asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-004asurgery-434Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEИз опыта более 1000 клеевых облитераций варикозных вен: как это делатьFrom the experience of more than 1000 glue ablation procedures for varicose veins: how to do ithttps://orcid.org/0000-0003-2116-2247ШиринбекО.ShirinbekО.

Олими Ширинбек - д.м.н., врач-хирург, заместитель главного врача по хирургии, руководитель.

125130, Москва, Старопетровский проезд, д. 7а, стр. 22

Olimi Shirinbek - Dr. Sci. (Med.), Surgeon, Head Doctor Deputy for Surgery, Head.

7a, Bldg. 22, Staropetrovskiy Lane, Moscow, 125130

olims@mail.ruЦентр флебологии «СМ-Клиника»Россия“SM-Clinic” Phlebology CentreRussian Federation202417052024211158167Copyright © Ширинбек О., 20242024Ширинбек О.Shirinbek О.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/434

Цианоакрилатная клеевая облитерация в настоящее время является одним из основных методов нетермической облитерации несостоятельных магистральных подкожных вен. Данные международных клинических рекомендаций, а также реальной клинической практики свидетельствуют о высокой эффективности и безопасности метода. Преимуществом облитерации вен цианоакрилатным адгезивом является низкий уровень периоперационных болей и экхимозов, быстрота и простота выполнения вмешательства, ускоренная послеоперационная реабилитация, высокий уровень комфорта и удовлетворенности пациентов, а также отсутствие необходимости в послеоперационной компрессии. В настоящей статье рассматриваются практические аспекты выполнения клеевой облитерации вен на основании 5-летнего (2019–2023 гг.) опыта применения метода в Центре флебологии «СМ-Клиника» (Москва). Сформулированы показания к предпочтительному применению цианоакрилатной клеевой облитерации, такие как низкий болевой порог пациентов; невозможность (либо нежелание) использования послеоперационной компрессии; наличие выраженной коморбидной патологии; наличие сопутствующего морбидного ожирения; наличие аксиального рефлюкса по магистральным подкожным венам; необходимость облитерации нескольких несостоятельных стволовых подкожных вен; несостоятельность сафенной вены ниже колена, включая рецидивный варикоз в этом сегменте; выраженный липодерматосклероз и/или трофические язвы голени; наличие у пациента ВИЧ-инфекции и вирусных гепатитов. Представлен пошаговый протокол клеевой облитерации вен с описанием модифицированных вариантов выполнения вмешательства. Обсуждены непосредственные и отдаленные исходы цианоакрилатной клеевой облитерации по данным мировой и отечественной литературы. Отдельное внимание уделено нежелательным явлениям после процедуры, а также техническим аспектам их профилактики. Несмотря на высокий профиль эффективности и безопасности клеевой облитерации, ограничением для повсеместного внедрения и широкого применения метода на сегодняшний день является сравнительно высокая стоимость расходных материалов.

Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.

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