Duplex ultrasound (DUS) is an imaging technique that is widely used in order to assess venous system conditions in healthy subjects and in patients with chronic venous disease, deep venous thrombosis and superficial thrombophlebitis. A thoroughly performed DUS is crucially important for precise diagnostics and treatment. DUS is widely accepted as mandatory in phlebology practice. Other specialists are often in need for duplex ultrasound also in order to exclude deep venous thrombosis as a complication of different pathologic conditions. This is an updated version of guidelines developed by an expert group. The document systematizes data on the ultrasound anatomy of the veins of the lower extremities. It describes the main algorithms DUS as well as requirements for the configuration and settings of the ultrasound machine. The position of the patient during the study, ultrasound transducer placing, depending on the situation are presented. Criteria of pathologic venous reflux are discussed. DUS methodology for different venous segments are presented. A newly developed algorithms of examination of patients having different clinical scenarios are presented. The document suggests examples for formal conclusions based on the results of the ultrasound examination. A lawyer’s report based on the results of the analysis of the regulatory documentation regarding justification of the use of DUS by phlebologists in their clinical practice is presented. Guidelines are addressed to ultrasound diagnostics specialists, phlebologists, vascular specialists, general surgeons and others.
Outpatient management and early discharge for patients with pulmonary embolism (PE) who are at low and intermediate-low risk for early mortality are emerging approaches that are gaining increased attention. Objective. This study aims to evaluate the efficacy and safety of different management strategies for patients with PE: early hospital discharge, outpatient care, and standard inpatient treatment. Material and methods. The study cohort comprised 127 patients recently diagnosed with PE, categorized into those with hospital stays of 3–4 days (early discharge) or 5 days or more (standard inpatient treatment), as well as patients receiving outpatient care. The primary efficacy outcome measured was the incidence of symptomatic recurrent venous thromboembolism (VTE) and/or VTE-related death following the initiation of anticoagulant therapy. The primary safety outcome assessed was the bleeding rate, along with evaluations of VTE-related and all-cause mortality rates. Results. The outpatient group included 50 patients, the early discharge group 37, and the standard inpatient group 40. The mean ages were 65±10, 63.6±12.1, and 61.5±12.4 years, respectively. No fatal VTE recurrences were reported in any group. Bleeding rates were 2% (1 patient) in the outpatient group, 5.4% (2 patients) in the early discharge group, and 0% in the standard inpatient group (p=1). Re-admission rates were similar across the groups: 2 patients (4%) in the outpatient group, 1 patient (2.7%) in the early discharge group, and 1 patient (2.5%) in the standard inpatient group (p=1). The rates of VTE recurrence were comparable among the groups. Chronic heart failure emerged as the only potential predictor for VTE recurrence (odds ratio [OR] 5.02; 95% confidence interval [CI] 1.03–24.51). Outpatient management did not lead to an increased rate of VTE recurrence (OR 0.63; 95% CI 0.12–3.35). Conclusion. Both outpatient management and early discharge for hemodynamically stable patients with PE at low and intermediate-low risk of 30-day mortality are safe and effective alternatives to standard inpatient treatment.
The lecture presents findings from studies on endothelial function and the glycocalyx, contemporary data on the significance of markers of endothelial dysfunction, and initial results from electron microscopy of the glycocalyx in the venous wall endothelium of patients with varicose veins in the lower extremities. Research conducted over the past two decades has consistently indicated that protecting the endothelium is essential for preventing thrombus formation and inhibiting the progression of venous-specific inflammation. The endothelial glycocalyx is a crucial structural component of the venous wall, mediating endothelial adaptation to various hemodynamic conditions while protecting the endothelium. In cases of varicose veins and chronic venous insufficiency, there is observable systemic damage and shedding of the endothelial glycocalyx. The loss of this protective layer exposes adhesive molecules on the endothelial surface, initiating a cascade of pathological events: leukocyte and platelet adhesion occur, leading to localized inflammation, disrupted barrier function, increased vascular permeability, and a significant reduction in antithrombotic potential. Therefore, damage to the endothelial glycocalyx is a key factor in the emergence of endothelial dysfunction in veins. The restoration of the glycocalyx is recognized as a promising therapeutic approach, not only for enhancing venous tone but also for providing pathogenetic treatment of chronic venous diseases. The lecture outlines methodologies for studying glycocalyx integrity and markers of endothelial dysfunction, as well as results on the effectiveness of comprehensive correction strategies using sulodexide in patients with varicose veins.
The case presented highlights the challenges of clinically and instrumentally differentiating between clitoral hypertrophy and vulvar varicose veins (VVV) in a 47-year-old female patient. The patient reported perineal and clitoral pain, significant clitoral enlargement when in an upright position, and discomfort during intercourse. Following an initial clinical assessment by both a gynecologist and a vascular surgeon, VVV was suspected. Further examinations were conducted, including duplex ultrasound (DUS) of the pelvic and perineal veins, as well as computed tomography venography (CTV) of the pelvis. These investigations revealed no abnormalities in the pelvic and perineal veins; however, a hypodense, non-contrast-enhanced lesion was identified in the clitoral area, leading to a diagnosis of clitoral hypertrophy. A surgical procedure was subsequently performed, which revealed not only clitoral enlargement but also localized vein dilation measuring up to 1 cm in the clitoral region. A clitoral resection was carried out, along with the resection of the dilated vein. Postoperative recovery was smooth, with no complications reported. During follow-up examinations, the patient exhibited no symptoms, and clitoral size returned to normal. This clinical case illustrates the discordance between clinical findings, imaging results, and intraoperative observations, suggesting a likely interplay of organ-related and venous factors contributing to clitoral enlargement and perineal pain. The phlebological awareness of the gynecologist during the procedure facilitated the identification of the localized vein dilation in the clitoral area, allowing for a simultaneous clitoral vein resection alongside the clitoral resection.
Objective. To develop and assess an algorithm for open surgery in patients with traumatic gunshot arteriovenous fistulas (AVFs). Material and methods. The early results of open surgery were retrospectively assessed in 60 wounded subjects with traumatic gunshot AVFs admitted to a level 5 rear military medical facility. All the wounded were men with an average age of 34.5±8.9 years. The individual management approach depended on the presence of acute complications of AVF, the location and width of the AVF, the presence of a false aneurysm of the main vessel, intraoperative findings, and the decision on which intervention to perform based on the morphology of the artery and vein samples. The intervention was performed in four consecutive steps: precise isolation of the AVF and the false aneurysm, AVF separation, repair of the artery, and repair of the vein. Results. Fifty-nine patients underwent surgery;. 6 (10%) interventions were emergent, 4 (6.8%) were urgent, 4 (6.8%) were delayed, and 45 (76.3%) were elective. The main artery was grafted with reversed autologous vein in the majority of cases (38 patients, 63.3%). Main veins were mostly ligated (51 patients, 88.5%). No deaths were registered. There was no need for secondary amputations. An additional revascularization procedure was required in 2 (3.4%) cases due to arrosive bleeding and thrombosis of the PTFE popliteal artery graft. Non-massive pulmonary embolism developed in 1 (1.7%) patient. Conclusion. Individualized management of traumatic gunshot AVFs of the lower extremities with a four-step open intervention is effective and safe.
Objective. To evaluate the efficacy and safety of a therapeutic agent derived from regulatory polypeptides sourced from bovine vascular tissue in combination therapy for patients diagnosed with chronic venous diseases (CVD) in the lower extremities. Material and methods. This multicenter, randomized, double-blind, placebo-controlled trial involved 190 patients with CVD, randomly assigned to two groups. Group 1 received a combination of vascular polypeptides and troxerutin (n=95), while Group 2 received placebo with troxerutin (n=95). The total duration of the observation period extended to 137 days. This period included five scheduled visits: Visit 1 at the start of therapy; Visit 2 after 14±2 days of treatment; Visit 3 at the end of the treatment (35±2 days); Visit 4 30±3 days after the end of the treatment; and Visit 5 90±5 days after the end of the treatment. Efficacy was evaluated using the Venous Clinical Severity Score (VCSS), and pain and discomfort were quantified using the Visual Analog Scale (VAS). Quality-of-life outcomes were measured using the CIVIQ-20 questionnaire, and changes in malleolar circumference were recorded. Safety was assessed by the frequency and types of adverse events. Results. At Visit 4, the mean VCSS in Group 1 was 2.33±1.31, compared to 3.24±1.62 in Group 2, resulting in a mean difference of –0.92 (95% CI from –1.34 to –0.50; p<0.001), confirming the hypothesis of the efficacy of the combination therapy. At Visit 4, a clinically significant improvement in quality of life, defined as a reduction of 5 points or more on the CIVIQ-20, was observed in 93.7% of patients in Group 1, compared with 75.8% in Group 2 (p=0.0006). This effect persisted at Visit 5, with improvements noted in 92.6% in Group 1 compared to 78.9% in Group 2 (p=0.007). Additionally, a reduction of at least 1 point in pain intensity on the VAS was observed in 91.6% of patients in Group 1, compared with 74.7% in Group 2 (p=0.002). Malleolar circumference exhibited a greater reduction in Group 1 at Visit 5 (0.76±0.79 cm vs. 0.46±0.64 cm; p=0.004). No serious adverse events were reported throughout the study. Conclusions. Incorporating bovine regulatory vascular polypeptides into a combined therapeutic approach effectively alleviates symptoms of chronic venous disease and enhances quality of life while maintaining a favorable safety profile.
Treatment of venous stasis ulcer is challenging. Data on the use of topical agents to promote wound healing are extremely limited. The objective of the study was to evaluate the effectiveness of a topical agent based on recombinant human epidermal growth factor and silver sulfadiazine in accelerating the healing of venous stasis (chronic) ulcers. Materials and methods. A prospective, comparative, non-randomized study was conducted, including 180 patients with venous stasis ulcers. Wound coverings and compression therapy were used in all patients. In the test group, the studied agent was applied to the ulcer under the wound covering; in the control group, topical ointments/gels were not used. Results. The studied agent provided the best outcome for ulcer reduction. The relative decrease in area (% of baseline) after 1 month of follow-up was (Me [Q1; Q3]) –43.3% [–59.2; –29.9] and –36.2% [–52.0; –21.0] (p=0.021) in the study and control groups, respectively. The absolute change in area (cm2) after 1 month was –2.1 [–4.4; –1.1] and –1.0 [–2.1; –0.2] (p≤0.001), and after 2 months, –4.2 [–6.8; –2.9] and –2.2 [–4.3; –0.8] (p≤0.001), respectively. The proportion of patients with a fully healed ulcer, re-weighted by the initial ulcer area, was 2.3% and 0.4% (p=0.025) at 1 month, and 39.4% and 27.6% (p≤0.001) at 2 months, respectively. For ulcers with an initial area of more than 5 cm2, the relative decrease in area (% of the initial area) at 1 month was –49.1% [–60.0; –40.0] and –30.5% [–40.0; –20.0] (p≤0.001), respectively, and the absolute decrease (cm2) was –4.3 [–6.4; –2.7] and –2.8 [–3.4; –1.6] (p≤0.001), respectively. In patients with varicose veins, no differences were found between the groups in the relative decrease in the area of ulcers after 1 month (p=0.256), but differences were found in the absolute change in area (cm2): –2.1 [–4.7; –1.1] and –0.7 [–1.3; –0.2] (p≤0.001), respectively. Conclusions. A topical agent based on recombinant human epidermal growth factor and silver sulfadiazine accelerates the healing of venous stasis (chronic) ulcers.
Elastic compression is common in patients with chronic venous diseases (CVD). The evidence regarding the efficacy of compression treatment in reducing subjective symptoms of CVD is inconsistent. Objective — of the study was to identify factors influencing the efficacy of compression therapy in reducing subjective symptoms of CVD. Material and methods. The study included patients with CVD classified as C0S—C3S according to the CEAP. All patients wore first-class compression below-knee stockings (RAL standard). Changes in venous pain and discomfort in the lower limbs were assessed using the Visual Analog Scale (VAS) before and four weeks after treatment initiation. Potential influencing factors included age, sex, BMI, clinical class according to CEAP, and daily duration of compression wear. Multiple linear regression analysis was performed to evaluate their impact. Results. The study involved 49 patients with symptomatic CVD, with a mean age of 44.3±10.5 years, the average BMI was 26.1±3.4. Distribution across CEAP classes was as follows: C0 — 1 (2%), C1 — 20 (41%), C2 — 13 (26%), C3 — 15 (31%). No factors showed a significant correlation with changes in venous pain severity (p>0.05). A trend was observed toward an association between daily wear duration and changes in lower limb discomfort (p=0.07). Female sex was associated with a more intensive reduction in pain severity (p=0.04). Longer wear duration of the compression below-knee stockings was linked to a more significant decrease in pain and discomfort in the lower limbs (p=0.07 and p=0.04, respectively). Conclusions. Female sex and a 12-hour daily wear regimen are predictors of a more noticeable effect on venous pain. The only predictor of a more significant reduction in discomfort related to CVD is a 12-hour therapy regimen.
Subclavian vein aneurysm is a rare form of vascular pathology with poorly understood causes and mechanisms. There is little information in the literature on its prevalence, and it is mainly limited to individual case reports. The article presents a rare case of saccular aneurysm of the subclavian vein in a patient with chronic heart failure and pulmonary hypertension. It was shown that high venous pressure was among the most likely etiological factors for subclavian venous aneurysm. The primary diagnostic method for evaluating the pathology of the principal veins, including aneurysms, is ultrasound duplex scanning. However, the ultrasound examination in the presented case posed several diagnostic challenges due to both the aneurysm’s peculiar location and the comorbidities, necessitating the use of angiographic techniques to differentiate it from arterial aneurysms and other neck masses. Even though venous aneurysms generally are oligosymptomatic with a benign course, in some cases, they can be complicated by thrombosis and thromboembolism. Therefore, the management of venous aneurysms can be surgical or non-surgical. The choice of surgical approach is based on the risk of thromboembolic complications and local symptoms such as pain or cosmetic defect. In the presented case, surgery was not performed due to the high surgical risk associated with decompensated comorbidity.
The objective was to study the venous and lymphatic outflow of the limb in cases of gunshot wounds (GWs) and to assess the effect of lymphotropic antibacterial therapy with regional stimulation of lymphatic drainage on blood and lymph circulation. Materials and methods. Experimental studies were performed on 57 laboratory rabbits with a bullet gunshot injury of the limb, divided into three groups: in the test group (25 animals), lymphotropic antibiotic therapy and lymphatic drainage stimulation were used, in the comparison group (25 animals), standard of care (intramuscular antibiotic therapy) was used; 7 animals without GW and treatment were included in the control group. The state of venous and lymphatic outflow from the muscles of the wound channel was studied using the radionuclide scanning. Conventional and lymphological approaches in the treatment of limb GWs were compared. Results. Radionuclide studies showed that a gunshot bullet wound on Day 1 reduced venous blood flow by 6.5 times, from 5.2±0.024 mL/min/100 g (nintact=7) to 0.81±0.027 mL/min/100 g (pintact=0.001); lymphatic outflow slowed down by 2.4 times, from 1.2±0.07 mL/min/100 g (nintact=7) to 0.49±0.05 mL/min/100 g (pintact=0.004). On Day 5, improvement in blood flow (2.2±0.048 mL/min/100 g in the comparison group; 3.9±0.113 mL/min/100 g in the test group; p=0.024) and lymphatic outflow (0.43±0.03 and 0.96±0.03 mL/min/100 g, respectively; p=0.012) was observed in the group of animals treated with lymphotherapy. On Day 9, there was a significant recovery in lymphatic outflow in the lymphatic therapy group vs. the comparison group: 0.98±00.7 vs. 0.55±0.04 mL/min/100 g, respectively (p=0.024). Conclusions. GWs result in early significant slowing of blood flow and impairment of lymphatic drainage of affected tissues. Regional lymphotropic antibiotic therapy with lymphostimulation leads to earlier recovery of the lymphatic and venous outflow from the wound channel compared with conventional treatment. The inclusion of lymphatic therapy in the complex treatment of limb GWs can accelerate the healing and reduce postoperative complications.
Thrombomodulin (TM) is an active link in coagulation and hemostasis, demonstrating multimodal properties due to its unique structure. TM is expressed mainly on endothelial cells of most vessels, in gestational tissues (placenta and myometrium), in smooth muscle cells of the arteries, and in immune cells. Normally, the TM blood level in healthy individuals does not exceed 10 ng/mL, and usually increases (sometimes decreases) in various abnormal conditions. The role of TM is not limited to the activation of fibrinolysis; it also includes the regulation of inflammation and the immune response, as well as neuro- and angioprotection. The therapeutic potential of recombinant TMs in disseminated intravascular coagulation and preeclampsia is currently under active investigation. In addition, the diagnostic and prognostic value of TM as a blood biomarker across a wide range of diseases is well established. However, the diagnostic utility of TM is still limited by its relatively low specificity. Nevertheless, the experience of using TM in clinical practice indicates the potential for further study of this molecule. This review provides up-to-date information on the structure of TM, its functions, and its current use in medical practice. Also, potential prospects for further study as a marker of thrombosis risk are addressed.
The objective of the study was to compare the results of endovenous laser ablation (EVLO) with wavelengths of 1470 and 1940 nm at powers of 5 and 8.5 watts. Materials and methods. In an experiment on sheep, EVLO of the subcutaneous veins of the extremities was performed using a laser with wavelengths of 1470 and 1940 nm and powers of 5 and 8.5 W. Before, during, and 7 days after laser exposure, ultrasound and histological examination of coagulated veins was performed with an assessment of the blood flow rate, the presence of a thrombus in the vein, as well as thermal damage to paravenous tissues. Results. A linear endovenous energy density (LEED) of 25 J/cm at 1470 nm was insufficient for achieving complete vein occlusion while preserving blood flow. Although the LEED value of 42.5 J/cm contributes to the complete vein occlusion, thermal damage to paravenous tissues was observed. The use of a wavelength of 1940 nm and a LEED of 25 J/cm was associated with complete vein occlusion and minor damage to paravenous tissues. Increasing the LEED to 42.5 J/cm causes coagulation necrosis and destruction of the vein wall and paravenous tissues. Conclusion. The optimal mode for EVLO is 1940 nm wavelength with a LEED of 25 J/cm, providing sufficient vein occlusion without significant damage to paravenous tissues.
Venoactive Drugs (VADs) are an integral part of the conservative management of chronic venous diseases (CVD). The mechanism of action of these drugs is well-described. It targets key ways of pathogenesis of CVD, such as loss of venous tone, chronic inflammation in the venous wall and its subsequent remodeling, increased capillary permeability, and insufficient compensatory function of the lymphatic system. The clinical efficacy of VADs concerning quality of life, CVD signs and symptoms, has been demonstrated in numerous randomized controlled trials (RCTs), meta-analyses, and systematic reviews. The incidence of adverse events appears to be low, and the use of VADs is considered a safe method of treatment for CVD symptoms. The most extensively studied group of VADs are flavonoids, which include drugs based on diosmin and rutosides. Diosmin, a principal flavonoid used in drugs, exhibits pleiotropic effects. It slows the degradation of norepinephrine in the venous wall, potentiating its effect and enhancing venous tone. Diosmin possesses anti-inflammatory activity by inhibiting leukocyte adhesion and the synthesis of pro-inflammatory mediators. It decreases capillary and venule permeability, which is directly associated with reduced fluid movement into the tissues. RCTs show that diosmin is effective in managing diseases of other organs and systems which also present with edema.
Leiomyosarcoma is a rare, poorly studied malignancy derived from smooth muscle cells, prone to recurrence and metastasis. Of superficial neoplasms, soft tissue leiomyosarcomas account for no more than 2.3%, while tumors of vascular origin, which mainly occur in large veins, account for 0.5% to 0.7% of cases. In the practice of a vascular surgeon or phlebologist, patients often have a combined pathology of the lower extremities (chronic venous disease, atherosclerotic obliterans of the lower extremity arteries, varicose disease, gonarthrosis, etc.). The article presents a clinical case of soft tissue leiomyosarcoma of the inguinal region in a patient treated for the left lower extremity varicose vein disease shortly before the detection of a tumor. The possibility that any physician may encounter a patient in need of treatment for a rare malignancy such as soft tissue leiomyosarcoma has been shown.
Objective. To evaluate the effect of micronized purified flavonoid fraction (MPFF) on vein-inflammatory markers (E-selectin, MCP-1, VEGF, MMP-2, MMP-9) and quality of life in patients with varicose veins, including combination with endovenous laser ablation (EVLA). Material and methods. A prospective study included 186 patients with varicose veins of clinical classes C2—C6 (CEAP), divided into four groups: group 1 used compression hosiery; group 2 received MPFF 1000 mg daily; group 3 underwent EVLA; group 4 received MPFF after EVLA. Biomarkers were measured before treatment, at 2 months, and at 12 months. Adverse events were recorded. Changes in quality of life were assessed using the CIVIQ-20 and SF-36 questionnaires. Results. At 2 months follow-up there was a significant reduction in E-selectin, MCP-1, and VEGF (p<0.001) in the MPFF group. Effect on MCP-1 and VEGF sustained up to 12 months in C2—C3 patients. MMP-2 and MMP-9 levels showed no significant change. After EVLA, there was a short-term decrease in E-selectin, MCP-1, and MMP-2. The most pronounced effects were observed in the EVLA+MPFF group: MCP-1 decreased by 46.2% at 2 months and 40.7% at 12 months; VEGF decreased by up to 52% (C2—C3) and 44.4% (C4—C6); E-selectin decreased by 36.2 and 29.9%, respectively. Quality of life improvement was greatest in the EVLA+MPFF group and persisted up to 12 months. No significant changes were registered in the compression group. Conclusions. MPFF exerts an anti-inflammatory effect, particularly in early-stage disease (C2—C3). The combination of EVLA and MPFF provides the most substantial and sustained reduction in inflammatory markers and the best quality-of-life outcomes. In advanced stages (C4—C6), prolonged pharmacotherapy is advisable.
Objective. To analyze the incidence of non-thrombotic iliac vein obstruction (NIVO) among patients with symptomatic and asymptomatic pelvic venous disorders (PeVD) using CT and MR venography; to compare their diagnostic capabilities and to determine the relationship between severity of iliac vein obstruction and symptoms of PeVD. Material and methods. A single-center crossover study enrolled 123 symptomatic and asymptomatic patients with NIVO. After clinical examination and Doppler ultrasound of pelvic and retroperitoneal veins, all patients underwent CT and MR venography. We assessed iliac and pelvic veins, as well as the relationship between narrowing of iliac veins and PeVD symptoms. Results. The incidence of left-sided NIVO among patients with PeVD was 48%. Symptomatic forms of disease were identified in 35.2% of women, asymptomatic — in 12.9% of cases. CT and MR venography revealed narrowing of the left common iliac vein > 50% in 47.8% of symptomatic and 45.5% of asymptomatic patients (p=0.79). Diagnostic capabilities of CT and MR venography in identifying NIVO and determining severity of vascular narrowing have no significant differences. No correlation was found between narrowing of the left common iliac vein and PeVD symptoms (r=0.28). A strong association was found between moderate-to-severe reflux in pelvic veins and PeVD symptoms (r=0.85). Conclusions. CT and MR venography is effective for detecting NIVO and determining severity of iliac vein stenosis. Meanwhile, they do not allow to assess impact of iliac vein stenosis on pelvic venous hemodynamics, state of pelvic veins and symptoms of disease.
Ovarian veins embolization (OVE) and iliac vein stenting are common in the treatment of pelvic venous disorders (PeVD). At the same time, clinical effectiveness (symptom relief) of endovascular treatment for PeVD varies widely. In some cases, endovascular interventions do not have the expected positive effects, and sometimes they are accompanied by clinical deterioration (increased pain). The authors describe several cases of ineffective endovascular interventions caused by wrong choice of treatment of patients with PeVD. These cases demonstrate some obvious causes of ineffective endovascular treatment of PeVD: unjustified pelvic vein embolization, incorrect endovascular stages for iliac and pelvic veins, spiral occlusion of ovarian veins with spiral protrusions. These clinical examples and literature data indicate the need for a multidisciplinary approach to examination and treatment of patients with PeVD, rational and differentiated use of endovascular methods in patients with various forms of PeVD.
Phlebology as a branch of medicine studying venous diseases is faced with some critical conditions requiring immediate surgical intervention. The authors present several patients with venous diseases. Considering own experience and literature data, the authors recognized not only intraoperative complications, but also acute lesions of inferior vena cava caused by thrombosis, embolism, bleeding and inflammation as emergency situations in the treatment of patients with venous diseases. These conditions pose a direct threat to the patient’s life and necessitate emergency diagnosis and active surgical strategy. Successful treatment of these circumstances depends on the coordinated work of a multidisciplinary team, including surgeons, vascular surgeons, endovascular surgeons and cardiologists.
Small saphenous vein is registered in up to 15% of varicoe veins patients. Invasive treatment is preferable. However, recurrence rate after procedure is about 64%. The basis for any invasive treatment is anatomical data. The last ones are variable for saphenopopliteal junction. Objective. To analyze the anatomical features of saphenopopliteal junction considering CT venography and duplex ultrasound data. Material and methods. We consecutively enrolled 150 individuals aged 39-70 years without vascular pathology of the lower limbs who underwent CT venography and duplex ultrasound. Results. Saphenopopliteal junction was observed in 62.5% of cases. In most cases, it was localized lateral to popliteal vein. Other sites of entry of terminal segment of small saphenous vein were sural veins (24%), deep veins of the thigh (12%), and subcutaneous veins of the thigh/calf (10.5%). Length of subfascial part of terminal segment of small saphenous vein varied from 7.6 to 20.9 mm according to ultrasound data and from 8.6 to 24.3 mm according to CT phlebography data. Angle of entry of terminal segment of small saphenous vein varied from 44° to 48.3° according to ultrasound data and from 34.6° to 41.2° according to CT phlebography data. Subcutaneous tributaries near saphenopopliteal junction were identified in 40% of cases. Conclusions. Four variants of terminal segment of small saphenous vein were identified. The most common one was variant with formation of saphenopopliteal junction and cranial continuation.
Recurrence of varicose veins is common in vascular surgery. Superficial femoral vein incompetence is one of the important causes of recurrent varicose veins. Objective. To improve the outcomes of surgery for recurrent varicose disease in patients with femoral vein incompetence. Material and methods. There were 164 patients with recurrent varicose veins including 49 (30%) men and 115 (70%) women. Mean age was 43 years. Patients were divided into two groups: group 1 — patients with reflux in superficial femoral vein; group 2 — patients without deep vein reflux. The 1st group was subdivided into subgroups: 1a — microsurgical reconstruction of the femoral vein valve with concomitant phlebectomy; 1b — phlebectomy alone. In the 2nd group, varicose veins were removed in standard fashion. Results. Long-term follow-up confirmed better results in patients without deep reflux (group 2). There were worse results in subgroup 1b compared to subgroup 1a. Results in subgroup 1a and group 2 were comparable (favorable outcomes in 90% and 93.1% of cases, respectively). On the contrary, long-term results were unfavorable in subgroup 1b. Quality of life significantly improved in all groups. Our data demonstrate significant impact of femoral vein incompetence on postoperative outcomes in patients with recurrent varicose veins. Conclusions. Microsurgical reconstruction of typical incompetent femoral vein valve significantly improves the results of surgery for recurrent varicose veins.
