B. Boldin, B. Boldin, G. A. Varich, O. V. Dzhenina, R. Abdosh
This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m2 or more, and overweight as a BMI from 25 to 30 kg/m2 according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.
{"title":"Chronic venous diseases and obesity: pathogenetically based treatment and prevention options","authors":"B. Boldin, B. Boldin, G. A. Varich, O. V. Dzhenina, R. Abdosh","doi":"10.21518/akh2024-014","DOIUrl":"https://doi.org/10.21518/akh2024-014","url":null,"abstract":"This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m2 or more, and overweight as a BMI from 25 to 30 kg/m2 according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"111 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. E. Milyukov, A. Chernookov, S. Kandyba, N. O. Bartosh, O. M. Dondup, А. A. Atayan, A. A. Ramazanov, A. Z. Pshmakhova, T. I. Shadyzheva
Introduction. In recent years, surgeons have increasingly used combined operations in patients with inguinal hernias and recurrent varicose veins. However, it is necessary to justify the choice of the type and volume of the main and concomitant stages of combined surgery, depending on the individual characteristics of both diseases.Aim. Optimization of surgical treatment of patients with inguinal hernias in combination with relapses of varicose veins.Materials and methods. The study included 39 patients aged 35 to 78 years with inguinal hernias and RVB. Of these, 21 patients who underwent combined operations were included in the main group. The control group included 18 patients who underwent staged hernioplasty, and then after 1–26 months, operations for RVB, or interventions were performed in reverse order. A comparative assessment of the duration of operations, the level of postoperative pain, immediate and long-term results, and the number of complications of uncorrected diseases in two-stage treatment was carried out.Results and discussion. Performing combined operations in this category of patients does not lead to an increase in the level of postoperative complications, it is accompanied by an average increase in the duration of surgery by 33.6 minutes and an increase in the intensity of postoperative pain by 0.8 points, a decrease in temporary disability by 1.2 times.Conclusions. Performing combined operations is the optimal intervention in patients with inguinal hernias with concomitant recurrence of varicose veins. The use of combined operations makes it possible to simultaneously eliminate both diseases and exclude the development of complications from an uncorrected disease, which, with two-stage treatment, was observed in 11.1% of cases and required emergency operations.
{"title":"Optimization of treatment of patients with inguinal hernia in combination with recurrence of varicose veins","authors":"V. E. Milyukov, A. Chernookov, S. Kandyba, N. O. Bartosh, O. M. Dondup, А. A. Atayan, A. A. Ramazanov, A. Z. Pshmakhova, T. I. Shadyzheva","doi":"10.21518/akh2024-006","DOIUrl":"https://doi.org/10.21518/akh2024-006","url":null,"abstract":"Introduction. In recent years, surgeons have increasingly used combined operations in patients with inguinal hernias and recurrent varicose veins. However, it is necessary to justify the choice of the type and volume of the main and concomitant stages of combined surgery, depending on the individual characteristics of both diseases.Aim. Optimization of surgical treatment of patients with inguinal hernias in combination with relapses of varicose veins.Materials and methods. The study included 39 patients aged 35 to 78 years with inguinal hernias and RVB. Of these, 21 patients who underwent combined operations were included in the main group. The control group included 18 patients who underwent staged hernioplasty, and then after 1–26 months, operations for RVB, or interventions were performed in reverse order. A comparative assessment of the duration of operations, the level of postoperative pain, immediate and long-term results, and the number of complications of uncorrected diseases in two-stage treatment was carried out.Results and discussion. Performing combined operations in this category of patients does not lead to an increase in the level of postoperative complications, it is accompanied by an average increase in the duration of surgery by 33.6 minutes and an increase in the intensity of postoperative pain by 0.8 points, a decrease in temporary disability by 1.2 times.Conclusions. Performing combined operations is the optimal intervention in patients with inguinal hernias with concomitant recurrence of varicose veins. The use of combined operations makes it possible to simultaneously eliminate both diseases and exclude the development of complications from an uncorrected disease, which, with two-stage treatment, was observed in 11.1% of cases and required emergency operations.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"111 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141126771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.
{"title":"From the experience of more than 1000 glue ablation procedures for varicose veins: how to do it","authors":"О. Shirinbek","doi":"10.21518/akh2024-004","DOIUrl":"https://doi.org/10.21518/akh2024-004","url":null,"abstract":"Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Bogachev, B. Boldin, P. Y. Golosnitskiy, P. Turkin, I. M. Dizengof, D. A. Kobzarev, V. Y. Tsukan
The problem of studying the pathology of mesenteric fat of the small intestine in surgical practice has not yet received enough attention. A number of questions remain unresolved regarding the etiology and pathogenesis of mesenteric diseases, their possible connection with benign and malignant diseases, methods of their laboratory and instrumental diagnosis, possible options for conservative and surgical treatment, as well as systematization and structuring of the classification. One of the poorly studied representatives of diseases of the mesentery of the small intestine continues to be Sclerosing mesenteritis, characterized by various histological variants of damage to mesenteric fat and a varied nonspecific clinical picture. Taken together, this leads to certain difficulties in diagnosis, patients seeking access to doctors of various profiles, which ultimately negatively affects the results of treatment and can lead to social maladjustment and possible disability. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. However, in recent years, the frequency of detection of this pathology continues to grow steadily, which is associated with the progressive aging of the population, a high degree of surgical activity in relation to urgent diseases of the abdominal organs, and the improvement of instrumental diagnostic methods. Issues of etiology, pathogenesis, differential diagnosis of this disease and its possible connection with the paraneoplastic process currently continue to cause debate. Further accumulation of clinical experience, a better understanding of the pathogenesis of the disease, and improvement of imaging techniques will allow us to develop clearer diagnostic and clinical criteria, narrow the diagnostic search and, ultimately, improve and standardize treatment. The article provides a review of the literature on this rare surgical pathology, presents our own clinical observation, and discusses diagnostic issues and treatment options for this disease.
{"title":"Sclerosing mesenteritis as a surgical problem: a review of the literature and own clinical observation","authors":"V. Bogachev, B. Boldin, P. Y. Golosnitskiy, P. Turkin, I. M. Dizengof, D. A. Kobzarev, V. Y. Tsukan","doi":"10.21518/akh2024-001","DOIUrl":"https://doi.org/10.21518/akh2024-001","url":null,"abstract":"The problem of studying the pathology of mesenteric fat of the small intestine in surgical practice has not yet received enough attention. A number of questions remain unresolved regarding the etiology and pathogenesis of mesenteric diseases, their possible connection with benign and malignant diseases, methods of their laboratory and instrumental diagnosis, possible options for conservative and surgical treatment, as well as systematization and structuring of the classification. One of the poorly studied representatives of diseases of the mesentery of the small intestine continues to be Sclerosing mesenteritis, characterized by various histological variants of damage to mesenteric fat and a varied nonspecific clinical picture. Taken together, this leads to certain difficulties in diagnosis, patients seeking access to doctors of various profiles, which ultimately negatively affects the results of treatment and can lead to social maladjustment and possible disability. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. However, in recent years, the frequency of detection of this pathology continues to grow steadily, which is associated with the progressive aging of the population, a high degree of surgical activity in relation to urgent diseases of the abdominal organs, and the improvement of instrumental diagnostic methods. Issues of etiology, pathogenesis, differential diagnosis of this disease and its possible connection with the paraneoplastic process currently continue to cause debate. Further accumulation of clinical experience, a better understanding of the pathogenesis of the disease, and improvement of imaging techniques will allow us to develop clearer diagnostic and clinical criteria, narrow the diagnostic search and, ultimately, improve and standardize treatment. The article provides a review of the literature on this rare surgical pathology, presents our own clinical observation, and discusses diagnostic issues and treatment options for this disease.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endovenous laser obliteration of the lower extremity veins: there is a time and place","authors":"D. S. Zubkov","doi":"10.21518/akh2024-017","DOIUrl":"https://doi.org/10.21518/akh2024-017","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 761","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Bogachev, O. A. Alukhanyan, G. N. Vanyan, S. M. Markin, A. S. Artemova, P. F. Kravtsov
Introduction. Despite modern advances in technologies for the treatment and prevention of varicose veins, there is currently no radical treatment for varicose veins. The probability of recurrence of dilated veins, according to various authors, ranges from 5 to 70%. Along with the well-established concept of recurrence of varicose veins, the term progression of varicose veins is increasingly common in everyday life.Aim. To study the current understanding of the term relapse and the practical attitude of specialists involved in the treatment of varicose veins to it.Material and methods. In 2023, a survey of 117 specialists on the recurrence/progression of varicose veins was conducted. The respondents were doctors involved in the treatment of varicose veins: vascular surgeons 22.4%, phlebologists 50%, general surgeons 19.8%, specialists in ultrasound/functional diagnostics 7.8%, X-ray endovascular surgeon 0.85%. The questionnaire included 18 questions regarding the frequency of visits of patients with relapse/progression of varicose veins; views on tactics, as well as the attitude of specialists to the issue of progression and recurrence of varicose veins in patients after its surgical treatment.Results and discussion. The concept of recurrence and progression of varicose veins among specialists dealing with this pathology is not always comparable. There are differences in views both on the predisposing factors for the recurrence of dilated veins, and, accordingly, on the tactics of treatment and preventive measures. In some cases, according to statistics, they are due to specialization.Conclusions. The incidence of relapse and progression at the reception of the respondents has a slight difference. Despite the fact that there are opinions that do not correspond to generally accepted and abhorrent collegiality, mostly specialists try to separate these concepts, see differences in provoking factors and, accordingly, in recommendations.
{"title":"Experts’ views on recurrence and progression of varicose veins","authors":"V. Bogachev, O. A. Alukhanyan, G. N. Vanyan, S. M. Markin, A. S. Artemova, P. F. Kravtsov","doi":"10.21518/akh2024-015","DOIUrl":"https://doi.org/10.21518/akh2024-015","url":null,"abstract":"Introduction. Despite modern advances in technologies for the treatment and prevention of varicose veins, there is currently no radical treatment for varicose veins. The probability of recurrence of dilated veins, according to various authors, ranges from 5 to 70%. Along with the well-established concept of recurrence of varicose veins, the term progression of varicose veins is increasingly common in everyday life.Aim. To study the current understanding of the term relapse and the practical attitude of specialists involved in the treatment of varicose veins to it.Material and methods. In 2023, a survey of 117 specialists on the recurrence/progression of varicose veins was conducted. The respondents were doctors involved in the treatment of varicose veins: vascular surgeons 22.4%, phlebologists 50%, general surgeons 19.8%, specialists in ultrasound/functional diagnostics 7.8%, X-ray endovascular surgeon 0.85%. The questionnaire included 18 questions regarding the frequency of visits of patients with relapse/progression of varicose veins; views on tactics, as well as the attitude of specialists to the issue of progression and recurrence of varicose veins in patients after its surgical treatment.Results and discussion. The concept of recurrence and progression of varicose veins among specialists dealing with this pathology is not always comparable. There are differences in views both on the predisposing factors for the recurrence of dilated veins, and, accordingly, on the tactics of treatment and preventive measures. In some cases, according to statistics, they are due to specialization.Conclusions. The incidence of relapse and progression at the reception of the respondents has a slight difference. Despite the fact that there are opinions that do not correspond to generally accepted and abhorrent collegiality, mostly specialists try to separate these concepts, see differences in provoking factors and, accordingly, in recommendations.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 387","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Development of venous pathology of the lower extremities is based on morphological changes in the vascular wall. Further structural restructuring of the vein wall in chronic venous insufficiency will depend on the initially present differences in the structure of their walls.Aim. To conduct a comparative analysis of morphological and morphometric features of the structure of the walls of the main venous collectors of the lower leg: the great saphenous vein, intramuscular veins, posterior tibia veins and poplitea vein.Materials and methods. Histological studies were carried out on autopsy material of the veins of 32 people who died from various causes aged 35 to 50 years and 10 amputated limbs. Morphological studies of the venous wall were carried out by light microscopy with digital photo processing.Results. A quantitative comparative analysis of morphological changes with the determination of the volume fraction of smooth muscle and connective tissue elements of various membranes of the venous wall, as well as measurement of the total thickness of the vascular wall and its ratio to the lumen of the veins showed statistically significant differences at a significance level of p < 0.05.Discussion. Despite the similarity of the general morphological picture of the structure of various venous collectors of the lower leg, structural differences were established, which concerned the volume fraction of the presence of both smooth muscle and connective tissue elements.Conclusion. The comparative qualitative and quantitative statistical analysis of morphological and morphometric features of the structure of the walls of the main venous collectors of the lower leg allows us to make an assumption about the unequal role of individual main venous collectors in the work of the muscular-venous pump of the lower leg as a whole.
{"title":"Comparative morphological and morphometric analysis of the structure of the wall of the calf venous collectors","authors":"A. B. Sannikov, O. N. Morozova, E. Shaydakov","doi":"10.21518/akh2024-012","DOIUrl":"https://doi.org/10.21518/akh2024-012","url":null,"abstract":"Introduction. Development of venous pathology of the lower extremities is based on morphological changes in the vascular wall. Further structural restructuring of the vein wall in chronic venous insufficiency will depend on the initially present differences in the structure of their walls.Aim. To conduct a comparative analysis of morphological and morphometric features of the structure of the walls of the main venous collectors of the lower leg: the great saphenous vein, intramuscular veins, posterior tibia veins and poplitea vein.Materials and methods. Histological studies were carried out on autopsy material of the veins of 32 people who died from various causes aged 35 to 50 years and 10 amputated limbs. Morphological studies of the venous wall were carried out by light microscopy with digital photo processing.Results. A quantitative comparative analysis of morphological changes with the determination of the volume fraction of smooth muscle and connective tissue elements of various membranes of the venous wall, as well as measurement of the total thickness of the vascular wall and its ratio to the lumen of the veins showed statistically significant differences at a significance level of p < 0.05.Discussion. Despite the similarity of the general morphological picture of the structure of various venous collectors of the lower leg, structural differences were established, which concerned the volume fraction of the presence of both smooth muscle and connective tissue elements.Conclusion. The comparative qualitative and quantitative statistical analysis of morphological and morphometric features of the structure of the walls of the main venous collectors of the lower leg allows us to make an assumption about the unequal role of individual main venous collectors in the work of the muscular-venous pump of the lower leg as a whole.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":" 1219","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux.Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.
{"title":"The effectiveness of minimally invasive surgical techniques for treating patients with chronic venous insufficiency in the stage of trophic disorders: comparative study","authors":"A. Khitaryan, K. Veliev","doi":"10.21518/akh2024-018","DOIUrl":"https://doi.org/10.21518/akh2024-018","url":null,"abstract":"Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux.Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"17 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141016876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Khitaryan, A. Abovyan, A. Mezhunts, A. Orekhov, R. V. Karukes, A. A. Rogut, V. Khitaryan
Introduction. Roux-en-Y gastric bypass (RYGB) is one of the most popular bariatric procedures. However, the Impact of alimentary and biliopancreatic loops lengths on the results of Roux-En-Y Gastric Bypass with a maximum restrictive component remains insufficiently studied.Aim. To compare the long-term results of RYGB with a maximum restrictive component at different lengths of alimentary and biliopancreatic loops.Materials and methods. Our retrospective study included 170 patients: 98 (57.6%) in the group with long alimentary and biliopancreatic loops, 72 (42.4%) in the group with short loops. Follow-up examinations were carried out with a follow-up period of at least 24 months (median follow-up 38 months). In the first group, the lengths of the alimentary and biliopancreatic loops were 150 and 100 cm, in the second group – 100 and 60 cm respectively. In the preoperative period, all patients underwent a standard set of examinations with an obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. The size of the gastroenteroanastomosis was assessed 12 months after surgery using fibrogastroscopy.Results. Both groups showed good results in weight loss and control of associated diseases. The prevalence of moderate sarcopenia in the group of RYGB with long loops was 24.5% (19.4% in the preoperative period), severe sarcopenia was observed in 3% of the subjects (initially severe sarcopenia was not detected in any patient). In the group of RYGB with short loops, the incidence of sarcopenia increased from 13 to 16% (the difference is statistically insignificant). No pronounced sarcopenia was detected in this group after surgery.Conclusion. If patients have signs of moderate sarcopenia according to bioelectrical impedance analysis, type 2 diabetes mellitus, as well as in the elderly, it is advisable to perform RYGB with a minimal malabsorptive and maximum restrictive component.
{"title":"Dynamics of sarcopenia after Roux-en-Y gastric bypass in patients with morbid obesity","authors":"A. Khitaryan, A. Abovyan, A. Mezhunts, A. Orekhov, R. V. Karukes, A. A. Rogut, V. Khitaryan","doi":"10.21518/akh2023-043","DOIUrl":"https://doi.org/10.21518/akh2023-043","url":null,"abstract":"Introduction. Roux-en-Y gastric bypass (RYGB) is one of the most popular bariatric procedures. However, the Impact of alimentary and biliopancreatic loops lengths on the results of Roux-En-Y Gastric Bypass with a maximum restrictive component remains insufficiently studied.Aim. To compare the long-term results of RYGB with a maximum restrictive component at different lengths of alimentary and biliopancreatic loops.Materials and methods. Our retrospective study included 170 patients: 98 (57.6%) in the group with long alimentary and biliopancreatic loops, 72 (42.4%) in the group with short loops. Follow-up examinations were carried out with a follow-up period of at least 24 months (median follow-up 38 months). In the first group, the lengths of the alimentary and biliopancreatic loops were 150 and 100 cm, in the second group – 100 and 60 cm respectively. In the preoperative period, all patients underwent a standard set of examinations with an obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. The size of the gastroenteroanastomosis was assessed 12 months after surgery using fibrogastroscopy.Results. Both groups showed good results in weight loss and control of associated diseases. The prevalence of moderate sarcopenia in the group of RYGB with long loops was 24.5% (19.4% in the preoperative period), severe sarcopenia was observed in 3% of the subjects (initially severe sarcopenia was not detected in any patient). In the group of RYGB with short loops, the incidence of sarcopenia increased from 13 to 16% (the difference is statistically insignificant). No pronounced sarcopenia was detected in this group after surgery.Conclusion. If patients have signs of moderate sarcopenia according to bioelectrical impedance analysis, type 2 diabetes mellitus, as well as in the elderly, it is advisable to perform RYGB with a minimal malabsorptive and maximum restrictive component.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"40 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138957255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. The conducted epidemiological studies show a significant socio-economic burden borne by modern society due to the high prevalence of varicose veins of the lower extremities among the able-bodied population of developed countries. Aim. Assessment ofthe influence ofthe factor of widespread use of minimally invasive inpatient replacement technologies on the prevalence of varicose veins of the lower extremities in a large region of the Central Federal District of the Russian Federation under the conditions of transformation of approaches to the treatment of varicose veins of the lower extremities. Materials and methods. A retrospective study was conducted for 2011–2021 of statistical indicators of the work of medical organizations of the Yaroslavl region, namely: the total number of attached adult population, the dynamics of the number of attached population, the total number and dynamics of the number of patients with an established diagnosis of varicose veins of the lower extremities. Results and discussion. The total population weight of the sample in the Yaroslavl region for all periods of the study was 11 406 181 people. The fixed weighted average value of the prevalence of varicose veins of the lower extremities at the end of the year in the Yaroslavl region in the period 2011–2021, according to medical organizations providing medical care on a territorial-precinct basis, was 0.784% (CI: 0.779–0.789). At the same time, in 2011–2012 and 2018–2019, the frequency of varicose veins of the lower extremities event was higher than the average value, in 2013–2016 and 2020–2021. Conclusion. It has been established that over the past decade there has been an annual decrease in the prevalence of varicose veins of the lower extremities in the region. At the same time, there was an increase in the share of medical care provided to patients by non-governmental medical organizations. The latter in their activities are focused on hospital-substituting technologies in the treatment of this disease.
{"title":"Inpatient substitution approaches to medical care and their impact on the dynamics of the prevalence of varicose veins","authors":"M. P. Potapov","doi":"10.21518/akh2023-037","DOIUrl":"https://doi.org/10.21518/akh2023-037","url":null,"abstract":"Introduction. The conducted epidemiological studies show a significant socio-economic burden borne by modern society due to the high prevalence of varicose veins of the lower extremities among the able-bodied population of developed countries. Aim. Assessment ofthe influence ofthe factor of widespread use of minimally invasive inpatient replacement technologies on the prevalence of varicose veins of the lower extremities in a large region of the Central Federal District of the Russian Federation under the conditions of transformation of approaches to the treatment of varicose veins of the lower extremities. Materials and methods. A retrospective study was conducted for 2011–2021 of statistical indicators of the work of medical organizations of the Yaroslavl region, namely: the total number of attached adult population, the dynamics of the number of attached population, the total number and dynamics of the number of patients with an established diagnosis of varicose veins of the lower extremities. Results and discussion. The total population weight of the sample in the Yaroslavl region for all periods of the study was 11 406 181 people. The fixed weighted average value of the prevalence of varicose veins of the lower extremities at the end of the year in the Yaroslavl region in the period 2011–2021, according to medical organizations providing medical care on a territorial-precinct basis, was 0.784% (CI: 0.779–0.789). At the same time, in 2011–2012 and 2018–2019, the frequency of varicose veins of the lower extremities event was higher than the average value, in 2013–2016 and 2020–2021. Conclusion. It has been established that over the past decade there has been an annual decrease in the prevalence of varicose veins of the lower extremities in the region. At the same time, there was an increase in the share of medical care provided to patients by non-governmental medical organizations. The latter in their activities are focused on hospital-substituting technologies in the treatment of this disease.","PeriodicalId":398195,"journal":{"name":"Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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