asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-028asurgery-487Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEНеврологические осложнения пенной склеротерапииNeurologic complications of foam sclerotherapyhttps://orcid.org/0000-0002-0746-7290ЩегловЭ. А.ShcheglovE. A.

Щеглов Эрнест Анатольевич, д.м.н., доцент, профессор кафедры общей и факультетской хирургии, сердечно-сосудистый хирург

185035, Россия, Петрозаводск, проспект Ленина, д. 33 

Ernest A. Shcheglov, Dr. Sci. (Med.), Associate Professor, Professor of the Department of General and Faculty Surgery, Cardiovascular Surgeon

33, Lenin Ave., Petrozavodsk, 185035, Russia 

ernestsheglov@gmail.comhttps://orcid.org/0009-0005-5649-7647ЕвменчиковА. В.EvmenсhikovA. V.

Евменчиков Александр Владимирович, заведующий неврологическим отделением

185031, Россия, Петрозаводск, ул. Кирова, д. 40 

Alexandеr V. Evmenсhikov, Head of the Neurological Department

40, Kirov St., Petrozavodsk, 185031, Russia; 

evmenchikov@yandex.ruhttps://orcid.org/0009-0000-5980-110XКалиновскаяО. А.KalinovskayaO. A.

Калиновская Ольга Александровна, врач функциональной диагностики

185031, Россия, Петрозаводск, ул. Кирова, д. 40 

Olga A. Kalinovskaya, Doctor of Functional Diagnostics

40, Kirov St., Petrozavodsk, 185031, Russia 

okalinovskaia@inbox.ruДаниловаА. С.DanilovaA. S.

Данилова Анна Сергеевна, и. о. заведующего кардиологическим отделением

185031, Россия, Петрозаводск, ул. Кирова, д. 40 

Anna S. Danilova, Acting Head of the Cardiology Department

40, Kirov St., Petrozavodsk, 185031, Russia 

asmed-0404@mail.ruhttps://orcid.org/0000-0003-3372-0250МаксимовВ. И.MaksimovV. I.

Максимов Владислав Игоревич, врач-невролог отделения острых нарушений мозгового кровообращения

185002, Россия, Петрозаводск, ул. Пирогова, д. 3 

Vladislav I. Maksimov, Neurologist of the Department of Acute Cerebral Circulation Disorders

3, Pirogov St., Petrozavodsk, 185002, Russia 

NobleVlad@icloud.comhttps://orcid.org/0009-0007-7598-5026ПоповаМ. А.PopovaM. A.

Попова Мария Алексеевна, врач-невролог

185031, Россия, Петрозаводск, ул. Кирова, д. 40 

Maria A. Popova, Neurologist

40, Kirov St., Petrozavodsk, 185031, Russia 

dreams.86@yandex.ruПетрозаводский государственный университетРоссияPetrozavodsk State UniversityRussian FederationРеспубликанская больница скорой и экстренной медицинской помощиРоссияRepublican Hospital of Emergency and Emergency Medical CareRussian FederationРеспубликанская больница имени В.А. БарановаРоссияBaranov Republic HospitalRussian Federation202421112024212238243Copyright © Щеглов Э.А., Евменчиков А.В., Калиновская О.А., Данилова А.С., Максимов В.И., Попова М.А., 20242024Щеглов Э.А., Евменчиков А.В., Калиновская О.А., Данилова А.С., Максимов В.И., Попова М.А.Shcheglov E.A., Evmenсhikov A.V., Kalinovskaya O.A., Danilova A.S., Maksimov V.I., Popova M.A.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/487

Статья посвящена описанию клинического случая неврологических осложнений пенной склеротерапии. Целью является ознакомление врачей с достаточно серьезным осложнением процедуры, выполняемой чаще всего с косметической целью. Инсульт и транзиторные ишемические атаки зарегистрированы как «отдельные случаи» после проведения склеротерапии. Значительно чаще (0,1–1%) встречаются зрительные нарушения и жалобы на головную боль и мигрень. Основными причинами возникновения данных нарушений являются либо газовая эмболия, которая возникает непосредственно после процедуры, либо пародоксальная тромбоэмболия, которая регистрируется спустя какое-то время после склеротерапии. Основной причиной возникновения нарушений является врожденный порок сердца, дефект межпредсердной или межжелудочковой перегородки, однако проведение тотального скрининга перед процедурой считается нецелесообразным. Рекомендуется ограничить объем вводимой пены 10 мл и тщательно собирать анамнез. Наличие в анамнезе порока сердца с право-левым шунтом является абсолютным противопоказанием к процедуре. Описан клинический случай с пациенткой 39 лет, ранее проходившей сеансы пенной склеротерапии по косметическим показаниям. При третьем сеансе склеротерапии у пациентки развились признаки острого нарушения мозгового кровообращения, потребовавшие госпитализации и лечения в условиях неврологического отделения. Врожденный порок сердца ранее не выявлялся. В дальнейшем на фоне проводимого лечения все неврологические нарушения полностью регрессировали. Врачи должны знать о возможности развития описанного в статье серьезного осложнения, которое при неблагоприятном стечении обстоятельств и отсутствии своевременной медицинской помощи может привести к инвалидизации пациента. В случае развития данного осложнения необходимо в максимально короткие сроки направить пациента к врачу-неврологу для установления диагноза и начала терапии.

The article is devoted to the description of a clinical case of neurological complications of foam sclerotherapy. The goal is to familiarize doctors with a fairly serious complication of the procedure, most often performed for cosmetic purposes. Stroke and transient ischemic attacks have been reported as “isolated cases” following sclerotherapy. Visual disturbances and complaints of headaches and migraines are much more common (0.1–1%). The main causes of these disorders are either gas embolism, which occurs immediately after the procedure, or paradoxical thromboembolism, which is recorded some time after sclerotherapy. The main cause of disorders is congenital heart disease, atrial or ventricular septal defect, however, total screening before the procedure is considered inappropriate. It is recommended to limit the volume of foam injected to 10 ml and carefully collect anamnesis. A history of heart disease with a right-to-left shunt is an absolute contraindication to the procedure. A clinical case is described with a 39-year-old patient who had previously unde rgone foam sclerotherapy sessions for cosmetic reasons. During the third session of sclerotherapy, the patient developed signs of acute cerebrovascular accident, which required hospitalization and treatment in the neurological department. Congenital heart disease has not been previously detected. Subsequently, with the treatment, all neurological disorders completely regressed. Conclusions. Doctors should be aware of the possibility of developing the serious complication described in the article, which, under unfavorable circumstances and lack of timely medical care, can lead to disability of the patient. If this complication develops, it is necessary to refer the patient to a neurologist as soon as possible to establish a diagnosis and begin therapy.

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