RESULTS OF TREATMENT OF DEEP VEINS THROMBOSIS IN PATIENTS WITH CONGENITAL ANOMALIES OF THE INFERIOR VENA CAVA.

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the inferior vena cava. Congenital anomalies of IVC development are a rather rare pathology. The analysis of treatment results will better understand the pathophysiology of the disease and form an optimal treatment strategy. We analyzed the results of treatment of 1243 patients with venous thromboembolism from 2010 to 2022. Congenital anomalies of inferior vena cava(IVC) development were diagnosed in 2 (0.16%) patients. One patient had IVC aplasia, the other had IVC hypoplasia. Both patients had bilateral iliofemoral deep vein thrombosis(DVT). For the treatment of patients, we used anticoagulant therapy and elastic compression of the lower extremities. During the study period, venous thromboembolic complications in the form of pulmonary embolism were not recorded, fatal complications were not diagnosed. Thus, the results of treatment of patients with venous thromboembolism and anomalies in the development of IVC suggest that the use of anticoagulant therapy in this category of patients allows to obtain positive results of treatment.

[Role of perforating veins in occurrence of varicose disease and its recurrences after surgical interventions].

The blood horizontal reflux via insufficient perforating veins (PV) from the deep venous system into subcutaneous one is considered an important factor of formation of chronic venous insufficiency in varicose disease (VD) and its recurrences (VDR). The role of PV in a VD progressing and in a VDR postoperatively in 774 patients, operated on for primary VD and 243 - VDR, is discussed. While determining significance of the blood horizontal reflux and substantiation of necessity for the PV ligation there must be taken into account the data of the colour duplex scanning concerning their valve apparatus state and clinical estimation of the disease severity.

[Thrombotic complications in severe forms of varicose disease: diagnosis, surgical treatment, using miniinvasive methods].

Actual issues of surgical treatment of patients, suffering complications of varicose disease severe forms, are discussed. The causes of unsatisfactory results of treatment of patients, suffering varicothrombophlebitis, the main of which is the absence of common tactics of operative treatment and anticoagulant therapy, were analyzed. There were formatted the groups of patients, suffering severe forms of varicose disease of various localization of thrombotic process, a differentiated tactics of their surgical treatment was proposed.

[Thrombotic complications of severe forms of varicose disease: modern approach to diagnosis and treatment of hereditary thrombophilia and immunohistochemical peculiarities of vascular wall].

Experience of treatment of 176 patients, suffering thrombotic complications of severe forms of the lower extremities varicose disease (VDLE), was analyzed. In 20 patients, suffering varicothrombophlebitis (VTHPH) in severe forms of VDLE, morphological and immunohistochemical changes in the venous wall and surrounding tissues were studied. There were examined 28 patients, in whom thrombotic complications of the VDLE have had occurred, using diagnostic complex "PLR genetics thrombophilia". Recurrent course of thrombotic complications and coexistence of VTHPH and thrombosis of deep veins have had constitute the main criterion of such patients selection. The groups of patients, suffering severe forms of VDLE, were delineated, depending on thrombotic process localization, differentiated tactics of their surgical treatment was proposed.

[Patient care in programmed relaparotomy].

The authors have analyzed the results of treatment of 35 patients, in whom theylaparostoma put on. The mortality have constituted 45.7%. The attention was drawn on technical aspect of laparostomy establishment and closure, the issues of intestinal tubage and quantity of laparosanation conduction were discussed.

[Venous forms of the inborn vascular malformations of the lower extremities. Diagnosis and surgical treatment].

Pathogenetically substantiated approach, using surgical, laser and echosclerosing methods, was applied for improvement of the treatment results in patients, suffering venous forms of the inborn vascular malformations of the lower extremities. The results of examination and treatment in 2006-2009 period were analyzed in 98 patients. The stem malformations with superficial venous system affection was diagnosed in 59 (60.2%) patients, the same with a deep venous system affection--in 27 (27.6%), the extrastem affections--in 7 (7.1%) and the combined malformations--in 5 (5.1%). There was differential tactics of the surgical treatment used together with combination of original surgical procedures, newest laser methods and sclerotherapy, which have permitted to achieve satisfactory late results in 73 (74.5%) patients. Poor results in 25 (25.5%) patients were caused by the pathological process spread and proliferative activity of malformation, what was confirmed by immunohistochemical and morphological investigations data.

[Sclerotherapy in surgical correction of varicocele].

The method of intraoperative sclerotherapy, using 40% glucose solution, for varicocele surgical treatment was proposed. Diathermocoagulation of all visible accompanying veins was conducted for reduction of the varicocele recurrence rate. The recurrence is reduced to 6.6%.

[Gangrene of Fournier, treatment, classification].

The experience of treatment with favorable outcome of 3 patients, in whom gangrene of Fournier was diagnosed, was summarized.The necessity of application of "agressive" surgical tactics in early terms of the disease was stressed.

[Possibilities of reconstructive plastic surgery in the treatment of vascular malformations of the head region].

Results of treatment of 19 patients, suffering vascular malformation of the head region, were analyzed. Application of a new highly informative diagnostic methods of surgical intervention differential methods have promoted significant clinical improvement.

[Surgical treatment of persisting chylothorax].

Results of surgical treatment of 8 patients, suffering chylothorax, persisting during 1-14 months are presented. The desease have appeared also resistant to complex conservative treatment trial. This kind of treatment was conducted with simultaneous intensive preoperative preparation, surgical intervention consisted of open thoracotomy with thoracic duct suturing and ligature. The operative treatment had appeared primarily ultimately successful in 5 (62.5%) patients, and after postoperative pleurodesis conduction--in 3 (37.5%). One week of intensive conservative therapy trial with simultaneous preoperative preparation and subsequent shift to surgical intervention constitutes an optimal tactical principle in the persisting chylothorax treatment.

[Noncomplicated varicose disease: morphological peculiarities, the ways of reflux spread].

The studying results of anatomical variants of the leg large subcutaneous vein (LLSV) and its tributaries structure are adduced, the possible ways of the blood reflux spread are determined. The authors present anatomical classification of varicose disease of the LLSV basin, the epidemiology data of the disease forms incidence are adduced.

[Retrospective analysis and modern concept of treatment of the limbs lymphoedema].

Lymphoedema--is a chronic disease, characterized by the volume enhancement of some part of body, more often--of the limbs, as a consequence of tissues oedema, caused by the lymphatic system transport and resorptive function disorder. Modern approaches to lymphoedema treatment foresees combination of conservative and surgical ones, for example, microsurgical, taking into account the oedema character, stage of the disease, the previous treatment efficacy.

[Clinical and ultrasonographic diagnosis of angiodysplasia].

Diagnosis and treatment of the inborn angiodysplasia constitutes the complex problem of vascular surgery. Of the multiple causes, conditioned by such the state of the issue, it is necessary to stress such as unsatisfactory knowledge of physician, the absence of strict diagnostic criterions, the attempts of the pathology elimination by specialists of various disciplines. The aim of the investigation was to determine the principal clinical and ultrasonographic criterions, permitting to reveal vascular malformation rapidly and objectively, to differentiate its type, the spreading, to characterize hemodynamical disorders.

[Varicose disease: classification and ultrasonic diagnosis]. / Varikoznaia bolezn'. Klassifikatsiia, ul'trazvukovaia diagnostika.

Results of clinical examination and ultrasonic investigation in 478 patients with varicosic disease (VD) of lower extremities are adduced. Basing on the data obtained the clinicoanatomic forms of VD were deliniated. The typical and nontypical forms diseases criterions of ultrasound diagnosis were determined. It was demonstrated that the choice of the surgical treatment tactics in patients with VD depends on its clinicoanatomic form, and the principal method of diagnosis is the color duplex scanning.

[Current possibilities of the diagnosis and surgical treatment of acute thrombophlebitis and severe forms of varicose disease]. / Sovremennye vozmozhnosti diagnostiki i khirurgicheskogo lecheniia ostrogo tromboflebita i tiazhelykh form varikoznoi bolezni.

The data on examination and surgical treatment of 35 patients, suffering severe forms of varicose disease in stage of trophic disorders occurrence and with an acute thrombophlebitis are adduced. The concept of an active surgical help, including thromboembolic complications prophylaxis, depending on thrombophlebitis localization, correction of the venous hemodynamics disorders and the staged closure of trophic ulcer is substantiated. Introduction of the proposed tactics had permitted to achieve satisfactory outcomes, including the trophic ulcer healing and the trophic disorders regression in all the patients operated on.

[Compression syndromes in chronic venous insufficiency of lower extremities]. / Kompressionnye sindromy pri khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei.

Results of examination and surgical treatment of 77 patients with severe forms of chronic venous and lymphovenous insufficiency of lower extremities were analyzed. The compression syndrome concept and its role in pathogenesis of severe forms of chronic venous and lymphovenous insufficiency of lower extremities were determined. There was elaborated the tactics of complex treatment of patients, application of which had permitted to achieve the trophic ulcers healing in 98% operated patients, previously considered noncurable.

[Syndrome of chronic lympho-venous insufficiency of the lower extremities: contemporary views of the problem]. / Sindrom khronichskoi limfovenoznoi nedostatochnosti nizhnikh konechnostei. Sovremennyi vzgliad na problemu.

The results of clinical examination and surgical treatment of 115 patients with syndrome of chronic lymphovenous insufficiency of the lower extremities were adduced. The pathogenetically substantiated differentiated approach to the treatment was elaborated, which includes the staged surgical treatment conduction, directed on correction of the venous hemodynamics and the lymph outflow disorders, and the staged surgical treatment of trophic ulcers using alloderma and free cutaneous transplants. The tactics proposed had permitted to achieve satisfactory result of treatment in late period in 81%.