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The problem of finding an ideal method for the correction of vertical venous reflux in lower extremity varicose disease is highly relevant due to the rapid development of technologies and the opening of new treatment methods, including minimally invasive ones. According to many researchers, the main parameters for choosing the optimal surgical technique should be low invasiveness, compliance with the anatomical, including ultrasound, picture, the possibility of using local anesthesia, taking into account concomitant pathology and individual intolerance of various drugs by patients, effectiveness of venous vessel obliteration, and minimal risk of possible complications. The review considers a comparative characterization of endovascular treatment methods for varicose disease, as well as lists the main possible complications of each of them. In terms of obliteration effectiveness and the least pronounced complications, the leading position is occupied by the method of cyanoacrylate obliteration. There is an increasing amount of information in the literature about the use of cyanoacrylate composite in the treatment of lower extremity varicose disease. Since this method is relatively new, the number of publications describing complications of this procedure is increasing. We describe a number of specific adverse events that occur during this surgery (extravasation of cyanoacrylate composite with the formation of aseptic granulomas and, in some cases, phlebitis-like phenomena, formation of rigid subcutaneous bands limiting mobility in the knee joint, migration of cyanoacrylate into the deep venous system of the lower extremities), possible mechanisms of their occurrence, and various approaches to treatment. Special attention is paid to proximal migration of cyanoacrylate composite into the area of the saphenofemoral junction, with a description of a specific clinical case and a discussion of further management tactics for this category of patients.

The problem of studying the pathology of mesenteric fat of the small intestine in surgical practice has not yet received enough attention. A number of questions remain unresolved regarding the etiology and pathogenesis of mesenteric diseases, their possible connection with benign and malignant diseases, methods of their laboratory and instrumental diagnosis, possible options for conservative and surgical treatment, as well as systematization and structuring of the classification. One of the poorly studied representatives of diseases of the mesentery of the small intestine continues to be Sclerosing mesenteritis, characterized by various histological variants of damage to mesenteric fat and a varied nonspecific clinical picture. Taken together, this leads to certain difficulties in diagnosis, patients seeking access to doctors of various profiles, which ultimately negatively affects the results of treatment and can lead to social maladjustment and possible disability. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. However, in recent years, the frequency of detection of this pathology continues to grow steadily, which is associated with the progressive aging of the population, a high degree of surgical activity in relation to urgent diseases of the abdominal organs, and the improvement of instrumental diagnostic methods. Issues of etiology, pathogenesis, differential diagnosis of this disease and its possible connection with the paraneoplastic process currently continue to cause debate. Further accumulation of clinical experience, a better understanding of the pathogenesis of the disease, and improvement of imaging techniques will allow us to develop clearer diagnostic and clinical criteria, narrow the diagnostic search and, ultimately, improve and standardize treatment. The article provides a review of the literature on this rare surgical pathology, presents our own clinical observation, and discusses diagnostic issues and treatment options for this disease.

This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m2 or more, and overweight as a BMI from 25 to 30 kg/m2 according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.

Introduction. The prevalence of phlebopathies varies from 15 to 31%. The QoL of patients with phlebopathies is impaired. Phlebotropic therapy is the main method for treating phlebopathies. Aim. Evaluation of the efficacy and safety of micronized purified flavonoid fraction (MPFF) (Troxaktiv). Materials and methods. A total of 129 females aged 18 to 45 years (average age of 35,2 ± 4,1 years) were included in the open observational study. To exclude pathology of the principal veins of the lower extremities, all patients underwent ultrasound examination, as well as photoplethysmography with automatic measurements of the venous refilling time and the power of the calf muscle-venous pump. All patients were divided into three groups: Group 1 received MPFF at a daily dose of 1000 mg only, Group 2 – class I compression hosiery in addition to MPFF, Group 3 – a course of psychotherapy and guidelines on lifestyle changes, augmentation of physical activity, etc.Results. Due to ongoing treatment measures, positive changes with decreased number of complaints and their intensity were observed. Positive changes occurred mainly in the groups of patients receiving phlebotropic therapy and combined phlebotropic/compression therapy: the number of patients with vein-specific symptoms decreased by more than half, while 31 patients reported the persistence in complaints at baseline level or their slight decrease while taking psychotherapy course and lifestyle changes. The specific therapy groups reported a significant dynamic reduction in the feeling of heaviness and pain as well as night cramps in the calves. Discussion. In the presented study, the patients were prescribed MPFF/Troxaktiv™ at a daily dose of 1000 mg, both as monotherapy and in combination with compression. A significant decrease in the frequency and severity of vein-specific symptoms and a significant increase in the patients’ quality of life was recorded in both of these groups. Photoplethysmography results showed an improvement in elastic rebound properties of the venous wall. All patients were satisfied with the treatment. Conclusion. MPFF/Troxaktiv™ has demonstrated high efficacy and safety in the treatment of patients with phlebopathies of various origins.

Elastofibroma is a rare, slow growing, benign soft tissue tumor characterized by a typical location in the subscapularis. It has a mesenchymal origin and consists of proliferating fibrous and adipose tissue with elastic and collagen fibers in its composition. Pain and discomfort in the subscapular region, restriction on movement are typical complaints for patients with elastofibroma, however, the absence of clinical symptoms and difficult differential diagnosis make it difficult to choose treatment tactics. A 70-year-old patient applied to a surgeon at the Clinical Diagnostic Center of the Central Clinical Hospital of St Alexis with complaints of a painless tumor-like subcutaneous mass in the region of the lower angle of the right scapula. She noted the presence of this formation 5 years ago, during this time the tumor gradually grew. When viewed on the back along the lower edge of the right shoulder blade, a volumetric tumor-like formation in the form of a ball measuring 7.5 × 6.0 × 2.0 cm, soft-elastic consistency is determined. On palpation, painless, not soldered to the skin. The skin over the formation is not changed. A preliminary diagnosis was established lipoma of the back. The diagnosis of elastofibroma was established after ultrasound of the posterior chest wall, MSCT of the chest. For differential diagnosis, the puncture biopsy material was sent for histological examination, the result of which confirmed the diagnosis of elastofibroma. Observational tactics in this case is preferable, since elastofibroma is not accompanied by pain, limitation of mobility, and does not bring discomfort when moving. Thus, at the moment, imaging methods allow establishing an accurate diagnosis, but histological examination is necessary for differential diagnosis. However, a histologically confirmed diagnosis will not always be an indication for surgery. In most cases, in the absence of clinical manifestations, observational tactics are followed in the treatment.

Venous malformations are the most type of angiodysplasia, which cause both physiological and emotional discomfort to patients. In this article, the authors presented a clinical example of effectiveness combined foam form sclerotherapy and laser photocoagulate with Intensive Pulsed Light therapy and show a long-term outcome in a patient with superficial venous malformation of her anogenital area, which are accompanied with such symptoms as pain and bleeding. As a sclerosing agent, a 1 and 3% sodium tetradecyl sulphate solution was used. The interval between procedures was 6 weeks. After two sessions, the superficial venous malformations of the anogenital area decreased in the size and volume, and the patient presented less complaints. After the first stage of treatment, which includes sclerotherapy, then 3 sessions of laser photocoagulate were performed, with an interval between sessions from 1.5 months. Ultrasound angioscanning allows us to assess the degree of regression of venous dysplasia, cavities and cavities of the pathological process. Ultrasound is a minimally invasive and affordable diagnostic method that, in addition to universality, excludes the component of psychoemotional discomfort. This is due to the absence of a large routine during the study with the application of any physical or mental impact on the body and the patient as a whole. The main advantage is the possibility of implementing minimally invasive treatment at the outpatient stage, with the possibility of combination therapy, both in a hospital stay, and in commercial and private medical centers. The combination of foam sclerotherapy with percutaneous laser coagulation (plus IPL therapy) in this clinical case demonstrates the effectiveness and safety in localizing the pathological process in the anogenital region. The obtained result demonstrates the absence of malformation growth and complications in the form of repeated bleeding with a good cosmetic effect in the medium and long term.

Venous trophic ulcers are one of the most common in the population, and costly in terms of treatment costs for complications of chronic venous insufficiency. The prevalence of venous trophic ulcers ranges from 0.18 to 1%. Over the age of 65 it increases to 4%. The cause of the formation of venous trophic ulcers is chronic diseases of the veins of the lower extremities. Chronic disease of the veins is a term that includes a wide range of morphological and functional disorders affecting the venous system. At the same time, even after conservative treatment, the level of recurrence of venous trophic ulcers remains extremely high, which leads to an increase in the duration of treatment for patients in the hospital, in some cases causing permanent disability in patients of working age. The literature has accumulated a huge volume of both fundamental and clinical research on the etiology, pathogenesis, diagnosis and treatment of venous ulcers. However, despite the numerous studies, the number of patients with this disease continues to steadily increase, and a number of important aspects of the pathogenesis have not yet been studied. In addition, these works do not allow us to formulate a unified concept of the pathogenesis of venous ulcers, which in turn affects the effectiveness of treatment of venous trophic ulcers. Our study highlights modern aspects of the pathogenesis of venous trophic ulcers, which may be of key importance in the treatment of this pathology. Promising directions of scientific research in this area are determined. This requires a more in-depth study of aspects of intercellular interactions, and also opens up the prospect of searching for new methods of influencing the pathogenesis of venous trophic ulcers, taking into account the presence of microflora resistant to standard antibacterial agents.

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

The rapid development of innovative medical technologies, the expansion of indications for surgical treatment, a significant increase in the number of operations performed for varicose veins entails a steady increase in the frequency of iatrogenic damage to the vascular-nerve bundle and lymphatic collectors of the lower limb. This can lead to severe complications requiring surgery, social and economic consequences associated with the need forlong-term outpatient and inpatient treatment, social security costs and a marked decrease in quality oflife. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. Timely diagnosis of complications, tactics of surgical treatment of patients with iatrogenic injuries in the surgical treatment of varicose veins and possible options for correcting emerging complications continue to cause discussion and remain one of the discussed problems of modern angiosurgery. The article provides a review of the literature devoted to the analysis of possible causes of iatrogenesis in varicose vein surgery: damage to the neurovascular bundle and lymphatic vessels of the femoral triangle, femoral vein, great saphenous vein, femoral artery, concomitant damage to the artery and vein, lymph nodes and basins, saphenous nerve during phlebectomy. The issues of diagnosis and options for correcting the complications that have arisen. The problem of mistakes and complications in the vein surgery should be resolved through comprehensive training of phlebologists, including compulsory teaching of vascular surgery skills, as well as supplying special equipment and instruments to the clinics.

Введение. SARS-CoV-2 сопровождается развитием дисфункции венозного эндотелия, которая может привести к развитию персистирующей флебопатии нижних конечностей, снижаю щей качество жизни пациентов.Цель. Оценить эффективность фармакологической терапии пациентов с постковидной флебопатией.Introduction. SARS-CoV-2 is accompanied by the development of venous endothelial dysfunction, which can lead to the development of persistent phlebopathy of the lower limbs, reducing the quality of life of patients.Objective. To evaluate the efficacy of pharmacological therapy in patients with postcocclusive phlebopathy.Materials and methods. 178 patients (125 women), mean age 34.8 ± 3.2 years, who underwent SARS-CoV-2, for their first veno-specific complaints received micronized purified flavonoid fraction (MPFF) 1,000 mg per day for 90 days. Complaints were monitored using a 10-cm visual analog scale and the CIVIQ-20 questionnaire. All patients underwent ultrasound examination of the venous system of both lower extremities and photoplethysmography. Laboratory biochemical examination with determination of endothelial dysfunction marker levels was performed in 30 patients before and after treatment.Results. After 90 days of phlebotropic therapy, there was a significant reduction in the severity of all venous-specific complaints, except for intradermal vein dilation. The global quality of life index increased from 64.4 ± 11.2 to 86.6 ± 9.1% (p < 0.001). There was an improvement in photoplethysmography (PPG) scores. Return blood-flow time and tibial venous muscle pump strength increased significantly (p < 0.05) by 4.3 s and 3.5%, respectively. The 30 patients who underwent biochemical examination in the first blood samples obtained from the great saphenous vein showed a significant increase in IL-1 concentration (7.8 ± 0, 7 pg/ml), IL-6 (18.7 ± 1.8 pg/ml), VEGF (187.8 ± 11.6 pg/ml), TNF (7.8 ± 0.9 pg/ml), histamine (22.4 ± 11.4 nmol/L) and hsCRB (5.4 ± 0.3 mg/L), indicating that a proinflammatory phenotype of venous endothelium was formed. After 90 days of MOFF administration, these indices significantly decreased. The levels of IL-1 and IL-6 decreased by 3.2 and 10.4 pg/ml, respectively, the values of VEGF and TNF decreased by 114.6 pg/ml and 2.9 pg/ml. There was a gradual normalization of histamine and hsCRB to 6.1 ± 4.1 nmol/L and 1.1 ± 0.9 mg/L.Conclusions. The data obtained indicate that the appearance of veno-specific symptoms and syndromes in patients who have undergone SARS-CoV-2 may be due to the development of phlebopathy, the correction of which requires the use of pharmacological drugs with relevant mechanisms of action.

Introduction. Today, antimicrobial photodynamic therapy (a-PDT) becomes more and more popular, because of it pronounced bactericidal activity, anti-inflammatory effect. At the same time, no animal model studies have been conducted on morphological changes in cells after exposure to PDT on venous ulcers (VU) when using different types of photosensitizers (PS). The problem of comparing morphological changes in tissues when using a-PDT vs conventional PDT have not yet been resolved.Aim. Evaluation of the effectiveness of PDT and APDT in a comprehensive examination of trophic ulcers in an in vivo experiment and compare them with standard methods for the treatment of VLU.Materials and мethods. A series of experiments was conducted on 21 rabbits, separated into 3 equal groups of 7 rabbits each. Venous trophic ulcer was originally modeled for all rabbits. To obtain a VU, we performed an additional ligation of v. femoralis. The control group received standard therapy for VU. The PDT group had PDT with Photosens. The a-PDT group underwent a-PDT using Cholosens. Every 3 days, picture of local inflammation, regeneration rate and ulcer volume were determined. A morphological study of VLU was carried out on the first, 9th and 15th days.Results. The a-PDT group, day 15: 100% wound epithelization. Control group, day 21st: The volume of wounds decreased on average by 50%. The PDT group: 100% wound epithelization. The morphological study indicated a positive trend in the a-PDT group compared with PDT and control groups, which resulted in a decrease in the total mass of necrotic detritus, a change in the quantitative and qualitative composition of inflammatory infiltrate.Conclusion. The data obtained indicate that the use of a-PDT is recommended in treatment of VLU. Both PDT and a-PDT methods showed better results in comparison with standard therapy.

Introduction. The main method of varicose vein disease treatment is surgical intervention. At the same time, there is a rather large group of patients who postpone surgical treatment indefinitely. In this situation, conservative measures come to the fore, the key one among which is compression therapy.Aim. Study of the immediate effect of compression therapy on venous outflow from the lower extremities in patients with varicose veins and the medium-term results of medical knitwear classes 1 and 2.Materials and methods. The study enrolled 64 patients (mean age 28.3 ± 2.2 years, mean BMI 25.3 ± 4.1) with large saphenous vein reflux to the upper third of the tibia. Blood flow return time and pump force were measured while walking without and with zero, class 1, and class 2 compression knitted garments on.Results and discussion. On photoplethysmography return times without and with zero compression were 18.4 ± 2.2 s and 18.9 ± 1.4 s (p = 0.62), tibial venous pump strength was 3.6 ± 0.3% and 3.4 ± 0.2% (p = 0.57). Wearing a class 1 knitwear significantly increased return time and lower leg muscle venous pump strength to 21.6 ± 1.9 sec and 6.2 ± 1.8% (p < 0.001). Grade 2 knitwear increased return blood-flow time and tibia musculo-venous pump strength to 28.2 ± 2.6 sec and 12.3 ± 1.6%, which was significantly higher (p < 0.001). Global quality of life index according to CIVIQ-14 at baseline and follow-up was 44.3 ± 4.6 and 17.8 ± 3.6 points respectively (p < 0.001) in the class 1 group. Compression Class II had a mean value of 45.1 ± 3.9 and 18.1 ± 4.3 (p < 0.001).Conclusion. In summary, the RAL class 2 standard compression knitted fabric shows better immediate correction of lower leg muscle venous pump function in patients with primary varicose veins compared to the class 1 compression knitted fabric. In the mid-term followup there were no differences in the elimination of initial venous specific symptoms and in the improvement of the global quality of life index between class I and class II knitwear.

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.

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.

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.

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.

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

RETRACTED ARTICLEChronic 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.

RETRACTED ARTICLEThe 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.

СТАТЬЯ ОТОЗВАНАКомпрессионная терапия служит эффективной и неинвазивной технологией, предназначенной для лечения и профилактики заболеваний вен и лимфатических сосудов конечностей. Регламент использования компрессионной терапии и ее инновационные методики являются предметом постоянного обсуждения в профессиональной врачебной аудитории. В данной обзорной публикации представлены регламентирующие данные по особенностям компрессионной терапии актуальных нозологических форм, обобщенные и проанализированные экспертами, являющимися участниками Международного компрессионного клуба.

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.

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

The article is devoted to chronic vein diseases (CVD), initial manifestations of the disease (Ms, ds and С2s by СЕАР Classification), attention is focused on subjective complaints of the patient, pathophysiological mechanisms and CVD symptoms that significantly reduce the life quality. A modern drug therapy of phlebotropic drugs is proposed.

Chronic venous diseases (CVDs) represent the most common pathology of peripheral vessels, the development of which involves different patho-genetic mechanisms leading to functional and structural abnormalities of the venous and lymphatic system of the lower extremities. One of the current trends in the correction of different stages and forms of CVD is pharmacological therapy which prioritizes the use of phlebotropic drugs (syn.: phleboprotectors, venoactive drugs (VADs)). The review summarizes the most recent data concerning the effect of phlebotropic drugs on macro- and microhemodynamics of CVDs.

The article tells about the current approaches to the treatment of deep vein thrombosis without the risk for embolism. Based on the findings of the global randomized controlled trials, as well as the updated Russian and international recommendations, the authors confirm the possibility, feasibility and safety of outpatient treatment of people with distal deep vein thrombosis with new anticoagulants administered per os.

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

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

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