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Introduction: the relevance of further study of the morphogenesis of changes occurring in the superficial veins of the lower extremities is due to the high prevalence of varicose veins and the lack of answers to many questions of interest to phlebologists.The aim of the study was to study the morphological restructuring of connective tissue elements of the human great saphenous vein wall on the calf in norm, ectasia and development of varicose transformation.Material and methods. The study of morphological restructuring of the great saphenous vein wall on the calf was carried out in 3 comparison groups (norm, ectasia, varicose veins) by light microscopy. In 1th group, the structure of the GSV wall was studied on autopsy material of people who died from various causes at the age of 5 to 80 years. In the 2nd and 3rd groups, fragments of GSV in the calf were taken by biopsy (miniphlebectomy) during the execution of the operations for varicose veins. In order to conduct a quantitative analysis of the nature of structural changes in the connective tissue elements of the GSV wall on the calf, a visual analog scale of morphological changes was developed-Visual Analog Morphology Scale (VAMS), in which a certain number of points (from 1 to 10) corresponded to a certain character of morphological changes. Statistical analysis of the obtained data in groups was performed using the IBM SPSS Statistics software package (USA).Results. The general morphological analysis of histological preparations made it possible to visually identify various variants of changes in connective tissue elements inherent in the inner, middle and outer shells of the GSV wall.Conclusions. Age-related morphological changes in the connective tissue elements in the GSV wall on the calf, over the course of a person’s life, do not have the same character as changes occurring in its wall during the development of its ectasia and varicose transformation.

Introduction. In order to perform endovasal vein lining, the American Rodney D.Raabe developed a system for varicose veins obliteration, consisting of a glue gun and two catheters, called “VenaSeal”. As an occlusant for varicose veins in this system, “Medtronic” company today proposes to use an adhesive compound synthesized on the basis of butyl ether of α-cyanacrylic acid.Materials and methods. Endovasal catheter obliteration of tributaries and main trunks of the great saphenous vein on the tibia was performed in 15 patients with varicose disease (C2 to CEAR) in order to substantiate the possibility of using the adhesive compound Sulfacrylate. Severity of pain, presence or absence of phlebitis and thrombophlebitis, hyper pigmentation, neurological disorders, allergic reaction were clinically evaluated.Results and discussion. All patients after the introduction of the glue Sulfakrilat had a clinic of moderate phlebitis, without the formation of blood clots in the lumen of the vein. No local or general allergic reaction was observed. From day 7 occluded venous segments were palpated in the form of moderate density bands, without infiltration to surrounding tissues. In the absence of blood flow ultrasound examination showed gradual biodegradation of the adhesive strip inside the vein with the development of complete obliteration of the lumen starting from the 4th month. Starting with the 7th day gradually stopped aseptic inflammation in the wall of the vein was observed on histological examination. Monocytic infiltration of the venous wall with the formation of multinucleated cells of foreign bodies was present until the time of complete biodegradation of the glue. The process of diffuse growth of connective tissue with the presence of fibroblasts from the subendothelium and in the middle shell was most actively observed in histological material from 90 to 120 days after occlusion. Within 180 days, the lumen of the veins occluded by “Sulfacrylate” was completely obliterated by mature connective tissue, in the absence of glue particles, which indicated its complete biodegradation.Conclusion. The experimental studies conducted with the assessment of clinical symptoms, ultrasound examination and histological study of morphogenesis in the lumen of blood vessels in different periods up to 6 months allow us to conclude the potential use of the adhesive compound “Sulfacrylate” (produced in Russia) for endovasal obliteration of varicose veins in humans.

В 60 случаях (исследовательские группы) использовалась лазерная коагуляция подкожных вен как альтернатива флебэктомии по Бебкокку после кроссэктомии. Срок наблюдения за пациентами достигал 12 месяцев. Наиболее интересными представляются результаты, полученные в IV группе больных. В 94,2% наблюдений удалось добиться стойкой ликвидации стволового варикоза при быстрой медико-социальной реабилитации, с минимальным набором осложнений. Значительно улучшились результаты в данной группе с использованием лечебной гимнастики в воде, The article presents the results of using endovascular laser coagulation of the great saphenous vein in varicose vein disease in four groups of patients (n=80). In 60 cases (research groups), laser coagulation of subcutaneous veins was used as an alternative to phlebectomy by Babcock after crossectomy. The period of the patients' follow-up reached 12 months. The results obtained in the IV group of patients are the most interesting. In 94.2% of cases, the authors succeeded in achieving stable elimination of stem varicosis with rapid medical and social rehabilitation, with a minimal set of complications. The results in this group significantly improved when using therapeutic gymnastics in water, Здравоохранение Чувашии, Выпуск 4 2022, Pages 19-32

The OBJECTIVEof the study was to assess the immediate results of the use of two internal thoracic arteries during coronary bypass surgery.MATERIAL AND METHODS. 200 patients with coronary artery disease underwent coronary artery bypass grafting in Samara cardiology dispensary from 2016 to 2018. Patients were divided into 2 groups. Group 1 (100 people) used both internal thoracic arteries (ITA) and the radial artery as conduits; group 2 (100 people) used the left ITA and the great saphenous vein as conduits. The duration of the operation, complications in the early postoperative period, and hospital mortality were evaluated.RESULTS. Groups (1 – 73 % of men, average age (59±12) years, average number of conduits – (3.1±0.4), 2 – 62 % of men, average age (67±7) years, average number of conduits – (3.3±0.6)) were significantly different only in age. The average duration of the operation in the group 1 was (174±25) min, in 2 – (165±18) min (p0.05). The number of complications in the early postoperative period did not have a statistically significant difference between the groups.CONCLUSION. Bilateral internal thoracic arteries coronary artery bypass grafting in CHD patients did not lead to a significant increase in the duration of the operation, an increase in mortality and infectious complications from the sternum, compared with single internal thoracic arteries grafting.

A comparative analysis of the dynamics of lower limb vein angioscopy parameters in case of orthostasis between male patients (age 30–50 years) with arterial hypertension (test group – 60 people) and normal arterial pressure (control group – 27 people) was made. Orthostatic sample in all examined patients was characterized by a reliable increase in the diameter and area of vein section at a decrease in blood flow rate. However, in patients with hypertension the increase in the area of vein section was significantly less than in the control group. In orthostasis, the drop in blood flow rate in the total femoral vein was lower in men with hypertension than in men in the control group. In the great saphenous vein, a larger decrease in blood flow velocity was recorded than in the control group. In hypertension, no increase in the number of refluxes was recorded in orthostasis. Thus, hypertension in men is characterized by altered reaction of venous blood flow to orthostasis in both deep and saphenous veins.

Цель исследования: оценить особенности структурных изменений в стенке большой подкожной вены под влиянием 3%-й пены полидоканола разной температуры.Материалы и методы. Материалом исследования послужили фрагменты вен, забранные мини-инвазивным хирургическим путем после воздействия 3%-й пеной полидоканола комнатной температуры и охлажденной.Результаты. Показатели глубины повреждения стенки вены и процент отсутствия эндотелия после воздействия охлажденной пены полидоканола составили 276,9 (197,8; 297,8) µm и 79,3 (76,9; 80,4) % соответственно, в сравнении с пеной комнатной температуры – 166,3 (136,1;187,4) µm и 40,1 (36,3;42,25) %.Выводы. Охлажденная пена полидоканола оказывает более выраженное повреждающее действие на стенку вены в сравнении с пеной комнатной температуры., Purpose. To evaluate the structural changes in the great saphenous vein wall under the influence of 3% polydocanol foam of different temperatures.Methods. The research is based on morphological evaluation of vein fragments that were removed with minimally invasive technique after sclerotherapy with the room temperature 3% polydocanol foam and the chilled one.Results. The depth of the venous wall damage and the percentage of endothelial cell loss after exposure to the chilled foam were 276.9 (197.8; 297.8) µm and 79.3 (76.9; 80.4) %. The similarparameters after the exposure to the room temperature foam were 166.3 (136.1; 187.4) µm and 40.1 (36.3; 42.25) %, respectively.Conclusion. The chilled polydocanol foam has a more pronounced damaging effect on the vein wall in comparison with the room temperature foam., Рецепт, Выпуск 6 2021, Pages 856-862

Background: In multi-vessel atherosclerotic coronary artery disease, coronary artery bypass grafting remains the method of choice and allows for the best possible revascularization and maximal continuity of the results. Conduit functioning to a large extent depends on the coronary artery (CA) diameter and on the severity of atheromatous involvement and anatomic abnormalities of its walls. However, there is no consensus on what minimal diameter and extent of CA lesions could provide robust long-term results of bypass surgery. Consequently, surgical strategy for bypass grafting in diffuse coronary involvement and small vessel diameters has not been clearly defned.Aim: To perform a comparative analysis of the bypass grafts functioning depending on CA anatomy and methods of revascularization.Materials and methods: The study included 98 patients, who, irrespective of their clinical condition, had a control coronary angiography (CAG) with shuntography (SHG) between 6 months to 5 years after they had undergone direct myocardial revascularization by coronary artery bypass grafting. In total, 215 anastomoses were assessed. The bypassed CAs were divided into two groups according to their diameters and into two subgroups depending on the severity of the coronary vasculature involvement. When bypassing an artery with diffuse involvement, angioplastic anastomoses were done in 52.5% of the cases. Long-term graft functioning was assessed by shuntography.Results: Conduit functioning after bypassing of CA >1.5 mm in diameter and with local CA narrowing did not depend on the graft type and was 95.1% for the internal thoracic artery (ITA) grafts and 90.1% for the great saphenous vein (GSV) grafts. With diffuse lesions, these values decreased to 68.4% for ITA and 69.1% for GSV (р < 0.05). Long-term revascularization results for coronary arteries with a diameter of ≤ 1.5 mm were signifcantly lower for all types of conduits: with local stenosis, 78.6% ITA and 68.4% GSV grafts were patent, whereas in diffuse coronary bed involvement, 50 and 33.3%, respectively (р < 0.05). After placement of an angioplastic anastomosis to the CA with diffuse lesions, 79.3% of the ITA and 69.2% of the GSV grafts were functioning, whereas after the use of the standard technique, such were 55.6 and 40%, respectively (р < 0.05).Conclusion: Bypass grafting of CA with local lesions and > 1.5 mm in diameter, the graft type has not signifcant impact on its long-term functioning. In diffuse CA involvement, angioplastic anastomoses should be used.

Background. Autovein is considered as the best prosthesis in the infrainguinal bypass surgery. However, in 30 % of individuals great saphenous vein is inappropriate for grafting because it is too small or due to phlebitis, varicosity and prior surgery. From this point of view, decellularized vascular grafts, which retain most of the properties of living tissues, seem quite interesting. Due to the high frequency of development of prosthetic aneurysm in the postoperative period xenografts does not gain high popularity. This complication occurs in an average of 6 % of cases, but modern technological advances in manufacture of xenografts have reduced the percentage of aneurysms to 4.1 %, which is still high. To solve this problem, we decided to use external support of nitinol mesh. Aim: assessment of efficiency of bioprosthesis with external support by knitted nitinol mesh as a conduit in infrainguinal bypass surgery. Materials and methods. It was a single-center randomized controlled trial in two groups, 36 patients in each group. There were no statistically significant differences between the groups. Patients of the control group underwent a standard femoropopliteal bypass surgery. In experimental group we used bioprosthesis with external support by knitted nitinol mesh. Results. Aneurysms development was observed in 6 patients (16.67 %) of the control group (4 patients - anastomotic aneurysms; 2 patients - true shunt aneurysms). There were no aneurysms in the experimental group (p < 0.05). Conclusion. The use of a nitinol-based mesh effectively prevents the development of an aneurysm of the xenograft in the postoperative period.

Введение. Эндовенозная термическая абляция (ЭТА) поверхностных вен, включая лазерную абляцию или радиочастотную абляцию, широко применяется в лечении варикозной болезни нижних конечностей. Учитывая высокую частоту встречаемости варикозной болезни, частоту венозных тромбоэмболических осложнений (ВТЭО) после данного вмешательства, логично предположить, что выполнение ЭТА увеличит риск возникновения послеоперационного венозного тромбоза у онкологических больных. Существует недостаток данных о частоте ВТЭО в онкохирургии при ЭТА в анамнезе. Цель исследования: оценить влияние ранее проведенной ЭТА поверхностных вен нижних конечностей на послеоперационные ВТЭО в онкохирургии. Материалы и методы. Одноцентровое исследование с ретроспективным анализом онкологических больных на хирургическом этапе лечения злокачественных опухолей абдоминальной, гинекологической или урологической локализации проведено с мая 2013 г. по ноябрь 2018 г. В исследование были включены 36 пациентов, перенесших ЭТА более 3 мес назад (319 мес). Ультразвуковое дуплексное исследование вен нижних конечностей проводили перед операцией (за 110 дней) по поводу онкологического заболевания всем пациентам. Полная облитерация ствола большой подкожной вены (БПкВ) обнаружена в 66,7 случаев (n 24), реканализация в 33,3 (n 12). Все пациенты получали стандартную антикоагулянтную профилактику (надропарин по 0,4 мл/сут подкожно). Проведен морфологический анализ 3 случаев послеоперационного венозного тромбоза. Результаты. ВТЭО возникли в 20,8 (n 5) случаев при полной облитерации БПкВ, в 66,7 (n 8) с реканализацией ствола (95 ДИ 1,37,7) в послеоперационном периоде. Реканализация вены увеличила частоту развития послеоперационного венозного тромбоза в 3,2 раза. Заключение. ВТЭО часто возникают после неполной облитерации при ЭТА в отдаленном периоде при наличии дополнительных факторов риска. Учитывая широкое распространение данного типа операций во флебологии и возможность серьезных осложнений, необходимы дальнейшие исследования частоты венозного тромбоза при ЭТА в анамнезе у онкологических больных и определение стратегии профилактики ВТЭО., Introduction. Endovenous thermal ablation of saphenous vein (EVTA SV) including laser ablation or radiofrequency ablation widely used in varicose veins treatment of the lower extremities. EVTA SV can increase the risk of postoperative venous thrombosis in cancer patients. There is a deficiency of data examining rates of thrombotic events (VTE) in oncological patients. Aim: to assess influence of previously performed EVTA SV on postoperative VTE in oncosurgery. Materials and methods. This was a single centre study with retrospective analysis of consecutive oncological patients who underwent abdominal, gynecological or urological surgery from May 2013 to November 2018. 36 patients were included who underwent EVTA SV more than 3 month ago (319 months). Duplex ultrasound (DUS) was performed before oncological surgery (110 days). Complete SV obliteration was found in 66.7 of cases (n 24), recanalization in 33.3 (n 12). All patients had standard anticoagulant prophylaxis nadroparin 0.4 ml per day. We performed a morphologic analysis of 3 VTE cases. Results. Thrombotic complications occurred in 20.8 (n 5) of cases with complete SV obliteration, in 66.7 (n 8) with recanalization (95 CI 1.37.7). Recanalization of SV increased rate of postoperative cancer-associated VTE in 3.2 times. Conclusion. Thrombotic events occur frequently following incomplete obliteration after procedures EVTA SV. Taken account of the high rate of this procedures and the potential for serious consequences, further research is needed on VTE сomplications in oncology and their management., №1(81) (2020)