Фиксированная комбинация на основе экстракта рускуса и ее место в современных клинических рекомендациях по лечению хронических заболеваний вен

Хронические заболевания вен (ХЗВ) представляют собой самую распространенную сосудистую патологию нижних конечностей. Разнообразные веноспецифические симптомы и синдромы, связанные с ХЗВ, оказывают негативное влияние на все составляющие качества жизни современного человека. В настоящее время доказано, что появление и развитие веноспецифической симптоматики связано с раздражением С-ноцицепторов в результате воздействия т. н. алгогенов – биологически активных субстанций, образующихся в результате сосудистого воспаления и дисфункции эндотелия, а также увеличения локальной температуры и внутривенозного давления. Основной причиной эндотелиальной дисфункции при ХЗВ выступает флебостаз со снижением напряжения сдвига, приводящий к гипоксии эндотелиоцитов. В дальнейшем активируется многоступенчатый механизм лейкоцитарно-эндотелиального взаимодействия, в результате которого на микроциркуляторном уровне формируется венозная микроангиопатия, а на макроциркуляторном – повреждается клапанный аппарат и формируется варикозная трансформация магистральных поверхностных вен. Очевидно, что подавление лейкоцитарно-эндотелиальной воспалительной реакции не только приведет к уменьшению или исчезновению веноспецифической симптоматики, но и предотвратит макро- и микроциркуляторные нарушения. В этой связи большой интерес представляют т. н. флеботропные, или веноактивные, фармакологические препараты, мишенями воздействия которых служат различные патогенетические механизмы развития и прогрессирования ХЗВ. При этом, несмотря на общий для этой группы препаратов флебопротективный эффект, конкретные механизмы его достижения у различных веноактивных агентов могут иметь существенные различия. В данном обзоре мы хотим обсудить основные показания и регламент применения флеботропных препаратов у пациентов с ХЗВ, опираясь на наиболее авторитетные международные и российские клинические рекомендации.

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