asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2022-19-1-34-42asurgery-279Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYСовременные тенденции в лечении венозных трофических язв у пожилых пациентовModern technologies of venous ulcers treatment in elderly populationhttps://orcid.org/0000-0002-6262-4770ТуркинП. Ю.TurkinP. Yu.

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

117997, Москва, ул. Островитянова, д. 1

 

Pavel Yu. Turkin, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2 of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

pavelturkin@gmail.comСлесареваА. А.SlesarevaA. A.

Слесарева Анна Андреевна, ассистент кафедры факультетской хирургии №2 лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Anna A. Slesareva, Аssistant of the Department of Faculty Surgery No. 2 of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

byann_lin@mail.ruРодионовС. В.RodionovS. V.

Родионов Сергей Васильевич, д.м.н., профессор кафедры факультетской хирургии №2 лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Sergey V. Rodionov, Dr. Sci. (Med.), Professor of the Department of Faculty Surgery No. 2 of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

rodionov.51@mail.ruВаричГ. А.VarichG. A.

Варич Георгий Александрович, к.м.н., доцент кафедры факультетской хирургии №2 лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Georgiy A. Varich, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2 of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

geravarich@mail.ruКужугетА. А.KuzhugetA. A.

Кужугет Айлана Аясовна, клинический ординатор кафедры факультетской хирургии №2 лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Aylana A. Kuzhuget, Clinical Resident of the Department of Faculty Surgery No. 2 of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

aylana17@inbox.ruПономарьС. А.PonomarS. A.

Пономарь Сергей Алексеевич, доцент кафедры факультетской хирургии №2 лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Sergey А. Ponomar, Associate Professor of the Department of Faculty Surgery No. 2 of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

serge-ponomar@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation2022190520221913442Copyright © Туркин П.Ю., Слесарева А.А., Родионов С.В., Варич Г.А., Кужугет А.А., Пономарь С.А., 20222022Туркин П.Ю., Слесарева А.А., Родионов С.В., Варич Г.А., Кужугет А.А., Пономарь С.А.Turkin P.Y., Slesareva A.A., Rodionov S.V., Varich G.A., Kuzhuget A.A., Ponomar S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/279

Венозные трофические язвы являются проявлением терминальной стадии хронической венозной недостаточности. Проблема венозных трофических расстройств крайне актуальна ввиду высокой распространенности среди населения. В данном обзоре рассматривается сравнительная характеристика данных заболеваемости на примере Германии и Российской Федерации. Особое внимание уделяется влиянию течения заболевания на психоэмоциональное состояние пациентов во время лечения и возможные последствия несвоевременной или недостаточной по объему и длительности оказываемой квалифицированной помощи. Рассматриваются причины высокозатратного лечения с приблизительными расчетами на 1 клинический случай и общегодовых затрат, по данным зарубежных исследователей (Австралия, Великобритания, США). Перечислены факторы риска в виде определенных сопутствующих нозологий, значительно усугубляющих процесс заживления язвенных дефектов с кратким описанием патогенеза. В обзоре определены основные цели лечения венозных трофических язв, а также выделены отдельные группы направлений, по которым рекомендуется проводить лечебные мероприятия. Проведен сравнительный анализ между способами применения компрессионной терапии (эластическое бинтование, использование специальных трикотажных изделий) и влиянием выбора на качество жизни пациентов. Описаны различные способы местного ухода за дефектами кожи и подкожной клетчатки с обязательным учетом стадии раневого процесса, перечислены альтернативные методики местного лечения (к примеру, применение аутологичной плазмы, обогащенной тромбоцитами). Произведена оценка эффективности системной фармакотерапии при трофических расстройствах и влияния различных групп препаратов на скорость заживления язв. Определены преимущества применения оперативного лечения, перечислены основные хирургические техники с выделением преимуществ и недостатков каждой. По отношению к каждому из способов лечения параллельно проводилась критическая оценка с позиций выбора оптимальных схем в группе пожилых пациентов. Показаны сложности оценки эффективности новых методик и комплексного подхода к лечению, что в последующем поможет скорректировать направления поиска новых путей для решения проблемы венозных язв в данной возрастной категории больных.

Venous trophic ulcers take place in the terminal stage of chronic venous insufficiency. The problem of venous trophic disorders is extremely relevant due to the high prevalence among the population. This review considers the comparative characteristics of morbidity data on the example of Germany and the Russian Federation. Particular attention paid to the influence of the course of the disease on patient’s life quality during treatment. The causes of high-cost treatment are reported with approximate calculations for 1 clinical case and total annual costs according to foreign researchers (Australia, Great Britain, USA). The risk factors are discussed in the form of certain concomitant nosologies that significantly aggravate the healing process of ulcers with a brief description of the pathogenesis. The review defines the main goals of the treatment of venous trophic ulcers, as well as separate groups of directions in which it is reasonable to carry out therapeutic measures. Article presents a comparative analysis between the methods of applying compression therapy (elastic bandaging, the use of special stockings) and the influence of the choice on the quality of life of patients. Various methods of topical wound care are described with the obligatory consideration of the stage of the wound process, alternative methods of local treatment are listed (for example, the use of autologous platelet-rich plasma). The efficacy of systemic pharmacotherapy in trophic disorders and the treatment potential of various groups of drugs on the rate of ulcer healing were evaluated. The advantages of using surgical treatment are determined, the main surgical techniques are listed, highlighting the advantages and disadvantages of each. Possible treatment strategies for elderly patients also discussed. The complexity of evaluating the effectiveness of new techniques and an integrated approach to treatment is shown, which in the future will help to correct the direction of finding new ways to solve the problem of venous ulcers in this specific group of patients.

венозные трофические язвыхроническая венозная недостаточностьвенозная гипертензиякомпрессионная терапиямини-инвазивные методыvenous trophic ulcerschronic venous insufficiencyvenous hypertensioncompression therapyminimally invasive methodsReferencesNelson E.A., Adderley U. Venous leg ulcers. BMJ Clin Evid. 2016;2016:1902. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714578/.Nelson E.A., Adderley U. Venous leg ulcers. BMJ Clin Evid. 2016;2016:1902. Available at: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4714578/.Heyer K., Herberger K., Protz K., Glaeske G., Augustin M. Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data. Wound Repair Regen. 2016;24(2):434–442. https://doi.org/10.1111/wrr.12387.Heyer K., Herberger K., Protz K., Glaeske G., Augustin M. Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data. Wound Repair Regen. 2016;24(2):434–442. https://doi.org/10.1111/wrr.12387.Guest J.F., Ayoub N., McIlwraith T., Uchegbu I., Gerrish A., Weidlich D. et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015;5(12):e009283. https://doi.org/10.1136/bmjopen-2015-009283.Guest J.F., Ayoub N., McIlwraith T., Uchegbu I., Gerrish A., Weidlich D. et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015;5(12):e009283. https://doi.org/10.1136/ bmjopen-2015-009283.Kreft D., Keiler J., Grambow E., Kischkel S., Wree A., Doblhammer G. Prevalence and Mortality of Venous Leg Diseases of the Deep Veins: An Observational Cohort Study Based on German Health Claims Data. Angiology. 2020;71(5):452–464. https://doi.org/10.1177/0003319720905751.Kreft D., Keiler J., Grambow E., Kischkel S., Wree A., Doblhammer G. Prevalence and Mortality of Venous Leg Diseases of the Deep Veins: An Observational Cohort Study Based on German Health Claims Data. Angiology. 2020;71(5):452–464. https://doi.org/10.1177/0003319720905751.Zolotukhin I.A., Seliverstov E.I., Shevtsov Y.N., Avakiants I.P., Nikishkov A.S., Tatarintsev A.M., Kirienko A.I. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg. 2017;54(6):752–758. https://doi.org/10.1016/j.ejvs.2017.08.033.Zolotukhin I.A., Seliverstov E.I., Shevtsov Y.N., Avakiants I.P., Nikishkov A.S., Tatarintsev A.M., Kirienko A.I. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg. 2017;54(6):752–758. https://doi.org/10.1016/j.ejvs.2017.08.033.Evangelista D.G., Magalhães E.R.M., Moretão D.I.C., Stival M.M., Lima L.R. Impact of chronic wounds in the quality oflife for users of family health strategy. Rev Enferm Centro Oeste Min. 2012;2(2):254–263. Available at: https://seer.ufsj.edu.br/index.php/recom/article/view/15/308.Evangelista D.G., Magalhães E.R.M., Moretão D.I.C., Stival M.M., Lima L.R. Impact of chronic wounds in the quality oflife for users of family health strategy. Rev Enferm Centro Oeste Min. 2012;2(2):254–263. Available at: https://seer.ufsj.edu.br/ index.php/recom/article/view/15/308.Dias T.Y.A.F., Costa I.K.F., Salvetti M.G., Mendes C.K.T.T., Torres G.V. Influences of health care services and clinical characteristics on the quality oflife of patients with venous ulcer. Acta Paul Enferm. 2013;26(6):529–534. Available at: https://www.researchgate.net/publication/281771214_Influences_of_health_care_services_and_clinical_characteristics_on_the_quality_of_life_of_patients_with_venous_ulcer.Dias T.Y.A.F., Costa I.K.F., Salvetti M.G., Mendes C.K.T.T., Torres G.V. Influences of health care services and clinical characteristics on the quality oflife of patients with venous ulcer. Acta Paul Enferm. 2013;26(6):529–534. Available at: https://www.researchgate.net/publication/281771214_ Influences_of_health_care_services_and_clinical_ characteristics_on_the_quality_of_life_of_patients_with_ venous_ulcer.Joaquim F.L., Silva R.M.C.R.A., Garcia-Caro M.P., Cruz-Quintana F., Pereira E.R. Impact of venous ulcers on patients’ quality oflife: an integrative review. Rev Bras Enferm. 2018;71(4):2021–2029. https://doi.org/10.1590/0034-7167-2017-0516.Joaquim F.L., Silva R.M.C.R.A., Garcia-Caro M.P., Cruz-Quintana F., Pereira E.R. Impact of venous ulcers on patients’ quality oflife: an integrative review. Rev Bras Enferm. 2018;71(4):2021–2029. https://doi.org/10.1590/0034-7167-2017-0516.Szewczyk M., Cwajda-Białasik J., Jawień A. Review papersPrevention of recurrent venous ulceration. Postep Derm Alergol. 2012;29(4):308–312. https://doi.org/10.5114/pdia.2012.30472.Szewczyk M., Cwajda-Białasik J., Jawień A. Review papersPrevention of recurrent venous ulceration. Postep Derm Alergol. 2012;29(4):308–312. https://doi.org/10.5114/ pdia.2012.30472.Nussbaum S.R., Carter M.J., Fife C.E., DaVanzo J., Haught R., Nusgart M., Cartwright D. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value Health. 2018;21(1):27–32. https://doi.org/10.1016/j.jval.2017.07.007.Nussbaum S.R., Carter M.J., Fife C.E., DaVanzo J., Haught R., Nusgart M., Cartwright D. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value Health. 2018;21(1):27–32. https://doi.org/10.1016/j.jval.2017.07.007.Rice J.B., Desai U., Cummings A.K., Birnbaum H.G., Skornicki M., Parsons N. Burden of venous leg ulcers in the United States. J Med Econ. 2014;17(5):347–356. https://doi.org/10.3111/13696998.2014.903258.Rice J.B., Desai U., Cummings A.K., Birnbaum H.G., Skornicki M., Parsons N. Burden of venous leg ulcers in the United States. J Med Econ. 2014;17(5):347–356. https://doi.org/10.3111/13696 998.2014.903258.Carneiro J.A., Cardoso R.R., Durães M.S., Guedes M.C.A., Santos F.L., da Costa F.M., Caldeira A.P. Frailty in the elderly: prevalence and associated factors. Rev Bras Enferm. 2017;70(4):747–752. https://doi.org/10.1590/0034-7167-2016-0633.Carneiro J.A., Cardoso R.R., Durães M.S., Guedes M.C.A., Santos F.L., da Costa F.M., Caldeira A.P. Frailty in the elderly: prevalence and associated factors. Rev Bras Enferm. 2017;70(4):747–752. https://doi.org/10.1590/0034-7167- 2016-0633.Lal B.K., Saito S., Pappas P.J., Padberg F.T. Jr., Cerveira J.J., Hobson R.W. 2nd, Durán W.N. Altered proliferative responses of dermal fibroblasts to TGF-beta1 may contribute to chronic venous stasis ulcer. J Vasc Surg. 2003;37(6):1285–1293. https://doi.org/10.1016/s0741-5214(02)75295-6.Lal B.K., Saito S., Pappas P.J., Padberg F.T. Jr., Cerveira J.J., Hobson R.W. 2nd, Durán W.N. Altered proliferative responses of dermal fibroblasts to TGF-beta1 may contribute to chronic venous stasis ulcer. J Vasc Surg. 2003;37(6):1285–1293. https://doi.org/10.1016/s0741-5214(02)75295-6.Medeiros A.B., Frazão C.M., Fernandes M.I., Andriola I.C., Lopes M.V., Lira A.L. Association of Socioeconomic and Clinical Factors and Tissue Integrity Outcome of Patients With Ulcers. Rev Gaucha Enferm. 2016;37(1):e54105. Available at: https://pubmed.ncbi.nlm.nih.gov/26934612.Medeiros A.B., Frazão C.M., Fernandes M.I., Andriola I.C., Lopes M.V., Lira A.L. Association of Socioeconomic and Clinical Factors and Tissue Integrity Outcome of Patients With Ulcers. Rev Gaucha Enferm. 2016;37(1):e54105. Available at: https://pubmed.ncbi.nlm.nih.gov/26934612.Barnsbee L., Cheng Q., Tulleners R., Lee X., Brain D., Pacella R. Measuring costs and quality oflife for venous leg ulcers. Int Wound J. 2019;16(1):112–121. https://doi.org/10.1111/iwj.13000.Barnsbee L., Cheng Q., Tulleners R., Lee X., Brain D., Pacella R. Measuring costs and quality oflife for venous leg ulcers. Int Wound J. 2019;16(1):112–121. https://doi.org/10.1111/ iwj.13000.Alavi A., Sibbald R.G., Phillips T.J., Miller O.F., Margolis D.J., Marston W. et al. What’s new: Management of venous leg ulcers: Approach to venous leg ulcers. J Am Acad Dermatol. 2016;74(4):627–640. https://doi.org/10.1016/j.jaad.2014.10.048.Alavi A., Sibbald R.G., Phillips T.J., Miller O.F., Margolis D.J., Marston W. et al. What’s new: Management of venous leg ulcers: Approach to venous leg ulcers. J Am Acad Dermatol. 2016;74(4):627–640. https://doi.org/10.1016/j. jaad.2014.10.048.Melikian R., O’Donnell T.F. Jr., Suarez L., Iafrati M.D. Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment. J Vasc Surg Venous Lymphat Disord. 2019;7(1):98–105. https://doi.org/10.1016/j.jvsv.2018.07.014.Melikian R., O’Donnell T.F. Jr., Suarez L., Iafrati M.D. Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment. J Vasc Surg Venous Lymphat Disord. 2019;7(1):98–105. https://doi.org/10.1016/j.jvsv.2018.07.014.Bonkemeyer Millan S., Gan R., Townsend P.E. Venous Ulcers: Diagnosis and Treatment. Am Fam Physician. 2019;100(5):298–305. Available at: https://www.aafp.org/afp/2019/0901/p298.html.Bonkemeyer Millan S., Gan R., Townsend P.E. Venous Ulcers: Diagnosis and Treatment. Am Fam Physician. 2019;100(5):298–305. Available at: https://www.aafp.org/ afp/2019/0901/p298.html.Partsch H. Compression heals leg ulcers due to abolishment of venous reflux. J Wound Care. 2019;28(7):427. https://doi.org/10.12968/jowc.2019.28.7.427.Partsch H. Compression heals leg ulcers due to abolishment of venous reflux. J Wound Care. 2019;28(7):427. https://doi.org/ 10.12968/jowc.2019.28.7.427.Health Quality Ontario. Compression stockings for the prevention of venous leg ulcer recurrence: a health technology assessment. Ont Health Technol Assess Ser. 2019;19(2):1–86. Available at: https://www.hqontario.ca/evidence-to-improvecare/journal-ontario-health-technologyassessment-series.Health Quality Ontario. Compression stockings for the prevention of venous leg ulcer recurrence: a health technology assessment. Ont Health Technol Assess Ser. 2019;19(2):1–86. Available at: https://www.hqontario.ca/evidence-to-improvecare/journal-ontario-health-technologyassessment-series.Ashby R.L., Gabe R., Ali S., Adderley U., Bland J.M., Cullum N.A. et al. Clinical and Cost-Effectiveness of Compression Hosiery Versus Compression Bandages in Treatment of Venous Leg Ulcers (Venous leg Ulcer Study IV, VenUS IV): A Randomised Controlled Trial. Lancet. 2014;383:871–879. https://doi.org/10.1016/S0140-6736(13)62368-5.Ashby R.L., Gabe R., Ali S., Adderley U., Bland J.M., Cullum N.A. et al. Clinical and Cost-Effectiveness of Compression Hosiery Versus Compression Bandages in Treatment of Venous Leg Ulcers (Venous leg Ulcer Study IV, VenUS IV): A Randomised Controlled Trial. Lancet. 2014;383:871–879. https://doi.org/ 10.1016/S0140-6736(13)62368-5.Mościcka P., Szewczyk M.T., Cwajda-Białasik J., Jawień A. The role of compression therapy in the treatment of venous leg ulcers. Adv Clin Exp Med. 2019;28(6):847–852. https://doi.org/10.17219/acem/78768.Mościcka P., Szewczyk M.T., Cwajda-Białasik J., Jawień A. The role of compression therapy in the treatment of venous leg ulcers. Adv Clin Exp Med. 2019;28(6):847–852. https://doi.org/ 10.17219/acem/78768.Dyson M., Young S.R., Hart J., Lynch J.A., Lang S. Comparison of the effects of moist and dry conditions on the process of angiogenesis during dermal repair. J Invest Dermatol. 1992;99(6):729–733. https://doi.org/10.1111/1523-1747.ep12614460.Dyson M., Young S.R., Hart J., Lynch J.A., Lang S. Comparison of the effects of moist and dry conditions on the process of angiogenesis during dermal repair. J Invest Dermatol. 1992;99(6):729–733. https://doi.org/10.1111/1523-1747. ep12614460.Svensjö T., Pomahac B., Yao F., Slama J., Eriksson E. Accelerated healing of full-thickness skin wounds in a wet environment. Plast Reconstr Surg. 2000;106(3):602–612. Available at: https://journals.lww.com/plasreconsurg/Abstract/2000/09030/Accelerated_Healing_of_Full_Thickness_Skin_Wounds.12.aspx.Svensjö T., Pomahac B., Yao F., Slama J., Eriksson E. Accelerated healing of full-thickness skin wounds in a wet environment. Plast Reconstr Surg. 2000;106(3):602–612. Available at: https://journals.lww.com/plasreconsurg/ Abstract/2000/09030/Accelerated_Healing_of_Full_Thickness_ Skin_Wounds.12.aspx.Cutting K.F., White R.J. Maceration of the skin and wound bed. 1: Its nature and causes. J Wound Care. 2002;11(7):275–278. https://doi.org/10.12968/jowc.2002.11.7.26414.Cutting K.F., White R.J. Maceration of the skin and wound bed. 1: Its nature and causes. J Wound Care. 2002;11(7):275–278. https://doi.org/10.12968/jowc.2002.11.7.26414.Norman G., Westby M.J., Rithalia A.D., Stubbs N., Soares M.O., Dumville J.C. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018;(6):CD012583. Available at: https://pubmed.ncbi.nlm.nih.gov/29906322.Norman G., Westby M.J., Rithalia A.D., Stubbs N., Soares M.O., Dumville J.C. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018;(6):CD012583. Available at: https://pubmed.ncbi.nlm.nih.gov/29906322.Tate S., Price A., Harding K. Dressings for venous leg ulcers. BMJ. 2018;361:k1604. https://doi.org/10.1136/bmj.k1604.Tate S., Price A., Harding K. Dressings for venous leg ulcers. BMJ. 2018;361:k1604. https://doi.org/10.1136/bmj.k1604.Kavala A.A., Turkyilmaz S. Autogenously derived regenerative cell therapy for venous leg ulcers. Arch Med Sci Atheroscler Dis. 2018;3:e156–e163. https://doi.org/10.5114/amsad.2018.81000.Kavala A.A., Turkyilmaz S. Autogenously derived regenerative cell therapy for venous leg ulcers. Arch Med Sci Atheroscler Dis. 2018;3:e156–e163. https://doi.org/10.5114/amsad.2018.81000.Deppermann C. Platelets and vascular integrity. Platelets. 2018;29(6):549–555. https://doi.org/10.1080/09537104.2018.1428739.Deppermann C. Platelets and vascular integrity. Platelets. 2018;29(6):549–555. https://doi.org/10.1080/09537104. 2018.1428739.Eming S.A., Martin P., Tomic-Canic M. Wound repair and regeneration: mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):265sr6. https://doi.org/10.1126/scitranslmed.3009337.Eming S.A., Martin P., Tomic-Canic M. Wound repair and regeneration: mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):265sr6. https://doi.org/10.1126/ scitranslmed.3009337.Weller C.D., Gardiner E.E., Arthur J.F., Southey M., Andrews R.K. Autologous platelet-rich plasma for healing chronic venous leg ulcers: Clinical efficacy and potential mechanisms. Int Wound J. 2019;16(3):788–792. https://doi.org/10.1111/iwj.13098.Weller C.D., Gardiner E.E., Arthur J.F., Southey M., Andrews R.K. Autologous platelet-rich plasma for healing chronic venous leg ulcers: Clinical efficacy and potential mechanisms. Int Wound J. 2019;16(3):788–792. https://doi.org/10.1111/iwj.13098.Moneib H.A., Youssef S.S., Aly D.G., Rizk M.A., Abdelhakeem Y.I. Autologous platelet-rich plasma versus conventional therapy for the treatment of chronic venous leg ulcers: A comparative study. J Cosmet Dermatol. 2018;17(3):495–501. https://doi.org/10.1111/jocd.12401.Moneib H.A., Youssef S.S., Aly D.G., Rizk M.A., Abdelhakeem Y.I. Autologous platelet-rich plasma versus conventional therapy for the treatment of chronic venous leg ulcers: A comparative study. J Cosmet Dermatol. 2018;17(3):495–501. https://doi.org/10.1111/jocd.12401.Clement A.L., Moutinho T.J. Jr., Pins G.D. Micropatterned dermal-epidermal regeneration matrices create functional niches that enhance epidermal morphogenesis. Acta Biomater. 2013;9(12):9474–9484. https://doi.org/10.1016/j.actbio.2013.08.017.Clement A.L., Moutinho T.J. Jr., Pins G.D. Micropatterned dermal-epidermal regeneration matrices create functional niches that enhance epidermal morphogenesis. Acta Biomater. 2013;9(12):9474–9484. https://doi.org/10.1016/j. actbio.2013.08.017.Coleridge-Smith P., Lok C., Ramelet A.A. Venous leg ulcer: a metaanalysis of adjunctive therapy with micronized purified flavonoid fraction. Eur J Vasc Endovasc Surg. 2005;30(2):198–208. https://doi.org/10.1016/j.ejvs.2005.04.017.Coleridge-Smith P., Lok C., Ramelet A.A. Venous leg ulcer: a metaanalysis of adjunctive therapy with micronized purified flavonoid fraction. Eur J Vasc Endovasc Surg. 2005;30(2):198–208. https://doi.org/10.1016/j.ejvs.2005.04.017.Богачев В.Ю., Болдин Б.В., Туркин П.Ю., Дженина О.В., Саменков А.Ю. Современные показания к флеботропной терапии и ее продолжительность. Амбулаторная хирургия. 2021;18(1): 13–23. https://doi.org/10.21518/1995-1477-2021-18-1-13-23.Bogachev V.Yu., Boldin B.V., Turkin P.Yu., Dzhenina O.V., Samenkov A.Yu. Current indications for phlebotropic therapy and its duration. Ambulatornaya Khirurgiya. 2021;18(1):13–23. (In Russ.) https://doi.org/10.21518/1995-1477-2021-18-1-13-23.Coccheri S., Scondotto G., Agnelli G., Aloisi D., Palazzini E., Zamboni V. Randomised, double blind, multicentre, placebo controlled study of sulodexide in the treatment of venous leg ulcers. Thromb Haemost. 2002;87(6):947–952. https://doi.org/10.1055/s-0037-1613116.Coccheri S., Scondotto G., Agnelli G., Aloisi D., Palazzini E., Zamboni V. Randomised, double blind, multicentre, placebo controlled study of sulodexide in the treatment of venous leg ulcers. Thromb Haemost. 2002;87(6):947–952. https://doi.org/ 10.1055/s-0037-1613116.Mannello F., Ligi D., Canale M., Raffetto J.D. Sulodexide downregulates the release of cytokines, chemokines, and leukocyte colony stimulating factors from human macrophages: role of glycosaminoglycans in inflammatory pathways of chronic venous disease. Curr Vasc Pharmacol. 2014;12(1):173–185. https://doi.org/10.2174/1570161111666131126144025.Mannello F., Ligi D., Canale M., Raffetto J.D. Sulodexide downregulates the release of cytokines, chemokines, and leukocyte colony stimulating factors from human macrophages: role of glycosaminoglycans in inflammatory pathways of chronic venous disease. Curr Vasc Pharmacol. 2014;12(1):173–185. https://doi.org/10.2174/1570161111666131126144025.Carroll B.J., Piazza G., Goldhaber S.Z. Sulodexide in venous disease. J Thromb Haemost. 2019;17(1):31–38. https://doi.org/10.1111/jth.14324.Carroll B.J., Piazza G., Goldhaber S.Z. Sulodexide in venous disease. J Thromb Haemost. 2019;17(1):31–38. https://doi.org/ 10.1111/jth.14324.González Ochoa A. Sulodexide and phlebotonics in the treatment of venous ulcer. Int Angiol. 2017;36(1):82–87. https://doi.org/10.23736/s0392-9590.16.03718-4.González Ochoa A. Sulodexide and phlebotonics in the treatment of venous ulcer. Int Angiol. 2017;36(1):82–87. https://doi.org/10.23736/s0392-9590.16.03718-4.Raffetto J.D., Eberhardt R.T., Dean S.M., Ligi D., Mannello F. Pharmacologic treatment to improve venous leg ulcer healing. J Vasc Surg Venous Lymphat Disord. 2016;4(3):371–374. https://doi.org/10.1016/j.jvsv.2015.10.002.Raffetto J.D., Eberhardt R.T., Dean S.M., Ligi D., Mannello F. Pharmacologic treatment to improve venous leg ulcer healing. J Vasc Surg Venous Lymphat Disord. 2016;4(3):371–374. https://doi.org/10.1016/j.jvsv.2015.10.002.Nelson E.A., Prescott R.J., Harper D.R., Gibson B., Brown D., Ruckley C.V. A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers. J Vasc Surg. 2007;45:134–141. https://doi.org/10.1016/j.jvs.2006.09.043.Nelson E.A., Prescott R.J., Harper D.R., Gibson B., Brown D., Ruckley C.V. A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers. J Vasc Surg. 2007;45:134–141. https://doi.org/10.1016/j.jvs.2006.09.043.Hassan I., Dorjay K., Anwar P. Pentoxifylline and its applications in dermatology. Indian Dermatol Online J. 2014;5(4):510–516. https://doi.org/10.4103%2F2229-5178.142528.Hassan I., Dorjay K., Anwar P. Pentoxifylline and its applications in dermatology. Indian Dermatol Online J. 2014;5(4):510–516. https://doi.org/10.4103%2F2229-5178.142528.Дибиров М.Д. Лечение венозных трофических язв при варикозной недостаточности у лиц пожилого и старческого возраста. Амбулаторная хирургия. 2015;(3–4):12–16. Available at: https://www.a-surgeon.ru/jour/article/view/15/16.Dibirov M.D. Treatment of venous trophic ulcers with varicose insufficiency in elderly and senile persons. Ambulatornaya Khirurgiya. 2015;(3–4):12–16. (In Russ.) Available at: https://www.a-surgeon.ru/jour/article/view/15/16.Almeida J.I., Kaufman J., Göckeritz O., Chopra P., Evans M.T., Hoheim D.F. et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009;20:752–759. https://doi.org/10.1016/j.jvir.2009.03.008.Almeida J.I., Kaufman J., Göckeritz O., Chopra P., Evans M.T., Hoheim D.F. et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009;20:752–759. https://doi.org/10.1016/j.jvir.2009.03.008.Rasmussen L.H., Lawaetz M., Bjoern L., Vennits B., Blemings A., Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98:1079–1087. https://doi.org/10.1002/bjs.7555.Rasmussen L.H., Lawaetz M., Bjoern L., Vennits B., Blemings A., Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98:1079–1087. https://doi.org/10.1002/bjs.7555.Doganci S., Demirkilic U. Comparison of 980 nm laser and baretip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40:254–259. https://doi.org/10.1016/j.ejvs.2010.04.006.Doganci S., Demirkilic U. Comparison of 980 nm laser and baretip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40:254–259. https://doi.org/10.1016/j.ejvs.2010.04.006.Bozoglan O., Mese B., Eroglu E., Ekerbiçer H.C., Yasim A. Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient. J Lasers Med Sci. 2017;8(1):13–16. https://doi.org/10.15171%2Fjlms.2017.03.Bozoglan O., Mese B., Eroglu E., Ekerbiçer H.C., Yasim A. Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient. J Lasers Med Sci. 2017;8(1):13–16. https://doi.org/10.15171%2Fjlms.2017.03.Ontas H., Yavuz T., Acar A.N., Uysal D. Comparison of ultrasound results following endovenous laser ablation and radiofrequency ablation in the treatment of varicose veins. Ann Ital Chir. 2019;90:457–462. Available at: https://www.annaliitalianidichirurgia.it/prodotto/comparison-of-ultrasound-results-following-endovenouslaser-ablation-and-radiofrequency-ablation-in-thetreatment-of-varicose-veins-2/.Ontas H., Yavuz T., Acar A.N., Uysal D. Comparison of ultrasound results following endovenous laser ablation and radiofrequency ablation in the treatment of varicose veins. Ann Ital Chir. 2019;90:457–462. Available at: https://www.annaliitalianidichirurgia.it/prodotto/ comparison-of-ultrasound-results-following-endovenouslaser-ablation-and-radiofrequency-ablation-in-thetreatment-of-varicose-veins-2/.Liu X., Zheng G., Ye B., Chen W., Xie H., Zhang T., Lin J. A retrospective cohort study comparing two treatments for active venous leg ulcers. Medicine (Baltimore). 2020;99(8):e19317. https://doi.org/10.1097%2FMD.0000000000019317.Liu X., Zheng G., Ye B., Chen W., Xie H., Zhang T., Lin J. A retrospective cohort study comparing two treatments for active venous leg ulcers. Medicine (Baltimore). 2020;99(8):e19317. https://doi.org/10.1097%2FMD. 0000000000019317.Galanopoulos G., Lambidis C. Minimally invasive treatment of varicose veins: Endovenous laser ablation (EVLA). Int J Surg. 2012;10(3):134–139. https://doi.org/10.1016/j.ijsu.2012.02.013.Galanopoulos G., Lambidis C. Minimally invasive treatment of varicose veins: Endovenous laser ablation (EVLA). Int J Surg. 2012;10(3):134–139. https://doi.org/10.1016/j.ijsu.2012.02.013.Fiengo L., Gwozdz A., Tincknell L., Harvey V., Watts T., Black S. VenaSeal closure despite allergic reaction to n-butyl cyanoacrylate. J Vasc Surg Cases Innov Tech. 2020;6(2):269-271. https://doi.org/10.1016/j.jvscit.2020.03.011.Fiengo L., Gwozdz A., Tincknell L., Harvey V., Watts T., Black S. VenaSeal closure despite allergic reaction to n-butyl cyanoacrylate. J Vasc Surg Cases Innov Tech. 2020;6(2):269-271. https://doi.org/10.1016/j.jvscit.2020.03.011.Kolluri R., Chung J., Kim S., Nath N., Bhalla B.B., Jain T. et al. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2020;8(3):472–481.e3. https://doi.org/10.1016/j.jvsv.2019.12.061.Kolluri R., Chung J., Kim S., Nath N., Bhalla B.B., Jain T. et al. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2020;8(3):472–481.e3. https://doi.org/10.1016/j.jvsv.2019.12.061.Chan S.S.J., Yap C.J.Q., Tan S.G., Choke E.T.C., Chong T.T., Tang T.Y. The utility of endovenous cyanoacrylate glue ablation for incompetent saphenous veins in the setting of venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020;8(6):1041– 1048. https://doi.org/10.1016/j.jvsv.2020.01.013.Chan S.S.J., Yap C.J.Q., Tan S.G., Choke E.T.C., Chong T.T., Tang T.Y. The utility of endovenous cyanoacrylate glue ablation for incompetent saphenous veins in the setting of venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020;8(6):1041– 1048. https://doi.org/10.1016/j.jvsv.2020.01.013.Lawrence P.F., Hager E.S., Harlander-Locke M.P., Pace N., Jayaraj A., Yohann A. et al. Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020;8(4):601–609. https://doi.org/10.1016/j.jvsv.2019.09.016.Lawrence P.F., Hager E.S., Harlander-Locke M.P., Pace N., Jayaraj A., Yohann A. et al. Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020;8(4):601–609. https://doi.org/10.1016/j.jvsv.2019.09.016.Toonder I.M., Lam Y.L., Lawson J., Wittens C.H. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology. 2014;29(1 Suppl.):49–54. https://doi.org/10.1177/0268355514529696.Toonder I.M., Lam Y.L., Lawson J., Wittens C.H. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology. 2014;29(1 Suppl.):49–54. https://doi.org/ 10.1177/0268355514529696.Gohel M.S., Barwell J.R., Taylor M., Chant T., Foy C., Earnshaw J.J. et al. Long term results of compression therapy alone vs compression plus surgery in chronic venous leg ulcers (ESCHAR): randomized controlled trial. BMJ. 2007;335(7610):83. https://doi.org/10.1136/bmj.39216.542442.be.Gohel M.S., Barwell J.R., Taylor M., Chant T., Foy C., Earnshaw J.J. et al. Long term results of compression therapy alone vs compression plus surgery in chronic venous leg ulcers (ESCHAR): randomized controlled trial. BMJ. 2007;335(7610):83. https://doi.org/10.1136/bmj.39216.542442.be.Gohel M.S., Heatley F., Liu X., Bradbury A., Bulbulia R., Cullum N. et al. EVRA Trial Investigators. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med. 2018;378(22):2105–2114. https://doi.org/10.1056/nejmoa1801214.Gohel M.S., Heatley F., Liu X., Bradbury A., Bulbulia R., Cullum N. et al. EVRA Trial Investigators. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med. 2018;378(22):2105–2114. https://doi.org/10.1056/ nejmoa1801214.Köroglu M., Eris H.N., Aktas A.R., Kayan M., Yeşildağ A., Cetin M. et al. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Acta Radiol. 2011;52(3):278–284. https://doi.org/10.1258/ar.2010.100356.Köroglu M., Eris H.N., Aktas A.R., Kayan M., Yeşildağ A., Cetin M. et al. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Acta Radiol. 2011;52(3):278–284. https://doi.org/10.1258/ar.2010.100356.

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