[How real is the prevention of postoperative venous thromboembolic complications].

The article represents the results of the Study "The safety territory of venous thromboembolic complications". 59 surgical hospitals took part in the multi-centered study. The risk assessment of the venous thromboembolic complications and prevention measured were analyzed in 53, 596 patients.

[Remote outcomes of endoscopic dissection of crural perforating veins in chronic venous insufficiency].

We studied the long-term results following endoscopic dissection of crural perforating veins (EDCPV) in chronic venous insufficiency. The study comprised a total of 36 patients (41 lower limbs) who had endured the intervention concerned. The term having passed from the time of the operation till the moment of assessing the obtained outcomes varied from I to 10 years. Ultrasonographic angioscanning within the zone of the previous intervention revealed 38 perforating veins on 3.1 of the postoperative lower limbs (75.6 %). Amongst the veins revealed, most frequently encountered were Cockett's perforants (the so-called Cockett II) in the typical place - the lower third along the medial surface of the crus (29 cases). In five cases, perforants were revealed in the middle third of the crus, which located in the close proximity from the edge of the tibia (Cockett III). Perforants on the posterior crural surface were revealed on four extremities. Only 22 veins on 20 lower limbs (48.8%) turned out incompetent. The median access to perform EDPCV was used in 28 cases (68.3%); within the zone of the operative intervention performed we found 24 perforating veins, with 15 of these being incompetent. After EDPCV performed from the posterior or posterior-medial approaches on 13 limbs (317%), we revealed 14 perforating veins (of these, 7 - incompetent). Despite this, the patients regarded the effect obtained as either good or satisfactory in 79% of cases. The obtained findings suggest that thorough diagnosis of perforating reflux and improvement of the technique of endoscopic dissection thereof should be required. Along with it, it is also necessary to attentively examine the problem of the true role of the low vein-venous shunt in the pathogenesis of vein chronic diseases.

[A relapse of lower-limb varicose disease: definition, diagnosis and causes of pathology (review of literature)].

Current trends are towards a permanent growth of the number of patients presenting with a relapse of lower-limb varicose disease (RVD). According to the data of various investigators, from 5 to 80 % of postoperative patients develop RVD. Despite the close attention paid over decades to this problem by phlebologists of all the world over, there is no common interpretation of the notion "relapse of varicose disease". Recommendations on carrying out examination are of too general character and do not take into consideration the necessity of maximal individualization of therapeutic policy. Attention is attracted by a wide variety of the data concerning the causes of RVD with considerable differences as to the percentage ratio thereof. All this results in various readings when assessing the outcomes of different therapeutic methods, as well as hampers development of a unified therapeutic policy. It is necessary to eliminate terminological ambiguity, to be followed by devising a present-day diagnostic and therapeutic policy in RVD. The structure and classification of the causes leading to development of a relapse should also be studied, especially in the light of using novel, including minimally invasive technologies.

[Unadequate ostial ligation of the great saphenous vein as the cause of varicose disease reccurence].

Authors investigated the frequency of varicose disease recurrence after crossectomy, classified clinical types and proposed the tactics of treatment of this group of patients. 258 patients with varicose disease recurrence were examined and operated. In 179 cases (69,4%) there were found differ pathological changes in the place of saphenofemoral junction, which were collected in several groups. Pathological stump of the great saphenous vein was in 155 lower limbs (60,1%). 12 patients (4,7%) had not ligated saphenofemoral junction. And in 12 patients (4,7%) there were found signs of neoangiogenesis. We proposed the scheme of tactical actions in cases of pathological changes in the place of saphenofemoral junction. The absolute indication for surgery is present saphenofemoral junction and trunk of the great saphenous vein. Furthermore, recection of vein's stump is necessary if its length is more 3 cm, that always combined with varicose tranformation of the varicosities. If the linear size of stump is from 1 to 3 cm its resection have to be done only in case of considerable varicosities. In not severe lesions of varicosities it is enough to perform sclerotherapy or mini-phlebectomy of involved vessels. There is not necessary to surgery if the stump is short (less 1 cm). In this case the phlebosclerotherapy or mini-phlebectomy of varicosities are expedient. The method of choice for removal of neoangiogenesis is phlebosclerotherapy. Our results showed that treatment of patients with varicose disease recurrence is in special phlebological centers or vascular departments and improvement of technique of Troyanov-Trendelenburg operation.