[Endovascular treatment of a patient with post-thrombotic disease and obstruction of a cava filter]. / Éndovaskuliarnoe lechenie bol'nogo s posttromboticheskoi bolezn'iu i obstruktsiei kava-fil'tra.

Balloon angioplasty and stenting have increasingly been gaining widespread application for treatment of post-thrombotic alterations in the system of the vena cava. Endovascular ultrasonographic examination makes it possible with the utmost degree of reliability to determine both the extension and degree of the narrowing of venous segments, thus proving a possibility of choosing a venous stent of an appropriate diameter. Restoration of an adequate venous lumen leads to normalization of blood flow and elimination of venous hypertension. However, unsolved as yet remains the problem concerning proper management of post-thrombotic obstructions of the inferior vena cava at the level of a cava filter. Owing to a wide variety of configurations of cava filters to deploy, there are no common approaches to elimination of such obstruction. Presented herein is a clinical case report regarding successful endovascular treatment of a patient diagnosed with post-thrombotic disease secondary to endured thrombosis. The findings of both phlebography and endovascular ultrasonographic examination made it possible to diagnose obstruction of the left common iliac vein, external iliac vein, and inferior vena cava to the level of the cava filter previously deployed. In the segment of the inferior vena cava at the level of the cava filter also revealed was a pronounced luminal narrowing exceeding 90% of its diameter. We carried out stenting of the common and external iliac veins, inferior vena cava, and the cava filter. Swelling of the left leg subsided spontaneously within 2 weeks and the first postoperative month was accompanied by gradual disappearance of the previously existing feeling of heaviness in the lower limbs and a dramatic decrease in fatigue by the end of the working day.

[First experience with intravascular ultrasonographic examination in diagnosis of post-traumatic obstruction of deep veins]. / Pervyi opyt vnutrisosudistogo ul'trazvukovogo issledovaniia v diagnostike posttromboticheskoi obstruktsii glubokikh ven.

Intravascular ultrasonography (IVUS) is a highly effective method of diagnosis of post-thrombotic obstructions. Its possibilities by determining the degree and extension of obstructions of deep veins are superior to those of not only non-invasive methods of examination (ultrasonography, CT and MRI) but of phlebography whose results until recently were considered fundamental in diagnosis of the disease concerned. Limited possibilities of phlebography often lead to diagnostic errors when determining the degree and extension of post-thrombotic obstructions. Intravascular ultrasonography makes it possible to obtain a maximally objective picture of the degree of intravascular alterations in post-thrombotic diseases, as well as to determine the indications for performing balloon dilatation and stenting of deep veins. First experience in using intravascular ultrasonography in the Clinic of the Institute of Experimental Medicine confirmed these provisions. A total of 15 patients diagnosed with post-thrombotic disease while examination were subjected to antegrade transfemoral phlebography in the direct and lateral projections and IVUS. Significant post-thrombotic obstruction was revealed by phlebography in 3 (20%) of the 15 patients and confirmed by the findings of IVUS. In 12 (80%) patients only carrying out IVUS made it possible to detect pronounced obstruction of veins (more than 50% of its diameter) remaining undiagnosed by phlebography. Unnoticed in phlebography turned out to be May-Thurner syndrome in a female patient. Compression of the left common iliac vein by the right common iliac artery exceeding during systole 70% of the initial diameter of the vein was also revealed while performing IVUS. At the same time phlebography remains an indispensable method of examination while assessing collateral blood flow, thus making it possible to recommend its performing in combination with IVUS for obtaining the most complete notion on post-thrombotic alterations in deep veins of the inferior vena cava system.

[Antegrade diastolic blood flow and classic reflux in varicose dilatation of the intersaphenous vein].

INTRODUCTION: In the intersaphenous vein (ISV) there may take place the so-called "antegrade" or "paradoxical" reflux. This type of blood flow is revealed in a series of patients during muscular diastole and is a link of the pathogenesis of varicose disease, but has, as distinct from the "classical" reflux, an antegrade direction. An incompetent saphenopopliteal junction (SPJ) is a source of the antegrade diastolic blood flow (ADBF) through the ISV. Descriptions of possible variants of impaired blood flow through the ISV are fragmentary and their interpretations are controversial. Prevalence and pathogenesis of these disorders impairments have not yet been studied. MATERIAL AND METHODS: A cross-sectional study: over 4 years three centres examined a total of 1,413 patients diagnosed with class C2-C6 varicose veins according the CEAP classification. All patients underwent ultrasound duplex scanning of lower limb veins. The ADBF was determined as a unidirectional antegrade blood flow with the duration of not more than 0.5 second, observed after the crus was relived of compression (in the diastole). Of the patients included into the study who had no varicose veins on the contralateral extremity with the ISV being spotted we sequentially selected 40 subjects including them into the Study Group for the analysis of blood flow and the diameter of the ISV in health. RESULTS: Impairments of blood flow in the ISV were revealed in 61 (4.8%) of 1,265 extremities included into the study: the "classical" reflux in 9 (14.8%) limbs, ADBF was revealed in 37 (60.7%) limbs, a combination of the "classical" blood flow and ADBF - in 15 (24.6%) limbs. Hence, the patients were subdivided into three groups. Studying the nature of blood flow through the ISV in the control group on 40 lower limbs revealed no blood flow disorders. The mean ISV diameter amounted to 1.68 mm (ME=1 mm). The ISV diameter was considerably higher in all studied groups as compared with the control one (p<0.0001). The diameter of the ISV in its proximal portion averagely amounted to 4.48 mm (SD 1.337 mm, SE 0.171 mm). The diameter in the distal portion amounted to 5.39 mm (SD 1.725 mm, SE 0.221 mm).

[Carbonization in endovasal laser obliteration by radial light guide with wavelength of 1470 and 970 nm].

The authors assessed the effect of carbonization and its influence on the parameters of endovasal laser obliteration (EVLO) depending on wavelength of laser radiation (970 and 1470 nm) using a light guide with radial emission. They also analysed the value of drop of radiation power of the light guide after performing EVLO and visually assessed the degree of damage of the glass tip of the radial fibre by means of ultra-close-up photography. The study comprised a total of 20 patients with varicose disease. A total of ten procedures of EVLO were performed in two modes: mode one - W-laser 1470 nm, mode two - H-laser 970 nm, using fibre with radial emission, an automatic retractor of the light guide. It was determined that the median of power loss after EVLO with W-laser amounted to 0.6 W, and that for H-laser - 3.15 W (p=0.002). Ultra-close-up photography showed pronounced damage of the glass tip of the radial light guide while using H-laser and no damages while using the W-laser. It was proved that using laser radiation with wavelength of 970 nm using the light guide with radial emission leads to pronounced carbonization on the surface of the glass tip of the light guide, its damage, a decrease in radiation power and risk of mechanical destruction of the flask. Using the laser with wavelength of 1470 nm with the use of radial light guide did not result in the development of such negative effects, which increases the service life of laser fibre and makes it possible to use it for obliteration of several segments in one patient.

[Efficacy of Venarus in treatment of patients with post-thrombotic disease of lower limbs].

The authors studied efficacy of Venarus in comprehensive treatment of patients presenting with post-thrombotic disease. An open multicenter retrospective study included a total of 110 patients subdivided into two groups. Group One (Study Group) consisted of 51 patients with post-thrombotic syndrome, undergoing comprehensive medical treatment with the use of phlebotonic agent Venarus. Group Two (Control Group) comprised 59 patients with post-thrombotic syndrome undergoing similar conservative treatment but without taking phlebotonics. It was proved that Venarus included into comprehensive treatment of patients with post-thrombotic syndrome led to a statistically significant increase of both psychological and social activity and improved patients' quality of life. During the standard term of administration (2 months) Venarus levelled subjective symptoms and certain objective symptoms (according to the Villalta Scale) of post-thrombotic syndrome. After 2-month use Venarus demonstrated the highest efficacy in treating patients with mild-to-moderate post-thrombotic syndrome. The maximal efficacy was observed after 3 months of administration in standard doses. No side effects were noted during the whole period of the study.

[Review of materials of the Fourth European Venous Forum (Stockholm, Sweden)].

The article provides a brief review of the opinions and experience of the leading phlebologists from various countries, reflecting the latest updates and current problems regarding state-of-the-art management of diseases of major veins of lower extremities. Special attention is focussed on deep vein thromboses and consequence thereof, as well as varicose disease. This is followed by description of novel approaches to treatment of the pathology concerned.

[Analysis of efficacy of radiofrequency obliteration with due regard for the target vein's diameter].

AIM: Data concerning the effect of the target vein's diameter on efficacy of radiofrequency obliteration (RFO) in the current literature are limited. AIM: To assess efficacy of RFO and stripping, peculiarities of the postoperative period course with due regard for the diameter of the target veins, to compare the outcomes of RFO and classical phlebectomy in treatment of varicose disease during 1-year follow up by a composite end point. MATERIAL AND METHODS: A multicenter prospective non-randomized study based on analysing therapeutic outcomes in a total of 218 patients presenting with varicose disease (C2-C3 according to the CEAP). RFO was performed in 108 patients and phlebectomy in 110 subjects. The results were assessed by means of a composite end point including four components: technical outcome at 1-year follow-up, pain, subcutaneous haemorrhage, and paresthesias. The groups of patients who endured RFO and phlebectomy were subdivided into two subgroups according to the target vein's diameter with a border of 14 mm. Statistical analysis. We used the methods of non-parametric statistics (contingency tables, chi squared test), calculating the odds ratio (OR) for a favourable outcome with a 95% confidential interval. Pain dynamics was assessed by means of intellectual data analysis (cluster analysis). RESULTS: «Phelbectomy ≥ 14 mm¼ and «RFO ≥ 14 mm¼. The incidence rate of a good outcome in the subgroups amounted to 20 (30.8%) and 61 (95.3%), respectively. The odds ratio for favourable outcome between the subgroups of RFA and phlebectomy amounted to 45.8; 95% CI (44.5-47.0). "RFA ≥ 14 mm" and "RFA < 14 mm". Favourable outcome rate in the subgroups amounted to 25 (39.1%) and 17 (38.6%), respectively. The differences were not statistically significant, p=0.24. The odds ratio for a good outcome between the RFO subgroups amounted to: OR=0.98; 95% CI (0.18-1.77). Comparative analysis of RFO outcomes between the clinics. Favourable outcome rate in the first clinic was 50 (92.6%), in the second 34 (87.2%), and in the third 13 (86.6%), with the difference being statistically insignificant, p=0.7. The cluster analysis of the pain dynamics after the intervention. The clusters with moderate pain were composed of the patients after phlebectomy. These clusters showed association of pain intensity with increased BMI and greater vein diameter. CONCLUSION: 1) RFA of great-diameter veins by a favourable outcome by the composite end point (CED) turned out to be superior to the classic phlebectomy. 2) For RFA the incidence rate of a favourable outcome by the CED does not depend on the target vein's diameter. 3) A pronounced pain syndrome after phlebectomy was associated with excessive body weight or obesity and greater diameter of the vein.

[Endovenous laser obliteration and combined phlebectomy for treatment of varicose veins in elderly and senile patients].

In the available literature, we have found no comparative data on the efficiency and safety of endovenous laser ablation (EVLA) and traditional phlebectomy in elderly and senile patients. According to our results, in elderly and senile patients, the pain syndrome is much less pronounced after EVLA as compared with phlebectomy, the frequency of ecchymosis with an area of more than 100 cm2 and distal thrombosis of deep veins is lower. In the analyzed groups, there are no significant differences in the frequency of post-surgical complications after surgical intervention. Both EVLA and phlebectomy eliminate pathological reflux of the great saphenous vein with the same degree of reliability, within the period of examination of 1 year. In elderly and senile patients, the time for return to daily activity is significantly reduced after EVLA as compared to that after combined phlebectomy.