Venous Insufficiency In Patients Research Articles

Possibilities of surgical correction of complicated forms of chronic venous insufficiency in patients after coronavirus infection

Introduction. COVID-19 causes generalized endothelitis and impaired arthriolo-venular circulation leading to a slowdown in blood flow and venous hypervolemia. This leads to decompensation of the drainage function of perforated veins and the occurrence of horizontal venous reflux. Aim. To determine the possibilities of surgical correction of decompensated forms of chronic venous insufficiency (CVI) in patients after COVID-19, when determining the localization of pathological venous reflux by ultrasound duplex scanning of the lower extremity veins. To determine the character of microcirculatorydisorders in the examined patients. Material and methods. Ultrasound duplex scanning with a 7.5-10 MHz linear sensor was performed in 59 patients aged 40-78 years, 34 women and 25 men who had suffered from COVID-19 in a moderate form that did not require hospitalization. Patients had not previously noted manifestations of CVI and did not use diosmin drugs. The reason for treatment was the manifestation of complicated forms of CVI, which first appeared after COVID-19. 39 patients of group I underwent surgical correction of horizontal venous reflux, 20 patients of group II received conservative treatment. The microcirculatory bed was examined using a high-frequency ultrasound Dopplerograph on the nail bed of the 1st finger of the upper limb with a 25 MHz sensor. Results. The revealed microcirculatory disorders were characterized by a depletion of the Doppler spectrum, which corresponds to parietal stasis. Isolated horizontal venous reflux was recorded in the area of trophic disorders: pigmentation, induration and trophic ulcers (TU) of the shin. In group I patients, as compared to group II, pain syndrome, edema, induration and inflammation significantly decreased after treatment when assessed by the VCSS scale. More rapid and complete healing of TU was observed. Conclusions. COVID-19 provokes accelerated progression of isolated horizontal venous reflux, due to generalized microcirculatory disorders reported in patients in the post-COVID period. The surgical intervention for its elimination in the nearest future after applying undoubtedly surpasses conservative methods of treatment and allows achieving a good cosmetic and clinical result.

Clinicoepidemiologic Characteristics and Prevalence of Venous Insufficiency in Patients with Pigmented Purpuric Dermatosis

Clinicoepidemiologic Characteristics and Prevalence of Venous Insufficiency in Patients with Pigmented Purpuric Dermatosis

Comparison of three dimensional CT venography and ascending phlebography based on propensity score matching in the evaluation of recurrent varicose veins

Objective: To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins. Methods: A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results: One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group(M(IQR),3.0(4.3) vs.4.0(5.8),Z=-2.038,P=0.040).Additionally, the chronic venous insufficiency patients' quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217,P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference (χ2=0.453,P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference (χ2=4.800,P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions: CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

The Relationship between Body Mass Index and Severity of Chronic Venous Insufficiency in Patients at Siloam Hospitals Lippo Village Building B

BACKGROUND: Chronic venous disease, or chronic venous insufficiency (CVI), is a condition that occurs when the venous valves, particularly in the lower extremities, fail to function properly due to venous obstruction or reflux. CVI is often referred to as a chronic venous disease, with clinical symptoms frequently presenting as varicose veins and often remaining undiagnosed accurately. CVI can occur due to various causes, including congenital, primary, secondary, and idiopathic factors. Body mass index (BMI) is a calculation used to estimate the amount of fat in the body and categorize an individual’s degree of obesity. Obesity is one of the risk factors that can contribute to the development of CVI, as it can lead to increased volume and pressure in the venous blood vessels due to an elevated BMI. OBJECTIVE: This study was conducted to investigate and understand the relationship between BMI and the severity of CVI in patients at Siloam Lippo Village Hospital Building B. METHODOLOGY: This research employed a cross-sectional study design utilizing unpaired categorical comparative analytic study types. The sample was selected using consecutive sampling, with a target sample size of 115 individuals who were patients with CVI at Siloam Lippo Village Hospital Building B. Data were collected through patient interviews during Duplex ultrasound (USG Duplexs) examinations. Subsequently, the data were analyzed using the Chi-square analysis method. RESULTS: The study revealed a significant association between BMI and the severity of CVI (p &lt; 0.001, odds ratio: 6.556, 95% confidence interval: 2.681–16,028). CONCLUSION: The research findings indicate a significant relationship between BMI and the severity of CVI in patients at Siloam Lippo Village Hospital Building B.

Polidocanol sclerotherapy for venous insufficiency in patients with recalcitrant leg ulcers: More treatment is better

Polidocanol sclerotherapy for venous insufficiency in patients with recalcitrant leg ulcers: More treatment is better

The relationship between neuropsychiatric disorders and constitutional venous insufficiency in patients during the period of clinical manifestations of new Coronavirus infection COVID-19

The relationship between neuropsychiatric disorders and constitutional venous insufficiency in patients during the period of clinical manifestations of new Coronavirus infection COVID-19

Prevalence and predictors of combined >50% iliocaval venous obstruction and superficial venous reflux in chronic venous insufficiency patients with healed or active venous leg ulcer

ObjectiveThe aim of the present study was to investigate the prevalence and predictors of combined >50% iliocaval venous obstruction (ICVO) and superficial venous reflux (SVR) in patients with chronic venous insufficiency (CVI) with a healed (C5) or an active (C6) venous leg ulcer (VLU). MethodsWe conducted a retrospective review of prospectively collected data from patients with CVI with CEAP (Clinical, Etiology, Anatomy, Pathophysiology) class C5 (healed ulcer) or C6 (active ulcer) with SVR who had been treated at our institution from February 2017 to January 2018. The demographic, clinical, and surgical data and duplex ultrasound and computed tomography venography findings were collected. We used OsiriX MD, version 2.9, software (Pixmeo SARL, Bernex, Switzerland) to measure the vein diameter via multiplanar reconstruction. The prevalence of combined >50% ICVO and SVR was evaluated, and univariate and multivariate analyses were performed to identify the independent predictors of >50% ICVO in patients with CVI and SVR. ResultsA total of 79 limbs from 67 patients were enrolled. The mean age was 59.82 ± 12.86 years, the mean body mass index was 28.68 ± 6.41 kg/m2, and 41.8% were men. The prevalence of >50% ICVO in the patients with SVR was 31.6%. Univariate analysis showed a history of deep vein thrombosis (DVT) in the affected leg (P = .001), a VLU in the left leg (P = .033), a history of a recurrent VLU (P = .038), and reversed flow in the superficial epigastric vein (P = .004) were significantly associated with >50% ICVO in patients with CVI and SVR. Multivariate analysis revealed a history of DVT in the affected leg (adjusted odds ratio [aOR], 8.31; 95% confidence interval [CI], 2.29-30.19; P = .001), a VLU in the left leg (aOR, 3.95; 95% CI, 1.18-13.19; P = .026), and a history of a recurrent VLU (aOR, 3.08; 95% CI, 1.02-9.32; P = .047) to be independently associated with combined >50% ICVO and SVR in patients with CVI. ConclusionsThe prevalence of combined >50% ICVO and SVR in patients with CVI and CEAP C5 or C6 was 31.6%. The independent predictors of combined >50% ICVO and SVR in those with CVI were a history of DVT in the affected leg, a VLU in the left leg, and recurrent VLUs.

Petogodišnji klinički rezultati lečenja 1073 pacijenta sa proširenim venama, lečenih radiofrekventnom ablacijom, endovenskom laserskom ablacijom i embolizacijom cijanoakrilatom

Background: There is little research on the long-term outcomes of radiofrequency ablation, endovenous laser ablation, and cyanoacrylate embolization. This study retrospectively examined the clinical results of radiofrequency ablation, endovenous laser ablation, and cyanoacrylate embolization methods. Materials and Methods: The population of the study consisted of 1256 patients who applied to the clinic with the diagnosis of chronic venous insufficiency between the specified dates and were treated with endovenous varicose veins. Sample: 431 patients in the cyanoacrylate embolization group, 230 patients in the radiofrequency ablation group, 412 patients in the endovenous laser ablation group, a total of 1073 patients. Bilateral cyanoacrylate embolization, radiofrequency ablation, and endovenous laser ablation were not applied to the patients in the same session. Results: When the 1-year occlusion rates were examined, it was determined as 97.57%, 98.26%, and 95.59% in the endovenous laser ablation, radiofrequency ablation, and cyanoacrylate embolization groups, respectively. There was no significant difference in Venous Clinical Severity Score scores between the groups before and after the procedure. Pain, paresthesia, ecchymosis, pigmentation, induration, burn, deep vein thrombosis, and phlebitis were significantly more common in the endovenous laser ablation group. Conclusions: Complications were seen in the cyanoacrylate embolization group. Endovenous laser ablation, radiofrequency ablation, and cyanoacrylate embolization applications have similar long-term results. Therefore, cyanoacrylate embolization is recommended for chronic venous insufficiency patients who want to get rid of varicose veins and improve their quality of life.

A study of chronic superficial venous insufficiency in patients with competent saphenofemoral junction

Background: Chronic venous insufficiency (CVI) is a condition that affects the venous system of the lower extremities rendering the superficial, perforating, and deep veins incompetent. This results in venous hypertension causing various pathologies including pain, swelling, edema, skin changes and ulcerations. Traditionally SFJ incompetence was viewed as the primary pathology for varicose veins and Trendelenburg’s surgery is considered as a standard surgical procedure for the treatment of varicose veins. Later studies have shown incidence of chronic superficial venous insufficiency (CSVI) with competent SFJ was seen in as many as about 40% cases. Therefore, present study aims to identify the incidence of CSVI with competent SFJ, severity of disease in these individuals and patient outcome and response to Trendelenburg’s surgery.Methods: Prospective observational study with non-randomised purposive sampling.Results: Prevalence of competent SFJ was about 40.54% in patient with CSVI. 56.7% patients had C4 disease, 26.7% had C6 disease, 13.3% had C5 disease and 3.3% had C2 disease. In all the patients, progression of the disease was arrested after surgical intervention and no recurrence or ulceration was seen by the end of the 3 months.Conclusions: In comparison to patients with CVI with incompetent SFJ, patient with CSVI. Competent SFJ vary in that there is high male preponderance compared to females, disease progression and severity is independent of age and gender. Surgical outcomes were comparable to the patients with CSVI and incompetent SFJ Trendelenburg surgery can be used as the choice of surgical treatment in patients with competent SFJ and CSVI.

Comparison of Doppler Ultrasound and Clinical Features of Patients With and Without Femoral Hernia in Lower Extremity Venous Insufficiency Patients.

In this study, we aim to evaluate Doppler ultrasound (US) and clinical features of patients with and without femoral hernia (FH) in lower extremity chronic venous insufficiency (CVI) patients.We retrospectively analyzed prospectively collected data of 1364 limbs with the CVI suspected. Femoral hernia was detected in 32 of the limbs, and the control group was formed with 32 limbs without FH. All limbs were evaluated with Valsalva maneuver and augmentation method to detect venous reflux in FH group. Venous reflux rates in the Doppler US, venous clinical severity scores (VCSSs), and clinical classes of Clinical-Etiology-Anatomy-Pathophysiology classification were compared statistically in both groups.The mean VCSS was 3.87 ± 0.74 in the FH group and 2.68 ± 0.65 in the control group, which was statistically significant ( P = 0.04). In the more severe clinical classes of Clinical-Etiology-Anatomy-Pathophysiology (C4-6), the number of limbs in the FH group was higher than in the control group (8 and 4, respectively). Doppler US examinations showed venous reflux in 22 of 32 limbs in the FH group and 19 of 32 patients in the control group, and there was a statistically significant difference ( P = 0.029). In the FH group, reflux could be shown only by augmentation method in the vast majority of limbs (16 of 22, 73%).In conclusion, VCSS and reflux rates are higher in limbs with CVI accompanied by FH. In addition, FH may cause false negative results in the evaluation of CVI. The use of augmentation method in limbs with FH can help avoid false negatives.

SYSTEMIC INFECTION WITH SINGLE OR MULTI-ORGAN DAMAGE CAUSED BY INADEQUATELY MANAGED CHRONIC WOUNDS: A CASE SERIES.

SUMMARYChronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID-19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID-19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID-19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.

Prevalence of Vasculitis among Chronic Venous Insufficiency Patients Attending a Tertiary Care Centre, Tamil Nadu, India: A Descriptive Observational Study

Introduction: Chronic Venous Insufficiency (CVI) is a relatively common condition seen worldwide and also in the Indian population. Vasculitis is a heterogenous group of disorders that affects and destroys blood vessels by inflammation. While both are separate disease entities, the presence of vasculitis in patients who present with CVI often goes unnoticed, thereby complicating the treatment of varicose veins. Aim: To determine the clinical profile and prevalence of vasculitis among patients with CVI attending a tertiary care hospital in India. Materials and Methods: This descriptive study was carried out in the Department of General Surgery among 162 patients (out of which 130 were selected based on inclusion criteria) with CVI attending tertiary care centre in Tamil Nadu, India, from February 2018 to January 2019. Patients with an active or healed ulcer on the long and short saphenous vein of lower limbs were included in the study. They were studied to assess the prevalence of vasculitis among them and the implications it had on the overall morbidity of the patient and their treatment outcome. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. Results: The mean age of the study population was 45.52 years. Out of 130 patients, 33.08% and 23.85% of the study population were diagnosed with Type 2 Diabetes Mellitus (T2DM) and systemic hypertension respectively. Only 3 (2.3%) participants had vasculitis and all of them were smokers and had a painful ulcer, fever, elevated C Reactive Protein (CRP), elevated Erythrocyte Sedimentation Rate (ESR), and elevated total leukocyte count levels. Two (66.7%) of them had an active ulcer at the time of presentation, against 1 (33.3%) who had a healing ulcer. All patients were cured by Bisgaard’s regimen + steroids/no steroids + surgery. Conclusion: The prevalence of vasculitis was 2.3%. This study confirms that patients suffering from CVI may be at a marginal risk of having co-existing vasculitis which may complicate the clinical picture and result in postoperative complications if left unchecked.

Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

Exercise Training as an Adjunctive Therapy for Chronic Venous Insufficiency Patients: Evidence from Research to Practice.

Chronic venous insufficiency, which is defined as a condition relevant to persistent ambulatory venous hypertension, is a common cause of venous leg ulcers. Compression therapy is commonly used to relieve ambulatory venous hypertension and heal leg ulcers. Exercise is considered as adjunctive therapy, targeting calf muscle pump function, to additionally favor the compression treatment for facilitating the healing process. Different exercise training regimens for promoting wound healing and its relevant outcomes are reviewed and discussed in this study.

Case Series Analysis of Chronic Venous Insufficiency Patients to Determine Associated Arthrosis

Case Series Analysis of Chronic Venous Insufficiency Patients to Determine Associated Arthrosis

Effects of Venous Insufficiency in Patients Undergoing Primary Total Knee Arthroplasty: An Analysis of 1.2 Million Patients.

Chronic venous insufficiency (CVI) is extraordinarily prevalent in our aging population with over 30 million people in the United States suffering from the disease. There is a paucity of data analyzing the effects of CVI on outcomes following total knee arthroplasty (TKA). The purpose of this study was to utilize a nationwide administrative claims database to determine whether patients with CVI undergoing TKA have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmission rates; (3) medical complications; (4) implant-related complications; and (5) costs of care compared to controls. Using a nationwide database, we matched patients with CVI undergoing TKA to controls without CVI undergoing TKA in a 1:5 ratio by age, sex, and medical comorbidities associated with CVI. Primary outcomes analyzed within the study included LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, in addition to 90-day total global episode of care costs. The query yielded 1,265,534 patients with (n = 210,926) and without (n = 1,054,608) CVI undergoing primary TKA. Patients with CVI had significantly longer LOS (4 vs. 3 days, p < 0.0001), higher 90-day readmission rates (20.96 vs. 15.34%; odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.44-1.48, p < 0.0001), and higher odds of medical complications (2.27 vs. 1.30%; OR: 1.76, 95% CI: 1.70-1.83, p < 0.0001) compared to matched controls. Patients with CVI also had higher odds of periprosthetic joint infections (2.23 vs. 1.03%; OR: 2.18, p < 0.0001) and implant-related complications in general (4.27 vs. 2.17%; OR: 2.01, 95% CI: 1.96-2.06, p < 0.0001). Additionally, patients with CVI had higher total global 90-day episode of care costs ($15,583.07 vs. $14,286.95, p < 0.0001). Patients with CVI undergoing TKA have increased LOS, higher odds of medical and implant complications, and increased costs of care compared to those without CVI. The study can be utilized by orthopaedic surgeons to counsel patients on the potential complications following this procedure. This is a level III, retrospective cohort study.

The effect of phlebothrombosis on the condition of the muscle tissue of the lower extremity in oncopathology

Modern research has shown that cancer patients are at high risk of thrombotic complications, which worsen the results of anticancer treatment and occupy one of the leading places among the causes of death. Deep vein thrombosis of the lower extremities, as well as pulmonary embolism is the most dangerous complication of the cancer process in the body. The pathogenesis of hemostasiological paraneoplasia is based on the activation of both coagulation and vascular-platelet coagulation, which is provided by:disruption of the structural integrity and functional stability of the vascular endothelium by the cells of the tumor and cytokines; activation of platelets, which subsequently leads to their increased adhesion and aggregation; synthesis of procoagulants and fibrinolysis inhibitors; procoagulant activity of tumor-associated macrophages and activated peripheral blood monocytes. The aim of the study was to evaluate the structural changes of striated muscles and endothelial cells of the hemomicrocirculatory tract in deep vein thrombosis of the lower extremities of cancer patients. In order to detect changes in the muscular tissues of the lower extremity in oncopathology, scientists from I.Ya. Gorbachevsky Ternopil National Medical University conducted a light-optical histological and polarization study of skeletal muscle necropsies that died of cardiopulmonary shock in cancer patients. As a result of the assessment of structural changes of striated muscles and endothelial cells of the hemomicrocirculatory tract in deep vein thrombosis of the lower extremities of cancer patients, polarization microscopy showed significant contractural changes against the background of dyscirculatory changes. Given that the muscles of the lower extremities play a significant role in ensuring venous hemodynamics due to their contractile ability, these changes can be considered an important complementary link in the pathogenesis of venous insufficiency in patients with cancer and development of thrombotic complications in them. It should be noted that in this process an important role belongs to endothelial dysfunction. It is the damage of endothelial cells and "exposure of the bagal membrane" is the initial phase in the violation of microcirculation with the development of venule dystonia, interstitial and perivascular edema. At colon cancer against the background of hemodynamic disturbances expressed by degenerative damages of endotheliocytes with their desquamation, plethora of venules with dystonia of their gleam, interstitial and perivascular hypostasis there are heterogeneous displays of remodeling which are characterized by striated and contractural changes, homogenization of sarcoplasm with myocytolysis. Keywords: phlebothrombosis, oncological process, cancer, thrombotic complications, skeletal muscle in thrombosis.

Topical Sevoflurane: A Novel Treatment for Chronic Pain Caused by Venous Stasis Ulcers.

In the US, an estimated 1 - 2% of chronic venous insufficiency (CVI) patients (of 6 - 7 million nationwide) develop at least one venous stasis ulcer (VSU) during their illness. Of these, approximately 40% develop subsequent ulcers, making VSU prognostically poor. Current management of VSU is costly, with poor prognosis, high recurrence rate, inadequate pain management, and significantly reduced quality of life (QoL). Topical volatile anesthetic agents, such as sevoflurane, offer improved pain relief and symptom control in patients suffering from chronic VSU. The immediate impact of topical sevoflurane in reducing pain associated with ulcer bed debridement has several implications in improving the quality of life in patients with CVI induced ulcers and in the prognosis and healing of the ulcers. This review summarizes a topical formulation of a volatile anesthetic and its implications for the management of VSUs.

Pleiotropic therapy for the initial stages of chronic venous insufficiency in post-thrombotic disease

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 &lt;0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p &lt; 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p &lt; 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p &lt; 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p &lt; 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p &lt; 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 &lt; 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.

Connection of perforating and intramuscular veins of the crus in varicosity

This study was undertaken to investigate the clinical anatomy of indirect perforating veins and their connection to the intramuscular venous collector of the crus by means of MSCT phlebography. From 2015 till now, MSCT phlebography was used to examine a total of 400 patients with chronic diseases of lower limb veins. According to the CEAP classification, clinical class C0-C1 was present in 108 (27%) subjects, C2-C3 - in 173 (43.3%) patients, and C4-C6 - in 119 (29.7%) patients. All examinations were performed using a 128-slice multispiral CT scanner Philips Ingenuity, followed by 3D reconstruction with the help of the IntelliSpace Portal Image Editing Software package. In the 400 extremities examined, we identified a total of 11 655 indirect perforating veins of the calf. Studying the anatomical localization of perforating veins demonstrated that 3248 veins belonged to the posterior tibial group, 1830 veins - to the lateral group, 873 veins - to the paraachillary group, 276 veins - to the intergemellary group, 4451 veins - to the medial group, and 997 perforating veins - to the lateral group. 3D imaging made it possible to trace the entire course of the perforating veins originating from the posterior arched, intersaphenous, oblique veins or other communicating branches to the subfascial and intramuscular portions to the connection with the gastrocnemius and soleus veins which as the disease progresses undergo ectasia with the formation therein of pathological segmental hypervolemia. Studying the ratio of the revealed indirect perforating veins of the determined groups and the presence of gradually developing ectasia of the intramuscular venous collectors in patients of various clinical classes from C0-C1 to C4-C6 made it possible to draw a conclusion on the involvement of perforating veins and intramuscular veins of the crus into the common pathohaemodynamic circle of the development and progression of chronic venous insufficiency in patients with varicose veins.