asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-023asurgery-387Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYРасширение надлобковых вен как проявление варикозной болезни таза: описание клинического случаяDilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical casehttps://orcid.org/0000-0003-2820-2432АкуловаА. А.AkulovaA. A.

Акулова Анастасия Андреевна, заведующая отделением сосудистой хирургии; сердечно-сосудистый хирург 

125367, Москва, Волоколамское шоссе, д. 84;115280, Москва, ул. Ленинская Слобода, д. 26 

Anastasia A. Akulova, Head of the Department of Vascular Surgery; Cardiovascular Surgeon 

84, Volokolamskoe Shosse, Moscow, 125367;26, Leninskaya Sloboda St., Moscow, 115280

akulovanastya@gmail.comhttps://orcid.org/0009-0008-2921-2409СорокаВ. Л.SorokaV. L.

Сорока Виктория Леонидовна, врач-рентгенолог; врач-рентгенолог 

190020, Санкт-Петербург, набережная реки Фонтанки, д. 154;195271, Санкт-Петербург, проспект Мечникова, д. 27

Viktoria L. Soroka, Radiologist; Radiologist 

154, Fontanka River Emb., St Petersburg, 190020;27, Mechnikov Ave., St Petersburg, 195271

vika_chernaya@mail.ruhttps://orcid.org/0000-0001-8752-0591БондарчукД. В.BondarchukD. V.

Бондарчук Дмитрий Владимирович, врач-рентгенолог; врач-рентгенолог 

105203, Москва, ул. Нижняя Первомайская, д. 70; 127051, Москва, ул. Петровка, д. 24, стр. 1

Dmitry V. Bondarchuk, Radiologist; Radiologist 

70, Nizhnyaya Pervomaiskaya St., Moscow, 105203;24, Bldg. 1, Petrovka St., Moscow, 127051

bond.mrct@gmail.comhttps://orcid.org/0009-0004-8008-3738СоломахинА. Е.SolomakhinA. E.

Соломахин Антон Евгеньевич, к.м.н., хирург-флеболог, руководитель 

115280, Москва, ул. Ленинская Слобода, д. 26 

Anton E. Solomakhin, Cand. Sci. (Med.), Surgeon-Phlebologist, Director 

26, Leninskaya Sloboda St., Moscow, 115280

phlebolog@centrvarikoza.ruhttps://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович, д.м.н., доцент кафедры общей хирургии лечебного факультета 

117997, Москва, ул. Островитянова, д. 1

Kirill V. Lobastov, Dr. Sci. (Med.), Associate Professor of the Department of General Surgery, Faculty of Medicine 

1, Ostrovityanov St., Moscow, 117997

lobastov_kv@hotmail.comЦентральная клиническая больница «РЖД-Медицина»; Центр инновационной флебологии и проктологии клиники «Доктор Лидер»РоссияCentral Clinical Hospital “RZD-Medicine”; Center for Innovative Phlebology and Proctology of Clinic “Doctor Leader”Russian FederationКлиника высоких медицинских технологий имени Н.И. Пирогова; Клиническая больница «РЖД-Медицина»РоссияClinic of High Medical Technologies named after N.I. Pirogov; Clinical Hospital “RZD-Medicine”Russian FederationНациональный медико-хирургический центр имени Н.И. Пирогова; Научно-практический клинический центр диагностики и телемедицинских технологийРоссияNational Medical and Surgical Center named after N.I. Pirogov; Scientific and Practical Clinical Center for Diagnostics and Telemedicine TechnologiesRussian FederationЦентр инновационной флебологии и проктологии клиники «Доктор Лидер»РоссияCenter for Innovative Phlebology and Proctology of Clinic “Doctor Leader”Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation2023211120232025462Copyright © Акулова А.А., Сорока В.Л., Бондарчук Д.В., Соломахин А.Е., Лобастов К.В., 20232023Акулова А.А., Сорока В.Л., Бондарчук Д.В., Соломахин А.Е., Лобастов К.В.Akulova A.A., Soroka V.L., Bondarchuk D.V., Solomakhin A.E., Lobastov K.V.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/387

Наличие расширенных надлобковых вен (надлобковый шунт) считается классическим проявлением посттромботической и нетромботической венозной обструкции. Между тем в литературе имеются описания единичных случаев формирования надлобкового шунта во время беременности у женщин с варикозной болезнью таза. Мы представляем клинический случай успешного лечения варикозной болезни таза с наличием расширенных вен в надлобковой области. Пациентка, 33 года, обратилась с жалобами на наличие варикозных вен на нижних конечностях, в области промежности и над лобком, на тяжесть и боли в нижних конечностях, периодическое ощущение тяжести и жжения в области варикозных вен, болезненные менструации и боли при половом акте. Симптомы появились и прогрессировали во время 4 беременностей, после последней отметила появление расширенных вен над лобком. При ультразвуковом ангиосканировании вен нижних конечностей выявлена клапанная недостаточность сафено-феморального соустья и стволов большой подкожной вены с обеих сторон, передней добавочной подкожной вены слева, признаки пельвиоперинеального рефлюкса, расширение вен промежности и круглой связки матки. Первым этапом выполнена флебография с эмболизацией яичниковых вен с двух сторон, после которой достигнута положительная динамика в виде купирования диспареунии и уменьшения альгодисменореи. Вторым этапом выполнена эндовенозная лазерная коагуляция стволов большой подкожной вены с обеих сторон, передней добавочной подкожной вены слева. Варикозные притоки на нижних конечностях удалены методом минифлебэктомии, варикозные вены промежности и надлобковой области облитерированы с помощью пенной склеротерапии. Через 3 мес. после вмешательства отмечена стойкая облитерация всех целевых вен, клиническое улучшение, исчезновение расширенных вен в надлобковой области, регресс болей в нижних конечностях и полное купирование диспареунии и альгодисменореи. Таким образом, наличие варикозно расширенных вен в надлобковой области может быть не только следствием венозной обструкции, но и проявлением варикозной болезни таза. При выявлении надлобкового шунта требуется тщательное обследование пациента, включая визуализирующие методы оценки вен таза и брюшной полости, по результатам которого необходима разработка индивидуальной тактики лечения.

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

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