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Modern vascular surgery has the data on a substantial role of the endothelium in pathogenesis of vascular diseases. Endothelial dysfunction is associated with a wide range of pathological processes including those in chronic diseases of lower-limb veins. The discovery of the endothelial glycocalyx made it possible to evaluate its role in the development of endothelial dysfunction as a trigger mechanism in impairment of venous blood flow. The understanding of the unifying role of endothelial dysfunction in pathology in various fields of medicine provides a possibility of predicting the development of serious socially significant diseases such as cardiovascular diseases, diabetes mellitus, obstetrical complications, and to correct the conditions associated therewith. The present study was aimed at carrying out a systematic literature review, thus making it possible to evaluate the role of the endothelial glycocalyx in the development of endothelial dysfunction, as well as to determine therapy with sulodexide capable of decreasing the probability of the onset of endothelial dysfunction at the expense of an anti-inflammatory, antithrombotic, and angioprotective effect on the endothelial wall.

Analysed herein is the experience with micronized purified flavonoid fraction (MPFF) in treatment of geriatric patients with decompensated forms of chronic venous diseases. A total of 218 geriatric patients were examined and treated. Of these, 132 patients had trophic disorders (C4-C6 class), including 40 patients found to have venous trophic ulcers (VTU). Therapeutic policy consisted in wound cleansing, application of topical antiseptics, hydroalginate dressing, stimulation of regenerative processes by therapy with MPFF at a dose of 1,000 mg daily. The microcirculatory blood flow was examined by means of laser Doppler flowmetry. By the end of a 4-week course of comprehensive treatment, 31 of 40 patients were found to have elevated microcirculation index to 16.9±2.1 perfusion units, suggesting improved perfusion of the lower-limb skin. Venous trophic ulcers completely epithelialized in 9 patients and decreased by half of their initial area in 22 patients. Repeat assessment of cardiac activity showed a decreased functional class of chronic heart failure in 9 of 17 patients with healed VTU. Assessing safety of phlebotrophic therapy revealed neither adverse reactions nor decompensation of accompanying diseases during the whole follow-up period.

The authors analysed the results of comprehensive examination and treatment of a total of 40 patients presenting with lower limb chronic venous insufficiency at the stage of trophic disorders (class C6), including 28 (70%) patients with varicose disease of lower extremities and 12 (30%) patients with post-thrombotic disease. Studying the microcirculatory blood flow by means of laser Doppler flowmetry showed a statistically significant (p<0.05) baseline decrease in the index of microcirculation in patients (12.2±2.4 perf. units for varicose disease and 10.8±1.8 perf. units for post-thrombotic disease) as compared with the control group of apparently healthy volunteers (20.4±1.5 perf. units). All stages of treatment included the program of stimulation of reparative processes and normalization of microcirculation by means of sulodexide. Conservative measures were independent therapeutic procedures in 31 patients. Of these, trophic ulcers completely epithelialized in 9 patients and decreased by half of its initial surface in 22 patients. The study of the microcirculatory blood flow in dynamics suggested improvement of microcirculation during treatment. Hence, comprehensive therapy using sulodexide in patients with venous trophic ulcers is accompanied by an endothelium-protecting effect and leads to improvement of the indices of microcirculation of the skin of the crus.

A relapse of lower-limb varicose disease (LLVD), despite the development of surgical achievements in surgical technologies is currently an important problem of present-day phlebology. A considerable factor of its pathogenesis is endothelial dysfunction (ED). The results of clinical studies of "false" relapses (n=32) and the control group were indicative of pronounced ED. Studying the level of leukocytes confirmed a hypothesis on a "leukocytic" trap at the level of the varicose veins of lower extremities. The authors analysed the dynamics of certain markers of ED (CECs, VCAM-1, P-selectin, E-selectin t-RA, endothelin-1), suggestive of the degree of ED severity, revealing a tendency towards normalization of the ED markers on the background of phlebotrophic therapy (Antistax). The carried out study also makes it possible to conclude that the level of endothelemia and biochemical indices of ED may serve as an evaluating marker of the activity of processes of varicose transformation of veins in patients with a relapse of the disease.

The article deals with medicamentous therapy of lower limb chronic venous insufficiency (LLCVI). The authors analysed herein the results of treating patients suffering from LLCVI using Venarus whose basic components are diosmin and hesperidin. The obtained findings demonstrated that clinical administration of this phlebotonic agent is effective in the given cohort of patients during the whole therapeutic course, with a maximum positive effect observed within the first 4 weeks. The parameters of quality of life of the patients with LLCVI improved significantly on the background of taking the phlebotonic Venarus.

Endothelium as the main structural unit of the vessel appears to exert a considerable influence on the processes of regulation of the cardiovascular system. The authors generalize herein and present the findings of the studies aimed at investigating endothelial dysfunction in varicose disease. Based on analysing the results of various methods of study they show importance of endothelial dysfunction, followed by discussing possibilities of medicamentous correction thereof, proceeding from pathogenetic mechanisms of its development.

The article deals with the findings obtained by present-day studies in pathophysiology of venous outflow disorders. The authors highlight a considerable role of the endothelium of the vascular wall resulting from its lesion with metabolic products of activated leukocytes in the development of varicose transformation. Also studied was the dynamics of the endothelial dysfunction marker, i.e., the number of the circulating endothelial cells (CECs). In so doing, amongst the patients presenting with segmental subcutaneous varicosity with reflux along the superficial and perforating veins, endothelial dysfunction was revealed most frequently, i.e., in 91% of the cases. It was proved that the CEC index might be used as a marker of endothelial dysfunction in patients presenting with varicose disease. An increase in this parameter above 6 x 10(4) cells per 1 ml of blood should be considered as a reliable manifestation of an endothelial lesion in diseases of the peripheral veins. By the degree of severity of endotheliemia, one may judge of the activity of the process of varicose transformation of veins, which makes it possible to timely take appropriate corrective measures. A priority trend in medical treatment of venous transformation is assigned to diosmine-based phlebotonics.

Symptoms of lower limb chronic venous insufficiency (CVI) are related to hypertension in vena cava inferior system. All changes that take place in macrocirculatory segment of hemodynamics are reflected at microcirculatory level, including metabolic and trophic processes -- the most important function of microcirculation, which is named "transcapillary exchange". Endothelial dysfunction and blood-venous wall interface changes play a crucial role in the development of pathology. Drug therapy remains the main and integral part of CVI treatment. One of its aims is to protect venous wall, normalize permeability and alleviate CVI symptoms at microcirculatory level. Antistax efficiency in patients with CVI was demonstrated in several trials and warranted the inclusion of this drug into complex treatment of lower limb CVI.

Edematous syndrome is one of the most frequently occurring manifestations of chronic venous insufficiency (CVI). This paper analyzes an experience with conservative treatment of CVI patients with edematous syndrome. A complex of rehabilitation measures was used in addition to therapy by the phleboprotector Ginkor Fort. Based on the study of microcirculatory changes, malleolar volume, the thickness of subcutaneous fat as well as on subjective sensations and the quality of life in 117 patients with the edematous forms of CVI the authors have demonstrated the high efficacy of combined pharmacotherapy by Ginkor Fort and rehabilitation treatment in the given patient group.