asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2025-024asurgery-530Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYХирургическое лечение варикозной болезни вен нижних конечностей и актуальный коморбидный фонSurgical treatment of varicose veins of the lower extremities and the current comorbid backgroundhttps://orcid.org/0000-0003-4488-9123БолдинБ. В.BoldinB. V.

Болдин Борис Валентинович, д.м.н., профессор, заведующий кафедрой факультетской хирургии №2 лечебного факультета,

117997, Москва, ул. Островитянова, д. 1

Boris V. Boldin, Dr. Sci. (Med.), Professor, Head of the Department of Facuity Surgery No. 2,

1, Ostrovityanov St., Moscow, 117997

bvb195411@mail.ruhttps://orcid.org/0000-0002-3940-0787БогачевВ. Ю.BogachevV. Yu.

Богачев Вадим Юрьевич, д.м.н., профессор, кафедра факультетской хирургии №2 лечебного факультета, 117997, Москва, ул. Островитянова, д. 1;

научный руководитель, 117447, Москва, ул. Дмитрия Ульянова, д. 31

Vadim Yu. Bogachev, Dr. Sci. (Med.), Professor of the Department of Facuity Surgery No. 2, 1, Ostrovityanov St., Moscow, 117997;

Scientific Supervisor, 31, Dmitry Ulyanov St., Moscow, 117447

vadim.bogachev63@gmail.comhttps://orcid.org/0009-0009-1230-1269АбдошР.AbdochR.

Абдош Робеар, аспирант, кафедра факультетской хирургии №2 лечебного факультета,

117997, Москва, ул. Островитянова, д. 1

Robear Abdosh, Postgraduate Student of the Department of Facuity Surgery No. 2,

1, Ostrovityanov St., Moscow, 117997

robear532@gmail.comhttps://orcid.org/0000-0002-3574-6190ВаричГ. А.VarichG. A.

Варич Георгий Александрович, к.м.н., доцент кафедры факультетской хирургии №2, 117997, Москва, ул. Островитянова, д. 1;

заместитель главного врача по хирургии, 141407, Московская обл., Химки, Куркинское шоссе, д. 11

George A. Varich, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No.2, 1, Ostrovityanov St., Moscow, 117997;

Deputy Chief Physician for Surgery, 11, Kurkinskoe Shosse, Khimki, Moscow Region, 141407

geravarich@mail.ruhttps://orcid.org/0009-0005-1238-2645КомовК. В.KomovK. V.

Комов Константин Витальевич, к.м.н., доцент кафедры факультетской хирургии №2,

117997, Москва, ул. Островитянова, д. 1

Konstantin V. Komov, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No.2,

1, Ostrovityanov St., Moscow, 117997

Drkoma@mail.ruhttps://orcid.org/0009-0003-8165-7230СлесареваА. А.SlesarevaA. A.

Слесарева Анна Андреевна, ассистент кафедры факультетской хирургии №2,

117997, Москва, ул. Островитянова, д. 1

Anna A. Slesareva, Аssistant of the Department of Faculty Surgery No.2,

1, Ostrovityanov St., Moscow, 117997

byann_lin@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Первый флебологический центрРоссияPirogov Russian National Research Medical University; First Phlebological CenterRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Химкинская областная больницаРоссияPirogov Russian National Research Medical University; Khimki Regional HospitalRussian Federation2025090620252218390Copyright © Болдин Б.В., Богачев В.Ю., Абдош Р., Варич Г.А., Комов К.В., Слесарева А.А., 20252025Болдин Б.В., Богачев В.Ю., Абдош Р., Варич Г.А., Комов К.В., Слесарева А.А.Boldin B.V., Bogachev V.Y., Abdoch R., Varich G.A., Komov K.V., Slesareva 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/530Введение

Введение. Варикозное расширение вен нижних конечностей является распространенной патологией, затрагивающей около 25–33% взрослого населения. Лечение данного заболевания требует изучения влияния сопутствующих заболеваний на выбор тактики хирургического лечения варикозного расширения вен.

Цель

Цель. Оценить степень воздействия коморбидных состояний на принятие решений о методе оперативного вмешательства и разработать алгоритм персонализированного подхода к лечению.

Материалы и методы

Материалы и методы. Был проведен ретроспективный анализ 500 историй болезни пациентов, перенесших хирургическое лечение варикозной болезни, с использованием многофакторного статистического анализа и методов машинного обучения для выявления значимых корреляций. Для оценки отдаленных результатов дополнительно проведено проспективное наблюдение за 100 пациентами в течение года после операции.

Результаты

Результаты. Результаты исследования показали, что наличие сердечно-сосудистых заболеваний повышает риск послеоперационных осложнений на 23%, что требует коррекции хирургической тактики. Выявлена достоверная связь между сахарным диабетом и увеличением продолжительности заживления послеоперационных ран (р < 0,01). Анализ отдаленных результатов показал, что пациенты с сопутствующими заболеваниями имеют более высокий риск рецидива варикозной болезни, особенно при наличии ожирения и сахарного диабета.

Обсуждение

Обсуждение. Результаты подтверждают необходимость дифференцированного подхода к выбору хирургической тактики с учетом индивидуального профиля коморбидности пациента.

Выводы

Выводы. Разработанный прогностический алгоритм и предложенные рекомендации могут служить основой для создания клинических руководств, направленных на повышение эффективности и безопасности хирургического лечения варикозной болезни у пациентов с сопутствующими заболеваниями.

Introduction

Introduction. Varicose veins of the lower extremities are a common pathology affecting about 25–33% of the adult population. The treatment of this disease requires studying the influence of comorbidities on the choice of surgical treatment tactics for varicose veins.

Aim

Aim. To assess the degree of influence of comorbid conditions on decision-making regarding the method of surgical intervention and to develop an algorithm for a personalized treatment approach.

Materials and methods

Materials and methods. A retrospective analysis of 500 medical records of patients who underwent surgical treatment for varicose veins was conducted using multivariate statistical analysis and machine learning methods to identify significant correlations. To assess long-term results, a prospective observation of 100 patients was additionally conducted for one year after surgery.

Results

Results. The results of the study showed that the presence of cardiovascular diseases increases the risk of postoperative complications by 23%, which requires correction of surgical tactics. A significant association between diabetes mellitus and increased duration of postoperative wound healing was revealed (p < 0.01). The analysis of long-term results showed that patients with comorbidities have a higher risk of varicose vein recurrence, especially in the presence of obesity and diabetes mellitus.

Discussion

Discussion. The results demonstrate the necessity of differentiated approach to the choice of surgical tactics taking into account the individual profile of the patient’s comorbidity.

Conclusions

Conclusions. The developed prognostic algorithm and the proposed recommendations can serve as a basis for the creation of clinical guidelines aimed at improving the efficacy and safety of surgical treatment of varicose veins in patients with comorbidities.

варикозное расширение венкоморбидностьхирургическое лечениеперсонализированная медицинапрогностический алгоритмпослеоперационные осложненияvaricose veinscomorbiditysurgical treatmentpersonalized medicineprognostic algorithmpostoperative complicationsReferencesPannier-Fischer F, Rabe E. Epidemiology of chronic venous disorders. Hautatzt. 2003;54(11):1037–1044. https://doi.org/10.1007/s00105-003-0616-0.Pannier-Fischer F, Rabe E. Epidemiology of chronic venous disorders. Hautatzt. 2003;54(11):1037–1044. https://doi.org/10.1007/s00105-003-0616-0.Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, Kirienko AI. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg. 2017;54(6):752–758. https://doi.org/10.1016/j.ejvs.2017.08.033.Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, Kirienko AI. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg. 2017;54(6):752–758. https://doi.org/10.1016/j.ejvs.2017.08.033.Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S. https://doi.org/10.1016/j.jvs.2011.01.079.Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S. https://doi.org/10.1016/j.jvs.2011.01.079.Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: an integrated approach. Circulation. 2010;121(19):2146–2150. https://doi.org/10.1161/CIRCULATIONAHA.110.951236.Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: an integrated approach. Circulation. 2010;121(19):2146–2150. https://doi.org/10.1161/CIRCULATIONAHA.110.951236.Clark A, Harvey I, Fowkes FG. Epidemiology and risk factors for varicose veins among older people: cross-sectional population study in the UK. Phlebology. 2010;25(5):236–240. https://doi.org/10.1258/phleb.2009.009045.Clark A, Harvey I, Fowkes FG. Epidemiology and risk factors for varicose veins among older people: cross-sectional population study in the UK. Phlebology. 2010;25(5):236–240. https://doi.org/10.1258/phleb.2009.009045.Onida S, Davies AH. Predicted burden of venous disease. Phlebology. 2016;31(1 Suppl):74–79. https://doi.org/10.1177/0268355516628359.Onida S, Davies AH. Predicted burden of venous disease. Phlebology. 2016;31(1 Suppl):74–79. https://doi.org/10.1177/0268355516628359.Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M et al. Editor’s Choice – Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. https://doi.org/10.1016/j.ejvs.2019.11.027.Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M et al. Editor’s Choice – Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. https://doi.org/10.1016/j.ejvs.2019.11.027.Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. https://doi.org/10.1016/j.ejvs.2020.09.023.Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. https://doi.org/10.1016/j.ejvs.2020.09.023.Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. https://doi.org/10.1016/j.jvsv.2019.12.075.Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. https://doi.org/10.1016/j.jvsv.2019.12.075.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity inlongitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity inlongitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8.Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality oflife questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996;5(6):539–554. https://doi.org/10.1007/BF00439228.Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality oflife questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996;5(6):539–554. https://doi.org/10.1007/BF00439228.Vuylsteke ME, Mordon SR. Endovenous laser ablation: a review of mechanisms of action. Ann Vasc Surg. 2012;26(3):424–433. https://doi.org/10.1016/j.avsg.2011.05.037.Vuylsteke ME, Mordon SR. Endovenous laser ablation: a review of mechanisms of action. Ann Vasc Surg. 2012;26(3):424–433. https://doi.org/10.1016/j.avsg.2011.05.037.Rasmussen LH, Lawaetz M, Bjoern L, Vennits A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079–1087. https://doi.org/10.1002/bjs.7555.Rasmussen LH, Lawaetz M, Bjoern L, Vennits A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079–1087. https://doi.org/10.1002/bjs.7555.van der Velden SK, Biemans AA, De Maeseneer MG, Kockaert MA, Cuypers PW, Hollestein LM et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015;102(10):1184–1194. https://doi.org/10.1002/bjs.9867.van der Velden SK, Biemans AA, De Maeseneer MG, Kockaert MA, Cuypers PW, Hollestein LM et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015;102(10):1184–1194. https://doi.org/10.1002/bjs.9867.Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31(2):105–115. Available at: https://pubmed.ncbi.nlm.nih.gov/22466974/.Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31(2):105–115. Available at: https://pubmed.ncbi.nlm.nih.gov/22466974/.Lehtola A, Asko-Seljavaara S, Laurikka J, Perhoniemi V. Laskimoiden kroonisen vajaatoiminnan ja säärihaavan kirurginen hoito [Surgical treatment of chronic venous insufficiency and varicose ulcer]. Duodecim. 1997;113(20):2077–2088. Available at: https://www.duodecimlehti.fi/duo70460.Lehtola A, Asko-Seljavaara S, Laurikka J, Perhoniemi V. Laskimoiden kroonisen vajaatoiminnan ja säärihaavan kirurginen hoito [Surgical treatment of chronic venous insufficiency and varicose ulcer]. Duodecim. 1997;113(20):2077–2088. Available at: https://www.duodecimlehti.fi/duo70460.Meissner MH. What is the medical rationale for the treatment of varicose veins? Phlebology. 2012;27 Suppl 1:27–33. https://doi.org/10.1258/phleb.2012.012s17.Meissner MH. What is the medical rationale for the treatment of varicose veins? Phlebology. 2012;27 Suppl 1:27–33. https://doi.org/10.1258/phleb.2012.012s17.Baraldi C, Bissacco D. Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6). Vasc Endovascular Surg. 2024;58(1):60–64. https://doi.org/10.1177/15385744231188804.Baraldi C, Bissacco D. Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6). Vasc Endovascular Surg. 2024;58(1):60–64. https://doi.org/10.1177/15385744231188804.Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. https://doi.org/10.1016/j.jvsv.2019.12.075.Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. https://doi.org/10.1016/j.jvsv.2019.12.075.

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