk of the great saphenous vein and an incompetent perforating vein of the crus, followed by complete obliteration thereof. On POD 7, she developed positive dynamics in the process of healing of the trophic ulcer, and on POD 50 the ulcer healed completely. Thus, in elderly patients with lower limb varicose veins with incompetence of trunks of the great and small saphenous veins and pronounced trophic impairments of the crus, preference should be given to minimally invasive methods of treatment. Their combination ensures a good therapeutic effect without increasing the risk for local and systemic complications.В данной работе представлено описание клинического случая 70-летней пациентки с варикозной болезнью нижних конечностей в системе большой и малой подкожных вен, аневризматическим расширением проксимальной части большой подкожной вены, открытой трофической язвой голени и наличием сопутствующей гипертонии и ишемической болезни сердца. Учитывая эти факторы, выполнена эндовенозная лазерная коагуляция большой и малой подкожных вен, микропенная эхосклеротерапия дистальной части ствола большой подкожной вены и несостоятельной перфорантной вены голени. При этом достигнута их полная облитерация. В результате на 7 сутки появилась положительная динамика в процессе заживления трофической язвы, а на 50 сутки язва полностью зажила. Таким образом, у пациентов старших возрастных групп при варикозной болезни нижних конечностей с несостоятельностью стволов большой и малой подкожных вен и выраженными трофическими нарушениями голени предпочтение следует отдавать малоинвазивным методам лечения. Их сочетание обеспечивает хороший эффект лечения без увеличения риска развития осложнений местного и общего характера.

Objective: this paper aims at studying the efficacy of the thermocoagulation (TCG) method using TC-3000 apparatus for the treatment of lower extremity telangiectasias. Materials and methods. The TCG method has been used in 145 patients (223 cases) with telangiectasias (TA) and reticular veins (RV) of the lower extremities for 2 years. 17 patients (11.7%) had classes C1, 2 chronic venous diseases (CHV), and they underwent correction of pathological refluxes in the subcutaneous and perforating veins prior to TCG. Out of 128 patients with class C1 CHV, 25 people (19.5%) underwent microsclerotherapy (MST) in the past, just before the TCG procedure or in combination with it, MST was performed in 46 (35.9%). MST was performed for RV situated outside or within TA areas, and also was performed for TA from 0.6 to 1.0 mm in diameter. The TCG procedures were performed using TC-3000 (Belgium) apparatus, which operation is based on the impact of high-frequency electromagnetic field (4 MHz) on the dilated vessels in the skin. Needles made of nickel with a working diameter of 0.150 mm were used. Thermocoagulation was applied for the treatment of TA with a diameter of 0.3 mm to 0.6 mm. The results were evaluated within the following time-limits: 3 months (64 patients/97 limbs), 6 months (72/110), 12 months (70/107). Results of the treatment. The patients reported the results of the treatment as «no change and worse» in 73.4% of cases, pigmentation was detected in 73.2%, and residual TA in 81.4% of cases 3 months following the treatment. According to subjective assessment, the results were reported as «excellent» + «better» in 47.2%, pigmentation phenomena and residual TA were observed in 50.0% and in 50.9% of cases 6 months following the treatment. According to subjective assessment, the results were reported as «excellent» + «better» in 75.7%, pigmentation in 14.9%, residual TA in 13.1%, relapses TA in 14.0% 12 month following the treatment. Conclusion. 13.1% of patients with TA showed tolerance towards TCG. A positive effect included the absence of registered necrosis of the skin 3 months following the treatment, as well as atrophic and hypertrophic scars 12 months following the treatment.

Aim. To estimate a risk factor frequency of venous thromboembolism (VTE) in patients urgently hospitalized in hospitals, and also to estimate of patients part having effective prevention of VTE. Material and methods. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Setting) is the international register. Patients of 40 years and older hospitalised in therapeutic departments as well as patients of 18 years and older hospitalised in surgical departments (358 hospitals in 32 countries) were included in the register. The case history analysis of all patients was performed for estimation of risk VTE and evaluation of preventive therapy quality according to American College of Chest Physicians (ACCP) Recommendation 2004. Results. Totally 68 183 patients (including 30 827 (45%) surgical patients and 37 356 (55%) therapeutic patients) were enrolled in Global ENDORSE Register. Russian centers enrolled 4 788 patients (including 2 829 (59%) surgical patients and 1 959 (41%) therapeutic patients). Totally 35 329 (51,8%) patients enrolled in Global ENDORSE Register (64,4% of surgical patients (19 842) and 41,5% of therapeutic patients (15 487)) had VTE risks. In Russia 2 188 enrolled patients (45,7%) had VTE risks (52% of surgical patients (1 470) and 36,7% of therapeutic patients (718). Totally 17 732 (50,2%) patients enrolled in Global Register ENDORSE and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. In Russia 521 (23,8%) patients enrolled in Global ENDORSE Register and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. It is more than 2 times less in comparison with world level (р

to investigate criteria for selection of patients for radiofrequency ablation (RFA), as well as to assess the immediate and remote outcomes of comprehensive minimally invasive treatment of patients presenting with class C2-C6 chronic venous disease (CVD).we performed a total of 604 interventions in 512 patients (554 on the superior vena cava (diameter from 3 to 26 mm), 45 on the inferior vena cava (diameter from 3 to 14 mm), 5 on the anterior accessory veins (4-8 mm in diameter) The varicose veins were removed by means of compression sclerotherapy. The interventions were performed using tumescent anaesthesia in out-patient conditions. The check-up ultrasonographic duplex scanning was carried out within 1-5 days after RFA, then after 6, 12, 24, 36 and 48 months.All major veins except two were found to be occluded immediately after the interventions. A complication was observed in one case (0.2%). The remote results were assessed on 514 lower limbs. In all, except two, major trunks of the subjected to RFA saphenous veins were occluded. Recurrent varicose veins were observed on 82 (13.9%) lower limbs. Using two ports was required in tortuosity of the SVC and with thrombophlebitis of the SVC in the anamesis. A small diameter of the vein may currently not be considered as a limiting factor. Of the 11 patients with a varicose node above the saphenofemoral junction, one patient was found to have a floating thrombus in it which required crossectomy. RFA demonstrated advantages as compared with crossectomy and stripping in obese patients, while in acute ascending superficial thrombophlebitis in a series of cases it made it possible to refuse the traditional surgical operations. In class C6 CVD conservative therapy was carried out parallel to correction of venous haemodynamics which made it possible to reduce the term of epithelisation of the trophic ulcer. Removal of the deep vertical veno-venous reflux by means of RFA in all cases resulted in SVC occlusion.Planning of RFA requires a thorough clinical and ultrasonographic assessment, ideally an ultrasonographic examination should be performed by the operating surgeon. Technical obstacles in the majority of cases may be overcome. RFA is a method of choice in obese patients with a deep vertical veno-venous reflux. Early application thereof in class C6 CVD reduces the term of epithelisation of trophic ulcers. 99.7% of cases showed occlusion of the vein immediately after the intervention and 99.6% of cases within the term of up to 48 months.

The article reviews the worldwide current literature devoted to one of the presently important problems, i. e., lowerlimb varicose disease, systematizing all available information concerning modern methods of examination and treatment of patients suffering from venous insufficiency, including operations, scler other apy, echo scler other apy, endovasal laser coagulation and radiofrequency ablation. It was underlined that ultrasonographic diagnosis is currently becoming the main method in assessing haemodynamic disorders in the venous system and determining the methods of removal of varicose veins. Also analysed are advantages and disadvantages of these methods both in elective surgery and in emergency states. Reflected are contradictions presently existing in phlebology and a trend towards minimising interventions in varicose disease. The classical combined phlebotomy, remaining for long years the main surgical procedure, has gradually been replaced by the socalled "office" methods of treatment. It was shown that there are a lot of unsolved problems requiring investigation from the positions of efficacy and safety.

The paper presents the results of non-surgical outpatient treatment of 528 patients with lower limb varicose veins (C2-C6 CEAP classes) by echo-Foam-sclerotherapy and compression therapy. Patients were divided into 3 groups (1) patients with vertical veno-venous refluxes: total 315 echo-Foam-sclerotherapy procedures were fulfilled on 202 great saphenous veins (GSV) and 113 lesser saphenous veins (LSV) - occlusion was achieved in 305 cases (96.8%); (2) patients with recurrent varices or after crossectomy (separation of sapheno-popliteal junction): 265 echo-Foam-sclerotherapies on GSVs and/or LSVs - occlusion was achieved in 262 cases (98.9%); (3) 147 thigh or shin incompetent perforating veins - occlusion was achieved in 142 cases (96.6%). Follow-up lasted up to 2 years. Hemodynamically sound recanalization was revealed in 18 (14.4%) from 125 sclerosed veins in the first group; in 1 (2.1%) from 48 veins in the second group and in 5 (10.6%) from 47 perforating veins in the third group. In general, positive long-term effect was achieved in 89.1% cases of echo-Foam-sclerotherapy. In order to assess the feasibility of additional phlebotropic therapy, all patients were divided into the main group, which received Antistax, and control group, which received no venotonics. It was shown that Antistax attenuates main symptoms of chronic venous insufficiency and improves the quality of life.

Ultrasound duplex angioscanning (USAS) is designed to detect, among other things, venous reflux, its source and extent. Up to now, there have been no reliable tests making it possible to unambiguously detect the valvular incompetence of the superficial veins. Hence, the necessity of developing methods for the solution of tis problem. We proposed the method for the detection of superficial venous reflux with the use of ultrasound duplex angioscanning that allows to generate the retrograde blood flow in the subcutaneous veins by means of manual compression, i.e. sliding movements of the hand along the incompetent venous trunk, to enhance the effectiveness of this 7 procedure.

The purpose of the study was to evaluate efficacy of Diosmin (Phlebodia 600, Innothera, France) in treatment of patients presenting with class C0s-C3 chronic venous diseases (CVD) according to the CEAP classification. Presented herein are the results of a prospective observational study aimed at assessing the outcomes of two-month administration of Phlebodia 600 (600 mg diosmin) in patients suffering from class C0s-C3 CVD according to the CEAP classification. The study comprised a total of 868 patients, including 175 (20.2%) men and 693 (79.8%) women. Of these, 866 patients completed the study according to the protocol. Amongst the 868 followed-up patients, 851 (98.0%) subjects strictly adhered to the physician's prescription and stopped taking the drug without violation of the regimen and dosing of diosmin. The main drug dosage regimen of diosmin was 1 tablet once a day in 851/868 (98.04%) patients. Satisfaction with treatment with diosmin was reported as 'excellent' by 46.7 % of patients (95% CI: 43.3-50.0) and by 49.4% of physicians (95%: CI 46.1-52.7), being rated as 'good' by 45.0% of patients (95 % CI: 41.7-48.4) patients and by 43.6% of physicians (95% CI: 40.3-47.0). The score for the quality of life of patients according to the CIVIQ-20 scale at the first follow-up visit amounted to 45.4±15.4 points (median 43.0 points). At the second follow-up visit, this parameter improved dramatically, dropping to the level of 35.6±11.5 points (median 33.0 points). By the third follow-up visit, the positive dynamics of the parameters preserved continued, averagely amounting to 28.9±8.7 points (median 26.0 points). A decrease in the circumference of the left and right crura (by 0.39±0.74 and by 0.36±0.75 cm, respectively) was observed at the second follow-up visit. The difference of the malleolar measurements between the first and third follow-up visits amounted to 7.2±9.4 mm and 6.6±9.7 mm for the right and left crus, respectively (p0.001). The number of patients with a reported feeling of heaviness in the legs statistically significantly decreased from 97.6% at the stage of enrollment into the study to 73.0% after 2 months of therapy, that of those with painful sensations from 84.5 to 55.3%, those with complaints of swelling (oedemas) of the lower limbs from 83.9 to 56.8%, with complaints of convulsions from 71.2 to 35.7%, with complaints of sensation of tingling from 63.4 to 34.1%, respectively. Hence, a statistically significant improvement of the patients' condition was observed as early as 30 days after the beginning of treatment. By day 60, the positive effect of the carried out therapy continued to grow. Safety and good tolerance of the drug were noted, which was confirmed by low incidence of undesirable events and high adherence to treatment.