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Presented herein are the results of using Detralex in conservative treatment of women suffering from pelvic varicose veins. Our open prospective study included a total of 30 women with various forms of the course of the disease. All patients took Detralex prescribed at a daily dose of 1,000 mg for 60 days. Dynamic assessment of clinical manifestations of pelvic varicose veins in this cohort of patients was carried out with the help of a specialized quality-of-life questionnaire, an adapted clinical scale of determining disease severity, as well as a visual analogue scale for assessment of the main symptoms of the disease manifestations. The questionnaires and scales were filled in before the beginning of taking the drug and immediately after stopping it. The obtained findings objectively confirmed efficacy of conservative therapy in the majority of the responders. Reported was a decrease in the average index of quality of life from 46.77±13.25 to 36.87±8.53 points (p=0.001). The mean score of the clinical scale of disease severity regressed from 10.8±5.06 to 6.97±3.9 points (p=0.002). The average composite score for the degree of the main symptoms of the disease according to the visual analogue scale decreased from 32.9±21.26 to 19.16±16.04 points (p=0.006). We observed a dramatic decrease in severity of manifestations of the main clinical symptoms and improvement of quality of life of women on the background of taking the drug, thus suggesting its efficacy for the pathological condition concerned. The obtained results make it possible to recommend routine prescription of Detralex to all women with detected pelvic varicose veins as one of the main components of basic pharmacotherapy.

Haemostatic disorders play an important role in the pathogenesis of acute venous thrombosis. One of the least studied reactions of blood coagulation and thrombogenesis is spontaneous contraction of blood clots, which takes place at the expense of the contractility apparatus of activated blood platelets adhered to fibrin fibres. The work was aimed at studying the parameters of contraction of blood clots, formed in vitro, in blood of 41 patients with acute venous thromboses as compared with the same parameters in apparently healthy donors. We used a new instrumental method making it possible to determine the time from initiation to the beginning of contraction, as well as the degree and velocity of clot contraction. It was revealed that in patients with venous thrombosis the ability of clots to shrink was significantly reduced as compared with the control. We detected a statistically significant retardation of and decrease in of blood clot concentration in patients with venous thrombosis complicated by pulmonary artery thromboembolism as compared with contraction in patients with isolated deep vein thrombosis, witch may be important for early diagnosis and determination of the risk of thromboembolism. Besides, we revealed a statistically significant retardation of contraction in patients with proximal thrombosis as compared with contraction in patients with distal thrombosis, with similar values of the degree of contraction. Contraction was statistically significantly reduced in acute thrombosis (less than 21 days), whereas in subacute thrombosis (more than 21 days) the parameters of contraction were closer to normal values. The obtained findings suggest that reduction of blood clot contraction may be a new, hitherto unstudied pathogenetic mechanism deteriorating the course and outcome of venous thrombosis. The clinical significance of contraction and its impairments, as well as the diagnostic and prognostic value of the laboratory test for blood clot contraction would merit further study.

The study was aimed at assessing efficacy of open thrombectomy in acute iliofemoral venous thrombosis.From January 2012 to December 2016, a total of 37 patients underwent transfemoral thrombectomy for acute iliofemoral venous thrombosis. The Control Group consisted of 24 patients receiving standard anticoagulant therapy. Six patients were subjected to a hybrid operation consisting in thrombectomy supplemented with stenting of the residual compression stenosis of the left common iliac vein (CIV). The outcomes of the operations were controlled by means of duplex scanning. Clinical efficacy of the operations was evaluated with the help of the Venous Clinical Severity Score (VCSS) and CEAP classification.Patency of the iliofemoral segment at 6 months of follow up after thrombectomy was observed in 92% of patients. At the same time, in patients receiving anticoagulant therapy recanalization of the iliofemoral segment was observed in only 21% (5/24; χ2=31, p0.01) of cases. Recanalization of the femoropopliteal segment 6 months after thrombectomy was noted to occur in 70% (23/33) of patients. The median of the composite index by the VCSS after 6 months decreased from 7 to 2 (p=0.002). The cumulative patency of the iliofemoral segment 36 months after surgery amounted to 86%. Clinical assessment of the remote results of thrombectomy according to the CEAP classification demonstrated that 90% (19/21) of patients were either free from or had weakly pronounced symptoms of post-thrombotic syndrome.Performing thrombectomy for iliofemoral thrombosis by selective indications using modern methods of restoring patency of deep veins significantly increases efficacy of treating patients presenting with this severe pathology and prevents the development of pronounced manifestations of post-thrombotic syndrome.Цель исследования. Оценка эффективности открытой тромбэктомии при остром подвздошно-бедренном венозном тромбозе. Материалы и методы. С января 2012 по декабрь 2016 гг. у 37 пациентов выполнена трансфеморальная тромбэктомия при остром подвздошно-бедренном венозном тромбозе. Контрольная группа была представлена 24 больными, получавшими стандартную антикоагулянтную терапию. У 6 пациентов проведена гибридная операция – тромбэктомия, дополненная стентированием резидуального компрессионного стеноза левой общей подвздошной вены (ОПВ). Контроль результатов операции осуществлялся с помощью дуплексного сканирования. Оценка клинической эффективности операций проводилась с помощью шкалы VCSS (Venous Clinical Severity Score) и классификации CEAP. Результаты. Проходимость подвздошно-бедренного сегмента через 6 месяцев наблюдения после тромбэктомии отмечена у 92% пациентов. В то же время у больных, получавших антикоагулянтную терапию, реканализация илиофеморального сегмента зафиксирована лишь в 21% (5/24; c2=31, p0,01) случаев. Реканализация бедренно-подколенного сегмента через 6 месяцев после тромбэктомии наступила у 70% (23/33) больных. Медиана суммарного показателя по шкале VCSS через 6 месяцев уменьшилась с 7 до 2 (P=0,002). Кумулятивная проходимость подвздошно-бедренного сегмента через 36 месяцев составила 86%. Согласно клинической оценке отдаленных результатов тромбэктомии по классификации CEAP, у 90% (19/21) больных после тромбэктомии симптомы ПТБ отсутствовали либо были слабо выраженными. Заключение. Выполнение тромбэктомии при илиофеморальном тромбозе по селективным показаниям с использованием современных методов восстановления проходимости глубоких вен существенно повышает эффективность лечения пациентов с этой тяжелой патологией и предотвращает развитие выраженных проявлений посттромботической болезни.

The study was aimed at bettering therapeutic outcomes in patients with acute arterial lower-limb insufficiency by means of improving the method of selective thrombolysis (STL). We analyzed both immediate and remote results of treating a total of 118 patients presenting with acute lower limb ischaemia of not more than grade 2B (according to I.I. Zatevakhin, 2002) within the terms up to 2 months from the onset of the disease. The Study Group patients (n=67) were subjected to STL and the Control Group patients (n=51) underwent standard open surgical interventions. The remote results of treatment were assessed within the terms up to 1 year in 38 patients of the Study Group and in 31 patients of the Control Group. The main criteria for efficacy of treatment were the incidence rate of amputation and mortality. In the immediate postoperative period in the Control Group, the frequency of amputations of lower limbs was more than 5-fold higher as compared with the Study Group (p0.005); no significant differences on lethal outcomes were revealed (p0.05). In the remote period of follow up, the incidence of amputations in the Study and Control Groups did not statistically differ (p0.05), whereas mortality in Control Group was 4.3-fold higher as compared with the Study Group (p0.05).

Analysed herein are the results of examining and treating a total of 290 patients presenting with relapses of varicose disease, including 198 women and 92 men. The patients' age averaged 51.6 ± 8.7 years, with the mean term of the appearance of relapses after surgery amounting to 4.8 ± 1.4 years and that of reoperation - 11.1 ± 7.5 years. According to the CEAP classification, the patients were subdivided as follows: C2 - 36 (12.4 %), С3 - 117 (40.4 %), С4 - 103 (35.5 %), С5 - 20 (6.9 %), С6 - 14 (4.8 %). All patients underwent ultrasound duplex scanning. Relapses in the basin of the great saphenous vein were revealed in 205 (70.63 %) patients, in the basin of the small saphenous vein in 65 (22.4 %) subjects. Neoangiogenesis was observed in 62 (21.3 %) cases, pathological reflux from pelvic veins as a cause of relapses - in 31 (10.7 %) patients, varicosity-altered tributaries of the great and small saphenous veins, not connected with the pathological stump or unremoved trunk - in 52 (17.9 %) cases. Based on the results of diagnosis, treatment was carried out in 241 patients. 179 patients underwent various types of interventions, of these, 94 with the use of minimally invasive therapeutic technologies. 76 patients were subjected to different methods of phlebosclerosing treatment, of these 62 in outpatient conditions. The study showed negative influence of axial reflux along through deep veins on the appearance and course of varicose veins relapses. The remote results of treatment at terms from one year to 9 years (mean 4.9 ± 2.6 years) were studied in 76 patients. Good results were noted in 52 (68.5 %) patients, satisfactory outcomes were observed in 22 (28.9 %), and unsatisfactory results - in 2 (2.6 %) patients.

The study was based on the findings of examination and treatment of fifty-four 19-to-55- year-old female patients (mean age 35.3 ± 7.3 years) presenting with varicosity of small pelvis veins. Of these, seventeen women with stenosis of the left renal vein were subjected to the following reconstructive operations on small pelvis veins: creating proximal ovarian-iliac anastomoses - 10 procedures, establishment of sapheno-ovarian anastomoses - 5 operations, one procedure of prosthetic repair of the left renal vein and one operation of transposition of the left renal vein. All interventions were completed with resection of the distal segments of the ovarian vein. A further 19 women with idiopathic reflux along the ovarian veins underwent uni- or bilateral embolization thereof, with multi-stage embolization of the branches of the internal iliac vein performed in one patient. The remaining eighteen endured the following interventions: unilateral resection of the left ovarian vein performed in twelve cases (3 endoscopic operations), bilateral resection in four cases (3 endoscopic resections). In seven cases the operations were supplemented with microphlebectomy of the varicosely altered perineal veins. Two patients underwent operations of crossectomy and resection of the pathologically altered internal pudendal vein. Five-year follow up showed that good-to-satisfactory results were obtained in 45 (83.3%) cases, with a disease relapse revealed in seven cases.

The authors share herein their first experience gained in stenting for stenosing and occlusive lesions of the iliac-femoral segment veins, reporting the outcomes of treating a total of thirteen patients subjected to balloon angioplasty and stenting of iliac veins for chronic venous obstruction. While treating non-thrombotic venous lesions, stenting was successfully performed in 100% of the patients concerned. Inpost-thrombotic lesions therapeutic outcomes were successful in 9 (75%) patients. No immediate postoperative complications were observed. The remote results were followed up in eleven out of the 13 patients. Patency within the terms up to 16 months amounted to 81.1%. Clinical improvement was noted in 12 (92.3%) patients. According to the VCSS scale, there was a reliable decrease in the intensity of chronic venous insufficiency manifestations along all parameters. The integral index decreased from 6.56+/-0.71 to 4.45+/-0.65 (t=3.82, p0.002). The malleolar volume decreased from 275.3+/-6.7 to 241.6+/-6.1mm (t=12.3, p0.001). Hence, angioplasty and stent-grafting of iliofemoral veins turned out to be a minimally invasive, safe, and highly efficient therapeutic modality. The efficacy of the procedure was confirmed by a considerable improvement of the limb's condition and good remote results concerning patency of the reconstructed segments of the venous bed. Endovascular methods may be considered as a promising modality of treatment for this patient cohort.

The authors analysed a total of 152 surgical interventions on the brachiocephalic arteries (BCAs) performed in 142 patients. All the patients were subjected to intraoperative monitoring of cerebral haemodynamics by means of transcranial Doppler (TCD) ultrasonography simultaneously accompanied by electroencephalography (EEG). Additionally, the state of the reconstructed carotid arteries was controlled by means of ultrasonographic duplex scanning (USDS). Comparing the findings of the TCD recording and EEG made it possible to single out 5 groups of the operated patients. The EEG technique turned out to have more informative value as compared with TCD ultrasonography in determining the degree of cerebral ischaemia during clamping of the carotid arteries (CAs). Nine (5.9%) patients demonstrated lower tolerance of the brain to ischaemia, and the operation on the BCA was performed with the use of a temporal intraluminal bypass graft. Microembolic signals (MES) were registered in 54.6% of cases. Single MES were detected in six patients, sporadic MES--in 53, and multiple MES--in 24. Mention should be made that the--MES associated with the placement of the bypass graft appeared to be multiple and were registered in all the operated patients. Diffusion-weighted magnetic resonance tomography revealed fresh foci of lacunar cerebral infarctions in 14 (25%) of the 56 patients thus examined. Intraoperative USDS of the reconstructed carotid arteries revealed floatation of the residual remnants of the intima in two patients, which was the cause of a repeat intervention. Combined monitoring of cerebral haemodynamics makes it possible to timely prevent cerebral ischaemia, to narrow the indications for placement of an intraluminal bypass graft, and to dramatically decrease the rate of postoperative complications.

In order to work out the indications for surgical and endovascular treatment of floating thromboses in the system of the inferior vena cava (IVC) and to evaluate the therapeutic outcomes obtained we examined a total of one hundred and forty-five 17-to-85-year-old patients presenting with acute thrombosis in the system of the IVC. Of these, floating thromboses were revealed in ninety-five patients. The most frequently encountered localization of the floating thrombus was the common femoral vein (CFV). In 77 patients, thrombosis originatedfrom the femoral vein (FV), and in 12 instances -from the saphenofemoral junction. The signs of pulmonary thromboembolism (PTE) were diagnosed in 22 cases. Instrumental studies included ultrasonographic duplex scanning (USDS), roentgenopaque and computer-assisted phlebography, and perfusion-mediated scintigraphy of the lungs. Thrombectomy from the common iliac vein (CIV), external iliac vein (EIV) and common femoral vein (CFV) with resection of the femoral vein was performed in forty-seven patients; of these, the procedure was combined with establishing a temporal proximal arteriovenous fistula (AVF) in sixteen subjects. The femoral vein was resected in nineteen instances. Thrombectomy form the IVC with the help of the "TREKS" device was carried out in six patients. Cava filters were implanted in a total of eighty-four patients. Of these, ten devices were intended and had to be 3 left for permanent implantation, with the remaining seventy-four patients having received retrievable ones. Rethromboses in the early postoperative period were observed to occur in four patients. The patients with the AVFs applied had no thromboses. PTE occurred in four patients, with one lethal outcome. Another patient died due to myocardial infarction. Temporary cava filters were successfully retrieved in sixty-eight patients within the terms from 10 to 56 postoperative days long-term results up to 2 years were followed up for thirty-eight patients, with good outcomes noted in twenty-six cases, satisfactory in ten, and poor results seen in two patients. An active therapeutic policy pursued in management of floating embolus-hazardous thromboses is the only efficient measure making it possible to reliably prevent the development of both PTE and post-thrombotic disease.

The purpose of this study was to assess the outcomes of using a mini-approach in surgery of carotid arteries. From September 2006 to December 2007, one hundred and twenty-nine patients (with a total of 139 operations sustained) underwent interventions on the carotid bifurcation for atherosclerotic lesions and pathological tortuosity of the carotid arteries. The patients were subdivided into two groups. Group A consisted of those operated on from the standard access to the carotid arteries, with Group B comprising the patients undergoing interventions on the carotid bifurcation from a mini-approach (a cutaneous incision less than 5 cm long, averaging 4.7 +/- 0.3 cm). The control Group C was composed of forty-two patients having endured operations on the carotid arteries from the conventional access performed at other specialised departments. In the patient groups referred to above, we compared the incidence rate of perioperative complications (stroke/death), lesions of the cranial and cervical nerves, as well as wound complications. In Group A patients, there were two patients with stroke, one of whom had eventually died. Neuropathies of the cranial and cervical nerves in this group of patients were observed to have developed in eight (6.2%) and ninety-two (71.3%) cases, respectively, and in Group C patients--in eleven (28.0%) cases. Cervical haematoma was observed in fourteen (10.9%) subjects. The average duration of the postoperative hospital stay amounted to 6.8 +/- 1.1 days. Amongst the Group B patients, cervical haematoma was noted in two (3.2%, P0.0001) cases only. A lesion of the cranial nerves (that of the superior laryngeal nerve) took place in two patients (P0.0001), and that of the cervical nerves--in four patients (P0.0001). No cheloid cicatrices were observed. The patients reported excellent and aesthetically pleasing surgical outcomes. The average duration of the postoperative hospital stay amounted to 2.8 +/- 0.69 days (P = 0.002). Hence, operations on the carotid bifurcation may be successfully performed from a mini-approach, with thus discomfort kept at a minimum and rapid rehabilitation of patients.

The purpose of the work was to assess the diagnostic significance of combined bolus magnetic resonance angiography (MRA) and two-dimensional time-of-flight MRA of lower limb arteries as compared to radioangiography in patients with occlusive diseases of lower limb arteries.Twenty-six patients with the symptoms of lower limb ischemia of varying severity were provided bolus MRA with prolonged manual injection of contrast substance and transposition of the MR-tomograph table. Additionally, all the patients underwent two-dimensional time-of-flight (2D TOF) MRA of the leg arteries.The statistic processing of bolus MSA for visualization of the pelvic segment has demonstrated its high sensitivity and specificity (97.74% and 92.31% respectively). On visualization of the femoral artery segment the sensitivity of this modality accounted for 97.57%, the specificity for 94.57%. In patients with severe ischemia, visualization of the leg arteries was difficult. Consequently, the specificity of the modality accounted for 44.58%. However, when this technique was combined with two-dimensional time-of-flight MRA of the leg arteries, the sensitivity and specificity of the modality reached 96.38% and 91.92% respectively.Bolus MRA of lower limb arteries is marked by the high sensitivity and specificity for visualization of the arteries of the iliac and femoral segments. To visualize the leg arteries in patients with severe forms of lower limb ischemia, this modality should be supplemented by two-dimensional time-of-flight MRA.

Combined atherosclerotic involvement of the brachiocephalic arteries (BCA) and lower limb arteries has been analysed in 107 patients (56 females and 51 males) with a verified diagnosis of ischemic heart disease (IHD). BCA atherosclerosis was detected in 83.9% females and 93.1% males. 75.8% examinees had no murmur. It is suggested that arterial hypertension and obesity in females with IHD may be risk factors of BCA kinking. Frequency of combined affection of extracranial arteries and lower limb arteries reached 23.2% females and 96% males. Therefore, it is necessary to screen these arteries for atherosclerosis in all IHD patients.

The aim of the present work was to study the causes of post-operative recurrences of varicosity and to define approaches to their optimal correction. Duplex scanning (DS) with Color Doppler Imaging of the blood flow was used to examine 126 patients (136 extremities) with recurrences of varicosity. The patients were distributed according to the CEAP clinical classification. Altogether 76 patients (78) extremities with recurrences of varicosity were operated on. 27 persons received different variants of sclerotherapy including echoscleroobliteration. According to the DS data, the most frequently obtained finding in patients with recurrences of varicosity was identification of the perforating veins with valvular insufficiency, namely in 120 (or in 88.2%) extremities. The long stump of the greater saphenous vein (CSV) was discovered in 86 (63.2%) extremities, the long stump of the lesser saphenous vein (LSV) in 6 (4.4%), ectasia of LSV trunk was recognised in 20 (14.5%), incompetence of the valves of the sural veins in 12 (8.8%) extremities. Incompetence of the valves of the deep veins was present in 73 (53.6%) patients. No sources of pathological veno-venous runoff were identified in 12 (8.1%) cases. A good agreement was established between the incidence of valvular incompetence of the deep veins and the disease severity. The indications for surgical correction of valvular insufficiency were worked out. It has been demonstrated that sclero-obliteration is the method of choice in the treatment of the recurrences of varices. The long-term results of operations for recurrences of varicosity were followed up in 62 patients over the period of one to 15 years. Good and satisfactory results were obtained in 60 (96.8%) cases. The authors believe that the majority of varicosity recurrences arise from an inadequate assessment of the status of lower extremity venous bed as well as from technical and methodological faults of the operating surgeon. DS in an indispensable component of preoperative examination of patients with varicosity recurrences.