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Venous malformations are the most common type of angiodysplasia, which cause both physiological and emotional discomfort to patients. Arteriovenous malformations occur most often in the upper and lower limbs at the ratio of 20.9% and 46.4%, respectively. On top of that, 70% of cases of superficial arteriovenous malformations are found in women. In this article, the authors present a clinical example of the effectiveness of microfoam sclerotherapy and show a long-term outcome in a patient with superficial venous malformations of her hands, which are accompanied with such symptoms as as pain and bleeding. As a sclerosing agent, a 1–3% sodium tetradecyl sulphate solution was used, followed by compression using class 2 garments (RAL standard) such as an arm sleeve and gloves. The interval between procedures was 4 to 6 weeks. After several sessions, the superficial venous malformations of the upper limb decreased in the size and volume, and the patient presented less complaints. A 5-year follow-up showed no growth of malformations and re-bleeding complications. Microfoam sclerotherapy of superficial venous malformations in the upper limbs (hands) has good long-term outcomes and allows patients to avoid traumatic surgery. Given this comparability of the surgical and minimally invasive techniques, the use of the latter option, in particular, the foam sclerotherapy technique, makes economic and financial sense.

Hypertrophic scars and keloids mostly develop as a result of wound healing and skin burns. Depending on their location, pathological scars can be not only aesthetically distressing, but also present challenges associated with limited function of the limbs, frequent trauma, inflammation, and persistent pain syndrome. The urgency of the problem of hypertrophic and keloid scars has led to a plethora of therapeutic strategies and innovation techniques to prevent or attenuate pathological scar formation. At the same time, preventing pathological scarring is undoubtedly more effective and cheaper than treating it later on. Next to surgical techniques, injection therapy and an appropriate general postsurgical care for fresh wounds, a multitude of topical drugs are now available for scareless wound healing. Parallel to various silicone-based products, onion extract or cepalin has been highlighted as one of the potential anti-scarring agents over recent years. Based on several studies, onion extract alone or in combination with allantoin and heparin helped to alleviate the woundhealing process in wounds of various origins and prevent their pathological scarring. Considering that hypotrophic scar and keloid formation following surgery or trauma is almost impossible to predict, it is advisable to actively use topical dosage forms to improve wound healing and minimize aesthetic defect, the more so as the prevention of pathological scarring is more effective, safe and comfortable than its treatment. The simplicity of their use opens up vast opportunities for the treatment and prevention of the pathological scar formation in outpatient practice.

Introduction. Martorell’s ulcer is a rather rare pathology that occurs exclusively in patients with long-term and poorly controlled arterial hypertension and continues to be one of the poorly studied areas of modern surgery. There are few reports on the occurrence of this pathology in the medical literature and, as a rule, describe extremely rare clinical cases. The issues of etiology, pathogenesis and differential diagnosis of this disease continue to cause debate. The article provides a review of the literature on this rare surgical pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.Clinical case. A 56-year-old patient was admitted with complaints of a non-healing trophic ulcer on the lateral surface in the lower third of the right leg since one year ago with severe pain syndrome not adequately controlled with non-narcotic analgesics. he received treatment in an outpatient department and in the hospital, underwent courses of rheological therapy to the ulcer region as a local therapy, used a wide range of dressings of domestic and foreign origin. No positive effect was reported on the top of already administered combination therapy, the ulcer continued to increase in size. A Martorell’s ulcer was diagnosed, and a decision was made to provide a course of presurgical conservative rheological therapy with PGE1 (VAP 20 mg), antibiotic therapy, and local therapy aimed at maximal ulcer necrotic tissue clearance before the forthcoming planned surgical treatment. The patient underwent the surgery – autodermatoplasty of the trophic ulcer of the right leg with a mesh graft, continued local treatment of the ulcer using dressings with peruvian balsam and other medications on an outpatient basis without chemical and biological components from the antiseptics and healing stimulants group. Two months after the surgery, the patient had no complaints, the pain syndrome in the ulcer region completely regressed, no edema occurred in the lower operated leg, the right let ulcer completely healed with the formation of a permanent scar.Conclusion. Surgical management is the final and definitive treatment for Martorell’s chronic hypertensive ulcer and should be carried out promptly to minimize the spread of the ulcer and minimize a pain syndrome.

Phlebotropic therapy is an important component of the pathogenetic treatment of chronic venous insufficiency (CVI) of the lower extremities. Venoactive drugs, which have proven their effectiveness and safety in a variety of studies, are widely represented in international and Russian clinical guidelines and standards. However, there is no consensus on the regulation of phlebotropic therapy and, above all, its duration in different clinical classes of CVI. In addition, there are no clear indications on the methods of treatment efficacy monitoring, which can be used in real clinical practice. The presented systematized review of the literature data on micronized purified flavonoid fraction not only reveals the possibilities of phlebotropic therapy of different clinical classes and forms of CVI, but also suggests effective regulations for the use of this drug in specific situations. The data concerning the efficacy of phlebotropic therapy in real clinical practice at the initial stages of CVI (C0s-C1s), in the treatment of C2s (varicose superficial veins with venospecific symptoms), C3 (chronic venous edema), C4 (trophic skin disorders), as well as in stages C5-C6 and C6r (venous trophic ulcers) are presented in details. In addition, the results of studies on the use of micronized purified flavonoid fraction in phlebosclerosing treatment are presented. The duration of phlebotropic therapy is in direct relation to the severity of the disease and the response to the ongoing treatment. The important role is played not only by personalization of treatment according to specific symptoms and syndromes, but also, if possible, by objective control of their dynamics.

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.

Venous aneurysms continue to be one of the little studied sections of modern vascular surgery. Messages on the occurrence of this pathology in the medical literature are very few and describe extremely rare clinical cases, localized mainly in the deep veins of the lower extremities and leading to thromboembolic complications. Single publications describe venous aneurysms localized in superficial saphenous veins. The etiology and pathogenesis of this disease currently continues to cause debate. The article provides a literature review on this rare surgical vascular pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.

Pharmacotherapy plays a key role in the treatment of chronic venous diseases and their complications. This category of patients traditionally uses a variety of phlebotropic drugs, the vast majority of which are of plant origin, introducing specific therapeutic features due to decreased bioavailability and, consequently, the presence of a dose-dependent effect. That is why the modern trend in pharmacotherapy of chronic venous diseases is the use of phlebotropic drugs that have high bioavailability with rapid achievement of therapeutic concentration, as well as demonstrating a polyvalent mechanism of action on the main pathogenetic mechanisms of development and progression of chronic venous diseases. One of such preparations is calcium dobesilate, which is a calcium salt of 2,5-dihydroxybenzenesulfonic acid (C12H10CaO10S2) obtained by chemical synthesis. In terms of pharmacological properties calcium dobesilate belongs to capillary protectors with more pronounced pluripotent effect on venous and lymphatic sections of the microcirculation. To date, calcium dobesilate is the only synthetic phlebotropic drug registered in the Russian Federation.Indications for the prescription of calcium dobesilate are microangiopathies of various genesis, but primarily associated with chronic venous and lymphatic failure.Numerous experimental and clinical studies demonstrate a high clinical efficacy of calcium dobesilate regarding major venospecific symptoms and syndromes, for the elimination of which the drug can be prescribed in a standard daily dose of 1500 mg, both in monotherapy and in combination with other drugs.Calcium dobesilate therapy is usually performed without undesirable reactions, the risk of which is low when using standard recommended daily doses of the preparation 500-1500 mg.

Chronic venous disease (CVD) is the most common vascular pathology that has a significant negative effect on physical and psychological health outcomes, and requires high level of public spending on healthcare. Number of CVD risk factors has been identified in recent decades, but only recently have the experts begun to discuss the role of inflammation and endothelial dysfunction. Modern knowledge enables us to identify several priority strategies and goals aimed at managing the basic pathophysiological mechanisms of the development and progression of CVD. In particular, the use of venoactive drugs, which role in enhancing vascular tone and contractility, reducing inflammation and edema and improving microcirculation and accelerating the healing of venous leg ulcers has been carefully studied and presented with positive outcomes in various publications. This review provides various pathophysiological mechanisms of the development of CVD, which present the targets for venoactive drug therapies.

The article is devoted to Aescusan, a well-studied preparation that is traditionally used in clinical practice for the treatment of chronic diseases of veins, hemorrhoids, postoperative and post-traumatic edema. The main active substance is aescin that is contained in horse chestnut seed extract - Aesculus hippocastanum. The paper presents data of a randomized controlled study demonstrating the efficacy of Aescusan in the treatment of chronic venous diseases and chronic venous edema along with the compression therapy. A number of in vitro and in vivo experimental studies provided convincing proof of efficacy of Aescusan. In particular, they proved the anti-edema, anti-inflammatory and venotonic effect of the preparation. Aescusan improves calcium ions entry into the smooth muscle cell channels in the vascular wall, which increases the venous vascular tone. The anti-inflammatory effect of Aescusan is associated with blockade of prostaglandin F2 (PGF2) release from the venous wall, 5-hydroxytryptamine (5-HT) and histamine antagonism, decreased catabolism of tissue mucopolysaccharides. Conclusion: Aescusan has a pluripotent effect on various pathogenetic mechanisms of chronic venous diseases. It is known for its good tolerability and ease of use, which makes it possible to use the preparation in patients with chronic venous diseases, hemorrhoids, and peripheral post-traumatic edema.

The article is devoted to etiopathogenesis, principles of diagnostics and treatment of chronic edema of the extremities associated with the pathology of the venous and lymphatic system. The authors emphasize the need for adequate compression therapy at all stages of treatment, with an emphasis on the usefulness of innovative flat-knit compression knitwear.

The incidence of peripheral arteries atherosclerosis varies in the general population between 3 to 10%, increasing to 15 to 20% in patients older than 70 years. Due to the high and constantly increasing prevalence, chronic obliterating diseases of lower limbs arteries (CODLLA) constitute an important medical and socioeconomic problem that cannot be solved only through wide introduction and application of various innovative surgical technologies. The fact is that even the most modern and knowledge-intensive surgical interventions do not exert a fundamental influence on the principles of the CODLLA pathogenesis. Moreover, there is no doubt that the success of arterial reconstruction and its prolongation are largely determined by adequate conservative treatment, the principles of which are discussed in this article.

The study was aimed at assessing efficacy and safety of micronized purified flavonoid fraction (MPFF, Detralex) in comprehensive treatment of chronic venous oedema induced by lower limb varicose veins.We performed a post hoc analysis of the results of treatment of 708 patients included into the observational programme VAP-PRO-C3 (ClinicalTrials.gov. NCT03722836). These patients, depending on the type of treatment, were divided into 8 subgroups: MPFF (n=32); MPFF + compression (n=145); MPFF + compression + topical treatment (n=158); MPFF + compression + topical treatment + endovasal laser coagulation (n=197); MPFF + endovasal laser coagulation (n=3); MPFF + compression + endovasal laser coagulation (n=152), patients not receiving MPFF (n=16); MPFF + topical treatment (n=2). Due to paucity of the participants, from the subsequent analysis we excluded the groups MPFF + endovasal laser coagulation, patients not receiving MPFF (n=16) and MPFF + topical treatment. All further statistical data are shown for the remaining 687 patients.Comparing the groups of patients undergoing conservative treatment alone and those subjected to surgical intervention demonstrated no statistically significant differences in dynamics of crural oedema. In both groups at every subsequent visit there was a statistically significant decrease in the ankle volume (p0.001). During the whole period of follow up the crural volume in patients from the group of conservative treatment totally decreased by 0.201±0.158 L and in the operated patients by 0.236±0.189 L (p=0.021). The QOL assessed by the CIVIQ-14 global index score statistically significantly improved in the unoperated patients from 31.5±19.2 to 12.0±10.1 (p0.001). In the operated patients, the baseline and final values of the QOL of the global index score amounted to 33.4±17.8 and 7.7±9.2, respectively (p0.001). In the groups with and without topical treatment, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 28.5±17.4 and 36.2±18.6, respectively. During the follow-up period, we observed statistically significant positive dynamics of all parameters of quality of life. The final visit demonstrated improvement of the CIVIQ-14 global index score to 9.4±9.2 in patients without topical treatment and 10.1±10.4 in those receiving topical treatment (p=0.367), with the mean value of this parameter during treatment in both groups decreased significantly (p0.001). A statistically significant decrease in the ankle volume in both groups was registered at every visit, finally amounting to 0.223±0.166 L and 0.248±0.174 L (p=0.118) for patients not receiving and receiving topical treatment, respectively. In groups of patients not receiving and those receiving compression therapy, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 21.4±14.2 and 33.1±18.5 (p0.001), respectively. At the final visit, these indices statistically significantly (p0.001) decreased to 7.3±9.1 and 9.9±9.9 (p=0.106). Compared with the baseline values, the ankle volume at the final visit in groups of patients with and without compression therapy statistically significantly decreased by 0.187±0.14 L and 0.238±0.17 L respectively (p=0.204). During the study, there were no adverse events related to the administration of MPFF and use of Detragel.MPFF and Detragel appear to be effective and safe components of comprehensive conservative therapy of chronic oedema induced by primary varicose veins of lower extremities.Цель – оценить эффективность и безопасность очищенной микронизированной флавоноидной фракции (МОФФ, Детралекс) в комплексном лечении хронического венозного отека, вызванного варикозной болезнью вен нижних конечностей. Материалы и методы. Проведен post hoc анализ результатов лечения 708 пациентов, включенных в наблюдательную программу VAP-PRO-C3 (ClinicalTrials.gov NCT03722836). Эти больные в зависимости от видов проведенного лечения были разделены на 8 подгрупп: МОФФ (n=32); МОФФ + компрессия (n=145); МОФФ + компрессия + местное лечение (n=158); МОФФ + компрессия + местное лечение + эндовазальная лазерная коагуляция (n=197); МОФФ + эндовазальная лазерная коагуляция (n=3); МОФФ + компрессия + эндовазальная лазерная коагуляция (n=152); пациенты, не получавшие МОФФ (n=16); МОФФ + местное лечение (n=2). Из-за малочисленности из дальнейшего анализа исключены группы МОФФ + эндовазальная лазерная коагуляция; пациенты, не получавшие МОФФ (n=16), и МОФФ + местное лечение подгрупп. Все дальнейшие статистические данные приведены в отношении оставшихся 687 пациентов. Результаты исследования. При сравнении групп пациентов, проходивших только консервативное лечение и перенесших хирургическое вмешательство, не было выявлено достоверных различий по динамике отека голени. В обеих группах при каждом последующем визите отмечено статистически значимое уменьшение объема голени (p0,001). При этом за весь период наблюдения объем голени у пациентов из группы консервативного лечения суммарно снизился на 0,201±0,158 л, а у оперированных больных – на 0,236±0,189 л (p=0,021). Глобальный индекс качества жизни, рассчитанный по опроснику CIVIQ-14, статистически значимо улучшился в группе неоперированных больных с 31,5±19,2 до 12,0±10,1 баллов (р0,001). У оперированных пациентов исходное и конечное значения глобального индекса качества жизни составили 33,4±17,8 и 7,7±9,2 баллов соответственно (р0,001). В группах наличия и отсутствия местного лечения исходное значение глобального индекса качества жизни по опроснику CIVIQ-14 составило 28,5±17,4 и 36,2±18,6 соответственно. Во время наблюдения отмечена достоверная положительная динамика всех показателей качества жизни. При этом на последнем визите отмечено улучшение глобального индекса качества жизни до 9,4±9,2 у пациентов без местного лечения, и 10,1±10,4 у больных, получавших местное лечение (р=0,367). При этом среднее значение данного показателя в ходе лечения в обеих группах достоверно уменьшилось (p0,001). Статистически значимое уменьшение объема голени в обеих группах было зафиксировано на каждом визите и в итоге составило 0,223±0,166 л и 0,248±0,174 л (p=0,118) для пациентов, не получавших и получавших местное лечение соответственно. В группах пациентов, не получавших и получавших компрессионную терапию, исходные значения глобального индекса качества жизни по опроснику CIVIQ-14 составили 21,4±14,2 и 33,1±18,5 (p0,001) соответственно. На итоговом визите эти показатели статистически значимо (p0,001) снизились до 7,3±9,1 и 9,9±9,9 (p=0,106). По сравнению с исходным значением объем голени на заключительном визите в группах пациентов с применением компрессионной терапии и без таковой статистически достоверно уменьшился на 0,187±0,141 л и 0,238±0,171 л соответственно (р=0,204). В ходе исследования не было выявлено нежелательных побочных явлений, связанных с приемом МОФФ и использованием Детрагеля. Заключение. МОФФ и Детрагель служат эффективными и безопасными компонентами комплексной консервативной терапии хронического отека, вызванного первичной варикозной болезнью вен нижних конечностей.

Sclerotherapy is a common technique for the removal of intradermal veins. This study examined the rationale for prescribing micronized purified flavonoid fraction (MPFF) in clinical, etiological, anatomic, pathophysiologic (CEAP) class C1 patients with dilated intradermal veins scheduled for sclerotherapy. In a national, multicenter, observational program, physicians recruited CEAP C1s patients scheduled for sclerotherapy. The decision to prescribe adjuvant MPFF (1000 mg/day for 6 weeks beginning 2 weeks before sclerotherapy) was made according to usual practice. Disease severity and treatment outcomes were assessed at baseline and 4 weeks post-sclerotherapy using a visual analog scale (VAS) as well as quality-of-life (CIVIQ-14) and patient satisfaction (Darvall) questionnaires. A total of 70 physicians recruited 1150 patients: 1071 (93%) women, 79 (7%) men. Mean age (± SD) was 40.7 ± 10.7 years (range 18–74) and mean body mass index was 23.6 ± 3.3 kg/m2. Reticular veins were observed in 42.1% of patients and 57.9% had telangiectasias. MPPF was prescribed to 905 patients (79%). Sclerotherapy was associated with statistically significant decreases in mean VAS scores for leg heaviness, pain, sensation of swelling, night cramps, and itching. For each symptom, MPFF-treated patients showed a more pronounced improvement than those undergoing sclerotherapy alone: mean VAS pain score with MPFF decreased from 1.90 ± 2.30 to 0.30 ± 0.62 versus 1.72 ± 1.93 to 0.52 ± 0.99 with sclerotherapy alone; mean VAS leg heaviness score with MPFF decreased from 2.80 ± 2.43 to 0.47 ± 1.07 versus 2.38 ± 2.23 to 0.76 ± 0.85 with sclerotherapy alone. Patient quality-of-life indicators improved with symptom resolution, particularly pain, and for each indicator the observed improvement was greater with MPFF. The outcomes of treatment exceeded patient expectations. Fewer patients experienced sclerotherapy-induced hyperpigmentation with adjunctive MPFF versus sclerotherapy alone (33.9% versus 41.2%, respectively, P = 0.034). No adverse events related to MPFF were observed. Resolution of venous symptoms post-sclerotherapy was greater in patients treated with MPFF compared with those undergoing sclerotherapy alone, supporting the rationale for use of MPFF in patients undergoing sclerotherapy. Servier.

Background Sclerotherapy is the treatment of choice for telangiectasias. The aim of this study was to investigate the systemic and local inflammatory response after sclerotherapy in women with chronic venous disease (CVD) and to assess the effects of micronized purified flavonoid fraction (MPFF) in combination with sclerotherapy on markers of inflammation and endothelial dysfunction. Methods Sixty women with primary CVD CEAP class C1 were randomly assigned sclerotherapy in combination with MPFF treatment (N=30) or sclerotherapy alone (control) group (N.=30). In the treatment group, patients received MPFF tablets 1000 mg daily for 2 weeks before the scheduled sclerotherapy and for at least 2 months after the procedure. Microsclerotherapy was performed according to standard protocol using modern sclerosing agents. Blood samples were collected from the central vein of the target vascular cluster before and 10 days after sclerotherapy to evaluate markers of inflammation and endothelial dysfunction including: C-reactive protein within the high-sensitivity range, histamine, interleukin-1, tumor necrosis factor-alpha, and vascular endothelial growth factor. To measure the systemic inflammatory response, blood samples were also collected from the forearm vein in 15 control patients. Results Baseline levels of markers of inflammation and endothelial dysfunction obtained from the central vein of the treatment site showed no statistically significant differences between treatment groups. In both groups, all markers were significantly increased 10 days after sclerotherapy. In the control group, the same markers obtained from the forearm were not modified 10 days after sclerotherapy indicating the inflammatory reaction was local and not systemic. MPFF treatment reduced all markers of inflammation and endothelial dysfunction compared with the control group. Conclusions Prescription of MPFF starting prior to sclerotherapy and throughout the post-operative period reduced the vein-specific pro-inflammatory reaction and may thereby reduce the unwanted side effects of sclerotherapy and improve treatment outcomes.

The purpose of the study was to assess efficacy and safety of using in real clinical practice micronized purified flavonoid fraction (Detralex) in patients with chronic venous oedema.The study enrolled a total of 708 patients presenting with chronic venous disease, belonging to C3EpAsPr according to the CEAP classification (chronic venous oedema), who. depending on the accepted clinical practice by expert physicians were prescribed compression and phlebotropic therapy, as well as undergoing surgical interventions. The main criteria for efficacy of the micronized purified flavonoid fraction included the dynamics of chronic venous oedema, vein-specific symptoms, as well as the main parameters of quality of life. Assessment was made using visual analogue scales, the vein-specific questionnaire CIVIQ-14, and the method of discs for measuring the volume of the crus.The obtained findings demonstrated significant positive dynamics of the main vein-specific symptoms assessed by a visual analogue scale. When comparing between the visits of recruitment into the study and its termination the feeling of heaviness in calves decreased form 5.38±2.19 cm to 1.56±1.56 cm (p0.001), pain in the calf diminished from 4.24±3.39 cm to 1.12±1.37 cm (p0.001), feeling of oedema dropped from 5.68±2.44 cm to 1.38±1.59 cm (p0.001), severity of nocturnal cramps fell from 2.46±2.30 cm to 0.43±1.01 cm (p0.001), and intensity of skin inching from 1.46±2.06 cm to 0.43±1.01 cm (p0.001). Positive dynamics of venous-specific symptoms appeared to be accompanied by significant improvement of all dimensions of quality of life according to the CIVIQ-14 scale: by the pain scale from 41.0±19.1% to 12.8±11.6% (p0.001), by the physical condition scale - from 31.6±23.8% to 11.1±15.4% (p0.001), by the psychological state scale - from 24.5±21.1% to 5.7±9.0% (p0.001). The global index of quality of life also improved significantly from 32.4±18.5% to 9.9±9.9% (p0.001). The results of the intervention along all the examined parameters (external appearance, possibility of wearing various clothes and increasing the quality of the self-performed work, to improve both interactions with surrounding people and the social activity and rest) turned out better than expectations form an intervention. The volume of the crus as the main criterion over the period of follow up averagely by the group decreased from 3.07±0.84 to 2.78±0.80 litres (p0.001). A significant decrease in the calf volume from 3.03±0.87 to 2.77±0.85 litres was observed in 288 patients who during the follow up period were not subjected to surgical interventions, with no significant differences in the dynamics of chronic venous oedema revealed between the operated patients and those having received conservative treatment alone.According to a meta-analysis, the micronized purified flavonoid fraction (Detralex) turned out to possess better parameters in relation to therapy of chronic venous oedema as compared with other phlebotropic agents. Therefore, it appears absolutely logical to predominantly use the micronized purified flavonoid fraction in real clinical practice in patients with the CEAP C3 clinical class, which was registered in our study. An important result was also the fact that within the specified terms of follow up surgical intervention demonstrated no significant advantage over conservative therapy alone in treatment of chronic venous oedema. Moreover, conservative treatment in the form of a combination of compression and phlebotropic therapy demonstrated a dynamic decrease in the volume of the affected extremity with a probable transition of the CEAP C3 clinical class to C2.The micronized purified flavonoid fraction (Detralex) at a standard daily dose of 1000 mg in a combination with compression therapy irrespective of the surgical intervention performed resulted in a significant dynamic decrease in the volume of the calf in patients with chronic diseases of lower limb veins (C3EpAsPr according to the CEAP classification). An anti-oedematous effect of the micronized purified flavonoid fraction (Detralex) in a combination with compression manifests itself during the entire period of treatment.ЦЕЛЬ: Оценить эффективность и безопасность применения в реальной клинической практике микронизированной очищенной флавоноидной фракции (Детралекс) у пациентов с хроническим венозным отеком. МАТЕРИАЛ И МЕТОДЫ: В исследование включены 708 пациентов с хроническим заболеванием вен, относящимся к С3EpAsPr по СЕАР (хронический венозный отек), которым в зависимости от принятой клинической практики врачи-эксперты назначали компрессионную и флеботропную терапию, а также проводили хирургическое вмешательство. Основными критериями эффективности микронизированной очищенной флавоноидной фракции были динамика хронического венозного отека, вено-специфических симптомов, а также основных показателей качества жизни. Для оценки использовались визуальные аналоговые шкалы, вено-специфический опросник CIVIQ-14, метод дисков для измерения объема голени. РЕЗУЛЬТАТЫ: Отмечена значимая положительная динамика основных вено-специфических симптомов, оцениваемых по визуальной аналоговой шкале. При сравнении между визитами включения в исследование и его завершением чувство тяжести в икрах уменьшилось с 5,38±2,19 см до 1,56±1,56 см (p0,001), боль в голени сократилась с 4,24±2,39 см до 1,12±1,37 см (р0,001), ощущение отека упало с 5,68±2,44 см до 1,38±1,59 см (р0,001), выраженность ночных судорог снизилась с 2,46±2,30 см до 0,43±1,01 см (р0,001), а интенсивность кожного зуда – с 1,46±2,06 см до 0,43±1,01 см (р0,001). Наряду с вено-специфическими симптомами зафиксировано значимое улучшение всех показателей качества жизни пациентов по CIVIQ-14: по шкале боли – с 41,0±19,1% до 12,8±11,6% (p0,001), по шкале физического состояния – с 31,6±23,8% до 11,1±15,4% (р0,001), по шкале психологического состояния – с 24,5±21,1% до 5,7±9,0% (р0,001). Глобальный индекс качества жизни также значимо улучшился с 32,4±18,5% до 9,9±9,9% (р0,001). Результаты вмешательства по всем рассматриваемым параметрам (внешний вид, возможность носить разную одежду и повысить качество выполнения своей работы, улучшить как взаимоотношения с окружающими, так и социальную активность и отдых) оказались лучше, чем ожидания от вмешательства. Объем голени как основной критерий за период наблюдения в среднем по группе уменьшился с 3,07±0,84 до 2,78±0,80 литров (p0,001). Значимое уменьшение объема голени с 3,03±0,87 до 2,77±0,85 литров (p0,001) отмечено у 288 пациентов, которым в период наблюдения хирургическое вмешательство выполнено не было. При этом в динамике хронического венозного отека не выявлено значимых различий между оперированными пациентами и теми, кто получал только консервативное лечение. Обсуждение. Согласно метаанализу микронизированная очищенная флавоноидная фракция (Детралекс) обладает лучшими показателями в отношении терапии хронического венозного отека по сравнению с другими флеботропными препаратами. В связи с этим абсолютно логично преимущественное использование микронизированной очищенной флавоноидной фракции в реальной клинической практике у пациентов с С3 клиническим классом по СЕАР, что и зафиксировало настоящее исследование. Важным результатом стал и тот факт, что в заданные сроки наблюдения хирургическое вмешательство не продемонстрировало значимого преимущества перед только консервативной терапией в лечении хронического венозного отека. Более того, консервативное лечение в виде комбинации компрессионной и флеботропной терапии показывало динамическое уменьшение объема пораженной конечности с вероятным переходом С3 клинического класса по СЕАР в С2. ЗАКЛЮЧЕНИЕ: Микронизированная очищенная флавоноидная фракция (Детралекс) в стандартной суточной дозе 1000 мг в сочетании с компрессионной терапией независимо от выполненного хирургического вмешательства приводит к значимому динамическому уменьшению объема голени у пациентов с хроническими заболеваниями вен нижних конечностей С3EpAsPr по СЕАР. Противоотечный эффект микронизированной очищенной флавоноидной фракции (Детралекс) в сочетании с компрессией проявляется в течение всего периода лечения.

The purpose of the study was to assess efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® in decreasing the incidence and treatment of the most common local adverse reactions in patients after endured sclerotherapy of reticular veins and telangiectasias.Our open prospective observational study included a total of sixty 18-to-35-year-old female patients who after undergoing standardized sclerotherapy of reticular veins and telangiectasias on symmetrical portions of lower limbs were given a tube of heparin sodium gel 1000 IU/g or Detragel® to be applied onto the skin of one (left) lower limb in the projection of the sclerotherapy-exposed vessels 2-3 times daily for 10 days followed by putting on a compression class 2 (RAL standard) stocking. The women were allowed to use only the paired stocking on the contralateral extremity. Efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® were evaluated based on the incidence of typical adverse reactions (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as on the patient's subjective perceptions.The use of heparin sodium gel 1000 IU/g and Detragel® in addition to compression after sclerotherapy of reticular veins and telangiectasias significantly and comparably decreased the incidence and accelerated the resolution of ecchymoses and phlebitides associated with phlebosclerosing treatment. The Detragel® group patients were found to develop hyperpigmentation or neovasculogenesis significantly less often as compared with the heparin sodium gel 1000 IU/g group women. What is more, using Detragel® was not accompanied by hyperkeratosis, pruritus or formation of a sticky film, the events, however, observed while applying heparin sodium gel 1000 IU/g.The use of Detragel® or heparin sodium gel 1000 IU/g for 10 days additionally to compression significantly decreased the incidence of typical undesirable reactions associated with sclerotherapy of reticular veins and telangiectasias. The Detragel® group women turned out to have lower incidence of hyperpigmentation and neovasculogenesis. Besides, Detragel® demonstrated better organoleptic properties.Цель исследования: оценить эффективность и безопасность геля натриевой соли гепарина 1000 МE/г и Детрагель® для снижения частоты развития и лечения наиболее частых местных нежелательных реакций у пациентов, перенесших склеротерапию ретикулярных вен и телеангиэктазов. Материалы и методы: в открытое проспективное наблюдательное исследование было включено 60 пациенток в возрасте от 18 до 35 лет, которым после выполнения стандартизированной склеротерапии ретикулярных вен и телеангиэктазов на симметричных участках нижних конечностей, выдавали по тубе геля натриевой соли гепарина 1000 МE/г или Детрагеля®, которые они должны были наносить на кожу одной (левой) нижней конечности в проекции подвергнутых склеротерапии сосудов 2-3 раза в сутки в течение 10 дней с последующим надеванием компрессионного чулка класс 2 (RAL стандарт). На контралатеральной конечности разрешено было использовать только парный компрессионный чулок. Эффективность и безопасность геля натриевой соли гепарина 1000 МE/г и Детрагеля® оценивали на основании частоты обнаружения типичных нежелательных реакций (экхимозы, флебиты, гиперпигментация и неоваскулогенез), а также субъективных ощущений пациента. Результаты: использование геля натриевой соли гепарина 1000 МE/г и Детрагеля® в дополнение к компрессии после склеротерапии ретикулярных вен и телеангиэктазов значимо и сопоставимо снижает частоту развития и ускоряет разрешение, связанных с флебосклерозирующим лечением, экхимозов и флебитов. При этом, в группе Детрагеля® в отличие от группы геля натриевой соли гепарина 1000 МE/г значимо реже развивается гиперпигментация и неоваскулогенез. Кроме того, при использовании Детрагеля® не было зафиксировано гиперкератоза, кожного зуда и образования липкой пленки, отмеченных при использовании геля натриевой соли гепарина 1000 МE/г. Заключение: применение Детрагеля® или геля натриевой соли гепарина 1000 МE/г в течение 10 дней дополнительно к компрессии значимо снижает частоту типичных нежелательных реакций, связанных со склеротерапией ретикулярных вен и телеангиэктазов. В группе Детрагеля® отмечена более низкая частота развития гиперпигментаций и неоваскулогенеза, а также Детрагель® продемонстрировал лучшие органолептические свойства.

The study was aimed at assessing efficacy and safety of using a micronized purified flavonoid fraction in the perioperative period in patients scheduled for endovascular surgical intervention for CEAP clinical class C2 lower limb varicose veins.This study enrolled a total of 1519 patients with CEAP C2a,sEpAs (primary varicose vein with valvular incompetence of the great and/or small saphenous vein) who were subdivided into two groups. Group One included 1039 patients who in the perioperative period were prescribed a micronized purified flavonoid fraction at a daily dose of 1000 mg and who continued therapy, including visit 4. Group Two was composed of 480 patients taking no venoactive agents. The main criterion for assessing efficacy of the micronized purified flavonoid fraction was the incidence rate of typical adverse events in the compared groups of patients after surgical intervention.The patients receiving the micronized purified flavonoid fraction were found to have adverse events significantly less often as compared with those in the control group: ecchymosis 7.1 versus 11.0% (p=0.01), haematoma 0.5 vs 1.3% (p=0.1), paresthesia 0.5 vs 1.7% (p=0.02), thrombophlebitis 0.2 vs 0.6% (p=0.2), pigmentation 0.6 vs 3.3% (p=0.001), heat-induced thrombosis 0.3 vs 1.3% (p=0.02). The total incidence rate of adverse events in patients receiving and those not receiving the micronized purified flavonoid fraction amounted to 7.6 vs 15.0%, respectively (0.001).The micronized purified flavonoid fraction prescribed in the perioperative period, owing to a pluripotent mechanism, adapts the venous system and microcirculatory bed of the lower extremities to operative stress, decreasing the anti-inflammatory response to endovascular intervention, lowering thereby the incidence of undesirable events.Prescription of the micronized purified flavonoid fraction in the perioperative period ensures a significant decrease in the incidence of typical adverse events developing after endovascular surgical treatment for CEAP clinical class C2 varicose veins and may be recommended for real clinical practice.Цель: оценить эффективность и безопасность использования микронизированной очищенной флавоноидной фракции в периоперационном периоде у пациентов, которым планируется эндоваскулярное хирургическое вмешательство по поводу варикозной болезни вен нижних конечностей клинического класса С2 по СЕАР. Материалы и методы: в исследование включено 1519 пациентов с С2a,sEpAs по СЕАР (первичная варикозная болезнь с клапанной недостаточностью большой и/или малой подкожной вены), которые были разделены на две группы. В первую группу вошли 1039 пациентов, которым в периоперационном периоде была назначена микронизированная очищенная флавоноидная фракция в суточной дозе 1000 мг и которые продолжали терапию, включая визит 4. Во вторую группу было включено 480 пациентов, не получавших веноактивные препараты. Основным критерием оценки эффективности микронизированной очищенной флавоноидной фракции стала частота типичных нежелательных явлений в сравниваемых группах пациентов после хирургического вмешательства. Результаты: у пациентов, получавших микронизированную очищенную флавоноидную фракцию, нежелательные явления встречались значимо реже, чем в контрольной группе: экхимозы 7,1 против 11,0% (p=0,01), гематомы 0,5 против 1,3% (p=0,1), парестезии 0,5 против 1,7% (p=0,02), тромбофлебит 0,2 против 0,6% (p=0,2), пигментация 0,6 против 3,3% (p=0,001), термоиндуцированный тромбоз 0,3 против 1,3% (p=0,02). Суммарная частота нежелательных явлений у пациентов, получавших и не получавших микронизированную очищенную флавоноидную фракцию, составила 7,6 против 15,0% соответственно (p0,001). Обсуждение: микронизированная очищенная флавоноидная фракция, назначаемая в периоперационном периоде, благодаря плюрипотентному механизму адаптирует венозную систему и микроциркуляторное русло нижних конечностей к операционному стрессу, снижает провоспалительный ответ на эндоваскулярное вмешательство, уменьшая тем самым частоту нежелательных явлений. Заключение: назначение микронизированной очищенной флавоноидной фракции в периоперационном периоде обеспечивает значимое снижение частоты типичных нежелательных явлений, возникающих после эндоваскулярного хирургического лечения варикозной болезни вен нижних конечностей С2 клинического класса по СЕАР и может быть рекомендовано для реальной клинической практики.