Ambulatornaya Khirurgiya

D. S. Zubkov

Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)

Legal bearings of the discontinuation of hormone replacement therapy in patients with venous thrombosis

静脉血栓患者停用激素替代疗法的法律影响

The aim of the review is to analyze the clinical efficacy of modern methods of treatment of patients with varicose veins of the lower extremities from the standpoint of a differentiated approach to determining treatment tactics, taking into account the individual characteristics of the pathogenesis and variants of the clinical course of the disease. The literature review presents a brief history of the development of methods for the treatment of patients with varicose veins of the lower extremities. An analysis of the clinical efficacy and long-term results of phlebectomy, scleroobliteration, endovenous laser obliteration, radiofrequency ablation, endovenous steam ablation, mechanochemical ablation, and the use of the adhesive agent cyanoacrylate was carried out. The analysis showed that there is currently no universal method of treatment for patients with varicose veins. There is no unified approach to the choice of treatment tactics, the problem of personalization of treatment taking into account the individual characteristics of the pathogenesis and variants of the clinical course of the disease has not been solved. With all the variety of nominally existing treatment methods, recurrence of varicose veins develops in 15.0–70.0% of patients. Currently, the majority of patients with varicose veins are treated using combined phlebectomy, an alternative to which is endovascular laser obliteration, as well as sclerosurgery. Of particular interest are the few studies of the individual features of the pathogenesis of primary varicose veins, in order to determine the criteria for predicting the variants of the clinical course, for the development of a differentiated approach to the choice of treatment tactics.

O. A. Tsarev

A. A. Senin

T. V. Rozenkova

Modern methods of treatment of patients with varicose veins of the lower extremities: History, myths and reality

下肢静脉曲张患者的现代治疗方法：历史、神话与现实

Venous trophic ulcers affect approximately 1% of the working-age population of industrialized countries, which gives rise to massive direct and indirect healthcare expenditure. Today, irreversible injury to the microcirculatory bloodstream caused by impaired venous outflow from the lower extremities is regarded as the main cause of venous trophic ulcers, which explains the high recurrence rate of venous trophic ulcers even after surgical management of pathological changes in the superficial, deep and perforating veins of the lower extremities. In other words, it is necessary to restore adequate skin covering with a normally functioning microcirculatory bloodstream in order to heal and prevent the venous trophic ulcer recurrences. That is why the complex systemic and local conservative therapy is required for the treatment of venous trophic ulcers, even after an apparent radical surgical intervention. The local treatment pathogenetically substantiated and adapted to the phase of the wound process combined with the compression therapy plays a crucial role in the treatment of venous trophic ulcers and prevention of ulcer recurrences. The reason for this is a change in the paradigm of chronic wound treatment due to clinical confirmation of the wound wet healing theory, expansion of the coatings line focused on different phases of the wound process, as well as the study of growth factor capabilities. The latter can be immobilized in wound coatings, incorporated into various ointments or used in an injection form. The epidermal growth factor (EGF) is the most studied one among the growth factors used to restore skin and soft tissues. It is included in the combination ointment (human recombinant epidermal growth factor + silver sulfadiazine) formulation, which improves tissue trophism and regeneration. This publication is devoted to the features of the use of this drug to treat venous trophic ulcers, with discussion of clinical case reports.

V. Yu. Bogachev

O. A. Alukhanyan

V. N. Lobanov

A. R. Larina

Principles of the local treatment of venous trophic ulcers and the role of epidermal growth factor

静脉性营养性溃疡局部治疗的原则及表皮生长因子的作用

Nowadays, vitamin K antagonists (VKA) remain the anticoagulants of choice for patients with implanted inferior vena cava (IVC) filters, while the use of direct oral anticoagulants (DOACs) is controversial. Aim of the review – the study aimed to compare the efficacy and safety of DOACs and VKAs in patients with IVC filters. A systematic search for the relevant papers was performed in Medline (Pubmed) and the Cochrane Library according to the PRISMA guidelines. The inclusion criteria for the analysis were as follows: comparative studies of any design that enrolled patients with verified venous thromboembolism (VTE) who underwent IVC filter implantation and received long-term therapy with DOACs or VKAs with reported numbers of thrombotic and hemorrhagic complications within a follow-up of ≥3 months. The primary endpoints were VTE recurrence and major bleeding. Secondary endpoints included deep vein thrombosis (DVT), IVC thrombosis or filter occlusion, pulmonary embolism (PE), clinically relevant non-major (CRNM) bleeding, any bleeding, and all-cause mortality. Meta-analysis was performed using a random or fixed-effect model depending on the identified heterogeneity. As a result of the literature search was performed in July 2024 and identified 189 references, of which four articles were selected for full-text analysis after screening and excluding 174 irrelevant papers. The final qualitative analysis and quantitative synthesis included two retrospective cohort studies of 302 patients comparing rivaroxaban and warfarin. There were no significant differences between rivaroxaban and warfarin according to the prespecified endpoints. Rivaroxaban is the only DOAC studied in patients with IVC filters. Anticoagulation with rivaroxaban is not less effective and safe than with warfarin after IVC filter implantation.

I. V. Schastlivtsev

V. V. Kozlova

A. B. Bargandzhiya

K. V. Lobastov

Efficacy and safety of direct oral anticoagulants in patients with implanted inferior vena cava filters: a systematic review and meta-analysis

植入下腔静脉滤器患者中直接口服抗凝药物的疗效与安全性：一项系统评价与Meta分析

Delated periorbital veins causing cosmetic discomfort are one of the most common reasons why patients seek treatment at clinics specializing in aesthetic phlebology. The etiology and pathogenesis of the expansion of once-normal veins on the lower and upper eyelids, as well as in the temporal region have not been established. The potential risk factors include various injuries, invasive cosmetic procedures, intake of female sex hormones, exposure to unfavourable environmental conditions, natural skin ageing, heavy sports activities, and sudden body weight loss. It should be noted that dilated periorbital veins can not only cause aesthetic discomfort, but also induce spontaneous haemorrhages into nearby soft tissues. Initially, dilated periorbital veins were treated using various sclerotherapy options or radiofrequency coagulation with a hair-thin electrode. In recent years, owing to the advent of latest laser platforms, especially neodymium activated yttrium-aluminum-garnet (Nd:YAG) ones, percutaneous laser coagulation (PLC) has become the first-choice technique for treating dilated facial veins. The modern long-pulsed Nd:YAG lasers generate 1064 nm laser radiation, which ensures the achievement of target veins located at different depths under the skin's surface, and also demonstrates high affinity towards haemoglobin and its derivatives. In other words, Nd:YAG lasers are the optimal option to treat dilated facial veins, including those in the periorbital region, in patients with any skin phototypes. The multi-application XEO (Cutera) platform designed for photo and laser therapy is the most successful representative of Nd:YAG lasers. The case reports presented in this article highlight the successful treatment of dilated periorbital veins.

R. Abdosh

Laser treatment of dilated periorbital veins

激光治疗扩张的眼周静脉

Varicose veins of the lower extremities is a chronic disease with primary veins extention of the subcutaneous veins of the lower extremities. According to various estimates, the prevalence of varicose disease reaches 60% of the adult population in different regions. The steadily progressing nature of the disease, as well as the importance of timely comprehensive treatment, requires a constant search for new optimal approaches to the treatment of varicose veins. The “gold” standard for the treatment of varicose veins with reflux along the main saphenous veins is endovasal laser ablation (EVLA), which in some cases has effectively replaced combined phlebectomy. The method has proven itself to be relatively safe, while effective and providing the opportunity to carry out treatment on an outpatient basis. However, it is not always possible to carry out thermal methods of obliteration of the main saphenous veins, and in such situations the best choice for treatment is ultrasound-guided foam sclerotherapy (UGFS) of the main saphenous veins. Despite thelong coexistence of both methods, there is no convincing data of treating patients with EVLA and UGFS. More than 50 russian and foreign articles from the open access were analyzed. Thelack of comparisons in the Russian articles and the contradictory nature of research results in foreign sources allow us to conclude that this issue requires further research and detailed study to determine the indications and the optimal treatment tactics using EVLA or UGFS.

P. E. Vakhratian

N. V. Khutornoy

A. A. Larionov

D. E. Lishov

E. S. Silchuk

Comparison of endovasal laser ablation and ultrasound-guided foam sclerotherapy of saphenous veins

隐静脉内激光消融与超声引导下泡沫硬化疗法的比较

This narrative literature review is dedicated to the issue of individual risk assessment and prevention of postoperative VTE in patients undergoing lower limb varicose vein surgery. The registry-based CAPSIVS trial showed that the detection frequency of any forms of VTE after modern minimally invasive superficial vein surgery reaches 3.4%, of which only 0.5% are symptomatic. The current clinical guidelines regulate the individual risk assessment of postoperative thrombosis using the Caprini Risk Score (CRS). The first validation study resulted in a proposal of evidence-based approach to the phlebological patient stratification into risk groups according to the Caprini scores with 0–6 scores indicating the low risk, 7–10 scores – the moderate risk and 11 scores or more –the high risk, which differs significantly from approaches in other medical specialties. At the same time, the pharmacoprophylaxis may be appropriate in the groups of moderate and high risk, especially when simultaneous varicose tributary ablation and perforating vein interventions increasing the risk of VTEC 6–11 times are performed. The duration of pharmacoprophylaxis of postoperative venous thrombosis is essential to its efficiency, which should not be less than 7 days for the moderate VTE risk group and reach 30 days for the high VTE risk group. A single injection of parenteral anticoagulants on the day of surgery has been shown to be associated with an 8.8% incidence of postoperative thrombosis. The risk of postoperative thrombosis in patients with VTE in their past medical history, including prior varicothrombophlebitis is increased by 4.2 times, which requires that secondary pharmacoprophylaxis be prescribed for at least 30 days, and in some cases up to 3-6 months. At this stage, there is sufficient evidence to support the use of the Caprini Risk Score to assess the risk of postoperative VTE and prescribe adequate pharmacological prophylaxis in varicose vein surgery treatment.

M. V. Shaldina

D. A. Borsuk

S. V. Kochetkov

L. A. Laberko

A. A. Fokin

An updated approach to the risk assessment and prevention of postoperative venous thromboembolism in varicose vein surgery

静脉曲张手术后静脉血栓栓塞风险评估与预防的最新方法

The mortality rate associated with postoperative eventration remains quite high at the moment. At the same time, recurrent eventrations are common. Despite the improvement of surgical techniques and suture materials, the incidence of eventrations does not decrease. The presence of previous oncological diseases in the patient significantly worsens the course of the wound process due to changes in the immune status and prevailing catabolic processes. One of the reasons that causes eventration in a high percentage of cases is suppuration of the postoperative wound. Given the polyetiology of this pathology, for the prevention of eventrations and for their effective treatment, a comprehensive approach is needed, including both an impact on the general somatic status of the patient (elimination of hypoproteinemia, normalization of bowel function, etc.), and an impact on the wound process in order to form high-quality scar tissue. This article presents a clinical case of a patient with wound eventration that developed in the postoperative period. The complexity of the case is due to previous oncological pathology and impaired reparative processes that developed as a result of hypoproteinemia. This clinical observation demonstrates the relevance of searching for new methods of influencing the course of the wound process, the possibility of using cellular concentrates of autologous blood to stimulate regeneration. The possibilities of stimulating the wound process by using platelet autoplasma are considered, in order to accelerate wound healing, it can be used in outpatient practice, both for the management of postoperative patients admitted for follow-up care after the inpatient stage, and as an independent treatment for chronic wounds.

D. A. Kalinichenko

E. N. Degovtsov

O. Yu. Tsygankova

R. A. Kazakov

I. I. Kotov

D. I. Trukhan

Clinical case of eventeration of postoperative wound

术后伤口裂开的临床病例

The article is devoted to the description of a clinical case of neurological complications of foam sclerotherapy. The goal is to familiarize doctors with a fairly serious complication of the procedure, most often performed for cosmetic purposes. Stroke and transient ischemic attacks have been reported as “isolated cases” following sclerotherapy. Visual disturbances and complaints of headaches and migraines are much more common (0.1–1%). The main causes of these disorders are either gas embolism, which occurs immediately after the procedure, or paradoxical thromboembolism, which is recorded some time after sclerotherapy. The main cause of disorders is congenital heart disease, atrial or ventricular septal defect, however, total screening before the procedure is considered inappropriate. It is recommended to limit the volume of foam injected to 10 ml and carefully collect anamnesis. A history of heart disease with a right-to-left shunt is an absolute contraindication to the procedure. A clinical case is described with a 39-year-old patient who had previously unde rgone foam sclerotherapy sessions for cosmetic reasons. During the third session of sclerotherapy, the patient developed signs of acute cerebrovascular accident, which required hospitalization and treatment in the neurological department. Congenital heart disease has not been previously detected. Subsequently, with the treatment, all neurological disorders completely regressed. Conclusions. Doctors should be aware of the possibility of developing the serious complication described in the article, which, under unfavorable circumstances and lack of timely medical care, can lead to disability of the patient. If this complication develops, it is necessary to refer the patient to a neurologist as soon as possible to establish a diagnosis and begin therapy.

E. A. Shcheglov

A. V. Evmenсhikov

O. A. Kalinovskaya

A. S. Danilova

V. I. Maksimov

M. A. Popova

Neurologic complications of foam sclerotherapy

泡沫硬化疗法的神经并发症

Violation of mesenteric circulation and intestinal damage are life-threatening conditions that require early diagnosis and, if necessary, prompt surgical intervention. Currently, the diagnosis of these conditions remains a difficult task due to the nonspecific nature of clinical symptoms andlimitations of existing diagnostic tools. The aim of the study is to study the potential of intestinal fatty acid binding protein (I-FABP) as a biomarker of mesenteric circulatory disorders and intestinal damage. The article discusses the structure and function of I-FABP, its expression and distribution in the small intestine, the mechanisms of release of I-FABP. Clinical studies of I-FABP levels in patients with these conditions are analyzed, assessing the accuracy of diagnosis and potential thresholds. The results of this study show that I-FABP has significant potential as a biomarker of OMI, intestinal ischemia and intestinal damage. Elevated levels of I-FABP have been observed in patients, and the diagnostic accuracy of I-FABP appears to be superior to other currently used biomarkers. However, further research is needed to determine optimal thresholds and establish standardized I-FABP measurement protocols. Thus, the introduction of I-FABP as a biomarker into clinical practice may lead to earlier diagnosis and improved outcomes in patients with intestinal ischemia.

M. R. Kuznetsov

A. I. Chernookov

A. A. Atayan

A. A. Ramazanov

O. N. Antonov

E. N. Belykh

Potential of intestinal fatty acid binding protein (I-FABP) as a biomarker in ischemia and intestinal damage

肠脂肪酸结合蛋白（I-FABP）作为缺血和肠损伤生物标志物的潜力

Publication Information	Publisher: Remedium Group Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2021，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:
Average review cycle	8 weeks

Ambulatornaya Khirurgiya

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