asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2025-043asurgery-582Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYХронические заболевания вен у пациентов с ожирением: стратегии лечения и профилактикиChronic venous diseases in obese patients: treatment and prevention strategieshttps://orcid.org/0000-0002-8903-1174ХитарьянА. Г.KhitaryanA. G.

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

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

Alexander G. Khitaryan, 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;

Head of the Surgical Department, 92a, Varfolomeev St., Rostov-on-Don, 344011

khitaryan@gmail.comhttps://orcid.org/0009-0001-9672-2088КиртанасоваЕ. Я.KirtanasovaE. I.

Киртанасова Елена Яковлевна, аспирант кафедры хирургических болезней №3, 

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

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

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

elena.kirtanasova@yandex.ruhttps://orcid.org/0000-0003-3782-2860ОреховА. А.OrekhovA. A.

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

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

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

Surgeon of the Surgical Department, 92a, Varfolomeev St., Rostov-on-Don, 344011

orekhov_aa@rostgmu.ruhttps://orcid.org/0009-0000-4339-4319ГусаревД. А.GusarevD. A.

Гусарев Дмитрий Александрович, к.м.н., врач-хирург хирургического отделения,

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

Dmitriy A. Gusarev, Cand. Sci. (Med.), Surgeon of the Surgical Department, 

92a, Varfolomeev St., Rostov-on-Don, 344011

gusadi@mail.ruhttps://orcid.org/0000-0001-9565-6640АндреевЕ. В.AndreevE. V.

Андреев Евгений Владимирович, к.м.н., доцент кафедры хирургических болезней №3,

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

Evgeny V. Andreev, Cand. Sci. (Med.), Associate Professor of Department of Surgical Diseases No. 3,

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

e.v.andreev.1980@mail.ruhttps://orcid.org/0009-0003-5292-9612БалинаК. Н.BalinaK. N.

Балина Кира Николаевна, ординатор кафедры хирургических болезней №3,

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

Kira N. Balina, Postgraduate Student of the Department of Surgical Diseases No. 3, 

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

kira_balina@mail.ruhttps://orcid.org/0009-0007-1335-7016ДюжиковА. И.DyuzhikovA. I.

Дюжиков Александр Игоревич, студент,

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

Alexander I. Dyuzhikov, Student of the Department of Surgical Diseases No. 3, 

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

a.duyzhikov@icloud.comhttps://orcid.org/0009-0003-2228-901XЕвдокимовВ. П.EvdokimovV. P.

Евдокимов Владислав Петрович, студент,

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

Vladislav P. Evdokimov, Student of the Department of Surgical Diseases No. 3,

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

didsteb.rpg@mail.ruРостовский государственный медицинский университет; Клиническая больница «РЖД-Медицина» города Ростова-на-ДонуРоссияRostov State Medical University; Clinical Hospital “RZD-Medicine” Rostov-on-DonRussian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationКлиническая больница «РЖД-Медицина» города Ростова-на-ДонуРоссияClinical Hospital “RZD-Medicine” Rostov-on-DonRussian Federation2025251120252226876Copyright © Хитарьян А.Г., Киртанасова Е.Я., Орехов А.А., Гусарев Д.А., Андреев Е.В., Балина К.Н., Дюжиков А.И., Евдокимов В.П., 20252025Хитарьян А.Г., Киртанасова Е.Я., Орехов А.А., Гусарев Д.А., Андреев Е.В., Балина К.Н., Дюжиков А.И., Евдокимов В.П.Khitaryan A.G., Kirtanasova E.I., Orekhov A.A., Gusarev D.A., Andreev E.V., Balina K.N., Dyuzhikov A.I., Evdokimov V.P.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/582

Обзор публикаций, посвященных проблеме хронических заболеваний вен у пациентов с ожирением (индекс массы тела ≥ 30,0 кг/м2). Поиск источников осуществлялся в базах данных PubMed и Cochrane. Данные проанализированных публикаций подтверждают, что ожирение является фактором риска развития как хронических заболеваний вен, так и осложнений и рецидивов после минимально инвазивного лечения хронической венозной недостаточности. В связи с этим обсуждается необходимость предварительного снижения массы тела у пациентов с ожирением перед хирургическим вмешательством на венах. Для этой цели все большую популярность приобретают бариатрические операции, после которых наблюдается корреляция между снижением массы тела и клиническим классом хронических заболеваний вен. Также изучаются перспективы фармакотерапии в лечении данной категории коморбидных пациентов. При этом особое внимание уделяется комбинации биофлавоноидов гесперидина и диосмина, комплексное воздействие которых приводит к уменьшению веноспецифических симптомов. Доказано, что гесперидин обладает противовоспалительными, ангиопротективными и гиполипидемическими свойствами. Он может предотвращать набор массы тела и уменьшать выраженность висцерального ожирения. Флеботропная терапия препаратом Венарус® в суточной дозировке 1000 мг (100 мг гесперидина и 900 мг диосмина) может успешно использоваться как для консервативного лечения ХЗВ у пациентов с избыточной массой тела и ожирением, так и в рамках комплексной терапии на этапах предоперационной подготовки к бариатрическим вмешательствам и после них. Стандартизированные дозировки двух компонентов препарата Венарус® способствуют его стабильному терапевтическому эффекту. Для иллюстрации влияния бариатрических операций на течение ХЗВ в ближайшем послеоперационном периоде приводим клинический пример: пациентка М., 42 года, вес 127 кг, ИМТ 49 кг/м2, ХЗВ 4b по CEAP – была выполнена лапароскопическая продольная резекция желудка. В послеоперационном периоде проводилась фармакотерапия препаратом Венарус® в дозе 1000 мг 1 раз в сутки в течение 3 мес., была рекомендована компрессионная терапия с помощью гольфов 2-го класса компрессии.

This review presents an analysis of publications on chronic venous diseases in patients with obesity (body mass index ≥ 30.0 kg/m2). The data were searched in the Pubmed and Cochrane database. Studies have shown that obesity is a significant risk factor not only for the onset of chronic venous disorders but also for the occurrence of complications and relapses after minimally invasive treatments. In this context, bariatric surgery is gaining popularity, as weight reduction has been shown to correlate with improvements in the clinical severity of chronic venous disease. There is growing interest in pharmacotherapy for this category of comorbid patients. The complex effect combination of bioflavonoids hesperidin and diosmin leads to reduction in venous symptoms. Hesperidin has been proven to have anti-inflammatory, angioprotective, andlipid-lowering properties. It can prevent weight gain and reduce the severity of visceral obesity. Phlebotropic therapy with Venarus® at a daily dose of 1000 mg (100 mg of hesperidin and 900 mg of diosmin) has demonstrated potential for effective use not only in conservative management of chronic venous diseases in patients with overweight and obesity, but also in comprehensive treatment protocols before and after bariatric surgery. Fixed dosages of the two components of the drug Venarus® contribute to a stable therapeutic effect. We present a clinical case report to illustrate the impact of bariatric surgeries on the course of chronic venous disease in the immediate postoperative period: patient M., 42 years old, weight 127 kg, BMI 49 kg/m2, CEAP 4b chronic venous disease, who underwent laparoscopic longitudinal gastric resection. In the postoperative period, the patient received pharmacotherapy with Venarus® at a dose of 1000 mg once a day for 3 months, and was recommended to use class 2 compression stockings.

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