[Adjuvant phlebotrophic therapy and its effect on anti-inflammatory response after sclerotherapy]. / Ad'yuvantnaya flebotropnaya terapiya i ee vliyanie na provospalitel'nyi otvet posle skleroterapii.

The study was aimed at evaluating the degree of the systemic and local inflammatory reaction after sclerotherapy, as well as the effect of micronized purified flavonoid fraction (Detralex) thereupon. The study comprised a total of 60 female patients presenting with reticular veins and telangiectasias (clinical class C1 according to the CEAP classification). The patients were subdivided into two groups, each comprising 30 women. The Study Group patients two weeks prior to the forthcoming sclerotherapy had been taking Detralex prescribed at a daily dose of 1,000 mg whose administration was prolonged by not less than 2 months after the procedure. The Control Group patients received no drug. We determined the systemic and local levels of inflammatory markers, anti-inflammatory cytokines and growth factors: C-reactive protein in a highly sensitive range, histamine, interleukin-1, tumour necrosis factor alpha and vascular endothelial growth factor. Patients in the Study and Control Groups on day 10 after sclerotherapy demonstrated a considerable increase in the levels of anti-inflammatory cytokines and inflammatory markers. At the same time, excess of the baseline levels of the parameters in patients taking Detralex was statistically significantly lower as compared with the Control Group patients: C-reactive protein - 6.0±0.9 mg/l vs 8.3±1.0 mg/l; histamine - 87.0±9.8 µg/l vs 156.9±33.9 µg/l; interleukin-1 - 5.9±0.4 pg/ml vs7.6±0.6 pg/ml; tumour necrosis factor alpha - 5.9±0.9 pg/ml vs 7.5±0.4 pg/ml; vascular endothelial growth factor - 252.3±26.0 pg/ml vs 325.1±47.7 pg/ml. A conclusion was made that microsclerotherapy with the use of low-concentration detergent drugs was accompanied by a local vein-specific inflammatory reaction whose degree may be diminished by means of prescribing micronized purified flavonoid fraction (Detralex) two weeks prior to and during the whole subsequent period of phlebosclerosing treatment in a standard daily dose of 1,000 mg.

[Effect of angioprotective therapy with bioflavonoids on endothelial dysfunction in patients with acute venous thromboses]. / Vliyanie angioprotektivnoi terapii bioflavonoidami na disfunktsiyu endoteliya u bol'nykh s ostrymi venoznymi trombozami.

The study was aimed at evaluating a possibility of correcting endothelial dysfunction by means of angioprotective therapy with natural-origin bioflavonoids in patients presenting with acute venous thromboses. Ours was an open comparative prospective study including a total of thirty 34-to-60-year-old patients suffering from lower limb deep vein thrombosis. The patients were subdivided into two groups. The Study Group was composed of 15 patients receiving on the background of anticoagulant therapy with direct thrombin inhibitors (dabigatran etexilate at a daily dose of 300 mg) natural-origin angioprotectors (red grape leaf extract). The Control Group also consisted of 15 patients undergoing anticoagulant therapy with direct thrombin inhibitors alone. Blood sampling for laboratory monitoring [the quantitative level of von Willebrand factor (vWF) in blood plasma, integral assessment of the links of blood coagulation and fibrinolysis by means of thromboelastography] and ultrasonographic angioscanning of lower extremities were carried out in both Group twice: at the beginning of the study and 3 months after the beginning of therapy. The absolute majority of patients demonstrated a quantitative increase in vWF (the median in the Study Group amounted to 208.3%, being 190.0% in the Control Group, with the cut-off level equaling 140.8%). Assessing dynamics of the vWF level after 3 months on the background of using natural-origin flavonoids (the Study Group) showed a more pronounced decrease in the vWF level in the Study Group patients as compared with the Control Group patients (98.4%). Comparing the dynamic composite indices of the thromboelastogram revealed that with similar parameters in patients from the Study and Control Groups at admission, in dynamics there was observed greater growth of the level of indices of the process of dissolution of the fibrin clot (lysis) in the Study Group as compared to the Control Group. Also noted was more pronounced recanalization of the venous bed in patients taking the natural-origin bioflavonoid. A conclusion was drawn that including angioprotectors (red vine leaf extract) into the comprehensive therapy in order to correct endothelial dysfunction may improve the immediate results and terms of treatment of patients with acute venous thrombosis.

[On possible role of endothelial dysfunction in development of acute venous thrombosis].

The study included a total of 18 patients (12 women and 6 men, aged from 22 to 51 years, mean age 34 years) with newly onset unilateral acute thrombosis of deep veins in the system of inferior vena cava, confirmed by the findings of ultrasound duplex scanning. The patients had no apparent risk factors for venous thromboembolic complications, they had not used antiplatelet drugs during the last month and were characterized by a low level of risk for cardiovascular complications. Along with general clinical examination the patients were subjected to measuring the quantitative level of the von Willebrand factor (vWF), resistance to activated C-protein conditioned by V factor mutation, D-dimer, qualitative assessment of the level of C-reactive protein by a highly sensitive method, as well as integral assessment of the links of blood coagulation and fibrinolysis by means of thromboelastography. Eighteen (100%) patients had the vWF level above the norm, four (22.2%) patients were found to have resistance to activated C protein conditioned by factor V mutation, these patients had non-O (I) blood group. In twelve (66.7%) patients the quantitative level of D-dimer remained within the normal limits, and in 6 patients the D-dimer level was above the norm. The findings of thromboelastography demonstrated decreased activity of blood platelets. Fibrinolysis (LY30 and LY60) in the absolute majority of the examined patients was lowered. Six (33.3%) patients when comparing the LY30 and LY60 levels had no significant elevation of the index (<1%), four (22.2%) patients when comparing LY30 and LY60 showed an elevation of the index (>3.8%). The mean level of C-reactive protein (4.93 mg/l) exceeded the median of the reference values (2.5 mg/l) and in five (27.8%) out of 18 patients the value was two times higher than the reference ones. The obtained experimental data suggest that acute venous thrombosis is accompanied by alterations in the work of the coagulation and fibrinolytic systems, associated with endothelial dysfunction.

[Peculiarities of treatment of chronic venous diseases in Russia. Preliminary results of the "VEIN ACT Program"].

Presented herein are the results of the Russian part of the International Research Program "VEIN ACT" aimed at studying the structure of variants of conservative treatment for chronic venous diseases in the Russian Federation, assessing its efficacy and safety, as well as monitoring of patient compliance. The obtained findings demonstrated high popularity, among both physicians and patients, of phlebotrophic drugs, determining high patient's adherence thereto. Recommendations on correction of the lifestyle were complied with by more than 80% of patients, however frequently not in the full scale. Noted was sufficiently low compliance to compression therapy, manifesting itself as a decrease in the class of compression and irregular use thereof in more than 30% of patients. Usefulness of conservative therapy was objectively proved, consisting in satisfaction with treatment and a statistically significant decrease in severity of symptoms of chronic venous diseases in the overwhelming majority of patients.

Surgical correction of varicose vein disease under micronized diosmin protection (results of the Russian multicenter controlled trial DEFANS).

The paper presents the results of DEFANS trial (Detralex - assessment of efficacy and safety for combined phlebectomy). The study enrolled 245 patients with varicose vein disease, who underwent unilateral combined phlebectomy. The main group (n=200) received micronized diosmin (Detralex, 1000 mg/day) for 2 weeks before and 30 days after the procedure; control group (n=45) did not receive Detralex in pre- and postoperative period. Pain severity by 10-point visual analog scale (VAS), an area of subcutaneous hemorrhage in the zone of femoral great saphenous vein resection (by original 12-point scale) and subjective feelings of limb heaviness and fatigability were evaluated 7, 14 and 30 days after the procedure. Subjective symptoms and the area of subcutaneous hemorrhage were significantly lower in the main group, then in control: 7 days after the procedure VAS score was 2.9 and 3.5, respectively; hemorrhage area - 3.4 and 4.6 points, respectively. The same trend was observed for limb heaviness and fatigability, evidencing the better exercise and orthostatic tolerance among patients of the main group in early postoperative period. Quality of life assessment by CIVIQ failed to reveal statistically significant difference between main and control groups in 4-weeks postoperative follow-up. Micronized diosmin in pre- and postoperative period after plebectomy helps to attenuate pain syndrome, to decrease postoperative haematomas and accelerate their resorption, to increase exercise tolerance in early postoperative period.

[Elimination of major trunk reflux as a basis for surgical management of lower limb varicosity].

The article reviews the available literature data related to the problem of eliminating the blood reflux along the trunks of saphenous veins in lower limb varicosity. The authors have herein classified the literature-proposed interventions depending on the underlying principle, to have also carried out a detailed analysis of the data contained in the available Russian and foreign publications, as well as having considered technical peculiarities concerning different methods of removing veins, i. e., phlebectomy according to the Babcock technique, inversion venectomy, and cryophlebectomy. The article also deals with comparing therapeutic outcomes and a wide variety of postoperative complications involved. The role of the trunk catheter sclerosing therapy in comprehensive management of varicose disease is also discussed herein. Special attention is paid to the present-day techniques aimed at removing the trunk reflux, i. e., with the help of radio-frequency and laser-mediated obliteration. The currently available information about both advantages and disadvantages of these methods necessitates further studies aimed at searching for an optimal method (or a combination of methods) of removing one of the most important links of pathogenesis of varicosity.