BACKGROUND:In Russia, physicians are virtually unaware of drugs based on needle extract. However, abroad, saponins and, in particular, a combined preparation containing needle extract, hesperidin and vitamin C is one of drugs of choice, if not the leading medication in treatment of venous oedemas and other venous symptoms.AIM:The authors conducted a systematic review of the Russian-and English-language literature using the following search terms: saponins, hesperidin, needle, ruscus, ruscogenin (and their Russian equivalents), each of which was entered in a combination with the word 'venous' or its Russian equivalent, respectively.RESULTS:Ruscogenin and neoruscogenin from the root of needle possess anti-inflammatory properties and induce venous wall contraction, thus making it possible to use needle extract in treatment of chronic venous insufficiency. It was experimentally determined that needle extract stimulates vein contractility, decreasing permeability of the venous wall, influencing extracellular matrix proteins, inhibiting leukocyte migration through regulation of both proteins and matrix ribonucleic acid. Analysed herein are the results of original studies of a combination of needle extract, flavonoid hesperidin methyl chalcone and ascorbic acid, also examining in detail the mechanism of action conditioned by synergism of pharmacological effects of these components. This is followed by discussing the place of saponins in the classification of phlebotropic drugs and comparing efficacy of needle root extract with that of other phlebotonics.CONCLUSION:It was experimentally determined that a combination of needle extract, hesperidin and vitamin C possesses multiple additive phlebotropic effects. According to clinical trials, it leads to relief of most symptoms and a decrease in the ankle volume (high level of evidence 1A), being not inferior by clinical efficiency and duration of action to the best-known flavonoids, whereas by the venotonizing effect, decreased permeability of the vascular wall, and inhibition of leukocytic aggression even superior thereto. Further experimental and clinical studies of efficacy of this combination for various forms of chronic venous diseases and venous thromboses are warranted.

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.

A widely used radiofrequency ablation technology for varicose veins treatment is accompanied by a high incidence of the adjacent nerves injury in a "risk zone". "Risk zone" term characterizes the region near the vein of the irreversible damage to the nerves and other structures. The mathematical numerical modelling of the propagation of heat emitted by the catheter on the vessel wall was performed using the differential heat equation. It was shown, that at the 20th second of standard radiofrequency ablation cycle the boundary of "risk zone" is located at the distance of 0.38 mm from the vein surface according to the mathematical model of RFA regimen proposed for the first time. The solution injecting under ultrasound surveillance in an amount sufficient to exceed a thickness of 0.38 mm around the vein has been recommended.

The article is a review of the reports delivered at the annual Saint Petersburg Venous Forum 'Christmas Meetings'. In 2017 it was held for the 10th time. Widely covered at the Forum were problems concerning non-tumescent methods of treatment of varicose veins, methods of diagnosis and treatment of deep-vein diseases, problems of pathogenesis of post-thrombotic disease, terminology in problems of phlebology.

Intravascular ultrasonography (IVUS) is a highly effective method of diagnosis of post-thrombotic obstructions. Its possibilities by determining the degree and extension of obstructions of deep veins are superior to those of not only non-invasive methods of examination (ultrasonography, CT and MRI) but of phlebography whose results until recently were considered fundamental in diagnosis of the disease concerned. Limited possibilities of phlebography often lead to diagnostic errors when determining the degree and extension of post-thrombotic obstructions. Intravascular ultrasonography makes it possible to obtain a maximally objective picture of the degree of intravascular alterations in post-thrombotic diseases, as well as to determine the indications for performing balloon dilatation and stenting of deep veins. First experience in using intravascular ultrasonography in the Clinic of the Institute of Experimental Medicine confirmed these provisions. A total of 15 patients diagnosed with post-thrombotic disease while examination were subjected to antegrade transfemoral phlebography in the direct and lateral projections and IVUS. Significant post-thrombotic obstruction was revealed by phlebography in 3 (20%) of the 15 patients and confirmed by the findings of IVUS. In 12 (80%) patients only carrying out IVUS made it possible to detect pronounced obstruction of veins (more than 50% of its diameter) remaining undiagnosed by phlebography. Unnoticed in phlebography turned out to be May-Thurner syndrome in a female patient. Compression of the left common iliac vein by the right common iliac artery exceeding during systole 70% of the initial diameter of the vein was also revealed while performing IVUS. At the same time phlebography remains an indispensable method of examination while assessing collateral blood flow, thus making it possible to recommend its performing in combination with IVUS for obtaining the most complete notion on post-thrombotic alterations in deep veins of the inferior vena cava system.

A widely used radiofrequency ablation (RFA) technology for insufficient saphenous veins treatment is accompanied by a high incidence of paresthesia. Thanks to mathematical modeling of standard RFA procedure the thermal damage zone that extends beyond the vein wall has been defined and the practical recommendations for reducing the incidence of side effects during the procedure have been given.

Несмотря на активное применение РЧО в лечении варикозной болезни вен нижних конечностей, до сих пор отсутствуют единые представления о механизмах облитерации и абляции вен, подвергающихся этой процедуре. Согласно рекомендациям производителя РЧО проводится в стандартном режиме вне зависимости от особенностей клинической картины: два цикла воздействия в приустьевом отделе магистральной подкожной вены и по одному циклу на каждый 7-ми см сегмент вены дистальнее. В большинстве случаев техническим исходом РЧО в отдаленные сроки является абляция (фиброзная трансформация) вены. Однако возможно сохранение облитерированной вены с реканализацией ее просвета в 2–8% [1–4]. Вероятность полной фиброзной трансформации вены зависит от большого количества факторов, в том числе степени поражения венозной стенки. На сегодняшний день данные о зависимости степени такого повреждения от количества циклов воздействия отсутствуют. Достоверно оценить морфологические изменения венозной стенки можно только после выполнения РЧО in vivo. При моделировании РЧО in vitro невозможно воспроизведение всех условий, влияющих на результат вмешательства, а именно: обжатие вены вокруг катетера при выполнении тумесцентной анестезии, эквивалентная естественной теплопроводность, наличие остаточной крови в просвете вены. Кроме того, хирургическое удаление вены для последующего проведения исследования in vitro неизбежно приводит к травматизации эндотелия ОЦЕНКА МОРФОЛОГИЧЕСКИХ ИЗМЕНЕНИЙ ВЕНОЗНОЙ СТЕНКИ ПОСЛЕ РАДИОЧАСТОТНОЙ ОБЛИТЕРАЦИИ IN VIVO

Objectives. To compare the indicators of endotheliumum viability at short-term conservation of vein segments in perftoran, physiological solutionvenous, arterial blood of a patient in vitro. Methods. Fragments of the great saphenous vein taken intraoperatively during the coronary artery bypass surgery in 58 patients with the ischemic heart disease have been examined. The examined fragments were placed in the test tubes with the equal volume of 10 ml each. 0,9% NaCl solution, heparinized auto-arterial and auto-venous blood and perftoran were used as preservatives. The control brush biopsy of intima was performed immediately after the surgery material taking. The following ones were performed on the 15th and 30th minutes of conservation. 522 membranous specimens of endothelium were examined. They included 58 control specimens, 232 specimens were taken on the 15th minute and 232 – on the 30th minute of conservation in the test media. A quantitative calculation of the proportion of endotheliocytes with the signs of necrobiosis was carried out in 5 fields of vision of each membranous specimen. Results. On the control membranous specimens the median of the proportion of endotheliocytes with signs of necrosis made up 10%, the interquartile range (IQR) – 8-13%. On the 15th minute of conservation the minimum proportion of cells with irreversible endothelium changes was observed in the sample with Perftoran: median – 18%, interquartile range – 16-20%. On the 30th minute of conservation a considerable proportion of necrosis was observed in all specimens, the minimum one was in the sample with Perftoran: median – 29%, interquartile range – 26-32%; the maximum ones were in auto-venous blood and in physiological solution. Conclusions. The determinant factor for preservation of vein graft endothelium is considered to be time. The minimum degradation of the venous segment with endothelium was observed immediately after taking a vein graft from the blood flow. If a vein segment is kept for less than 15 minutes perftoran is recommended to be used as a conservation medium. Conservation for more than 15 minutes is undesirable due to many indicators of endothelium necrosis in all test media.

In the available literature, we have found no comparative data on the efficiency and safety of endovenous laser ablation (EVLA) and traditional phlebectomy in elderly and senile patients. According to our results, in elderly and senile patients, the pain syndrome is much less pronounced after EVLA as compared with phlebectomy, the frequency of ecchymosis with an area of more than 100 cm2 and distal thrombosis of deep veins is lower. In the analyzed groups, there are no significant differences in the frequency of post-surgical complications after surgical intervention. Both EVLA and phlebectomy eliminate pathological reflux of the great saphenous vein with the same degree of reliability, within the period of examination of 1 year. In elderly and senile patients, the time for return to daily activity is significantly reduced after EVLA as compared to that after combined phlebectomy.

A prospective study included 106 patients with celiac trunk compression syndrome (CTCS). Duplex scanning of the celiac trunk and superior mesenteric artery and echocardiography were performed during their examination. The investigation revealed primary mitral valve prolapse (PMVP) in 78 (74%) patients. Operations of decompression of the celiac trunk were made on 101 patients. After operation the symptoms (neurovegetative included) were found to disappear. No authentic distinctions were revealed in the clinical semiology and postoperative course of patients with CTCS and with a combination of CTCS and PMVP.

The article presents results of examinations and surgical treatment of 300 patients aged from 19 through 72 years with the syndrome of compression of the celiac trunk of the abdominal aorta. Under study were the symptoms and features of the clinical course as well as the possibilities of diagnosis with the help of ultrasonic duplex scanning and aortography. The principal method of treatment of this syndrome is thought to be operative decompression of the celiac trunk resulting in the reestablished hemodynamics in this vessel and in recovery of the greatest part of the patients.