asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2025-018asurgery-537Research ArticleБАРИАТРИЧЕСКАЯ ХИРУРГИЯBARIATRIC SURGERYОжирение и хронические заболевания вен как коморбидные патологии в хирургической практикеObesity and chronic venous diseases as comorbid pathologies in surgical practicehttps://orcid.org/0000-0002-2108-2362ХитарьянА. Г.Khitar’yanA. G.

Хитарьян Александр Георгиевич, заведующий хирургическим отделением, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а;

д.м.н., профессор, заслуженный врач России, заведующий кафедрой хирургических болезней №3, 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Aleksandr G. Khitar’yan, Head of the Surgical Department, 92a, Varfolomeev St., Rostov-on-Don, 344011;

Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation, Head of the Department of Surgical Diseases No. 3, 29, Nakhichevansky Lane, Rostov-on-Don, 344022

khitaryan@gmail.comhttps://orcid.org/0000-0003-3782-2860ОреховА. А.OrekhovA. A.

Орехов Алексей Анатольевич, врач высшей категории, врач-хирург хирургического отделения, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а;

к.м.н., доцент кафедры хирургических болезней №3, 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Alexey A. Orekhov, Doctor of the Highest Category, Surgeon of the Surgical Department, 92a, Varfolomeev St., Rostov-on-Don, 344011;

Cand. Sci. (Med.), Associate Professor of the Department of Surgical Diseases No. 3, 29, Nakhichevansky Lane, Rostov-on-Don, 344022

ale-orekhov@yandex.ruhttps://orcid.org/0009-0001-9672-2088КиртанасоваЕ. Я.KirtanasovaE. Ya.

Киртанасова Елена Яковлевна, ординатор кафедры хирургических болезней №3,

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Elena Ya. Kirtanasova, Postgraduate Student of the Department of Surgical Diseases No. 3,

29, Nakhichevan Lane, Rostov-on-Don, 344022

elena.kirtanasova@yandex.ruhttps://orcid.org/0000-0003-4769-3193КисляковВ. Н.KislyakovV. N.

Кисляков Василий Николаевич, врач-хирург хирургического отделения,

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Vasiliy N. Kislyakov, Cand. Sci. (Med.), Surgeon of the Surgical Department,

92a, Varfolomeev St., Rostovon-Don, 344011

kislyakow.w@yandex.ruhttps://orcid.org/0000-0001-7787-4919МежунцА. В.MezhuntsA. V.

Межунц Арут Ваграмович, врач-хирург хирургического отделения, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а;

доцент кафедры хирургических болезней №3, 344022,  Ростов-на-Дону, пер. Нахичеванский, д. 29

Arut V. Mezhunts, Surgeon of the Surgical Department, 92a, Varfolomeev St., Rostovon-Don, 344011;

Associate Professor of the Department of Surgical Diseases No. 3, 29, Nakhichevansky Lane, Rostov-on-Don, 344022

arut.mezhunts@mail.ruhttps://orcid.org/0000-0002-0078-260XВелиевК. С.VelievK. S.

Велиев Камиль Савинович, врач-хирург хирургического отделения,

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Kamil S. Veliev, Cand. Sci. (Med.), Surgeon of the Surgical Department,

92a, Varfolomeev St., Rostov-onDon, 344011

koma.81@yandex.ruКлиническая больница «РЖД-Медицина» города Ростов-на-Дону; Ростовский государственный медицинский университетРоссияClinical Hospital “RZD-Medicine”; Rostov State Medical UniversityRussian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationКлиническая больница «РЖД-Медицина» города Ростов-на-ДонуРоссияClinical Hospital “RZD-Medicine”Russian Federation202509062025221146152Copyright © Хитарьян А.Г., Орехов А.А., Киртанасова Е.Я., Кисляков В.Н., Межунц А.В., Велиев К.С., 20252025Хитарьян А.Г., Орехов А.А., Киртанасова Е.Я., Кисляков В.Н., Межунц А.В., Велиев К.С.Khitar’yan A.G., Orekhov A.A., Kirtanasova E.Y., Kislyakov V.N., Mezhunts A.V., Veliev K.S.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/537

Работа посвящена современному взгляду на морбидное ожирение в развитии и лечении хронических заболеваний вен (ХЗВ) и включает в себя компиляцию данных отечественной и зарубежной литературы, в т. ч. клинических рекомендаций Всемирной организации здравоохранения, Минздрава России. В настоящее время имеются доказательства отягчающей связи морбидного ожирения (индекс массы тела (ИМТ) ≥ 40 кг/м2 или с ИМТ ≥ 35 кг/м2 при наличии серьезных осложнений, ассоциированных с ожирением) с хроническим заболеванием вен, при этом оба состояния широко распространены в мире с тенденцией на прогрессирование. Нередко они существуют у пациента одновременно, в связи с чем повышаются риски сосудистых событий, кардинально изменяется тактика ведения такого больного. Исходы развивающегося ремоделирования в стенках вен в виде прежде всего воспалительного процесса отражаются и на артериальном русле, что усиливает актуальность вопроса и подчеркивает необходимость своевременной коррекции, и главным образом адекватного хирургического лечения. Результаты различных хирургических вмешательств при несостоятельности вен ухудшаются вместе с возрастанием показателя ИМТ. В связи с этим на сегодняшний день пациентам с чрезвычайно (≥40 кг/м2) высоким ИМТ в первую очередь рекомендуется лечить не венозную недостаточность, а корректировать вес, в т. ч. за счет бариатрической хирургии, что обусловлено неэффективностью обратного подхода. Однако проблему лечения сочетания ХЗВ и морбидного ожирения на сегодняшний день трудно назвать решенной в полной мере. Поэтому требуется ее дальнейшее изучение и разработка новых стратегий, в т. ч. хирургических, для эффективной коррекции данного вида коморбидности.

This review is devoted to the modern view of morbid obesity in the development and treatment of chronic venous diseases (CVD) and includes a compilation of data from domestic and foreign literature, including clinical recommendations of WHO and the Russian Ministry of Health. Currently, there is evidence of an aggravating association of morbid obesity (BMI ≥ 40 kg/m2 or with BMI ≥ 35 kg/m2 in the presence of serious complications associated with obesity) with CVD, while both conditions are widespread in the world with a tendency to progress. Often they exist simultaneously in the patient, which increases the risk of vascular events and radically changes the management tactics of such a patient. The outcomes of developing remodeling in the walls of the veins in the form of, first of all, an inflammatory process are reflected in the arterial bed, which increases the relevance of the issue and emphasizes the need for timely correction and, mainly, adequate surgical treatment. The results of various surgical interventions at venous incompetence worsen along with an increase in BMI. In this regard, today, patients with extremely (≥40 kg/m2) high BMI are primarily recommended to treat not venous insufficiency, but to correct weight, including through bariatric surgery, which is due to the ineffectiveness of the reverse approach.

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