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Review authors consider the current possibilities of percutaneous laser coagulation for telangiectasias and reticular veins, which are the most common cosmetic defects of vascular genesis, occurring in more than 80% of women of different age groups. This vascular pathology constituting an aesthetic defect and causing local physical discomfort is one of the most common indications for phlebosclerosing therapy and percutaneous laser coagulation. The authors present the most effective and safe guidelines for percutaneous laser coagulation based on analyses of a large volume of specialized literature. Due to the use of state-of-the-art Nd:YAG lasers, percutaneous laser coagulation is increasingly used in patients with various types of intradermal vein lesions and, owing to high efficiency and safety, has advantages over compression sclerotherapy by several criteria. Nd:YAG lasers can be divided into long- and short-pulse ones according to their technical characteristics. Long-pulse lasers provide coagulation of the target vessel due to a single pulse with a high energy density (fluence), while short-pulse lasers, on the contrary, generate a series of pulses to the target vein with a running time of fractions of a millisecond, which ensures the conversion of hemoglobin into methemoglobin with a ten-fold increased ability to absorb laser energy and convert it to heat. As the duration of the pulses generated by the device is a priori shorter than the thermal relaxation time, the risk of burns to the skin and paravasal structures almost completely disappears. The authors provide clinical examples of the application of Aerolase Neo device that utilizes MicroPulse technology to confirm the effectiveness and safety of shortpulse Nd:YAG lasers.

Introduction. The development of phlebology and mainstreaming of ultrasonic techniques has led to the emergence of microfoam sclerotherapy, which proved itself as a more effective technique. In the world literature, there are isolated publications that say about the effectiveness and safety of the microfoam sclerotherapy combined with mini-phlebectomy, but no specific studies comparing the combination treatment for the elimination of varicose syndrome with separate use of each of the techniques are described.Aim. To increase the effectiveness of invasive treatment and to reduce the rate of complications in patients with varicose veins using a combination of microfoam sclerotherapy and mini-phlebectomy of tributaries after endovenous laser ablation.Material and methods. Simple single- center, non-randomized, retrospective study was conducted at the A.K. Eramishantsev Moscow State Hospital. It included 52 patients with varicose veins (a total of 77 lower limbs, 22 patients had bilateral disease), who had no previous invasive treatment for this disease. They underwent endovenous laser ablation of truncal vein combined with microfoam sclerotherapy and mini-phlebectomy of tributaries. Microfoam sclerotherapy was performed with 0.5–2.0% of polidocanol foam, and mini-phlebectomy per Varady technique. The patients had a postprocedural follow-up clinical examination and duplex ultrasound the day after the intervention, then at 1, 6, and 12 months.Results. Endovenous laser ablation of truncal veins was acutely successful in all cases. No cases of great saphenous vein recanalization were detected in follow-up period. In the early postprocedural period, the combined microfoam sclerotherapy and miniphlebectomy also showed 100% success rate, however redo sclerotherapy was required in 4 (5.2%) cases for new varicose tributaries developed in late postprocedural period.Conclusion. Combined microfoam sclerotherapy and mini-phlebectomy, as a method of treatment for various veins syndrome, can provide additional benefit such as reducing the volume of mini-phlebectomy and the resultant tissue damage, the varicosity recurrence rate, the number of subcutaneous hematomas and ecchymoses, the discomfort of the tumescent anesthesia, the risk of postprocedural varicose veins thrombosis and pigmentation rate.

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. Medical compression stockings are one of the main methods in a conservative strategy for the treatment of chronic vein diseases as well as for adjuvant treatment after superficial venous interventions. however, compliance to this treatment is low.Objective. To evaluate patient satisfaction with medical compression knitwear therapy in a short-term follow-up.Materials and мethods. The study included 150 patients of both sexes aged 42 ± 8.3 years. Endovenous laser obliteration combined with mini-phlebectomy and/or sclerotherapy for varicose veins was performed. All patients after the surgery wore compression stockings of compression class 2 with a recommended wearing period of 14 days. At the control visit at the end of the follow-up period all patients were asked to complete a satisfaction survey with a specially prepared questionnaire including 7 questions.Results and discussion. No significant adverse events and complications related to either the invasive intervention or the compression therapy were observed during the follow-up period. There were no abnormalities such as compression sensations or changes in blood flow under the knitwear. The compression was totally adequate, with no areas of over- and/or under-compression. All respondents felt that the knitwear was well anchored to the leg and no slipping or twisting due to the wide elastic band with droplet silicone. In addition to all of the above, the patients noted that the knitwear offered to them in the study had good tactile properties: it was soft and pleasant to the skin. According to the survey, the average score for all questions was 9.5 (QR 8-10).Conclusion. Elastic compression is an effective and safe means of preventing adverse events, complications and pain in patients after superficial varicose veins surgery. Additional consumer properties of medical compression knitwear can significantly influence patients’ compliance and therefore the effectiveness of treatment.

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.