asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-031asurgery-466Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYСовременные методы лечения больных варикозной болезнью нижних конечностей – история, мифы и реальностьModern methods of treatment of patients with varicose veins of the lower extremities: History, myths and realityhttps://orcid.org/0000-0001-9344-111XЦаревО. А.TsarevO. A.

Царев Олег Александрович, д.м.н., профессор кафедры госпитальной хирургии лечебного факультета 

410701, Россия, Саратов, ул. Большая Казачья, д. 112

Oleg A. Tsarev, Dr. Sci. (Med.), Professor of the Department of Hospital Surgery of the Faculty of General Medicine

112, Bolshaya Kazachya St., Saratov, 41070, Russia 

m-51@mail.ruhttps://orcid.org/0000-0001-6366-6246СенинА. А.SeninA. A.

Сенин Андрей Андреевич, аспирант кафедры госпитальной хирургии лечебного факультета 

410701, Россия, Саратов, ул. Большая Казачья, д. 112

Andrey A. Senin, Postgraduate Student, Department of Hospital Surgery of the Faculty of Medicine

112, Bolshaya Kazachya St., Saratov, 41070, Russia 

idopych@icloud.comhttps://orcid.org/0009-0008-0959-4315РозенковаТ. В.RozenkovaT. V.

Розенкова Татьяна Вячеславовна, к.м.н., врач-хирург отделения хирургии сосудов №2 

410056, Россия, Саратов, ул. Хользунова, д. 19 

Tatyana V. Rozenkova, Cand. Sci. (Med.), Surgeon of the Department of Vascular Surgery No. 2

19, Kholzunov St., Saratov, 410056, Russia 

z1powd8f@yandex.ruСаратовский государственный медицинский университет имени В.И. РазумовскогоРоссияSaratov State Medical University named after V.I. RazumovskyRussian FederationСаратовский государственный медицинский университет имени В.И. РазумовскогоРоссияSaratov State Medical University named after V.I. RazumovskyRussian FederationСаратовская городская клиническая больница №1 имени Ю.Я. ГордееваРоссияSaratov City Clinical Hospital No. 1 named after Y.Y. GordeevRussian Federation2024151120242122231Copyright © Царев О.А., Сенин А.А., Розенкова Т.В., 20242024Царев О.А., Сенин А.А., Розенкова Т.В.Tsarev O.A., Senin A.A., Rozenkova T.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/466

Целью обзора является анализ клинической эффективности современных методов лечения больных варикозной болезнью нижних конечностей c позиции дифференцированного подхода при определении тактики лечения с учетом индивидуальных особенностей патогенеза и вариантов клинического течения заболевания. В литературном обзоре представлена краткая история развития методов лечения больных варикозной болезнью вен нижних конечностей. Проведен анализ клинической эффективности и отдаленных результатов флебэктомии, склерооблитерации, эндовенозной лазерной облитерации, радиочастотной абляции, эндовенозной абляции паром, механохимической абляции, применения адгезивного агента цианоакрилата. Проведенный анализ показал, что в настоящее время нет универсального метода лечения больных варикозной болезнью. Отсутствует единый подход при выборе тактики лечения, не решена проблема персонализации лечения с учетом особенностей патогенеза и вариантов клинического течения заболевания. При всем многообразии номинально существующих методов лечения рецидив варикозной болезни развивается у 15,0–70,0% больных. В настоящее время основная часть больных варикозной болезнью лечится с применением комбинированной флебэктомии, альтернативу которой составляет эндоваскулярная лазерная облитерация, а также склерохирургия. Особый интерес представляют немногочисленные исследования индивидуальных особенностей патогенеза первичного варикоза с целью определения критериев прогнозирования вариантов клинического течения для разработки дифференцированного подхода к выбору тактики лечения.

The aim of the review is to analyze the clinical efficacy of modern methods of treatment of patients with varicose veins of the lower extremities from the standpoint of a differentiated approach to determining treatment tactics, taking into account the individual characteristics of the pathogenesis and variants of the clinical course of the disease. The literature review presents a brief history of the development of methods for the treatment of patients with varicose veins of the lower extremities. An analysis of the clinical efficacy and long-term results of phlebectomy, scleroobliteration, endovenous laser obliteration, radiofrequency ablation, endovenous steam ablation, mechanochemical ablation, and the use of the adhesive agent cyanoacrylate was carried out. The analysis showed that there is currently no universal method of treatment for patients with varicose veins. There is no unified approach to the choice of treatment tactics, the problem of personalization of treatment taking into account the individual characteristics of the pathogenesis and variants of the clinical course of the disease has not been solved. With all the variety of nominally existing treatment methods, recurrence of varicose veins develops in 15.0–70.0% of patients. Currently, the majority of patients with varicose veins are treated using combined phlebectomy, an alternative to which is endovascular laser obliteration, as well as sclerosurgery. Of particular interest are the few studies of the individual features of the pathogenesis of primary varicose veins, in order to determine the criteria for predicting the variants of the clinical course, for the development of a differentiated approach to the choice of treatment tactics.

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