The problem of finding an ideal method for the correction of vertical venous reflux in lower extremity varicose disease is highly relevant due to the rapid development of technologies and the opening of new treatment methods, including minimally invasive ones. According to many researchers, the main parameters for choosing the optimal surgical technique should be low invasiveness, compliance with the anatomical, including ultrasound, picture, the possibility of using local anesthesia, taking into account concomitant pathology and individual intolerance of various drugs by patients, effectiveness of venous vessel obliteration, and minimal risk of possible complications. The review considers a comparative characterization of endovascular treatment methods for varicose disease, as well as lists the main possible complications of each of them. In terms of obliteration effectiveness and the least pronounced complications, the leading position is occupied by the method of cyanoacrylate obliteration. There is an increasing amount of information in the literature about the use of cyanoacrylate composite in the treatment of lower extremity varicose disease. Since this method is relatively new, the number of publications describing complications of this procedure is increasing. We describe a number of specific adverse events that occur during this surgery (extravasation of cyanoacrylate composite with the formation of aseptic granulomas and, in some cases, phlebitis-like phenomena, formation of rigid subcutaneous bands limiting mobility in the knee joint, migration of cyanoacrylate into the deep venous system of the lower extremities), possible mechanisms of their occurrence, and various approaches to treatment. Special attention is paid to proximal migration of cyanoacrylate composite into the area of the saphenofemoral junction, with a description of a specific clinical case and a discussion of further management tactics for this category of patients.

Venous trophic ulcers take place in the terminal stage of chronic venous insufficiency. The problem of venous trophic disorders is extremely relevant due to the high prevalence among the population. This review considers the comparative characteristics of morbidity data on the example of Germany and the Russian Federation. Particular attention paid to the influence of the course of the disease on patient’s life quality during treatment. The causes of high-cost treatment are reported with approximate calculations for 1 clinical case and total annual costs according to foreign researchers (Australia, Great Britain, USA). The risk factors are discussed in the form of certain concomitant nosologies that significantly aggravate the healing process of ulcers with a brief description of the pathogenesis. The review defines the main goals of the treatment of venous trophic ulcers, as well as separate groups of directions in which it is reasonable to carry out therapeutic measures. Article presents a comparative analysis between the methods of applying compression therapy (elastic bandaging, the use of special stockings) and the influence of the choice on the quality of life of patients. Various methods of topical wound care are described with the obligatory consideration of the stage of the wound process, alternative methods of local treatment are listed (for example, the use of autologous platelet-rich plasma). The efficacy of systemic pharmacotherapy in trophic disorders and the treatment potential of various groups of drugs on the rate of ulcer healing were evaluated. The advantages of using surgical treatment are determined, the main surgical techniques are listed, highlighting the advantages and disadvantages of each. Possible treatment strategies for elderly patients also discussed. The complexity of evaluating the effectiveness of new techniques and an integrated approach to treatment is shown, which in the future will help to correct the direction of finding new ways to solve the problem of venous ulcers in this specific group of patients.

Introduction. Martorell’s ulcer is a rather rare pathology that occurs exclusively in patients with long-term and poorly controlled arterial hypertension and continues to be one of the poorly studied areas of modern surgery. There are few reports on the occurrence of this pathology in the medical literature and, as a rule, describe extremely rare clinical cases. The issues of etiology, pathogenesis and differential diagnosis of this disease continue to cause debate. The article provides a review of the literature on this rare surgical pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.Clinical case. A 56-year-old patient was admitted with complaints of a non-healing trophic ulcer on the lateral surface in the lower third of the right leg since one year ago with severe pain syndrome not adequately controlled with non-narcotic analgesics. he received treatment in an outpatient department and in the hospital, underwent courses of rheological therapy to the ulcer region as a local therapy, used a wide range of dressings of domestic and foreign origin. No positive effect was reported on the top of already administered combination therapy, the ulcer continued to increase in size. A Martorell’s ulcer was diagnosed, and a decision was made to provide a course of presurgical conservative rheological therapy with PGE1 (VAP 20 mg), antibiotic therapy, and local therapy aimed at maximal ulcer necrotic tissue clearance before the forthcoming planned surgical treatment. The patient underwent the surgery – autodermatoplasty of the trophic ulcer of the right leg with a mesh graft, continued local treatment of the ulcer using dressings with peruvian balsam and other medications on an outpatient basis without chemical and biological components from the antiseptics and healing stimulants group. Two months after the surgery, the patient had no complaints, the pain syndrome in the ulcer region completely regressed, no edema occurred in the lower operated leg, the right let ulcer completely healed with the formation of a permanent scar.Conclusion. Surgical management is the final and definitive treatment for Martorell’s chronic hypertensive ulcer and should be carried out promptly to minimize the spread of the ulcer and minimize a pain syndrome.

Venous aneurysms continue to be one of the little studied sections of modern vascular surgery. Messages on the occurrence of this pathology in the medical literature are very few and describe extremely rare clinical cases, localized mainly in the deep veins of the lower extremities and leading to thromboembolic complications. Single publications describe venous aneurysms localized in superficial saphenous veins. The etiology and pathogenesis of this disease currently continues to cause debate. The article provides a literature review on this rare surgical vascular pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.

Pharmacotherapy plays a key role in the treatment of chronic venous diseases and their complications. This category of patients traditionally uses a variety of phlebotropic drugs, the vast majority of which are of plant origin, introducing specific therapeutic features due to decreased bioavailability and, consequently, the presence of a dose-dependent effect. That is why the modern trend in pharmacotherapy of chronic venous diseases is the use of phlebotropic drugs that have high bioavailability with rapid achievement of therapeutic concentration, as well as demonstrating a polyvalent mechanism of action on the main pathogenetic mechanisms of development and progression of chronic venous diseases. One of such preparations is calcium dobesilate, which is a calcium salt of 2,5-dihydroxybenzenesulfonic acid (C12H10CaO10S2) obtained by chemical synthesis. In terms of pharmacological properties calcium dobesilate belongs to capillary protectors with more pronounced pluripotent effect on venous and lymphatic sections of the microcirculation. To date, calcium dobesilate is the only synthetic phlebotropic drug registered in the Russian Federation.Indications for the prescription of calcium dobesilate are microangiopathies of various genesis, but primarily associated with chronic venous and lymphatic failure.Numerous experimental and clinical studies demonstrate a high clinical efficacy of calcium dobesilate regarding major venospecific symptoms and syndromes, for the elimination of which the drug can be prescribed in a standard daily dose of 1500 mg, both in monotherapy and in combination with other drugs.Calcium dobesilate therapy is usually performed without undesirable reactions, the risk of which is low when using standard recommended daily doses of the preparation 500-1500 mg.

Chronic venous disease (CVD) is the most common vascular pathology that has a significant negative effect on physical and psychological health outcomes, and requires high level of public spending on healthcare. Number of CVD risk factors has been identified in recent decades, but only recently have the experts begun to discuss the role of inflammation and endothelial dysfunction. Modern knowledge enables us to identify several priority strategies and goals aimed at managing the basic pathophysiological mechanisms of the development and progression of CVD. In particular, the use of venoactive drugs, which role in enhancing vascular tone and contractility, reducing inflammation and edema and improving microcirculation and accelerating the healing of venous leg ulcers has been carefully studied and presented with positive outcomes in various publications. This review provides various pathophysiological mechanisms of the development of CVD, which present the targets for venoactive drug therapies.

The 19th Annual Meeting of the European Venous Forum held in the city of Athens in 28-30 June 2018 presented the long-awaited updated guidelines for the diagnosis and treatment of chronic venous diseases (CVD), the full text of which can be found in the June issue of International Angiology Journal. This publication aims at acquainting practitioners with one of the key sections of the new European guidelines devoted to the pharmacotherapy of CVD.

The 19th Annual Meeting of the European Venous Forum held in the city of Athens in 28-30 June 2018 presented the long-awaited updated guidelines for the diagnosis and treatment of chronic venous diseases (CVD), the full text of which can be found in the June issue of International Angiology Journal. This publication aims at acquainting practitioners with one of the key sections of the new European guidelines devoted to the pharmacotherapy of CVD.

The incidence of peripheral arteries atherosclerosis varies in the general population between 3 to 10%, increasing to 15 to 20% in patients older than 70 years. Due to the high and constantly increasing prevalence, chronic obliterating diseases of lower limbs arteries (CODLLA) constitute an important medical and socioeconomic problem that cannot be solved only through wide introduction and application of various innovative surgical technologies. The fact is that even the most modern and knowledge-intensive surgical interventions do not exert a fundamental influence on the principles of the CODLLA pathogenesis. Moreover, there is no doubt that the success of arterial reconstruction and its prolongation are largely determined by adequate conservative treatment, the principles of which are discussed in this article.

The article is devoted to etiopathogenesis, principles of diagnostics and treatment of chronic edema of the extremities associated with the pathology of the venous and lymphatic system. The authors emphasize the need for adequate compression therapy at all stages of treatment, with an emphasis on the usefulness of innovative flat-knit compression knitwear.

The article tells about the current approaches to the treatment of deep vein thrombosis without the risk for embolism. Based on the findings of the global randomized controlled trials, as well as the updated Russian and international recommendations, the authors confirm the possibility, feasibility and safety of outpatient treatment of people with distal deep vein thrombosis with new anticoagulants administered per os.

Chronic venous diseases (CVDs) represent the most common pathology of peripheral vessels, the development of which involves different patho-genetic mechanisms leading to functional and structural abnormalities of the venous and lymphatic system of the lower extremities. One of the current trends in the correction of different stages and forms of CVD is pharmacological therapy which prioritizes the use of phlebotropic drugs (syn.: phleboprotectors, venoactive drugs (VADs)). The review summarizes the most recent data concerning the effect of phlebotropic drugs on macro- and microhemodynamics of CVDs.

The article reflects modern approaches to etiology, pathogenesis, diagnosis and prevention of early occlusions after reconstructive surgery in patients with atherosclerosis obliterans of low extremities.

Presented in the article are the results of studying antiaggregate activity of acetylsalicylic acid and clopidogrel in a total of 36 patients suffering from various-severity chronic arterial insufficiency of lower limbs on the background of atherosclerosis obliterans. The study was conducted prior to treatment for correct selection of a particular antiplatelet agent. The obtained results showed that clopidogrel was not always more efficient than acetylsalicylic acid, since there is individual sensitivity of each patients to a particular antiplatelet agent. Therefore, an individual approach is necessary to conservative therapy of arterial insufficiency of lower limbs. For some patients it is preferable to administer clopidogrel, for others - acetylsalicylic acid. In a series of cases combined treatment is justified, while some patients having low sensitivity to both acetylsalicylic acid and clopidogrel require careful selection of alternative agents influencing other thrombocyte receptors.

Presented herein are the results of treating a total of sixty patients suffering from atherosclerosis obliterans of the lower limbs with degree IV chronic ischaemia according to the Fontain-Pokrovsky classification and accompanied by pyonecrotic alterations. The patients were subdivided into two clinically matching groups, each comprising 30 subjects. All patients after two-week conservative preparation underwent various reconstructive surgical operations performed on major arteries of the lower limbs. The local preoperative treatment was of two different types, i. e. consisting of Levomecol ointment used in the control group patients and Metrogyl 1% topical gel applied in the study group patients. Sampled before treatment, inoculations of the wound discharge demonstrated predominantly anaerobic flora in all patients, with the number of bacterial strains having dramatically decreased once Metrogyl gel 1% had been used, whereas application of Levomecol did not significantly influence the structure of the microbial profile. Following surgical treatment we had to perform high amputation of the lower limb in 5 patients of the control group, whereas in the study group patients only one patient required amputation at the foot level. Hence, prior to carrying out reconstructive vascular interventions in patients presenting with pyonecrotic lesions of lower extremities it is preferable to perform debridement of the necrotic foci using topical antibacterial agents, one of which may be Metrogyl 1% gel.

The study comprised a total of 107 patients (all men) after endured femoropopliteal bypass grafting above the genicular fissure with a synthetic stent graft manufactured by the Gore Company for stage IIB and III chronic arterial insufficiency of the lower extremities according to the Fontain-Pokrovsky classification. Group One I (control group) was composed of fifty-four patients permanently taking in the postoperative period at the out-patient stage pentoxiphylline (trental 400 mg 1 tablet 3 times daily) and xantinol nicotinate at a dose of 150 mg one tablet thrice daily. Group Two (Study Group) consisted of fifty-three patients taking after reconstructive vascular surgery at the out-patient stage in addition to pentoxiphylline and xantinol nicotinate acetylsalicylic acid (cardiomagnil 75 mg 1 tablet once daily). The Control Group patients within 3 to 6 months of follow up were found to have a considerable progressing improvement of the functional abilities of the microcirculatory bed requiring in 44 (81.5%) cases hospitalization to the Surgical Department for intensive vascular therapy. Despite this fact four (7.4%) patients within the time frame from 6 to 9 months after surgery developed thrombosis of the vascular implant requiring a repeat surgical intervention. In the Study Group patients, the degree of functional capabilities of the microcirculatory bed in the postoperative period was less considerable, reaching the maximum after 10-12 months of follow up, with eighteen (34.0%) patients requiring hospitalization for additional vascular therapy to perform. There were no cases of implants' thrombosis in the Study Group patients. Pathological alterations in the functional state of the peripheral vascular bed correlated with viscosimetric indices and activity of blood platelet aggregation. The addition of antithrombocytic agents to conservative postoperative therapy considerably improved the outcomes of surgical treatment.