[Comparative efficacy of various methods of treatment of chronic venous oedema in real clinical practice]. / Sravnitel'naia éffektivnost' razlichnykh metodov lecheniia khronicheskogo venoznogo oteka v real'noi klinicheskoi praktike.

AIM: The study was aimed at assessing efficacy and safety of micronized purified flavonoid fraction (MPFF, Detralex) in comprehensive treatment of chronic venous oedema induced by lower limb varicose veins. PATIENTS AND METHODS: We performed a post hoc analysis of the results of treatment of 708 patients included into the observational programme VAP-PRO-C3 (ClinicalTrials.gov. NCT03722836). These patients, depending on the type of treatment, were divided into 8 subgroups: MPFF (n=32); MPFF + compression (n=145); MPFF + compression + topical treatment (n=158); MPFF + compression + topical treatment + endovasal laser coagulation (n=197); MPFF + endovasal laser coagulation (n=3); MPFF + compression + endovasal laser coagulation (n=152), patients not receiving MPFF (n=16); MPFF + topical treatment (n=2). Due to paucity of the participants, from the subsequent analysis we excluded the groups MPFF + endovasal laser coagulation, patients not receiving MPFF (n=16) and MPFF + topical treatment. All further statistical data are shown for the remaining 687 patients. RESULTS: Comparing the groups of patients undergoing conservative treatment alone and those subjected to surgical intervention demonstrated no statistically significant differences in dynamics of crural oedema. In both groups at every subsequent visit there was a statistically significant decrease in the ankle volume (p<0.001). During the whole period of follow up the crural volume in patients from the group of conservative treatment totally decreased by 0.201±0.158 L and in the operated patients by 0.236±0.189 L (p=0.021). The QOL assessed by the CIVIQ-14 global index score statistically significantly improved in the unoperated patients from 31.5±19.2 to 12.0±10.1 (p<0.001). In the operated patients, the baseline and final values of the QOL of the global index score amounted to 33.4±17.8 and 7.7±9.2, respectively (p<0.001). In the groups with and without topical treatment, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 28.5±17.4 and 36.2±18.6, respectively. During the follow-up period, we observed statistically significant positive dynamics of all parameters of quality of life. The final visit demonstrated improvement of the CIVIQ-14 global index score to 9.4±9.2 in patients without topical treatment and 10.1±10.4 in those receiving topical treatment (p=0.367), with the mean value of this parameter during treatment in both groups decreased significantly (p<0.001). A statistically significant decrease in the ankle volume in both groups was registered at every visit, finally amounting to 0.223±0.166 L and 0.248±0.174 L (p=0.118) for patients not receiving and receiving topical treatment, respectively. In groups of patients not receiving and those receiving compression therapy, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 21.4±14.2 and 33.1±18.5 (p<0.001), respectively. At the final visit, these indices statistically significantly (p<0.001) decreased to 7.3±9.1 and 9.9±9.9 (p=0.106). Compared with the baseline values, the ankle volume at the final visit in groups of patients with and without compression therapy statistically significantly decreased by 0.187±0.14 L and 0.238±0.17 L respectively (p=0.204). During the study, there were no adverse events related to the administration of MPFF and use of Detragel. CONCLUSION: MPFF and Detragel appear to be effective and safe components of comprehensive conservative therapy of chronic oedema induced by primary varicose veins of lower extremities.

[Efficacy of micronized purified flavonoid fraction in treatment of chronic venous oedema]. / Éffektivnost' mikronizirovannoi ochishchennoi flavonoidnoi fraktsii pri lechenii khronicheskogo venoznogo oteka.

AIM: The purpose of the study was to assess efficacy and safety of using in real clinical practice micronized purified flavonoid fraction (Detralex) in patients with chronic venous oedema. PATIENTS AND METHODS: The study enrolled a total of 708 patients presenting with chronic venous disease, belonging to C3EpAsPr according to the CEAP classification (chronic venous oedema), who. depending on the accepted clinical practice by expert physicians were prescribed compression and phlebotropic therapy, as well as undergoing surgical interventions. The main criteria for efficacy of the micronized purified flavonoid fraction included the dynamics of chronic venous oedema, vein-specific symptoms, as well as the main parameters of quality of life. Assessment was made using visual analogue scales, the vein-specific questionnaire CIVIQ-14, and the method of discs for measuring the volume of the crus. RESULTS: The obtained findings demonstrated significant positive dynamics of the main vein-specific symptoms assessed by a visual analogue scale. When comparing between the visits of recruitment into the study and its termination the feeling of heaviness in calves decreased form 5.38±2.19 cm to 1.56±1.56 cm (p<0.001), pain in the calf diminished from 4.24±3.39 cm to 1.12±1.37 cm (p<0.001), feeling of oedema dropped from 5.68±2.44 cm to 1.38±1.59 cm (p<0.001), severity of nocturnal cramps fell from 2.46±2.30 cm to 0.43±1.01 cm (p<0.001), and intensity of skin inching from 1.46±2.06 cm to 0.43±1.01 cm (p<0.001). Positive dynamics of venous-specific symptoms appeared to be accompanied by significant improvement of all dimensions of quality of life according to the CIVIQ-14 scale: by the pain scale from 41.0±19.1% to 12.8±11.6% (p<0.001), by the physical condition scale - from 31.6±23.8% to 11.1±15.4% (p<0.001), by the psychological state scale - from 24.5±21.1% to 5.7±9.0% (p<0.001). The global index of quality of life also improved significantly from 32.4±18.5% to 9.9±9.9% (p<0.001). The results of the intervention along all the examined parameters (external appearance, possibility of wearing various clothes and increasing the quality of the self-performed work, to improve both interactions with surrounding people and the social activity and rest) turned out better than expectations form an intervention. The volume of the crus as the main criterion over the period of follow up averagely by the group decreased from 3.07±0.84 to 2.78±0.80 litres (p<0.001). A significant decrease in the calf volume from 3.03±0.87 to 2.77±0.85 litres was observed in 288 patients who during the follow up period were not subjected to surgical interventions, with no significant differences in the dynamics of chronic venous oedema revealed between the operated patients and those having received conservative treatment alone. DISCUSSION: According to a meta-analysis, the micronized purified flavonoid fraction (Detralex) turned out to possess better parameters in relation to therapy of chronic venous oedema as compared with other phlebotropic agents. Therefore, it appears absolutely logical to predominantly use the micronized purified flavonoid fraction in real clinical practice in patients with the CEAP C3 clinical class, which was registered in our study. An important result was also the fact that within the specified terms of follow up surgical intervention demonstrated no significant advantage over conservative therapy alone in treatment of chronic venous oedema. Moreover, conservative treatment in the form of a combination of compression and phlebotropic therapy demonstrated a dynamic decrease in the volume of the affected extremity with a probable transition of the CEAP C3 clinical class to C2. CONCLUSION: The micronized purified flavonoid fraction (Detralex) at a standard daily dose of 1000 mg in a combination with compression therapy irrespective of the surgical intervention performed resulted in a significant dynamic decrease in the volume of the calf in patients with chronic diseases of lower limb veins (C3EpAsPr according to the CEAP classification). An anti-oedematous effect of the micronized purified flavonoid fraction (Detralex) in a combination with compression manifests itself during the entire period of treatment.

[Additional possibilities in conservative treatment of patients with post-thrombotic disease of lower limbs]. / Dopolnitel'nye vozmozhnosti v konservativnom lechenii patsientov s posttromboticheskoi bolezn'iu nizhnikh konechnostei.

AIM: This study was undertaken to evaluate efficacy of Actovegin in the composition of comprehensive therapy in patients presenting with post-thrombotic disease of lower extremities free from trophic disorders. PATIENTS AND METHODS: The study included a total of 60 patients (28 men and 32 women) diagnosed as having post-thrombotic disease of lower limbs without trophic disorders (C1-C3 according to the CEAP classification), induced by previously endured iliofemoral phlebothrombosis. The duration of the disease varied from 1 year to 10 years. All patients for 10 days received Actovegin intravenously in drips at a dose of 1200 mg (30 ml of the drug reconstituted in 400 ml of normal saline) followed by continuing taking the drug orally in a daily dose of 1200 mg for 30 days. During the whole follow up period the patients wore class 2 compression stockings (RAL standard). The results of the carried out treatment in relation to the subjective complaints (pain, feeling of heaviness, convulsions, pruritus and paresthesias) were assessed by the visual analogue scale and based on the CIVIQ-20 questionnaire, with additionally measuring the malleolar circumference. RESULTS: On the background of the carried out therapy the patients demonstrated a significant decrease in the oedematous syndrome in the area of the ankles. This parameter decreased form 26.88±0.39 cm to 25.02±0.35 cm (p<0.05). The patients' complaints of tingling decreased form 5.73±0.79 to 2.32±0.68 points (p<0.05), the incidence and intensity of convulsions fell from 6.51±1.39 to 3.2±0.98 points (p<0.05). The intensity of the oedematous syndrome (swelling) decreased significantly from 8.11±1.75 to 4.33±1.20 points (p<0.05), the pain syndrome fell from 7.92±1.88 to 3.12±1.45 points (p<0.05), the feeling of heaviness in the lower limbs decreased from 8.52±1.73 to 3.91±1.48 points (p<0.05). Also, improvement of the general quality of life of patients was observed (the integral parameter decreased from 63.27±1.8 to 44.33±1.19 points, p<0.05).

[Local drugs in treating and decreasing the incidence of adverse reactions after sclerotherapy of telangiectasia]. / Mestnye preparaty v lechenii i snizhenii chastoty razvitiia nezhelatel'nykh reaktsii posle skleroterapii teleangiéktazov.

AIM: The purpose of the study was to assess efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® in decreasing the incidence and treatment of the most common local adverse reactions in patients after endured sclerotherapy of reticular veins and telangiectasias. PATIENTS AND METHODS: Our open prospective observational study included a total of sixty 18-to-35-year-old female patients who after undergoing standardized sclerotherapy of reticular veins and telangiectasias on symmetrical portions of lower limbs were given a tube of heparin sodium gel 1000 IU/g or Detragel® to be applied onto the skin of one (left) lower limb in the projection of the sclerotherapy-exposed vessels 2-3 times daily for 10 days followed by putting on a compression class 2 (RAL standard) stocking. The women were allowed to use only the paired stocking on the contralateral extremity. Efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® were evaluated based on the incidence of typical adverse reactions (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as on the patient's subjective perceptions. RESULTS: The use of heparin sodium gel 1000 IU/g and Detragel® in addition to compression after sclerotherapy of reticular veins and telangiectasias significantly and comparably decreased the incidence and accelerated the resolution of ecchymoses and phlebitides associated with phlebosclerosing treatment. The Detragel® group patients were found to develop hyperpigmentation or neovasculogenesis significantly less often as compared with the heparin sodium gel 1000 IU/g group women. What is more, using Detragel® was not accompanied by hyperkeratosis, pruritus or formation of a sticky film, the events, however, observed while applying heparin sodium gel 1000 IU/g. CONCLUSION: The use of Detragel® or heparin sodium gel 1000 IU/g for 10 days additionally to compression significantly decreased the incidence of typical undesirable reactions associated with sclerotherapy of reticular veins and telangiectasias. The Detragel® group women turned out to have lower incidence of hyperpigmentation and neovasculogenesis. Besides, Detragel® demonstrated better organoleptic properties.

[Perioperative administration of micronized purified flavonoid fraction in endovascular treatment of varicose disease]. / Perioperatsionnoe primenenie mikronizirovannoi ochishchennoi flavonoidnoi fraktsii pri éndovaskuliarnom lechenii varikoznoi bolezni.

AIM: The study was aimed at assessing efficacy and safety of using a micronized purified flavonoid fraction in the perioperative period in patients scheduled for endovascular surgical intervention for CEAP clinical class C2 lower limb varicose veins. PATIENTS AND METHODS: This study enrolled a total of 1519 patients with CEAP C2a,sEpAs (primary varicose vein with valvular incompetence of the great and/or small saphenous vein) who were subdivided into two groups. Group One included 1039 patients who in the perioperative period were prescribed a micronized purified flavonoid fraction at a daily dose of 1000 mg and who continued therapy, including visit 4. Group Two was composed of 480 patients taking no venoactive agents. The main criterion for assessing efficacy of the micronized purified flavonoid fraction was the incidence rate of typical adverse events in the compared groups of patients after surgical intervention. RESULTS: The patients receiving the micronized purified flavonoid fraction were found to have adverse events significantly less often as compared with those in the control group: ecchymosis 7.1 versus 11.0% (p=0.01), haematoma 0.5 vs 1.3% (p=0.1), paresthesia 0.5 vs 1.7% (p=0.02), thrombophlebitis 0.2 vs 0.6% (p=0.2), pigmentation 0.6 vs 3.3% (p=0.001), heat-induced thrombosis 0.3 vs 1.3% (p=0.02). The total incidence rate of adverse events in patients receiving and those not receiving the micronized purified flavonoid fraction amounted to 7.6 vs 15.0%, respectively (<0.001). DISCUSSION: The micronized purified flavonoid fraction prescribed in the perioperative period, owing to a pluripotent mechanism, adapts the venous system and microcirculatory bed of the lower extremities to operative stress, decreasing the anti-inflammatory response to endovascular intervention, lowering thereby the incidence of undesirable events. CONCLUSION: Prescription of the micronized purified flavonoid fraction in the perioperative period ensures a significant decrease in the incidence of typical adverse events developing after endovascular surgical treatment for CEAP clinical class C2 varicose veins and may be recommended for real clinical practice.

[Cryocompression sclerotherapy of reticular veins and teleangiectasias]. / Kriokompressionnaia skleroterapiia retikuliarnykh ven i teleangioéktazov.

Compression serves as an important component for carrying out successful and safe phlebosclerosing treatment. At the same time, the necessity of wearing compression hosiery or bandages is associated with known limitations and objections of patients, especially in a hot season. We comparatively assessed efficacy of usual compression stockings and a short-term pneumatic bandage with cryoelements while carrying out sclerosing treatment of dilated intradermal veins. Our open prospective observational study included a total of fifty 18-to-35-year-old women. After performing standardized sclerotherapy of reticular veins and telangiectasias on the symmetrical portions of the lower limbs, a pneumatic cryocompression bandage with a pressure of 50 mmHg was applied onto one of the limbs for 15 minutes, with a class 2 compression (RAL standard) medical stocking put on the other limb to be worn by the patients at daytime for 10 days. We assessed completeness of obliteration of the target veins, frequency of the development of typical undesirable events (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as the composite discomfort score according to an 11-point visual analogue scale. It was determined that using the pneumatic bandage with cryoelements as compared with the traditional compression stockings significantly decreased the frequency of the development of typical undesirable events after phlebosclerosing treatment, such as formation of ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis. Significance of differences was revealed as early as 7 days after sclerotherapy, to be increasing during further dynamic follow up. By convenience for the patients, the use of the short-term pneumatic cryobandage was four times better than wearing the compression stockings. A conclusion was drawn that while carrying out sclerotherapy of reticular veins and telangiectasias short-term pneumatic cryocompression by efficacy and safety was not inferior to the traditional medical stockings (RAL standard) and made it possible to significantly decrease the incidence of the known undesirable events after phlebosclerosing treatment.

[Detralex-phlebosclerosing treatment. Results of the national multicenter follow up programme VEIN ACT PROLONGED-C1]. / Detraleks - fleboskleroziruiushchee lechenie. Rezul'taty natsional'noi mnogotsentrovoi nabliudatel'noi programmy VEIN ACT PROLONGED-S1.

Presented herein are the results of the observational follow up study programme dedicated to the assessment of appropriate use of adjuvant therapy with Detralex while carrying out phlebosclerosing treatment in patients suffering from dilated intradermal veins (clinical class C1 according to the CEAP classification). A conclusion was drawn that administration of Detralex for 60 days decreased the incidence rate of typical undesirable side events after phlebosclerosing therapy, thus making the use of this drug appropriate in routine clinical practice.

[Efficacy of sulodexide in treatment of chronic venous insufficiency. Results of the ACCORD trial]. / Éffektivnost' sulodeksida pri lechenii khronicheskoi venoznoi nedostatochnosti. Rezul'taty issledovaniia ACCORD.

OBJECTIVE: The purpose of our study was to evaluate both clinical and laboratory efficacy of sulodexide given at a daily dose of 500 lipasemic units (LSU) in patients presenting with class C3-C4 chronic venous insufficiency (CVI) according to the CEAP classification. PATIENTS AND METHODS: The study included a total of 25 patients diagnosed with C3-C4 CVI and prescribed to receive sulodexide at a daily dose of 500 LSU for 90 days. Efficacy was comprehensively controlled by the following tools: the disease-specific Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), visual-analogue methods of assessment separate symptoms; the Venous Clinical Severity Score (VCSS), as well as ultrasonographic determination of the thickness of subcutaneous fat and crural fascia. Amongst the key laboratory indices determined by means of the ELISA test were the levels of interleukin-1 alpha (IL-1α), interleukin-1 beta (IL-1ß), matrix metalloproteinases-2 and -9 (MMP-2, MMP-9), vascular endothelial growth factor A (VEGF-A), vasopressin and endothelin. RESULTS AND DISCUSSION: Of the initially enrolled 25 subjects, twenty-two patients completed the study and were taken as 100%. The 90-day treatment yielded favourable results manifesting themselves in complete disappearance of convulsions in the calf muscles detected at the first visit in 22.7% of patients (p=0.0485), a significant reduction in the frequency of complaints of decreased tolerance to static loads from 27.3 to 9.1% (p=0.2404). The volume of the crus of the control lower extremity decreased from 134.18±14. 92 to 128.42±12.46 cm3 (p=0.0006), subcutaneous fat thickness at the fixed point decreased from 1.50±0.53 to 1.32±0.46 cm (p=0.0007), and fascial thickness decreased from 0.14±0.7 to 0.11±0.04 (p=0.0359). Pain syndrome according to the visual analogue scale (VAS) decreased from 36.45±25.60 to 17.50±19.27 mm (p=0.0002). The global index of quality of life (GIQoL) according to the CIVIQ-20 increased by 27.7% compared with the baseline level (p = 0.0001), the VCSS index decreased from 6.00±1.83 to 4.86±2.05 points (p=0.0002). as for the laboratory markers of endothelial dysfunction, there was a significant decrease in the levels of MMP-2 - from 178.53±36.30 to 176.35±36.67 ng/ml (p=0.0152), MMP-9 - from 90.84±20.41 to 89.78±20.32 ng/ml (p=0.0394), and that of endothelin - from 0.42±0.10 to 0.39±0.10 fmol/ml. CONCLUSION: Sulodexide exerting a statistically significant clinical and endothelium-protecting effect turned out to be an effective drug for treatment of initial forms of chronic venous insufficiency of lower limbs.

[Efficacy of compression knee-high socks ULCER X in treatment of venous-genesis trophic ulcers].

UNLABELLED: The study was aimed at comparatively assessing the efficacy of treatment for venous trophic ulcers at stages II-III of the wound process using special compression knee-length socks of the ULCER X kit (Sigvaris AG, St. Gallen, Switzerland) and long-stretch bandages Lauma. Compression therapy was included into the programme of outpatient treatment of forty 31-to-74-year-old patients presenting with trophic ulcers (stage II-III of the wound process) with an average area of 5,36±1,1 cm2. The Study Group consisting of 20 patients used compression knitted fabrics in the form of knee-length socks ULCER X and the comparison group (n=20) used long-stretch bandages Lauma. RESULTS: The obtained findings (6 months) demonstrated that using compression therapy exerted a positive effect on the process of healing of venous trophic ulcers, also proving advantages of compression therapy with the knee-length socks ULCER X that create an adequate level of pressure on the crus and maintain it in long-term daily use, reliably accelerating the healing of venous trophic ulcers as compared with elastic long-stretch bandages. The use of long-stretch elastic bandages in treatment of venous trophic ulcers turned out to be not only ineffective but fraught with a possibility of the development of various complications. During 6 months of follow up the patients using the special knee-length socks ULCER X were found to have 80 % of ulcers healed (16 patients), mainly within the first 2 months, whereas using elastic bandages resulted in only 30 % of healing (6 patients) by the end of the study. Along with it, we documented a considerable decrease in the malleolar circumference in the study group patients (from 30,05±0,78 to 28,35±0,86 cm) and in the control group from 31,2±30,35 to 30,25±0,75 cm), accompanied and followed by more than a two-fold increase in quality of life of the patients along all the parameters in the study group and a 1.4-fold increase in the control group patients.

[Bioflavonoids and their significance in angiology: focus on diosmin].

The article deals with historical information dedicated to the discovery of bioflavonoids and their effect on the human cardiovascular system, also considering the modern classification of phlebotrophic agents, followed by generalization and analysis of their mechanisms of action, as well as detailed discussion of different forms of diosmin. Summing up contains generalization of the Russian, European, and American guidelines on using phlebotrophic drugs for various forms and stages of chronic venous diseases.

[Cardiac pathology and autonomic dysfunction in patients with vertebral and spinal cord injury].

The disturbances of cardiovascular function were examined in 103 patients with vertebral and spinal cord injury. To evaluate myocardial conduction time and regulation of heart rate we used the method of spiroarteriocardiorythmography. Comparative power spectral and time domain analyses of heart rate variability were carried out in patient and healthy individuals. The autonomic nervous system dysfunction revealed in patients result in severe cardiovascular complications and is associated with high risk of heart diseases.

[On advisability of perioperative phleboprotection in endovascular treatment of lower in varicose disease: first initial results of the decision study].

Presented in the article are the results of the DECISION multicenter study dedicated io assessment of efficacy and feasibility of using the phlebotropbic drug detralex in the perioperative period in patients undergoing endovascular treatment of lower limb varicose discase. The study comprised a total of 230 patients presenting with chronic venous disease. (CVD) C2-4s according the CEAP classification, each of these had not less than three CVD- related symptoms. All patients were randomly assigned to the Study Group (126 people) and the Control Group (104 subjects). The Study Group patients 2 weeks prior to endovascular treatment and during 4 weeks thereafter took the phlebotrophic drug detralex at a standard daily dose of 1,000 mg. The Control Group patients received conventional compression thernpy using compression bandages or medicinal knitted fabric. The findings of the statistically processed results in the both groups demonstrated a significant decrease in the CVD severity score according to the VCSS scale and an increase in the quality of life parameters according to the disease-specilic questionnaire CIVIQ-14. While so doing, more pronounced dynamics was observed in patients taking detralex during the perioperative period. Besides, there was synergism between the results of the endovascular intervention and therapeutic effects from detralex. Based on the findings obtained in the present study, the authors made a conclusion on feasibility of using the drug detralex as an agent for nonspecific pharmacological protection in endovascular treatment of varicose disease.

[Participation of leucocytes in pathogenesis of primary forms of lower limb chronic venous disease].

AIM: The purpose of the study was to test the hypothesis on participation of WBCs in damaging the venous wall in patients presenting with primary forms of lower limb chronic venous diseases LLCVD . MATERIAL AND METHODS: The study included a total of fifteen consecutively selected patients (13 women and 2 men) diagnosed as having grade C2-C-4 LLCVD according to the CEAP classification. Static loading (30 minutes in the sitting position) was followed by simultaneous sampling of blood from the varicose vein of the cms and ulnar vein. The total blood count including determination of both the absolute values and percentage of blood formed elements was performed using the automated haematological counter «Advia 7¼ («Bayer¼, USA). The obtained findings were statistically processed using the Microsoft Office Excel software by means of the pared two-sample τ-test for the average values. RESULTS: The number of leukocytes and their subpopulations in blood samples obtained from the crural varicose veins turned out to be significantly less as compared with that in blood sampled from the ulnar vein. Thus, blood sampled from the crural varicose veins demonstrated a decrease in the counts of WBC by 9.6% in fourteen (93.3%) patients, that of neutrophils by 4.9% in twelve (80%) patients, that of lymphocytes by 16,8% in fifteen (100%) patients, and that oi monocytes by 24% in twelve (80%) patients. The mentioned differences were statistically significant at a = 0.05. The eosinophilic counts in blood sampled from the upper and lower extremities appeared similar in 66.7% of the examined subjects. In 33.3% of cases the eosinophilic count in blood samples from crural varicose vein was by 16.7% lower than that for blood samples form the ulnar vein. No differences for the rest parameters of the clinical blood count were revealed. CONCLUSION: The absolute lymphocytic count in the blood samples taken after the 30-minute static loading from the crural varicose veins was significantly lower as compared with that in blood sampled form the cubital vein. The counts for RBCs and blood platelets, as well as other qualitative haematological indices (haemoglobin, haematocrit, average volume of the RBC, erythrocytic diameter, etc.) in blood sampled form crural and ulnar veins in the same patient were identical, thus strongly suggesting the lack of either haemodynamic or haemorheological phenomena capable of leading to redistribution of the blood formed elements in varicose veins. Hence a decrease in the counts of leukocytes and their subpopulations in blood sampled from crural varicose veins might be associated with the «leukocytic trap¼ phenomenon.

[Pharmacotherapy of chronic venous diseases in the light of the Russian and International Guidelines].

The article reviews present-day data on pathogenesis of chronic venous diseases, as well as formulates the strategic missions of treatment, with an emphasis placed on the criteria ol evidence-based medicine, followed by critically analysing the standards of pharmacotherapy of chronic venous diseases, reflected in the European, American and Russian clinical guidelines. A conclusion is drawn on the necessity and advisability, from the point of view ol evidence-based medicine, of using phlebotropic drugs in patients suffering from various forms of chronic venous diseases.

[Review of the proceedings of the 11th Conference of the European Venous Forum (June 24-26, 2010, Antwerp, Belgium)].

The authors reviewed herein the proceedings of the 11th Conference of the European Venous Forum held under the badge of a more and more significant effect of the positions and principles of evidence-based medicine on the life of the European Phlebological Community. This concerned both the representative reports and special subject lectures dedicated to the statistical analysis in surgery and phlebology, as well as assessment of the remote outcomes of surgical management of venous chronic diseases. Also analysed herein are the materials devoted to the modern minimally invasive techniques aimed at obliterating major veins and used in randomized studies. Presented at the Congress were initial results of employing a novel technique of thermoregulation using steam. Also analysed are the reports concerning interrelationship between phlebology as a science and mass media including the World Wide Web.

[Pain and other symptoms of chronic venous diseases: pathophysiology and therapeutic principles].

The literature review presented herein analyses the mechanism of the development of pain and othersubjective signs and symptoms in chronic venous diseases. Also discussed are numerous findings suggesting a pivotal role played by the leukocytic-endothelial inflammatory reaction as the main stimulator of the nociceptors of the venous wall and paravasal tissue, resulting information of the pain syndrome. This is followed by substantiating the necessity of early initiation of comprehensive conservative therapy making it possible to block the molecular and cellular mechanisms damaging the venous wall and microcirculatory bed in patients presenting with various stages of venous chronic diseases.

[Surgical pathology of lower limb veins: from pathogenesis to prevention and management].

The paper reviews modern epidemiological, experimental and clinical data on chronic diseases of lower limb veins. In particular the latest data on pathogenesis of variceal disease and chronic venous insufficiency are discussed along with their relation to leukocytic-endothelial interactions.

[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.

Trophic venous ulcers and their relationship with the immune status.

This paper describes the results of an original study into the systemic and local immunity in 25 patients with trophic venous ulcers. The authors discovered a number of significant parameters demonstrating the influence of the immune status on the formation of venous ulcers and tempo of their healing. They revealed previously unknown relationships between the immune status, clinical manifestations arid natural history of venous ulcers. Presented herein are the first results of the local use of the immunomodulator gepon and evidence for its efficacy in the treatment of chronic trophic venous ulcers.

[Phlebology today and tomorrow. Review of the materials presented at the 15th World Congress of the Phlebologists (IUP)].

In addition to reviewing the traditionally presented printed matter, the article contains the information about the most interesting events including lectures, symposia, round tables and master-classes held within the framework of the 15th World Congress of the International Union of Phlebologists.