[Combined use of minimally invasive methods in treatment of varicose veins in an elderly woman]. / Sochetannoe primenenie maloinvazivnykh metodov v lechenii varikoznoi bolezni u pozhilogo patsienta.

The authors describe herein a clinical case report regarding a 70-year-old woman presenting with lower-limb varicosity in the system of the great and small saphenous veins, aneurysmal dilatation of the proximal portion of the great saphenous vein, and an open trophic ulcer of the crus with concomitant hypertension and coronary artery disease. Given these factors, she was subjected to endovenous laser coagulation of the great and small saphenous veins, microfoam echosclerotherapy of the distal portion of the trunk of the great saphenous vein and an incompetent perforating vein of the crus, followed by complete obliteration thereof. On POD 7, she developed positive dynamics in the process of healing of the trophic ulcer, and on POD 50 the ulcer healed completely. Thus, in elderly patients with lower limb varicose veins with incompetence of trunks of the great and small saphenous veins and pronounced trophic impairments of the crus, preference should be given to minimally invasive methods of treatment. Their combination ensures a good therapeutic effect without increasing the risk for local and systemic complications.

[Multicentre observational study of Phlebodia 600 in treatment of patients with CEAP class C0-C3 chronic venous diseases]. / Mnogotsentrovoe nabliudatel'noe issledovanie primeneniia Flebodia 600 u bol'nykh c khronicheskimi zabolevaniiami ven klassov C0-C3 po CEAP.

The purpose of the study was to evaluate efficacy of Diosmin (Phlebodia 600, Innothera, France) in treatment of patients presenting with class C0s-C3 chronic venous diseases (CVD) according to the CEAP classification. Presented herein are the results of a prospective observational study aimed at assessing the outcomes of two-month administration of Phlebodia 600 (600 mg diosmin) in patients suffering from class C0s-C3 CVD according to the CEAP classification. The study comprised a total of 868 patients, including 175 (20.2%) men and 693 (79.8%) women. Of these, 866 patients completed the study according to the protocol. Amongst the 868 followed-up patients, 851 (98.0%) subjects strictly adhered to the physician's prescription and stopped taking the drug without violation of the regimen and dosing of diosmin. The main drug dosage regimen of diosmin was 1 tablet once a day in 851/868 (98.04%) patients. Satisfaction with treatment with diosmin was reported as 'excellent' by 46.7 % of patients (95% CI: 43.3-50.0) and by 49.4% of physicians (95%: CI 46.1-52.7), being rated as 'good' by 45.0% of patients (95 % CI: 41.7-48.4) patients and by 43.6% of physicians (95% CI: 40.3-47.0). The score for the quality of life of patients according to the CIVIQ-20 scale at the first follow-up visit amounted to 45.4±15.4 points (median 43.0 points). At the second follow-up visit, this parameter improved dramatically, dropping to the level of 35.6±11.5 points (median 33.0 points). By the third follow-up visit, the positive dynamics of the parameters preserved continued, averagely amounting to 28.9±8.7 points (median 26.0 points). A decrease in the circumference of the left and right crura (by 0.39±0.74 and by 0.36±0.75 cm, respectively) was observed at the second follow-up visit. The difference of the malleolar measurements between the first and third follow-up visits amounted to 7.2±9.4 mm and 6.6±9.7 mm for the right and left crus, respectively (p<0.001). The number of patients with a reported feeling of heaviness in the legs statistically significantly decreased from 97.6% at the stage of enrollment into the study to 73.0% after 2 months of therapy, that of those with painful sensations from 84.5 to 55.3%, those with complaints of swelling (oedemas) of the lower limbs from 83.9 to 56.8%, with complaints of convulsions from 71.2 to 35.7%, with complaints of sensation of tingling from 63.4 to 34.1%, respectively. Hence, a statistically significant improvement of the patients' condition was observed as early as 30 days after the beginning of treatment. By day 60, the positive effect of the carried out therapy continued to grow. Safety and good tolerance of the drug were noted, which was confirmed by low incidence of undesirable events and high adherence to treatment.

[Criteria for selection of patients for radiofrequency ablation of major venous trunks in varicose disease, short- and long-term outcomes].

OBJECTIVE: to investigate criteria for selection of patients for radiofrequency ablation (RFA), as well as to assess the immediate and remote outcomes of comprehensive minimally invasive treatment of patients presenting with class C2-C6 chronic venous disease (CVD). MATERIAL AND METHODS: we performed a total of 604 interventions in 512 patients (554 on the superior vena cava (diameter from 3 to 26 mm), 45 on the inferior vena cava (diameter from 3 to 14 mm), 5 on the anterior accessory veins (4-8 mm in diameter) The varicose veins were removed by means of compression sclerotherapy. The interventions were performed using tumescent anaesthesia in out-patient conditions. The check-up ultrasonographic duplex scanning was carried out within 1-5 days after RFA, then after 6, 12, 24, 36 and 48 months. RESULTS: All major veins except two were found to be occluded immediately after the interventions. A complication was observed in one case (0.2%). The remote results were assessed on 514 lower limbs. In all, except two, major trunks of the subjected to RFA saphenous veins were occluded. Recurrent varicose veins were observed on 82 (13.9%) lower limbs. Using two ports was required in tortuosity of the SVC and with thrombophlebitis of the SVC in the anamesis. A small diameter of the vein may currently not be considered as a limiting factor. Of the 11 patients with a varicose node above the saphenofemoral junction, one patient was found to have a floating thrombus in it which required crossectomy. RFA demonstrated advantages as compared with crossectomy and stripping in obese patients, while in acute ascending superficial thrombophlebitis in a series of cases it made it possible to refuse the traditional surgical operations. In class C6 CVD conservative therapy was carried out parallel to correction of venous haemodynamics which made it possible to reduce the term of epithelisation of the trophic ulcer. Removal of the deep vertical veno-venous reflux by means of RFA in all cases resulted in SVC occlusion. CONCLUSION: Planning of RFA requires a thorough clinical and ultrasonographic assessment, ideally an ultrasonographic examination should be performed by the operating surgeon. Technical obstacles in the majority of cases may be overcome. RFA is a method of choice in obese patients with a deep vertical veno-venous reflux. Early application thereof in class C6 CVD reduces the term of epithelisation of trophic ulcers. 99.7% of cases showed occlusion of the vein immediately after the intervention and 99.6% of cases within the term of up to 48 months.

[Minimally invasive surgery of lower-limb varicose disease. Review of literature].

The article reviews the worldwide current literature devoted to one of the presently important problems, i. e., lowerlimb varicose disease, systematizing all available information concerning modern methods of examination and treatment of patients suffering from venous insufficiency, including operations, scler other apy, echo scler other apy, endovasal laser coagulation and radiofrequency ablation. It was underlined that ultrasonographic diagnosis is currently becoming the main method in assessing haemodynamic disorders in the venous system and determining the methods of removal of varicose veins. Also analysed are advantages and disadvantages of these methods both in elective surgery and in emergency states. Reflected are contradictions presently existing in phlebology and a trend towards minimising interventions in varicose disease. The classical combined phlebotomy, remaining for long years the main surgical procedure, has gradually been replaced by the socalled "office" methods of treatment. It was shown that there are a lot of unsolved problems requiring investigation from the positions of efficacy and safety.

[The use of echo-Foam-sclerotherapy for pathological refluxes in patients with lower limb varicose veins: early and long-term results].

The paper presents the results of non-surgical outpatient treatment of 528 patients with lower limb varicose veins (C2-C6 CEAP classes) by echo-Foam-sclerotherapy and compression therapy. Patients were divided into 3 groups (1) patients with vertical veno-venous refluxes: total 315 echo-Foam-sclerotherapy procedures were fulfilled on 202 great saphenous veins (GSV) and 113 lesser saphenous veins (LSV) - occlusion was achieved in 305 cases (96.8%); (2) patients with recurrent varices or after crossectomy (separation of sapheno-popliteal junction): 265 echo-Foam-sclerotherapies on GSVs and/or LSVs - occlusion was achieved in 262 cases (98.9%); (3) 147 thigh or shin incompetent perforating veins - occlusion was achieved in 142 cases (96.6%). Follow-up lasted up to 2 years. Hemodynamically sound recanalization was revealed in 18 (14.4%) from 125 sclerosed veins in the first group; in 1 (2.1%) from 48 veins in the second group and in 5 (10.6%) from 47 perforating veins in the third group. In general, positive long-term effect was achieved in 89.1% cases of echo-Foam-sclerotherapy. In order to assess the feasibility of additional phlebotropic therapy, all patients were divided into the main group, which received Antistax, and control group, which received no venotonics. It was shown that Antistax attenuates main symptoms of chronic venous insufficiency and improves the quality of life.