asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2021-18-1-13-23asurgery-224Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYСовременные показания к флеботропной терапии и ее продолжительностьCurrent indications for phlebotropic therapy and its durationhttps://orcid.org/0000-0002-3940-0787БогачёвВ. Ю.BogachevV. Yu.

Богачёв Вадим Юрьевич, д.м.н., профессор, кафедра  факультетской хирургии №2

117997, Москва, ул. Островитянова, д. 1;

117447, Москва, ул. Дмитрия Ульянова, д. 31

Vadim Yu. Bogachev, Dr. Sci. (Med.), Professor, Department of Intermediate Level Surgery No. 2

1, Ostrovityanov St., Moscow, 117997;

31, Dmitry ulyanov St., Moscow, 117447

vadim.bogachev63@gmail.comhttps://orcid.org/0000-0003-4488-9123БолдинБ. В.BoldinB. V.

Болдин Борис Валентинович, д.м.н., профессор, заведующий кафедрой факультетской хирургии №2

117997, Москва, ул. Островитянова, д. 1

Boris V. Boldin, Dr. Sci. (Med.), Professor, head of Intermediate Level Surgery No. 2

1, Ostrovityanov St., Moscow, 117997

facultysurgery@gmail.comhttps://orcid.org/0000-0002-6262-4770ТуркинП. Ю.TurkinP. Yu.

Туркин Павел Юрьевич, к.м.н., доцент, кафедра факультетской хирургии №2

117997, Москва, ул. Островитянова, д. 1

Pavel Yu. Turkin, Cand. Sci. (Med.), Associate Professor, Department of Intermediate Level Surgery No. 2

1, Ostrovityanov St., Moscow, 117997

pavelturkin@gmail.comhttps://orcid.org/0000-0003-3811-5156ДженинаО. В.DzheninaO. V.

Дженина Ольга Вадимовна, к.м.н., врач-хирург, сосудистый хирург

117447, Москва, ул. Дмитрия Ульянова, д. 31

Olga V. Dzhenina, Cand. Sci. (Med.), Surgeon, Vascular Surgeon

31, Dmitry ulyanov St., Moscow, 117447

helgelman@mail.ruСаменковА. Ю.SamenkovA. Yu.

Саменков Александр Юрьевич, аспирант, кафедра факультетской хирургии №2

117997, Москва, ул. Островитянова, д. 1

Aleksandr Yu. Samenkov, Postgraduate Student, Department of Intermediate Level Surgery No. 2

1, Ostrovityanov St., Moscow, 117997

samen-alex@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Первый флебологический центрРоссияPirogov Russian National Research Medical University; First Phlebological CenterRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationПервый флебологический центрРоссияFirst Phlebological CenterRussian Federation2021080620211811323Copyright © Богачёв В.Ю., Болдин Б.В., Туркин П.Ю., Дженина О.В., Саменков А.Ю., 20212021Богачёв В.Ю., Болдин Б.В., Туркин П.Ю., Дженина О.В., Саменков А.Ю.Bogachev V.Y., Boldin B.V., Turkin P.Y., Dzhenina O.V., Samenkov A.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/224

Флеботропная терапия является важным компонентом патогенетического лечения хронических заболеваний вен (ХЗВ) нижних конечностей. Веноактивные препараты, которые доказали свою эффективность и безопасность в ходе разнообразных исследований, широко представлены в международных и российских клинических рекомендациях и стандартах. Вместе с тем нет единого мнения о регламенте флеботропной терапии и, прежде всего, ее продолжительности при различных клинических классах ХЗВ. Кроме того, отсутствуют четкие указания на методики контроля эффективности лечения, которые могут быть использованы в реальной клинической практике. Представленный систематизированный обзор литературных данных о микронизированной очищенной флавоноидной фракции не только раскрывает возможности флеботропной терапии различных клинических классов и форм ХЗВ, но и предлагает эффективный регламент применения этого препарата в конкретных ситуациях. Подробно приведены данные по эффективности флеботропной терапии в реальной клинической практике при начальных стадиях ХЗВ (С0s–С1s), при лечении С2s (варикозное расширение поверхностных вен с веноспецифической симптоматикой), С3 (хронический венозный отек), С4 (трофические нарушения кожи), а также при стадиях С5–С6 и С6r (венозные трофические язвы). Кроме этого приведены результаты исследований применения микронизированной очищенной флавоноидной фракции при флебосклерозирующем лечении. Длительность флеботропной терапии находится в прямой зависимости от тяжести заболевания и отклика на проводимое лечение. При этом важную роль играет не только персонификация лечения по конкретным симптомам и синдромам, но и, по возможности, объективный контроль их динамики.

Phlebotropic therapy is an important component of the pathogenetic treatment of chronic venous insufficiency (CVI) of the lower extremities. Venoactive drugs, which have proven their effectiveness and safety in a variety of studies, are widely represented in international and Russian clinical guidelines and standards. However, there is no consensus on the regulation of phlebotropic therapy and, above all, its duration in different clinical classes of CVI. In addition, there are no clear indications on the methods of treatment efficacy monitoring, which can be used in real clinical practice. The presented systematized review of the literature data on micronized purified flavonoid fraction not only reveals the possibilities of phlebotropic therapy of different clinical classes and forms of CVI, but also suggests effective regulations for the use of this drug in specific situations. The data concerning the efficacy of phlebotropic therapy in real clinical practice at the initial stages of CVI (C0s-C1s), in the treatment of C2s (varicose superficial veins with venospecific symptoms), C3 (chronic venous edema), C4 (trophic skin disorders), as well as in stages C5-C6 and C6r (venous trophic ulcers) are presented in details. In addition, the results of studies on the use of micronized purified flavonoid fraction in phlebosclerosing treatment are presented. The duration of phlebotropic therapy is in direct relation to the severity of the disease and the response to the ongoing treatment. The important role is played not only by personalization of treatment according to specific symptoms and syndromes, but also, if possible, by objective control of their dynamics.

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The authors declare that there are no conflicts of interest present.