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Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area.

Objectives. The study set out to determine the equilibrium parameters of the 3,4-dicyanofuroxan molecule by means of molecule geometry optimization by quantum chemistry methods, verify the adequacy of the methods used, and compare the obtained results with X-ray diffraction analysis (XRD) and gas electron diffraction (GED) data.Methods. Quantum chemical calculations were carried out using B3LYP, MP2, and CCSD(T) methods with 6-31G(d,p), cc-pVTZ, and aug-cc-pVTZ basis sets.Results. The equilibrium molecular structure of 3,4-dicyanofuroxan was refined by means of quantum chemical calculations using the Gaussian09 program. The geometrical parameters were compared with the structure of this compound in the solid phase and a number of related compounds in gas and solid phases. It was theoretically established that the planar equilibrium structure of the dicyanofuroxan molecule has CS symmetry. The structure of the free dicyanofuroxan molecule was found to differ depending on the phase. The B3LYP and CCSD(T) methods describe the molecular structure of dicyanofuroxan more accurately than the MP2 method. A regularity was revealed, according to which an increase in the basis, as a rule, leads to a better agreement of the geometry, regardless of the functional.Conclusions. The calculations performed are in good agreement with the literature data and results of joint analysis by GED and XRD. The effect of cyano substituents on the ring geometry is observed in comparison with the literature data for the dicyanofuroxan molecule. For the molecule in question, it is better to use the B3LYP/aug-cc-pVTZ method. The values of geometric parameters obtained by this method are in better agreement with the structure in the gas phase. The discrepancies with the experimental XRD results may be due to interactions in the crystal structure. Differences in the geometric parameters obtained on the basis of different functionals and bases make this molecule interesting for experimental structural studies using GED or microwave spectroscopy, which will permit the identification of optimal methods and bases for obtaining the geometric parameters of furoxan class molecules.

The modern tactics of conservative treatment of trophic ulcers and skin wounds imply the staged use of hydroactive wound dressings whose task is to activate and create optimal conditions for the natural regenerative process. This publication presents an actual clinical case of an effective sequential administration of hydroactive wound dressings HydroClean and HydroTac in a 76-year-old patient with a history of deep vein thrombosis and pulmonary embolism. Two weeks after discharge from the hospital for treatment of severe coronavirus infection (COVID-19) with 70% lung involvement, the patient developed a bubble filled with clear fluid on the anterior surface of the shin. A surgeon at the place of the residence opened the blister and administered occlusive dressings with povidone-iodine, as a result of which the wound surface was covered with a necrotic scab. The patient went to a specialized phlebology clinic due to deterioration of the wound condition and pronounced pain both at rest and during dressings. In order to remove necrotic tissues, a hydroactive dressing HydroClean was prescribed, which was fixed on the limb using cohesive bandage Peha-haft. The authors emphasize the high efficiency and safety of these hydroactive dressings, as well as the possibility of their use at home, which is especially relevant during the COVID-19 pandemic. This clinical case demonstrates the effectiveness of modern hydroactive wound dressings, the use of which in a short time allowed to close a large skin wound in a patient with an extremely negative comorbid background and demonstrates the possibility of remote management of treatment using modern means of communication.

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.

Classic sclerotherapy using drugs in the native (liquid) state is almost the oldest method of minimally invasive treatment of various forms of varicose veins of lower extremities and not only. Despite more than 300 years of development of the sclerotherapy methodology, enormous international experience and almost thorough study of its mechanisms, the development of new sclerosing drugs and technologies of their delivery to the lumen of the target vein continues. Measures aimed at reducing the frequency of undesirable side effects after sclerotherapy and improving the quality of life of patients during treatment and after its completion are discussed separately. Currently, there are several guidelines that regulate phlebosclerosing treatment in various clinical situations in terms of evidence-based medicine. This publication provides a brief historical background on the formation of sclerotherapy technology, presents basic principles for liquid sclerotherapy based on the analysis of international and Russian recommendations for the treatment of chronic venous diseases. Indications, contraindications and the basic methods of carrying out sclerotherapy with the use of officinal, registered in the Russian Federation phlebosclerosing detergent agents are presented, their actual physical and chemical properties, similarities and distinctions, and also optimal concentrations and doses are discussed. The classic sclerotherapy technique which has become known as “empty vein technique” is described in detail and illustrated.In addition, current clinical examples demonstrating successful use of compression sclerotherapy are presented. Again, the authors conclude that liquid sclerotherapy with the use of modern phlebosclerosing agents such as lauromacrogol 400 and sodium tetradecyl sulfate, performed according to the classical “empty vein” technology, demonstrates high efficiency and safety regarding large varicose veins of various localizations.

The current compression garment selection guide is targeted at the earliest clinical stages of chronic venous disease (CVD) and assumes a priori that application of a higher class of compression improves the calf muscle pump function, which is the major mechanism promoting venous return from the lower limb to the heart.Objective of the study: to evaluate the calf muscle pump function in patients with the early forms of CVD using different classes of compression garments.Material and methods: A total of 30 patients (45 lower limbs) with Class 1 CVD (CEAP classification) were enrolled in the study. The calf muscle pump function was evaluated during wearing compression garments using remote cableless photoplethysmography of Bodytronic measurement system (Bauerfeind, Germany) with automatic data processing. The investigators measured venous refilling time (T0) and pump capacity (V0) in patients without compression garments and also in those wearing classes 0, I and II compression garments (RAL standard, Venotrain micro, Bauerfiend socks). All indicators were measured three times with an interval of 30 minutes. The final values of T0 and V0 were calculated as average.Results and discussion: when the indicators were measured without compression and with zero compression, T0 was 26.7 ± 1.2 sec and 25.4 ± 1.1 sec (p = 0.56); V0 - 8.6 ± 0.7% and 8.0 ± 0.4% (p = 0.47). When the calf muscle pump function indicators were measured using class I compression garments, its performance was improved. Thus, T0 and V0 (p

The article describes the method of aesthetic correction of dilated non-varicose superficial veins localized on the face, décolleté and upper extremities. It is concluded that the various sclerotherapy options are highly efficient and safe in these clinical situations.

Chronic venous insufficiency (CVI) is the most common pathology of the peripheral vascular system. One of the main principles of conservative treatment for both small and complicated forms is pharmacotherapy with the use of venoactive drugs. The effectiveness of therapy is largely associated with the choice of phlebotrophic drug. The article discusses approaches to systemic and topical drug therapy depending on the form and stage of CVI.

Venous thromboembolic complications (VTEC) are a frequent pathology accompanied by high lethality. After VTEC the risk of their recurrence not equivalent for all patients remains. The anticoagulant therapy available currently effectively prevents VTEC increasing a possibility of hemorrhages. This means that at planning the secondary prevention it’s necessary to maintain the optimal balance between a possibility of recurrence of VTEC and development of hemorrhagic complications. Thus, selection of patients for secondary prevention must be accompanied by a comprehensive analysis of numerous factors as determining the possibility of VTEC recurrence as well as a risk of complications development. Warfarin is the most frequently used drug for long-term anticoagulant per os therapy, it requires frequent monitoring with periodic dose correction and strict dietary limitations. New oral anticoagulants (NOAC) are applied at a fixed dose without obligatory strict hemostasiologic control, which makes them rather attractive for continues secondary prevention of VTEC.

Chronic vein diseases (CVD) depending on the design and evaluation criteria of conducted epidemiologic studies are diagnosed in 20-85% of adult residents of industrially developed countries. Meanwhile only due to appearance of the unified international classification CEAP it has become possible to reliably estimate the frequency and structure of CVD in various countries of the world. Moreover, implementation of СЕАР in the routine clinical practice determined the necessity of unification of terminology used with respect to CVD and their manifestations. In particular, clear definitions of notions "chronic vein diseases (CVD)" and "chronic venous insufficiency (CVI)". In the first case the matter at issue is all - functional as well as pathomorphologic - CVD manifestations. CVI is issued to designate graver forms of the disease accompanied by objective signs of venous macrohemodynamics disturbances. In other words, the diagnosis "chronic venous insufficiency" can be used with respect to patients with C3 (chronic venous edema) - С (active trophic ulcer) of the СЕАР clinical class [1, 2].

Venous thromboembolic complications (VTC) including deep veins thrombosis and pulmonary artery thromboembolia are sufficiently frequent but preventable states. In industrially developed countries 1-2 cases of VTC per 1 thousand persons per year are registered. In USA 900 thousand patients suffer from VTC annually. But these figures are most likely conservative as due to diffuseness of a clinical pattern and insufficient sensitivity of screening tests the frequency of verified VTC doesn't exceed 60-70% [1, 2].

Thrombophlebitis (inflammation and thrombosis of superficial veins of any localization) is a frequent pathologic state. In the special literature they use notions varicothrom-bophlebitis for designation of thrombosis and inflammation of the varicose vein as well as phlebitis - inflammation of the superficial vein without thrombosis. A traditional error is idea of thrombophlebitis as of local, self-limited process that as opposed to deep vein thrombosis has no serious dangers for life and health of patients. This position is a profound mistake hrombophlebitis (inflammation and thrombosis of superficial veins of any localization) is a frequent pathologic state. In the special literature they use notions varicothrom-bophlebitis for designation of thrombosis and inflammation of the varicose vein as well as phlebitis - inflammation of the superficial vein without thrombosis. A traditional error is idea of thrombophlebitis as of local, self-limited process that as opposed to deep vein thrombosis has no serious dangers for life and health of patients. This position is a profound mistake

An overview of the new guideLines of the European Society for VascuLar Surgery. Non-surgicaL (conservative) treatments of chronic venous diseases (CVD) of various cLinicaL cLasses are of paramount importance due to their versatiLity and affordabiLity. Compression therapy is primarily impLied when speaking about conservative treatment of CVD. It stiLL remains the cornerstone on which aLL other therapeutic and preventive approaches are based.n overview of the new guideLines of the European Society for VascuLar Surgery. Non-surgicaL (conservative) treatments of chronic venous diseases (CVD) of various cLinicaL cLasses are of paramount importance due to their versatiLity and affordabiLity. Compression therapy is primarily impLied when speaking about conservative treatment of CVD. It stiLL remains the cornerstone on which aLL other therapeutic and preventive approaches are based.