INTRODUCTION. Dysfunction of the calf muscle-venous pump (MVP) associated with venous obstruction contributes to ineffective venous blood emptying from the distal lower extremities and can be considered a therapeutic target in the treatment of chronic venous diseases. Physical exercise (PE) can be an effective method for increasing the hemodynamic efficiency of the MVP. AIM. A search and analytical review of research findings published in international databases, focusing on the role of MVP dysfunction in the pathogenesis of chronic venous insufficiency (CVI), as well as the effectiveness of various types of physical exercise. MATERIAL AND METHODS. Fifty-one sources were identified from databases eLibrary.RU, Scopus, PubMed, Web of Science from 1998 to 2025, of which 19 were systematic reviews, including two Cochrane reviews, five practice guidelines, and 27 randomized controlled trials. RESULTS. In patients with mild CVI, PE was found to improve venous reflux, muscle strength, ankle range of motion (AROM), and quality of life. In patients with severe CVI, PE increased ejection fraction, decreased residual volume, and improved muscle strength and AROM. Isotonic exercise was shown to improve muscle endurance, efficiency, and strength of the calf muscles, improving their contractility and overall hemodynamics in limbs with venous trophic ulcers (VTU). It was established that the effectiveness of MVP also depends on the mobility of the ankle joint and the calf muscles contractile strength. DISCUSSION. Despite the compelling evidence base for prescribing progressive strength training and aerobic activity to patients with VTU, there are no studies examining the effectiveness of isokinetic training in the comprehensive rehabilitation of patients with post-thrombotic syndrome (PTS). This underscores the need to develop modern isokinetic training protocols for patients with PTS, as they achieve improved performance through maximal muscle loading, which enhances motor learning through real-time feedback. CONCLUSION. Studying the effects of isokinetic exercise training on calf pump function, muscle strength, AROM, and quality of life in patients with PTS is a promising area of medical rehabilitation.

We present two clinical cases of successful endovascular treatment of proximal deep vein thrombosis following May-Thurner syndrome. In the first case, 2-day regional catheter thrombolysis, percutaneous mechanical thrombectomy and venous stenting were required to restore hemodynamics in the left lower limb. In the second case, regional catheter thrombolysis continued for 3 days with subsequent thrombotic mass lysis. However, iliac vein was severely narrowed that required venous stenting. Long-term results were favorable in both cases. Venous outflow has become almost normal after endovascular treatment. The patients' ability to work has been restored.

OBJECTIVE:The purpose of the study was to determine clinical and laboratory predictors suggesting an unfavorable outcome of acute limb ischemia. PATIENTS AND METHODS:The work was based on retrospective assessment of treatment of 556 patients with confirmed acute limb ischemia, undergoing treatment in 2000-2018. All patients were operated on. The mean age amounted to 69.9±12.8 years. Women accounted for 51.3%. According to the classification of I.I. Zatevakhin, degree I ischemia was in 36.1% of patients, degree II in 59.2%, and degree III in 4.7%. In the majority of patients, acute ischemia was caused by arterial embolism. The patients were divided into two groups: Group 1 included those discharged with the saved limb after restoration of arterial blood flow and Group 2 comprised patients discharged after amputation. RESULTS:The time from the onset of the disease to the moment of surgical intervention in Group 2 was 10.3-fold longer (p=0.0001). Arterial thrombosis was 2.5 times more associated with the risk of major amputation (p=0.002). The chance of amputation in acute ischemia of upper extremities was 6.8 times less than in lesions of lower limbs (p=0.003). Distal lesions of lower-limb arteries increased 3.6-fold the risk of amputation (p=0.001). The chance of limb loss directly depended on the ischemia degree (p<0.024). In Group 2 patients, the neutrophil-to-lymphocyte ratio was 1.5-fold higher (p=0.001). CONCLUSION:The duration prior to revascularization, limb ischemia degree, etiology and the level of the arterial bed lesion remain the most significant predictors of an unfavorable outcome in acute limb ischemia. Elevated values of the neutrophil-to-lymphocyte ratio appeared to directly associated with the necessity to perform amputation.

Glomus tumors usually occur in areas rich in glomus bodies, such as the subungual areas of the fingers or the deep dermis of the palm, wrist, and forearm, but they can also occur in deep visceral sites throughout the body, including the lungs, stomach, pancreas, liver, gastrointestinal and urinary tracts. They are thought to have originated from modified smooth muscle cells of the neuromyoarterial glomus, commonly referred to as the glomus body, whose function is to regulate temperature through arteriovenous shunting of the blood. Important during the pathological process for these tumors are pain that persists for a long time, which is often necessary for their detection and the possibility of relapse. The purpose: to analyze and evaluate our own clinical cases of glomus angioma of various localization. Materials and methods. 6 patients with a morphologically verified diagnosis of glomus angioma (5 women and 1 man aged 23 to 50 years, mean age 34.5 years) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2004 to 2023. All patients were operated on. Lesions localization: limbs soft tissues – 3, retroperitoneal space – 2, lung – 1. Results. The term of the lesions detection varied from 2 months to congenital. In 2 of 3 cases of the limbs soft tissues tumors localization they were congenital. Limbs soft tissues glomus tumors: the leions ranged in size from 40.0 × 28.65 mm to a large lesion, consisting of multiple foci ranging in size from 20.0 to 60.0 mm in diameter, all tumors were multinodular. Retroperitoneal glomus tumors: the lesions were rather large (a multinodular lesion from 6.0 to 48.0 mm in diameter and a single-nodular multi-chamber lesion of a polycyclic form, 150.0 × 100.0 × 80.0 mm in size). The lung glomus tumor was single-nodular and had a diameter of 12.5 mm. In the vast majority of cases (5/6), the lesions manifested with the pain and discomfort. Only the lung lesion was detected by chance and during a routine examination. The criteria for ultrasound and MSCT signs of the lesions of various localizations are given. The data are compared with literature data. Conclusion. Given the rarity of glomus angioma and the lack of publications on glomus angiomas of soft tissues of the extremities and deep-seated tumors in the domestic literature, the presented analysis of a series of our own cases will increase the awareness of clinicians and diagnosticians about these tumors and, thereby, increase their detection, which will allow for earlier surgery.

BACKGROUND:Venous malformations (VMs) constitute the largest group among patients with congenital vascular malformations. Recently, in the treatment of this category of patients, modern minimally invasive methods of obliteration of venous caverns and dysplastic veins have been widely used. OBJECTIVE:The purpose of this study was to compare the results of treatment of patients with VM using sclerobliteration (SO), laser coagulation (LC) and radiofrequency ablation (RFA). PATIENTS AND METHODS:Our retrospective study with a prospective component included (a total of) 156 patients with VM. Of these, 111 were women aged 18 to 42 years (mean age 38.5) and 45 men aged 18 to 56 years (mean age 30.2). Depending on the surgical intervention performed, all patients were divided into 3 groups: SO (n=48), LC (n=56), and RFA (n=54). Establishment of the diagnosis of VM, clarification of the localization, depth, and extent of the lesion were carried out based on the findings of duplex scanning (DS) of vessels and soft tissues. The dimensions of the venous cavities ranged from 5 to 42 mm. LC and RFA were not used with a lesion depth of less than 10 mm. The effectiveness of treatment was evaluated by the results of DS at 12 months, taking into account obliteration of cavities in the intervention zone, the presence of residual cavities and their sizes. Pain was assessed by means of a visual analogue scale. RESULTS:In the RFA group, complete obliteration of venous caverns in the area of intervention at 12 months of follow-up was achieved in 50 (92.6%) patients. At the same time, occlusion of rather large caverns (more than 30 mm in diameter) was noted. Three (5.5%) patients were found to have partial occlusion of the venous caverns, which was associated with a diffuse lesion. Complete obliteration of cavities in the LC group was achieved in 43 (76.8%) patients. The best result was recorded for cavities smaller than 30 mm. In the presence of partial obliteration, according to the DS findings, the blood flow continued to be registered. In the SO group, positive results were obtained in 44 patients (91.7%). The technical success of the performed procedure in this case can be explained by the presence of single limited cavities of small and medium diameter (less than 30 mm). In the RFA group, there were fewer complications than in other groups (pRFA,LC=0.0038, pRSA,SO=0.004). There was no significant difference between the results of obliteration in all groups, but there was a trend towards slightly worse results for obliteration in the LC group (p>0.05). CONCLUSION:The effectiveness of obliteration techniques in treatment of patients with VM directly depends on the depth, extent of the lesion and the diameter of the vascular formation. These methods make it possible to alleviate the course of the disease and reduce the recovery time after surgery. This is especially important, given the relapsing nature of the disease. Despite the fact that all these operations are palliative, their goal is to reduce primary complaints and improve quality of life of patients.

OBJECTIVE:To analyze the results of redo reconstructions of lower limb arteries in patients with obliterating atherosclerosis, immediate and long-term results in patients who underwent reconstructive interventions with occlusion of previous reconstruction and preventive interventions.MATERIAL AND METHODS:The study included 43 patients. The main group (group 1) consisted of 18 patients who underwent preventive vascular reconstructions. The control group enrolled 25 patients who underwent redo interventions for occlusion of previous reconstructions. The control group was divided into 2 parts; 15 patients had chronic limb ischemia (group 2), 10 patients had acute limb ischemia (group 3). Mean age of patients was 56.8±8.2 years; there were 37 (86%) men and 6 (14%) women. Multifocal vascular atherosclerosis was noted in 41 (95.3%) patients, carotid artery lesion - 29 (70.7%), coronary artery disease - 34 (79%). Patients with type II diabetes mellitus were excluded.RESULTS:We chose each surgical intervention considering preoperative diagnostic data. Open, endovascular and hybrid interventions were performed. There were no deaths and limb amputations in the 1st group. Two (13.3%) amputations were registered in the 2nd group, 3 (30%) amputations and 1 (10%) death were registered in the 3rd group. The follow-up period was 24 months. An 18-month freedom from amputations was 71.5%, 78% and 38%, respectively (p<0.05 compared to the 1st and 2nd groups).CONCLUSION:Preventive surgical interventions prevent ischemia and amputation, as well as improves the results of redo surgery.

Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors. Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus. Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes». Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented. Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.

Introduction. Congenital vascular malformation is one of the most difficult pathologies in modern vascular surgery. Due to a large variability of lesions in each case, a personalized approach is required.Material and Methods. A 16-year-old girl with a right half – face venous malformation was consulted in the clinic. While visiting a local clinic at the place of her residence, she was proposed to have a radical excision of the lesion, but her parents refused of it. Our additional examination revealed a subtotal lesion of the right masticatory muscle with invasion into the upper lip and in the area of nasolabial triangle. It was decided not to do an open surgery because of the volume and location of the lesion. The patient had the staged sclero-obliteration of angiomatous tissues.Results. After the treatment, the lesion was significantly reduced in size; there was a complete relief of pain syndrome; in addition, the patient’s face became more symmetrical. Conclusion. An individual approach when choosing the optimal tactics for the treatment of venous malformations allows to achieve the best functional and cosmetic outcomes.

Introduction. The development of phlebology and mainstreaming of ultrasonic techniques has led to the emergence of microfoam sclerotherapy, which proved itself as a more effective technique. In the world literature, there are isolated publications that say about the effectiveness and safety of the microfoam sclerotherapy combined with mini-phlebectomy, but no specific studies comparing the combination treatment for the elimination of varicose syndrome with separate use of each of the techniques are described.Aim. To increase the effectiveness of invasive treatment and to reduce the rate of complications in patients with varicose veins using a combination of microfoam sclerotherapy and mini-phlebectomy of tributaries after endovenous laser ablation.Material and methods. Simple single- center, non-randomized, retrospective study was conducted at the A.K. Eramishantsev Moscow State Hospital. It included 52 patients with varicose veins (a total of 77 lower limbs, 22 patients had bilateral disease), who had no previous invasive treatment for this disease. They underwent endovenous laser ablation of truncal vein combined with microfoam sclerotherapy and mini-phlebectomy of tributaries. Microfoam sclerotherapy was performed with 0.5–2.0% of polidocanol foam, and mini-phlebectomy per Varady technique. The patients had a postprocedural follow-up clinical examination and duplex ultrasound the day after the intervention, then at 1, 6, and 12 months.Results. Endovenous laser ablation of truncal veins was acutely successful in all cases. No cases of great saphenous vein recanalization were detected in follow-up period. In the early postprocedural period, the combined microfoam sclerotherapy and miniphlebectomy also showed 100% success rate, however redo sclerotherapy was required in 4 (5.2%) cases for new varicose tributaries developed in late postprocedural period.Conclusion. Combined microfoam sclerotherapy and mini-phlebectomy, as a method of treatment for various veins syndrome, can provide additional benefit such as reducing the volume of mini-phlebectomy and the resultant tissue damage, the varicosity recurrence rate, the number of subcutaneous hematomas and ecchymoses, the discomfort of the tumescent anesthesia, the risk of postprocedural varicose veins thrombosis and pigmentation rate.

BACKGROUND:In the structure of surgical events, acute limb ischemia is a cause of death in 25-30% of patients. OBJECTIVE:The present study was aimed at examining the structure of patients with lower and upper limb acute ischemia in the Barnaul urban agglomeration. PATIENTS AND METHODS:We analyzed a total of 1,366 patients presenting with arterial embolism or limb thrombosis within 14 days after the onset of the acute event and hospitalized to the Department of Vascular Surgery during 2000-2018. The epidemiological index of acute limb ischemia amounted to 10.1 per 100 thousand people per year, being comparable with the data of the international statistics. Of these, 865 patients were hospitalized during 2000-2010, and 501 during 2011-2018. RESULTS:Comparing the groups demonstrated an increased number of hospitalizations of women (from 4.6 to 5.3 per 100 thousand/year) in the structure of all patients with acute ischemia, a statistically significant decrease in the number of patients with arterial thromboses, and an increase in the number of those admitted with arterial embolisms. We revealed a tendency to a decrease in the overall number of hospitalized patients and an increase in the number of patients with stage II-III arterial ischemia, with upper limb ischemia diagnosed significantly more often (from 1.4. to 3.2 per 100 thousand/year). CONCLUSION:Along with a trend towards a decrease in the total number of hospitalized patients with acute limb ischemia, we revealed an increase in the number of patients with acute limb ischemia in the presence of arterial embolism and a decreased number of patients with acute arterial thrombosis.

Ограничение диапазона движений в голеностопном суставе (Ankle Range of Motion — AROM) приводит к дисфункции мышечно-венозной помпы (МВП) голени. ЦЕЛЬ ИССЛЕДОВАНИЯ Провести сравнительный анализ воздействия многослойного низкоэластичного бандажа (МНБ) и регулируемых нерастяжимых компрессионных бандажей (РНКБ) на работу МВП голени, а также на показатели AROM у больных лимфедемой нижних конечностей. МАТЕРИАЛ И МЕТОДЫ В пилотный проект включены 10 больных лимфедемой нижних конечностей I—III стадий, средний возраст — 62 года. Проводили гониометрию с измерением AROM дорсифлексии в градусах и изокинетическую динамометрию мышц нижних конечностей на роботизированном биомеханическом комплексе. РЕЗУЛЬТАТЫ Выявили снижение показателей AROM дорсифлексии на 30% и AROM подошвенного сгибания на 20,2%, что свидетельствует о функциональном ограничении движений в голеностопном суставе, лимитирующем полноценную работу мышечно-венозных насосов. У больных лимфедемой зарегистрировано снижение показателей изокинетической динамометрии: максимальной силы разгибания — на 26,5%, средней силы разгибания — на 35,7%, общей работы — на 29,8%. Применение МНБ, рекомендуемых в 1-ю фазу компрессионной терапии, приводит наряду с противоотечным действием к повышению эффективности мышечной помпы голени, что подтверждается увеличением средней и максимальной силы разгибания, но ограничивает AROM дорсифлексии на 47% от исходного показателя. Применение альтернативного противоотечного метода компрессии, РНКБ, также повышает производительность мышечной помпы: увеличивает среднюю и максимальную силу разгибания, при этом ограничение AROM происходит только на 20%. ЗАКЛЮЧЕНИЕ РНКБ не уступает многослойному бандажу не только в противоотечном действии, но и в повышении производительности мышечной помпы.

A composition in the form of liquid polymer substance intended for embolization procedures was studied in in vivo experiment. The preparation was injected to rabbits into the femoral artery and abdominal aorta. The polymer composition exhibited properties previously demonstrated in vitro: strong adhesion to the vascular wall, high plasticity sufficient for embolization of the blood vessels, distal distribution, and the absence of toxic effects. The contrast substance remained in the embolus, which simplified its further localization. The agent underwent nether resorption nor organization. Injection of the agent in a volume of 0.1 ml was sufficient for embolization of an artery with a diameter of 0.1 cm. The polymer composition completely obstructed the vessel without inducing perforation of its wall. During the first day of the experiment, a slight infiltration of surrounding tissues with lymphoid cells was observed. By day 7, total dry necrosis of pelvic limb distal to the injection site was diagnosed. Inflammation of the surrounding tissues was shown histologically and was considered as the body response to impaired circulation and necrosis.

Discussed in the article are the main problems related to surgical treatment of patients with peripheral artery disease, particularly taking into consideration that in the world there are from 160 to 202 million people suffering from this disease, with two thirds of such patients having signs of lesions of coronary or cerebral arteries. Vascular reconstructive interventions cannot completely eliminate the problem, since in the postoperative period there may develop cardiovascular complications related to both the limb involved as either acute or progressing chronic ischaemia and arteries of other localization (coronary, cerebral). The risk of serious cardiovascular complications in patients with a history of endured adverse ischaemic events on the part of limbs is severalfold higher. To solve these problems and decrease complications, salicylic acid is used as basic therapy. Attempts at replacing it by another drug or combined therapy with an alternative antiaggregant showed no advantages in increased risk of massive haemorrhage. On the other hand, a combination of salicylic acid with an anticoagulant at a low dose, i. e., rivaroxaban 2.5 mg twice daily as compared with acetylsalicylic acid monotherapy made it possible to significantly decrease the incidence of various cardiovascular complications in the form of myocardial infarction, stroke, adverse ischaemic events on the part of the extremity, limb amputation.

This paper discusses the issues emerging during the treatment of lower-limb arterial diseases and intermittent claudication. According to the international and Russian guidelines, the common management strategy for intermittent claudication is as follows: conservative treatment is recommended in patients without limiting intermittent claudication who can walk 30 m or more without pain. Drugs that are prescribed is these patients are addressed. No large well-designed studies on most of these drugs were conducted, therefore, it is challenging to assess their efficacy in patients with intermittent claudication. The authors focus on cilostazol that has the largest evidence base. This drug is included in the Russian and international clinical guidelines. Several students demonstrate that cilostazol provides antithrombotic effect, stabilizes atherosclerotic plaques, prevents hyperplasia of neointima and restenosis after vascular procedures, improves lipid metabolism, and significantly increases pain-free walking distance (intermittent claudication distance). Recent studies show that cilostazol can be used in the complex treatment for COVID-19 due to pleiotropic mechanism of action. KEYWORDS: lower-limb arterial diseases, intermittent claudication, conservative treatment, cilostazol, COVID-19, restenosis, antiplatelet therapy. FOR CITATION: Kuznetsov M.R., Reshetov I.V., Sapelkin S.V., Yasnopol’skaya N.V. Conservative treatment for intermittent claudication. Russian Medical Inquiry. 2021;5(4):212–217 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-212-217.

Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.

Recently collated scientific data on the management of C1 clinical class of chronic venous disorders; wide prevalence of the disease and high variability amongst medical practitioners in relation to managing this category of patients and absence of any regulatory documents has prompted the development of clinical guidelines for the treatment of patients with reticular varicose veins and telangiectasias of the lower extremities and various parts of the body. These guidelines have been developed by a self-regulated organization Association “The National College of Phlebology”. The purpose of the de novo guidelines is to systematize the existing evidence and offer minimal standards of care for chronic venous disorders in C1 patients.

ХирургияАнтитромбоцитарная терапия при периферическом атеросклерозе М.Р.Кузнецов 1, 2