[Truncal mechanochemical versus thermal endovenous ablation for varicose vein disease: a systematic review and meta-analysis]. / Sistematicheskii obzor i metaanaliz rezul'tatov primeneniya stvolovoi mekhanokhimicheskoi i termal'noi obliteratsii u patsientov s varikoznoi bolezn'yu.

OBJECTIVE: To compare the outcomes of thermal and mechanochemical endovenous ablative techniques in patients with varicose veins. MATERIAL AND METHODS: We searched the PubMed, EMBASE and Cochrane Library databases for studies devoted to mechanochemical and thermal endovenous ablative techniques from inception until July 2021. The primary outcome was anatomical success. Secondary endpoints were intraoperative pain syndrome, complications, modification of disease severity and quality of life. RESULTS: This meta-analysis enrolled 10 comparative studies and 1.252 participants after truncal ablations. The follow-up period ranged from 4 weeks to 36 months. With regard to overall anatomical success, 245 out of 267 (91.8%) patients after mechanochemical ablation and 249 out of 266 (93.6%) patients after thermal ablation had favorable results after a month (low-quality evidence; odds ratio [OR] 0.79; 95% CI 0.40-1.55). No statistical heterogeneity was identified (χ2=1.48; df=2; p=0.48; I2=0%). Further analysis identified different incidence of total occlusion after 12 months or later (OR 0.36; 95% CI 0.11-1.21; p=0.05; I2=68%). Mechanochemical ablation resulted less intraoperative pain. Mean difference was -1.3 (95% CI -2.53- -0.07; p=0.00001). MOCA was followed by fewer incidence of nerve injury, hematoma, deep vein thrombosis and phlebitis. There were more cases of skin pigmentation compared to thermal ablation (low-quality evidence, p>0.05). Subsequent assessment of disease severity identified significant between-group difference of means (-0.64 (95% CI -1.82-0.53; p=0.004) and -0.16 (95% CI -0.43-0.11; p=0.005) after 6 and 12 months, respectively). Further assessment of quality of life revealed no between-group differences. These data were characterized by moderate methodological quality. CONCLUSION: Mechanochemical ablation is as effective as standard TA within the first postoperative month. However, this approach is associated with lesser anatomical success after 12 months. In most studies, pain syndrome was less severe in case of mechanochemical ablation. These data suggest that mechanochemical ablation is a safe alternative for varicose veins. However, further large-scale trials are required to define the role of MOCA.

[Review of materials XVII World Congress of the International Union of Phlebologists (Boston, Massachusetts, USA, 2013)].

The article contains a review of the materials presented at the XVII World Congress of the International Union of Phlebology held in Boston in September 2013. Analysed herein are the opinions and experience of phlebologists from various countries. The contributors discussed various aspects of using foam sclerotherapy and thermal methods of ablation, briefly representing the results of studies concerning thromboses and embolisms, anatomy of veins and methods of ultrasound examination, epidemiology of chronic venous diseases (CVDs), relapses of varicose veins, pharmacotherapy of CVDs, etc.

[Results of ultrasound-guided foam sclerotherapy of the great saphenous vein according to the improved technique].

Foam sclerotherapy is an innovative method of treatment for varicose disease, including its truncal forms, making it possible in outpatient conditions to achieve favourable therapeutic and cosmetic outcomes. Analysed herein are the results of foam sclerotherapy of the great saphenous vein (GSV) and its tributaries in a total of 326 patients presenting with varicose disease of lower limbs (395 GSVs) according to the improved methodology (elevation of the extremity to 60°, crural bandage, use of a cooled sclerosant solution). 6-14 days after the first session of sclerotherapy, the control ultrasound examination confirmed occlusion of the GSV in its femoral segment with no reflux in 94.9% of cases (375 GSVs). At terms from 1 year to 5 years, occlusion was diagnosed in 91.1% of cases. Besides alterations in the ultrasound image of the venous superficial bed of the limb and reduction of the trunk of the GSV and its affluents, there was positive dynamics of the clinical symptomatology of the disease.