asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-033asurgery-488Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEОбновленный подход к оценке риска и профилактике послеоперационных венозных тромбоэмболических осложнений при хирургическом лечении варикозной болезниAn updated approach to the risk assessment and prevention of postoperative venous thromboembolism in varicose vein surgeryhttps://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович, д.м.н., доцент кафедры общей хирургии имени В.М. Буянова 

117997, Россия, Москва, ул. Островитянова, д. 1 

Kirill V. Lobastov, Dr. Sci. (Med.), Associate Professor of the Department of General Surgery named after V.M. Buyanov

1, Ostrovityanov St., Moscow, 117997, Russia 

lobastov_kv@mail.ruhttps://orcid.org/0000-0001-8288-7773ШалдинаМ. В.ShaldinaM. V.

Шалдина Мария Викторовна, врач сердечно-сосудистый хирург

 454091, Россия, Челябинск, ул. Пушкина, д. 50 

Maria V. Shaldina, Vascular Surgeon

50, Pushkin St., Chelyabinsk, 454091, Russia 

m.shaldina@mail.ruhttps://orcid.org/0000-0003-1455-9916БорсукД. А.BorsukD. A.

Борсук Денис Александрович, д.м.н., ассистент кафедры хирургии Института дополнительного профессионального образования; приглашенный профессор кафедры хирургии с курсом  анестезиологии и реаниматологии

454092, Россия, Челябинск, ул. Воровского, д. 64

050004, Казахстан, Алматы, проспект Абылай Хана, д. 51/53 

Denis A. Borsuk, Dr. Sci. (Med.), Assistant of the Department of Surgery, Faculty of Postgraduate and Additional Professional Education; Invited Professor of the Department of Surgery with a course in Anesthesiology and Resuscitation

64, Vorovsky St., Chelyabinsk, 454092, Russia

51/53, Abylay Khan Ave., Almaty, 050004, Kazakhstan 

borsuk-angio@mail.ruhttps://orcid.org/0009-0006-0968-4041КочетковС. В.KochetkovS. V.

Кочетков Сергей Викторович, врач сердечно-сосудистый хирург

 454091, Россия, Челябинск, ул. Пушкина, д. 50 

Sergei V. Kochetkov, Vascular Surgeon

50, Pushkin St., Chelyabinsk, 454091, Russia 

kochetkov-med@mail.ruhttps://orcid.org/0000-0002-1306-1502СчастливцевИ. В.SchastlivtsevI. V.

Счастливцев Илья Вениаминович, к.м.н., доцент кафедры общей хирургии имени В.М. Буянова

117997, Россия, Москва, ул. Островитянова, д. 1

Ilya V. Schastlivtsev, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery named after V.M. Buyanov

1, Ostrovityanov St., Moscow, 117997, Russia 

Schastlivtsev.ilya@gmail.comhttps://orcid.org/0000-0002-5542-1502ЛаберкоЛ. А.LaberkoL. A.

Лаберко Леонид Александрович, д.м.н., профессор кафедры общей хирургии имени В.М. Буянова

117997, Россия, Москва, ул. Островитянова, д. 1

Leonid A. Laberko, Dr. Sci. (Med.), Professor of the Department of General Surgery named after V.M. Buyanov

1, Ostrovityanov St., Moscow, 117997, Russia 

laberko@list.ruhttps://orcid.org/0000-0001-5411-6437ФокинА. А.FokinA. A.

Фокин Алексей Анатольевич, д.м.н., профессор, заведующий кафедрой хирургии факультета  послевузовского и дополнительного  профессионального образования Института  дополнительного профессионального образования 

454092, Россия, Челябинск, ул. Воровского, д. 64 

Alexey A. Fokin, Dr. Sci. (Med.), Professor, Head of the Department of Surgery, Faculty of Postgraduate and Additional Professional Education, Institute of Additional Professional Education

64, Vorovsky St., Chelyabinsk, 454092, Russia 

alanfokin@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationКлиника флебологии и лазерной хирургии «VenoClinica»РоссияClinic of Phlebology and Laser Surgery “VenoClinica”Russian FederationЮжно-Уральский государственный медицинский университет; Казахстанско-Российский медицинский университетРоссияSouth Ural State Medical University; Kazakhstan-Russian Medical UniversityRussian FederationЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation202421112024212244257Copyright © Лобастов К.В., Шалдина М.В., Борсук Д.А., Кочетков С.В., Счастливцев И.В., Лаберко Л.А., Фокин А.А., 20242024Лобастов К.В., Шалдина М.В., Борсук Д.А., Кочетков С.В., Счастливцев И.В., Лаберко Л.А., Фокин А.А.Lobastov K.V., Shaldina M.V., Borsuk D.A., Kochetkov S.V., Schastlivtsev I.V., Laberko L.A., Fokin A.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/488

Данный повествовательный обзор литературы посвящен проблеме индивидуальной оценки риска и профилактики послеоперационных венозных тромбоэмболических осложнений (ВТЭО) при хирургическом лечении варикозной болезни нижних конечностей. В соответствии с результатами регистрового исследования CAPSIVS частота выявления любых форм ВТЭО после современных малоинвазивных вмешательств на поверхностных венах достигает 3,4%, из которых симптоматическими являются лишь 0,5%. Актуальные клинические рекомендации регламентируют индивидуальную оценку риска развития послеоперационного тромбоза, для чего может быть использована шкала Каприни. По итогам первого валидационного исследования был предложен научно обоснованный подход к разделению флебологических пациентов на группы риска в зависимости от балла Каприни: низкий риск – 0–6 баллов, умеренный риск – 7–10 баллов, высокий риск – 11 и более баллов, что существенным образом отличается от подходов в других медицинских специальностях. При этом фармакологическая профилактика может быть целесообразна в группах умеренного и высокого риска, в особенности при выполнении симультанного удаления варикозных притоков и вмешательства на перфорантных венах, увеличивающих опасность развития ВТЭО в 6–11 раз. Важным фактором эффективности фармакологической профилактики послеоперационного венозного тромбоза является ее длительность, которая не должна быть менее 7 дней в группе умеренного риска и достигать 30 дней при высоком риске ВТЭО. Было показано, что однократная инъекция парентеральных антикоагулянтов в день операции ассоциируется с частотой развития послеоперационного тромбоза на уровне 8,8%. У пациентов с индивидуальным анамнезом ВТЭО, включая ранее перенесенный варикотромбофлебит, риск развития послеоперационного тромбоза увеличен в 4,2 раза, что требует обязательного назначения вторичной фармакопрофилактики на срок не менее 30 дней, а в отдельных случаях до 3–6 мес. Таким образом, на сегодняшний день накоплены данные, поддерживающие применение шкалы Каприни для оценки риска развития послеоперационных ВТЭО и назначения адекватной фармакологической профилактики при хирургическом лечении варикозной болезни.

This narrative literature review is dedicated to the issue of individual risk assessment and prevention of postoperative VTE in patients undergoing lower limb varicose vein surgery. The registry-based CAPSIVS trial showed that the detection frequency of any forms of VTE after modern minimally invasive superficial vein surgery reaches 3.4%, of which only 0.5% are symptomatic. The current clinical guidelines regulate the individual risk assessment of postoperative thrombosis using the Caprini Risk Score (CRS). The first validation study resulted in a proposal of evidence-based approach to the phlebological patient stratification into risk groups according to the Caprini scores with 0–6 scores indicating the low risk, 7–10 scores – the moderate risk and 11 scores or more –the high risk, which differs significantly from approaches in other medical specialties. At the same time, the pharmacoprophylaxis may be appropriate in the groups of moderate and high risk, especially when simultaneous varicose tributary ablation and perforating vein interventions increasing the risk of VTEC 6–11 times are performed. The duration of pharmacoprophylaxis of postoperative venous thrombosis is essential to its efficiency, which should not be less than 7 days for the moderate VTE risk group and reach 30 days for the high VTE risk group. A single injection of parenteral anticoagulants on the day of surgery has been shown to be associated with an 8.8% incidence of postoperative thrombosis. The risk of postoperative thrombosis in patients with VTE in their past medical history, including prior varicothrombophlebitis is increased by 4.2 times, which requires that secondary pharmacoprophylaxis be prescribed for at least 30 days, and in some cases up to 3-6 months. At this stage, there is sufficient evidence to support the use of the Caprini Risk Score to assess the risk of postoperative VTE and prescribe adequate pharmacological prophylaxis in varicose vein surgery treatment.

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