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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">asurgery</journal-id><journal-title-group><journal-title xml:lang="ru">Амбулаторная хирургия</journal-title><trans-title-group xml:lang="en"><trans-title>Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2712-8741</issn><issn pub-type="epub">2782-2591</issn><publisher><publisher-name>ООО «ГРУППА РЕМЕДИУМ»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21518/akh2023-004</article-id><article-id custom-type="elpub" pub-id-type="custom">asurgery-405</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБМЕН ОПЫТОМ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>EXCHANGE OF EXPERIENCE | PRACTICE</subject></subj-group></article-categories><title-group><article-title>Возможные механизмы развития флебитоподобной аномальной реакции (PLAR) после цианоакрилатной облитерации варикозных вен</article-title><trans-title-group xml:lang="en"><trans-title>Possible mechanisms of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1792-2434</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Санников</surname><given-names>А. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Sannikov</surname><given-names>A. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Санников Александр Борисович, к.м.н., сосудистый хирург </p><p>600031, Владимир, ул. Вокзальная, д. 24</p></bio><bio xml:lang="en"><p>Alexander B. Sannikov, Can. Sci. (Med.), Vascular Surgeon </p><p>24, Vokzalnaya St., Vladimir, 160031</p></bio><email xlink:type="simple">aliplast@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7260-4968</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шайдаков</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shaydakov</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шайдаков Евгений Владимирович, д.м.н., профессор, президент Санкт-Петербургской ассоциации флебологов, ведущий научный сотрудник; профессор кафедры госпитальной хирургии </p><p>197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68;185910, Петрозаводск, проспект Ленина, д. 33</p></bio><bio xml:lang="en"><p>Evgeniу V. Shaydakov, Dr. Sci. (Med.), Professor, President of the Saint Petersburg Association of Phlebologists; Professor of the Department of Hospital Surgery</p><p>68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758;33, Lenin Ave., Petrozavodsk, 185910</p></bio><email xlink:type="simple">evgevyshaydakov@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Клиника инновационной диагностики «Медика»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Innovation Diagnostic Clinic “MEDICA”</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр онкологии имени Н.Н. Петрова;&#13;
Петрозаводский государственный университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Petrov National Medical center Research Centre;&#13;
Petrozavodsk State University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>30</day><month>11</month><year>2023</year></pub-date><volume>20</volume><issue>2</issue><fpage>223</fpage><lpage>248</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Санников А.Б., Шайдаков Е.В., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Санников А.Б., Шайдаков Е.В.</copyright-holder><copyright-holder xml:lang="en">Sannikov A.B., Shaydakov E.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.a-surgeon.ru/jour/article/view/405">https://www.a-surgeon.ru/jour/article/view/405</self-uri><abstract><p>На основании собственных исследований и обзора литературы авторы проводят анализ возможных клеточных механизмов развития воспалительной реакции после проведения облитерации варикозных вен цианоакрилатными клеевыми соединениями (ЦАО), получившей в зарубежных источниках название флебитоподобной аномальной реакции (phlebitis like abnormal reaction – PLAR). Несмотря на существующее мнение об «аномальном» характере воспалительной реакции, отмечается, что основные этапы ее развития в полной мере согласуются с известными на сегодня молекулярно- клеточными механизмами ответа биологических тканей на контакт с инородным антигенным веществом и носят закономерный характер. Причиной развития острого альтеративного воспаления в стенке вены является непосредственный контакт эндотелия с агрессивной средой, которой является цианоакрилат. Специфической чертой развития хронического воспаления в стенке вен является продуктивный межуточный его характер, сменяющийся пролиферативными процессами. Основную роль в развитии сменяющих друг друга этапов развития PLAR имеют моноцитарные, тучные и гигантские клетки инородных тел, а также механизмы, лежащие в основе регуляции функциональной активности этих клеток. На протяжении периода биодеградации цианоакрилата клеточное окружение его соответствует всем морфологическим признакам фагоцитомы, активность которой снижается по мере биодеградации цианоакрилата с одновременной соединительнотканной пролиферацией. В основе развития возможного хронического гранулематозного воспаления лежит локальный аутоиммунный процесс, сопряженный с образованием гигантских многоядерных эпителиоидных клеток (клеток Лангерганса). В заключении подчеркивается, что на сегодня при использовании различных цианоакрилатных соединений с целью клеевой облитерации вен, с учетом накопленных клинических данных и проведенных морфологических исследований, окончательные ответы на имеющиеся обоснованные возражения по поводу полной безопасности использования цианоакрилатов в клинической практике должны дать фундаментальные иммуногистохимические и генетические исследования.</p></abstract><trans-abstract xml:lang="en"><p>Based on their own research and a review of the literature, the authors analyze the possible cellular mechanisms of the development of an inflammatory reaction after the obliteration of varicose veins with cyanoarylate adhesive compounds (CAO), which received the name phlebitis- Like abnormal Reaction (PLAR) in foreign sources. Despite the existing opinion about the “abnormal” nature of the inflammatory reaction, it is noted that the main stages of its development are fully consistent with the currently known molecular and cellular mechanisms of the response of biological tissues to contact with a foreign antigenic substance and are of a natural nature. The cause of the development of acute alterative inflammation in the vein wall is the direct contact of the endothelium with an aggressive environment, which is cyanoacrylate. A specific feature of the development of chronic inflammation in the vein wall is its productive interdaily character, which is replaced by proliferative processes. The main role in the development of successive stages of PLAR development is played by monocytic, mast and giant cells of foreign bodies, as well as the mechanisms underlying the regulation of the functional activity of these cells. During the period of cyanoacrylate biodegradation, its cellular environment corresponds to all morphological features of a phagocytoma, whose activity decreases with the biodegradation of cyanoacrylate with simultaneous connective tissue proliferation. The development of possible chronic granulomatous inflammation is based on a local autoimmune process associated with the formation of giant multinucleated epithelioid cells (Langerhans cells). In conclusion, it is emphasized that today, when using various cyanoacrylate compounds for the purpose of adhesive obliteration of veins, taking into account the accumulated clinical data and morphological studies, the final answers to the existing reasonable objections about the complete safety of the use of cyanoacrylates in clinical practice should be given by fundamental immunohistochemical and genetic studies.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>варикозные вены</kwd><kwd>нетермическая облитерация</kwd><kwd>цианоакрилаты</kwd><kwd>клеточный полиморфизм</kwd><kwd>флебит</kwd><kwd>гранулема</kwd><kwd>гиперчувствительность</kwd></kwd-group><kwd-group xml:lang="en"><kwd>varicose veins</kwd><kwd>non-thermal obliteration</kwd><kwd>cyanoacrylates</kwd><kwd>cellular polymorphism</kwd><kwd>phlebitis</kwd><kwd>granuloma</kwd><kwd>hypersensitivity</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B et al. 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