asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-023asurgery-472Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYОсобенности рецидива варикозной болезни нижних конечностей и его оперативной коррекцииFeatures of recurrence of varicose disease of the lower limb and its surgical correctionhttps://orcid.org/0000-0001-7564-8168МышенцевП. Н.MyshentsevP. N.

Мышенцев Павел Николаевич, к.м.н., доцент кафедры госпитальной хирургии 

 443099, Россия, Самара, ул. Чапаевская, д. 89 

Pavel N. Myshentsev, Cand. Sci. (Med.), Associate Professor of Department of Hospital Surgery

89, Chapaevskaya St., Samara, 443099, Russia 

pnmy63@rambler.ruhttps://orcid.org/0000-0001-7473-6692КаторкинС. Е.KatorkinS. E.

Каторкин Сергей Евгеньевич, д.м.н., профессор, заведующий кафедрой и клиникой госпитальной хирургии 

443099, Россия, Самара, ул. Чапаевская, д. 89 

Sergei E. Katorkin, Dr. Sci. (Med.), Professor, Head of Department of Hospital Surgery

89, Chapaevskaya St.,Samara, 443099, Russia 

katorkinse@mail.ruСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation2024171120242128193Copyright © Мышенцев П.Н., Каторкин С.Е., 20242024Мышенцев П.Н., Каторкин С.Е.Myshentsev P.N., Katorkin S.E.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/472

Несмотря на бурное развитие и стремительное распространение за последнее время малоинвазивных методик в хирургическом лечении хронических заболеваний вен, частота рецидивов с учетом срока послеоперационного периода продолжает оставаться высокой. В настоящее время отсутствует единый алгоритм хирургического лечения пациентов с рецидивами варикозной болезни нижних конечностей. Поэтому обсуждение вопросов хирургической тактики с учетом индивидуальной клинико-анатомической формы рецидива заболевания представляет актуальную проблему. В статье представлен обзор современной отечественной и зарубежной литературы по частоте встречаемости, этиологии, патогенезу, диагностике и вариантам хирургического лечения рецидива варикозной болезни нижних конечностей. Приведены современные классификации REVAS и PREVAIT, используемые для оценки рецидива варикозной болезни нижних конечностей. Детально отражены современные гипотезы об основных причинах, приводящих к его возникновению. Проведен анализ частоты рецидива после применения различных методов хирургической коррекции первичного заболевания. В обзоре дана характеристика как классических, так и современных методов коррекции рецидива варикозной болезни нижних конечностей. Акцентирована роль ультразвукового дуплексного ангиосканирования вен нижних конечностей как оптимального диагностического метода, позволяющего с высокой точностью выявить основные патоморфологические и гемодинамические причины развития рецидива заболевания. Оперативные вмешательства по поводу рецидива должны выполняться только в специализированных отделениях и высококвалифицированными хирургами. При оперативном лечении рецидива варикозной болезни нижних конечностей необходимо проводить коррекцию венозного кровотока во всех отделах мышечно-венозной помпы, а не ограничиваться простым удалением варикозно расширенных вен.

Despite the rapid development and rapid spread of minimally invasive techniques in the surgical treatment of chronic venous diseases in recent years, the relapse rate, taking into account the postoperative period, continues to remain high. Currently, there is no unified algorithm for surgical treatment of patients with recurrent varicose veins of the lower extremities. Therefore, discussion of surgical tactics taking into account the individual clinical and anatomical form of disease relapse is an urgent problem. The article provides a review of modern domestic and foreign literature on the incidence, etiology, pathogenesis, diagnosis and surgical treatment options for recurrent varicose veins of the lower extremities. The modern classifications REVAS and PREVAIT, used to assess the recurrence of varicose veins of the lower extremities, are presented. Modern hypotheses about the main reasons leading to its occurrence are reflected in detail. An analysis of the relapse rate after the use of various methods of surgical correction of the primary disease was carried out. The review provides characteristics of both classical and modern methods for correcting recurrent varicose veins of the lower extremities. The role of ultrasound duplex angioscanning of the veins of the lower extremities is emphasized as an optimal diagnostic method that makes it possible to accurately identify the main pathomorphological and hemodynamic causes of the development of relapse of the disease. Surgical interventions for relapse should be performed only in specialized departments and by highly qualified surgeons. When surgically treating recurrent varicose veins of the lower extremities, it is necessary to correct the venous blood flow in all parts of the muscular-venous pump, and not be limited to simple removal of varicose veins.

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