Review authors consider the current possibilities of percutaneous laser coagulation for telangiectasias and reticular veins, which are the most common cosmetic defects of vascular genesis, occurring in more than 80% of women of different age groups. This vascular pathology constituting an aesthetic defect and causing local physical discomfort is one of the most common indications for phlebosclerosing therapy and percutaneous laser coagulation. The authors present the most effective and safe guidelines for percutaneous laser coagulation based on analyses of a large volume of specialized literature. Due to the use of state-of-the-art Nd:YAG lasers, percutaneous laser coagulation is increasingly used in patients with various types of intradermal vein lesions and, owing to high efficiency and safety, has advantages over compression sclerotherapy by several criteria. Nd:YAG lasers can be divided into long- and short-pulse ones according to their technical characteristics. Long-pulse lasers provide coagulation of the target vessel due to a single pulse with a high energy density (fluence), while short-pulse lasers, on the contrary, generate a series of pulses to the target vein with a running time of fractions of a millisecond, which ensures the conversion of hemoglobin into methemoglobin with a ten-fold increased ability to absorb laser energy and convert it to heat. As the duration of the pulses generated by the device is a priori shorter than the thermal relaxation time, the risk of burns to the skin and paravasal structures almost completely disappears. The authors provide clinical examples of the application of Aerolase Neo device that utilizes MicroPulse technology to confirm the effectiveness and safety of shortpulse Nd:YAG lasers.

Introduction. Telemedicine is a new form of communication between a doctor and a patient. Of interest is the expediency of its use in the postoperative observation of patients.
Aim. To analyze the possibility of optimizing the postoperative management of patients who underwent outpatient surgical treatment of VVLE using telemedicine.
Materials and methods. The study was performed in two stages on patients with VVLE. At the first stage, a comparative prospective, randomized study of the main and comparison groups (50 patients C2 according to CEAP) in the early postoperative period was conducted. In the main group, telemedicine was used, in the comparison group – face-to-face examinations in the polyclinic. The frequency of complications associated with surgery, the frequency of acute respiratory infections and the time spent on a follow-up examination were compared. At the second stage, in 876 cases of telemedicine use in the postoperative period, the frequency and structure of complications requiring conversion to face-to-face examination were studied.
Results. Significant differences between the compared groups were revealed by the frequency of acute respiratory infections and the time spent by the patient on a follow-up examination. The reasons for conversion from telemedicine to face-to-face examination: copious wetting of the bandage with blood, swelling and severe pain of the operated limb, hyperthermia are rare.
Discussion. Most of the complications and side effects associated with surgical intervention registered in the study have characteristic specific manifestations: complaints and appearance, which allows them to be diagnosed through telemedicine.
Conclusion. The use of telemedicine optimizes the postoperative period in patients with VVLE: the risk of infection with acute respiratory infections is reduced, the time of the doctor and the patient is saved, while there is no negative effect on the frequency associated with surgery.

Introduction. There is a growing number of people over 60 years old and consequently a growing number of elderly and senile patients with varicose veins globally. These patients have involutive changes that occur in the body, and therefore they need a special and personalized approach to examination and treatment.
Aim. Study and evaluate age-related and varicose disease-related structural changes in the inner lining of the large subcutaneous vein.
Materials and methods. 135 fragments of the large subcutaneous vein were examined, 55 of which belonged to deceased people who had no venous disease, 80 operated patients with varicose veins. There are 4 age groups: young, middle, elderly and senile. Histological, morphometric and electron microscopic examination was performed.
Results and discussions. The study showed that involutive changes are characterized by a decrease in the number of endothelial cells along the inner perimeter and their flattening, loosening and edema of the subendothelial stroma in persons over 75 years of age. In varicose veins, morphological changes progress with increasing patient age and disease duration. In young and middle-aged people with varicose veins, endotheliocytes flatten, protrude into the lumen of the vessel, collapse, areas of endothelial atrophy appear along the perimeter, signs of myoelastofibrosis appear, as indicated by an increase in the volume fraction of intima due to connective-woven structures. In patients over 60 years of age, endothelial desquamation is more evident in intimacy, the preserved cells are destructively changed, the volume fraction of intima significantly decreases, which corresponds to the signs of intima sclerosis.
Conclusions. Under normal conditions in senile age, the volume fraction is significantly reduced compared to the middle age group (p < 0.005). In case of varicose veins, structural changes, both qualitative and quantitative, progress against the background of involutive changes and disease duration, which aggravates endothelial dysfunction.

Introduction. The prevalence of phlebopathies varies from 15 to 31%. The QoL of patients with phlebopathies is impaired. Phlebotropic therapy is the main method for treating phlebopathies.
Aim. Evaluation of the efficacy and safety of micronized purified flavonoid fraction (MPFF) (Troxaktiv).
Materials and methods. A total of 129 females aged 18 to 45 years (average age of 35,2 ± 4,1 years) were included in the open observational study. To exclude pathology of the principal veins of the lower extremities, all patients underwent ultrasound examination, as well as photoplethysmography with automatic measurements of the venous refilling time and the power of the calf muscle-venous pump. All patients were divided into three groups: Group 1 received MPFF at a daily dose of 1000 mg only, Group 2 – class I compression hosiery in addition to MPFF, Group 3 – a course of psychotherapy and guidelines on lifestyle changes, augmentation of physical activity, etc.
Results. Due to ongoing treatment measures, positive changes with decreased number of complaints and their intensity were observed. Positive changes occurred mainly in the groups of patients receiving phlebotropic therapy and combined phlebotropic/compression therapy: the number of patients with vein-specific symptoms decreased by more than half, while 31 patients reported the persistence in complaints at baseline level or their slight decrease while taking psychotherapy course and lifestyle changes. The specific therapy groups reported a significant dynamic reduction in the feeling of heaviness and pain as well as night cramps in the calves.
Discussion. In the presented study, the patients were prescribed MPFF/Troxaktiv™ at a daily dose of 1000 mg, both as monotherapy and in combination with compression. A significant decrease in the frequency and severity of vein-specific symptoms and a significant increase in the patients’ quality of life was recorded in both of these groups. Photoplethysmography results showed an improvement in elastic rebound properties of the venous wall. All patients were satisfied with the treatment.
Conclusion. MPFF/Troxaktiv™ has demonstrated high efficacy and safety in the treatment of patients with phlebopathies of various origins.

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

Introduction. Treatment of patients with severe chronic venous insufficiency of the lower extremities is complex and along with compression therapy includes transdural use of drugs.
Aim. To study the microcirculatory blood flow of the tissues of the distal segments of the lower limbs in patients with severe chronic venous insufficiency and the possibility of its correction with the use of a combined product for local application.
Materials and мethods. The study included 40 patients suffering from varicose vein disease with chronic venous insufficiency of C3-C5 stages according to CEAP. In the main group of patients (n = 30) the transdermal combined product Detragel® was used; patients of the comparison group (n = 10) received only basic compression therapy of functional class II. The basis for the assessment of microcirculation of the lower limbs soft tissues was the analysis of the results of laser doppler flowmetry.
Results. At local use of Detragel® in combination with elastic bandage in 91% of observations, there was a statically significant decrease of basal blood flow less than 4.0 pf. units (p < 0.05). The mean basal blood flow was 2.7 ± 0.6 pf. units (1.6–3.9 pf. units, 95% CI), which was consistent with normal values. Statistically significant decrease in veno-arteriolar response to 51.5 ± 10.8% (36.0–68.8%, 95% CI) was recorded in 75% of cases after 14 days of topical treatment, although veno-arteriolar response decreased to normal in only 53% of cases.
Conclusion. Correction of microcirculatory disorders in patients with varicose vein disease should include local use of medicine.

The article presents a series of clinical cases describing the successful use of the long-pulse neodymium laser in removing unaesthetic reticular veins and telangiectasia of various locations. The first two cases demonstrated reticular varicose veins of the lower limbs in female patients with a fear of injections, which were treated without compression garments and ecchymoses with excellent effect. The outcome of treatment was comparable with that of classical sclerotherapy. The third case showed a successful laser removal of large telangiectasias on the hands, which developed following the long-term use of injection narcotic drugs as part of trophovegetoneurosis. Such pathology is rare for medical practice and approaches to its treatment have not been developed. The fourth case showed large telangiectasias of the buccal and zygomatic regions A good effect after the use of a large diameter spot in that area was demonstrated. The fifth case demonstrated the treatment of the veins in the buccal region, including the vein curving over the mandibular angle. The outcome of the treatment allowed to evaluate not only the aesthetic effect of the procedure, but also the severity of side effects in that area. In the sixth case, the periorbital vein, which divides into two branches, was investigated. The treatment was successful despite the different structure of the vein wall and depth of occurrence. The seventh case demonstrated the removal of large temporal veins. The outcome of treatment was presented on the following day, reflecting the degree of visual discomfort in the early post-procedure period. The final outcome a month after treatment was also demonstrated. In conclusion, the eighth case demonstrated the effectiveness of the treatment of scattered small red telangiectasias on the face using a long-pulse neodymium laser.

Introduction. A significant number of nosologies can result in long-term non-healing wounds that mostly have similar principles of local treatment. However, positive clinical outcomes are not always obtained in the management of such wounds. The authors have developed a personalized technology for local treatment of chronic wounds depending on their etiology.
Aim. Was to investigate the effectiveness of the proposed methods and personalized approaches for local treatment of long-term nonhealing wounds.
Materials and methods. Innovative methods of cleaning and stimulating regeneration of non-healing wounds have been developed in the study; their effectiveness was tested in 3 blocks of the study. The first block of the study included patients with long-term non-healing wounds of venous etiology, the second and third blocks included patients with long-term non-healing arterial and neurotrophic wounds, respectively. Each block involved two series of tests studying the developed methods of cryodestruction and stimulation of regeneration, respectively. In the 1^st block, the 3^rd series of tests was additionally conducted; it included patients with wounds larger than 20 cm² in size. 
Results. The developed methods of cryodestruction accelerate the course of phase I of the wound process by 12% in patients with longterm non-healing wounds of venous etiology, by 27% in patients with critical ischemia of the lower extremities, by 70% in patients with neurotrophic etiology (p ≥ 0.05). The use of the proposed methods of stimulating regeneration significantly reduced the average area of wounds in the study blocks. The main components of treatment stimulating regeneration in long-term non-healing wounds have been identified considering wound etiology.
Conclusion. The use of the developed algorithm for local personalized treatment of long-term non-healing wounds considering underlying disorders contributes to an earlier cleaning of the wound surface, elimination of inflammation and an increased activity of regeneration processes when compared with conventional approaches.

Introduction. In the cascade of pathogenetic mechanisms of diabetes mellitus, one of the central positions is occupied by systemic vascular lesions, including the lower extremities with the formation of diabetic foot syndrome.
Aim. To investigate and evaluate the diagnostic significance of endotoxin concentration and plasma fibronectin parameters in indicating the severity of purulent-necrotic inflammation of the feet in patients with diabetes mellitus.
Materials and methods. The study included 112 patients with purulent-necrotic inflammation of the feet aged 61.4 ± 12.5 years. By types of surgical intervention, patients were divided into groups: the main group (21 patients with transmetadarsal ammutation of the foot and 27 with amputation at the level of the lower leg), the comparison group – 64 patients with necrectomy and plastic closure of wounds on the foot. The concentration of endotoxin in the bloodstream was determined by the micro-LAL test (EU/ml), the content of plasma fibronectin was assessed by enzyme immunoassay (µg/ml).
Results. With the progressive development of purulent inflammation of the feet in patients of the main group, the concentration of endotoxin reached 9.32 (0.91) EU/ml, in the comparison group – 5.73 (0.36) EU/ml, in which purulent-necrotic the process was limited. In the main group of examined patients, hypofibronectinemia also had a more significant character. At the same time, the lowest fibronectin in patients was observed with an extensive purulent-necrotic process, in whom an amputation was performed at the level of the lower leg – 124.7 (6.2) µg/ml, the concentration of endotoxin in them reached the maximum figures – 10.51 (0.5) EU/ml.
Discussion.The main factor determining the depth of endotoxin aggression and destructive lesions of the extremities can be the enhanced utilization of fibronectin. Conclusion. The progression of endotoxin aggression is a predictor of an increase in the severity of destructive tissue damage in patients with diabetes mellitus.

Introduction. When performing dressings on surgical patients, dressings must combine a barrier function and low trauma to the edges of the wound and surrounding skin.
Target. To conduct a comparative assessment of the effectiveness of using adhesive- and silicone-based postoperative bandages.
Material and methods. The study included 98 patients with postoperative wounds of the anterior abdominal wall after closure of intestinal stomas, laparotomies and minilaparotomies. In group I of patients (n = 50), new silicone-based dressings (Cosmopor silicone) were used. In group II patients (n = 48), adhesive bandages were used. The observation period was 10 days. We assessed the pain syndrome when removing the bandage, the presence of skin damage, the presence of subjective complaints of itching, burning, discomfort in the bandage area, and the number of purulent-septic complications.
Results and discussion. When using silicone-based patch-type dressings, the number of patients with unsatisfactory skin condition decreased from 8 cases in the control group to 1 observation. The intensity of pain when removing the bandages decreased statistically significantly on the 6th and 9th days of observation in the main group – 0.8 ± 0.5 and 3.6 ± 1.0 points, respectively. Statistically significant differences were obtained in subjective complaints of discomfort and itching under the dressing material. The same number of purulentseptic complications in the form of suppuration of postoperative wounds in the comparison groups (χ² = 0.002; p = 3.841) confirms that silicone-based dressings are not inferior in barrier function to adhesive-based dressings.
Conclusion. Cosmopor silicone self-adhesive patch-type bandages on a silicone base improve the subjective sensations of patients, reduce the incidence of pathological conditions of the skin and wound surface, prevent increased pain during their removal, are applied for a longer period and do not affect the number of purulent-septic complications.

Venous trophic ulcers are one of the most common in the population, and costly in terms of treatment costs for complications of chronic venous insufficiency. The prevalence of venous trophic ulcers ranges from 0.18 to 1%. Over the age of 65 it increases to 4%. The cause of the formation of venous trophic ulcers is chronic diseases of the veins of the lower extremities. Chronic disease of the veins is a term that includes a wide range of morphological and functional disorders affecting the venous system. At the same time, even after conservative treatment, the level of recurrence of venous trophic ulcers remains extremely high, which leads to an increase in the duration of treatment for patients in the hospital, in some cases causing permanent disability in patients of working age. The literature has accumulated a huge volume of both fundamental and clinical research on the etiology, pathogenesis, diagnosis and treatment of venous ulcers. However, despite the numerous studies, the number of patients with this disease continues to steadily increase, and a number of important aspects of the pathogenesis have not yet been studied. In addition, these works do not allow us to formulate a unified concept of the pathogenesis of venous ulcers, which in turn affects the effectiveness of treatment of venous trophic ulcers. Our study highlights modern aspects of the pathogenesis of venous trophic ulcers, which may be of key importance in the treatment of this pathology. Promising directions of scientific research in this area are determined. This requires a more in-depth study of aspects of intercellular interactions, and also opens up the prospect of searching for new methods of influencing the pathogenesis of venous trophic ulcers, taking into account the presence of microflora resistant to standard antibacterial agents.

Introduction. General anesthesia (GA) and spinal anesthesia (SA) are the main techniques applied during total knee arthroplasty (TKA). SA belongs to neuraxial anesthesia (NA) category. Numerous studies have explored benefits of NA in diminishing the complications, among which are pulmonary embolism (PE), urinary tract infection (UTI), and deep vein thrombosis (DVT).
Aim. To compare rate of complications of SA and GA in TKA.
Materials and methods. This is a retrospective cohort studie conducted on 190 patients who attended Alwasity teaching hospital in Baghdad and underwent TKA. The age ranged from 41 to 75 years and 69% of patients were females. The patients were enrolled into SA group (80 patients) and GA group (110 patients). We reviewed patients’ records and interviewed patients and medically examined them to obtain data on age, sex, body mass index (BMI), comorbidities including diabetes mellitus(DM), hypertension (HT) and other comorbidities.
Results: Higher age and BMI were found in SA group. Complications’ incidence in SA group vs. GA group was PE 0.03 vs. 0.09, DVT 0.04 vs. 0.10, Pneumonia 0.04 vs. 0.08, UTI 0.06 vs. 0.23, and ARF 0.03 vs. 0.33, they didn’t differ significantly.
Conclusion: SA is a good option for anesthesia in TKA because it wasn’t associated with higher complications rate compared to GA.

Introduction. Video capsule endoscopy (VSE) is a gold standard diagnostic method for small bowel diseases and is widely used in clinical practice. The presented analysis of the VCE results demonstrates the possibilities of this diagnostic tool and is the largest one of the analysis that were recently published in Russia.
Aim. To demonstrate the possibilities of video capsule endoscopy in the diagnosis of small bowel diseases.
Materials and methods. A total of 300 video capsule endoscopies were performed in patients with suspected and already established small bowel diseases between 2014 and 2022. All patients who underwent a video capsule endoscopy in the settings of the National Medical Research Center of Coloproctology named after A.N. Ryzhikh were over 18 years old. The study cohort included 158 men and 142 women. The average age of patients at the time of the video capsule endoscopy was 42 ± 15.4 years. The patients were recommended a standard preparation regimen: 3 days before the study, a protein diet was prescribed, and the day before, a two-stage administration of a PEGbased drug (“split dose”). To reduce gas production and decrease the amount of foamy intestinal contents, which worsens the quality of the endoscopic image, oral administration of an antifoam agent simethicone was prescribed: 80 mg on the eve of the endoscopy and 80 mg on the day of the endoscopy.
Results. The video capsule endoscopy demonstrated high information value in the diagnosis of inflammatory bowel diseases: its sensitivity was 86%, and specificity – 90%. Similar results were obtained during video capsule endoscopy used to diagnose the source of possible bleeding: sensitivity and specificity were 87 and 68%, respectively.
Conclusion. Video capsule endoscopy is an effective, safe and well-tolerated tool for diagnosing small bowel diseases. The video capsule endoscopy findings contribute to establishing a correct diagnosis and selecting treatment strategies.

Hemorrhoidal disease is one of the most common proctological diseases in the population, covering, according to a number of authors, from 4 to 86% of the population over the age of 40 years. In addition, the problem of metabolic syndrome and accompanying obesity have become a real disease of the century in developed countries. This condition predisposes to a large number of diseases, including hemorrhoidal disease. From these positions, it is advisable to highlight the possibilities of treating not only hemorrhoids themselves, but also combating metabolic syndrome in this category of patients. The article describes modern data on the therapeutic effect of bioflavonoids, in particular hesperidin, and the mechanisms of their therapeutic action in acute and chronic hemorrhoids. The possibilities of using topical therapy for hemorrhoids are also highlighted, attention is paid to suppositories based on sodium alginate, thanks to which the drug has a hemostatic, anti-inflammatory and reparative effect, alleviating local symptoms of hemorrhoids and anal fissure. Data are provided on the therapeutic effect of the combination of hesperidin + diosmin in relation to the symptoms of hemorrhoids in patients with excess body weight and to metabolic syndrome are presented, as well as the experience of clinical observation in the hospital of the Faculty of Surgery No. 2 L/F of the N.I. Russian National Research Medical University is presented. Pirogov in the treatment of 1 300 comorbid patients with acute hemorrhoids and exacerbation of chronic hemorrhoids, followed by surgical treatment. The potential benefits of drugs with a standardized content of hesperidin (Venarus®) in relation to the treatment of hemorrhoids in patients with excess body weight and metabolic syndrome, comparison with other drugs from the group of bioflavonoids, are described.

Picosulfate, a diphenylmethane derivative, belongs to a group of drugs called stimulant laxatives. It is widely used in surgery to treat various colon evacuation disorders due to its effectiveness, safety of use and ease of dosage selection, as well as the option to combine with other laxatives. It is administered much more frequently for colorectal cancer screening, when the colon is prepared using sodium picosulfate combined with other osmotic laxatives, most often polyethylene glycol, which allows to use smaller volumes of solution. According to the literature, this method for cleaning the colon is used most often, which is associated with better adherence of patients to the intake of small volumes of liquid, as shown by our observations. The article highlights the literature data, and the authors also present their own experience – a clinical case report of the treatment of a 30-year-old patient diagnosed with grade I external and internal hemorrhoids. Laser ablation of internal and excision of external hemorrhoids was performed under local anesthesia. Regulax® Picosulfate was included in the therapy in the postoperative period, along with topical and pain relief drugs. As a result, the patient had a comfortable, not very painful bowel movement on the following day after the surgery. The laxative was used to manage stool for a week. In conclusion, the authors draw attention to the fact that increased patient compliance in preparing the colon for examination leads to better cleaning and more informative results during colonoscopy. Therefore, Regulax® Picosulfate combined with other laxatives to prepare a patient for examination, in particular colorectal cancer screening, where it is used most often, applies to a huge number of patients, so the problem of further study of its use is socially significant.

Introduction. There are opinions that the use of modern high-tech additional techniques, including a navigation system for positioning a colonoscope (MEI), can both increase the diagnostic efficiency of colonoscopy and its comfort for the patient, and do not affect the quality of colonoscopy.
Aim. To determine the capabilities of MEI during colonoscopy without sedation.
Materials and methods. The single-center, prospective, randomized study included 120 patients (from 20 to 82 years, mean age 51.8 years; 53% men / 47% women) who underwent routine diagnostic outpatient colonoscopy using a rotational technique by experienced endoscopists using MEI navigation system. The study took place in two stages: Stage 1 – randomization and assessment of group comparability (group 1 – MEI, n = 57 and group 2 – without MEI, n = 63); Stage 2 – determination of the number of patients with colon preparation for colonoscopy according to the Boston scale > 6 points (n = 112: 1st study-MEI group, n = 52 and 2nd control group, n = 60); comparative analysis between groups of the frequency of cecal intubation, time of cecal intubation, pain assessment on the VAS scale in cm. Statistical analysis was carried out using Fisher’s exact test, two-sided Mann-Whitney rank sum U test at a significance level of 0.05.
Results and discussion. The groups were comparable in age, gender, preliminary indications for the study. The cecum was intubated significantly more often in group 1 (100% vs 90%, p < 0.05). There was no significant difference in the time required for cecal intubation (p = 0.258) and the difference in the mean time required for cecal intubation was 22 seconds. The VAS pain assessment also did not reveal significant differences (p = 1.023). We determined that the increase in the frequency of cecal intubation using MEI by experienced endoscopists increases by 10% and reaches 100%, while the opinion about reducing the time of cecal intubation and improving patient comfort were not confirmed.
Conclusion. MEI during rotational colonoscopy performed by experienced endoscopists increases the likelihood of cecal intubation during routine colonoscopy by 10%. MEI does not increase the time required for cecal intubation and is not associated with the frequency or intensity of pain or discomfort on the VAS scale in colonoscopy without sedation.

Introduction. As there is insufficient evidence to date to determine phlebotropic drug preferences, further research in this area is warranted.
Aim. To evaluate the effect of topical and oral phlebotropic agents on vascular wall permeability in preclinical studies.
Materials and methods. The objects of the study were 6 phlebotropic agents for external and oral use, which were administered according to the recommendations specified in the instructions for use, 2 hours before the trypan blue. The model for preclinical studies: the xylene petechiae test with trypan blue staining. The evaluation criterion was the intensity of staining, which was expressed semiquantitatively (points). The test system was 100 white male outbred conventional mice.
Results and discussion. Heparin + EPL + escin (Detragel) significantly reduces the intensity of staining in the xylene petechiae test. It was found that with a single external application reduces the intensity of staining by 25.0% compared to the control, which significantly by 60.0% exceeded the effectiveness of the drug heparin 1000 IU; with a course application of 15 days in 2 times, which significantly, least by 50%, exceeded the effect of the drug heparin 1000 IU and cosmetic product containing troxerutin. MPFF 1000 mg (Detralex) at a single oral administration significantly reduced the intensity of staining by 35.0% compared to the control group, which significantly by 69.2% exceeded the effectiveness of the reproduced preparations of MPFF and diosmin 600 mg. The indicated results are explained by differences in production technology, composition of components and are consistent with the known data on clinical efficacy of different groups of venotonics.
Conclusion. In preclinical studies on the model of xylene petechiae with trypan blue staining, high efficacy of the original drug MPFF 1 (Detralex) at a single oral application and the drug heparin + EPL + escin (Detragel) at external single and course application for 15 days was established, which showed a significant difference with the control group, not less than 50% exceeded the efficacy of analogues and may indicate the effect on the permeability of the vascular wall.

Introduction. Along with the generally accepted thermal methods of saphenous varicose veins ablation, the use of non-thermal and combined methods becomes attractive. Due to the variety of mechanisms of action, low-frequency ultrasound is a promising technology for performing a wide range of minimally invasive intravascular operations, including the treatment of varicose veins.
Aim. To elucidate the mechanism of action of a novel endovenous ultrasound ablation method and evaluate its effect on vein wall injury and lumen occlusion in an animal model.
Materials and methods. A total of 34 central ear vein (CEV) medial ramus were treated in 17 rabbits according to the follow-up protocol. Six femoral veins from three rabbits enrolled into the acute experiment were harvested 45 min after the procedure. All treated CEV medial ramus in the follow-up experiment were divided into four treatment groups with an observation time of: (0) 30 days, control procedure; (1) 60 days, ultrasound ablation; (2) 95 days, ultrasound ablation; (3) 138 days, ultrasound ablation.
Results. Occlusion was achieved in all but one CEV medial ramus (29/30; 97%) treated with ultrasound. Histologic examination of treated veins showed heat- and mechanical-induced changes in the vein wall, such as abrasion of the endothelium and fibrotic lesions in the tunica media and tunica adventitia. The occluded segments consisted mainly of cellular fibrotic material. In the acute group, histological evidence of damage to all vessel wall layers was found.
Discussion. Ultrasound ablation results in homogeneous and uniform damage to the venous wall. The results of this study suggest that the ultrasound treatment leads to venous occlusion by the additive thermomechanical mechanism of damage to the vessel wall.
Conclusions. Endovenous ultrasound ablation showed a similar pattern of thermal damage as endovenous laser (EVLA) and radiofrequency ablation (RFA) and damage to the endothelium as mechanochemical ablation (MOCA). Four months after ultrasound ablation, the occlusion rate was 90%.

Introduction. Sclerobliteration of varicose veins of the lower extremities is one of the most common methods of treating patients with varicose veins. However, the main disadvantage of echosclerobedation of the trunks of the great and small saphenous veins is the possibility of recanalization of sclerosed veins. In this regard, it is of interest to compare the results of using radiofrequency vein obliteration and endovenous laser coagulation in these patients.
Aim. To study the effectiveness, advantages and disadvantages of the use of radiofrequency vein obliteration and endovenous laser photocoagulation of recanalized varicose veins in patients undergoing sclerobliteration.
Materials and methods. 44 patients aged 18 to 62 years underwent radiofrequency obliteration and endovenous laser coagulation of varicose veins after previous sclerobliteration. A comparative assessment of the duration of the operation, technical success, intensity of the pain syndrome, the level of postoperative complications and relapses of the disease after the use of these methods of recanalized saphenous veins after previous sclerotherapy was made.
Results and discussion. The technical success of endovenous laser coagulation of reknalizirovanny varicose veins was 100%, radiofrequency obliteration of veins – 90.9%. The intensity of postoperative pain on the 7^th day from the moment of radio wave exposure was 12.1% lower than after the use of endovenous laser coagulation, the average duration of laser thermolysis was 32 ± 0.6 minutes, radio wave – 39 ± 0.7 minutes.
Conclusion. Laser coagulation compared to radiofrequency is a more reliable and feasible operation, but is accompanied by a higher level of postoperative pain and side effects.

Venous malformations are the most type of angiodysplasia, which cause both physiological and emotional discomfort to patients. In this article, the authors presented a clinical example of effectiveness combined foam form sclerotherapy and laser photocoagulate with Intensive Pulsed Light therapy and show a long-term outcome in a patient with superficial venous malformation of her anogenital area, which are accompanied with such symptoms as pain and bleeding. As a sclerosing agent, a 1 and 3% sodium tetradecyl sulphate solution was used. The interval between procedures was 6 weeks. After two sessions, the superficial venous malformations of the anogenital area decreased in the size and volume, and the patient presented less complaints. After the first stage of treatment, which includes sclerotherapy, then 3 sessions of laser photocoagulate were performed, with an interval between sessions from 1.5 months. Ultrasound angioscanning allows us to assess the degree of regression of venous dysplasia, cavities and cavities of the pathological process. Ultrasound is a minimally invasive and affordable diagnostic method that, in addition to universality, excludes the component of psychoemotional discomfort. This is due to the absence of a large routine during the study with the application of any physical or mental impact on the body and the patient as a whole. The main advantage is the possibility of implementing minimally invasive treatment at the outpatient stage, with the possibility of combination therapy, both in a hospital stay, and in commercial and private medical centers. The combination of foam sclerotherapy with percutaneous laser coagulation (plus IPL therapy) in this clinical case demonstrates the effectiveness and safety in localizing the pathological process in the anogenital region. The obtained result demonstrates the absence of malformation growth and complications in the form of repeated bleeding with a good cosmetic effect in the medium and long term.

Rapidly rising prevalence of ulcerative colitis in developed countries among young population compels the medical community to pay attention not only to the problems of early diagnosis and therapy of this disease, but also to preventing the development of complications, that may lead to disability. This article reviews a clinical case of the development of surgical complications in a patient with a long-term active course of ulcerative colitis, who has been also suffering from autoimmune hepatitis and primary sclerosing cholangitis for 20 years. The prolonged active course of the disease and total damage to the colon, association with primary sclerosing cholangitis, as well as the patient’s low adherence to therapy were risk factors for the development of adenocarcinoma of the ascending colon, which required radical surgical treatment. The formation of adhesive disease and multiple abdominal abscesses can be noted as long-term complications, which led to the repeated use of invasive methods of treatment. Over the next few months, the patient experienced 2 more episodes of local purulent complications that required surgical treatment due to the ineffectiveness of antibiotic therapy. All episodes of purulent complications were accompanied by progressive leukopenia due to prolonged use of immunosuppressive drugs. In our opinion, in patients with ulcerative colitis who take cytostatic agents for a long time, special attention should be paid to monitoring and correcting leukopenia, as well as preventing the development of purulent complications.

Introduction. The Russian Phlebological Register began work in 2016 under the patronage of the Association of Phlebologists of Russia. The creation of a phlebological register in a separate municipal center of the country complements and enriches national plans.
Aim. Тo investigate the trends in the organization of medical care to the population with chronic venous diseases (CVD) of a large industrial center using the phlebological register over the past 20 years.
Materials and methods. The data of municipal and private medical institutions of Ekaterinburg from 2003 to 2022 are analyzed. Data on municipal hospitals (MHs) are provided by the TFOMS of the Sverdlovsk region. Data on private medical centers (PMCs) are obtained by exporting them from the electronic databases of each center. The statistics of phlebectomies (PhE), outpatient minimally invasive interventions and procedures are summarized.
Results. Over the entire period of time, the number of classical phlebectomies in MHs decreased by 4 times – from 2300 (2003) to 587 (2022). At the same time, the development of minimally invasive procedures on the main veins in the PMCs increased from 313 (2003) to 4364 (2022). This made it possible to double the coverage of patients suffering from CVD with specialized medical care. In the structure of patients operated in MHs, the proportion of persons with severe chronic venous insufficiency (CVD C4–6) significantly decreased. The number of patients with superficial thrombophlebitis had a steady downward trend: the first 5 years (2003–2007) – about 200 PhE/year, then 5 years (2008–2012) – about 120 PhE/year, and from 2013 to 2022 < 100 PhE/year.
Discussion. Private medical centers have consistently introduced the latest technologies, but endovasal laser coagulation remains the leader.
Conclusion. The analysis of the register revealed a number of systemic changes in the organization of phlebological care.

Elastofibroma is a rare, slow growing, benign soft tissue tumor characterized by a typical location in the subscapularis. It has a mesenchymal origin and consists of proliferating fibrous and adipose tissue with elastic and collagen fibers in its composition. Pain and discomfort in the subscapular region, restriction on movement are typical complaints for patients with elastofibroma, however, the absence of clinical symptoms and difficult differential diagnosis make it difficult to choose treatment tactics. A 70-year-old patient applied to a surgeon at the Clinical Diagnostic Center of the Central Clinical Hospital of St Alexis with complaints of a painless tumor-like subcutaneous mass in the region of the lower angle of the right scapula. She noted the presence of this formation 5 years ago, during this time the tumor gradually grew. When viewed on the back along the lower edge of the right shoulder blade, a volumetric tumor-like formation in the form of a ball measuring 7.5 × 6.0 × 2.0 cm, soft-elastic consistency is determined. On palpation, painless, not soldered to the skin. The skin over the formation is not changed. A preliminary diagnosis was established lipoma of the back. The diagnosis of elastofibroma was established after ultrasound of the posterior chest wall, MSCT of the chest. For differential diagnosis, the puncture biopsy material was sent for histological examination, the result of which confirmed the diagnosis of elastofibroma. Observational tactics in this case is preferable, since elastofibroma is not accompanied by pain, limitation of mobility, and does not bring discomfort when moving. Thus, at the moment, imaging methods allow establishing an accurate diagnosis, but histological examination is necessary for differential diagnosis. However, a histologically confirmed diagnosis will not always be an indication for surgery. In most cases, in the absence of clinical manifestations, observational tactics are followed in the treatment.

Introduction. Postoperative venous thromboembolic complications – a frequent and difficult to control problem for a polyclinic surgeon.
Aim. To study and evaluate the possibilities of using the thrombodynamics test for the control of postoperative venous thromboembolic complications.
Materials and methods. In 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias and varicose veins of the lower extremities), who underwent planned surgical treatment, stratified into risk groups of postoperative venous thromboembolic complications: low, moderate and high, in the postoperative period for 2–3, 7–9, 14–16, 30 days, a study of D-dimer, thrombodynamics test was conducted in parallel with ultrasound examination of the veins of the lower extremities.
Results. It was revealed that hypercoagulation according to the thrombodynamics test was present in 34.2% of patients already at the first study, an increase in D-dimer was noted in 28.3% of patients at late follow-up, venous thrombosis was detected on ultrasound in 15% of the studied 6 people from each risk group within 2–15 days after surgery, carried in 83.3% The cases were asymptomatic, localized mainly in the deep veins of the lower leg and were always combined with hypercoagulation according to the thrombodynamics test and an increased level of D-dimer. It was noted that hypercoagulation against the background of the use of standard doses of anticoagulants in 61% of cases takes a positive trend, and in 39% remains unchanged.
Discussion. Hypercoagulation recorded by the thrombodynamics test in the first days after surgery indicates insufficient effectiveness ofstandard thromboprophylaxis in the perioperative period. An increase in the D-dimer cannot be used as a prognosis of a prethrombotic state.
Conclusions. Hypercoagulation as a precursor of venous thrombosis is well detected by the thrombodynamics test, its dynamics reflects the individual effectiveness of the use of anticoagulants, which justifies the possibility of using this indicator by a polyclinic surgeon in the control of postoperative venous thromboembolic complications.

Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body.
Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations.
Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.

Based on their own research and a review of the literature, the authors analyze the possible cellular mechanisms of the development of an inflammatory reaction after the obliteration of varicose veins with cyanoarylate adhesive compounds (CAO), which received the name phlebitis- Like abnormal Reaction (PLAR) in foreign sources. Despite the existing opinion about the “abnormal” nature of the inflammatory reaction, it is noted that the main stages of its development are fully consistent with the currently known molecular and cellular mechanisms of the response of biological tissues to contact with a foreign antigenic substance and are of a natural nature. The cause of the development of acute alterative inflammation in the vein wall is the direct contact of the endothelium with an aggressive environment, which is cyanoacrylate. A specific feature of the development of chronic inflammation in the vein wall is its productive interdaily character, which is replaced by proliferative processes. The main role in the development of successive stages of PLAR development is played by monocytic, mast and giant cells of foreign bodies, as well as the mechanisms underlying the regulation of the functional activity of these cells. During the period of cyanoacrylate biodegradation, its cellular environment corresponds to all morphological features of a phagocytoma, whose activity decreases with the biodegradation of cyanoacrylate with simultaneous connective tissue proliferation. The development of possible chronic granulomatous inflammation is based on a local autoimmune process associated with the formation of giant multinucleated epithelioid cells (Langerhans cells). In conclusion, it is emphasized that today, when using various cyanoacrylate compounds for the purpose of adhesive obliteration of veins, taking into account the accumulated clinical data and morphological studies, the final answers to the existing reasonable objections about the complete safety of the use of cyanoacrylates in clinical practice should be given by fundamental immunohistochemical and genetic studies.

Introduction. Desarterization of hemorrhoidal arteries with mucopexia, a pathogenetically caused minimally invasive operation, is more often performed in stationary conditions under regional or general anesthesia.
Aim. To study the results of desarterization of hemorrhoidal arteries in patients with hemorrhoids operated on an outpatient basis under local anesthesia.
Materials and methods. 459 patients with chronic hemorrhoids of stage 2–4 with varying degrees of node prolapse under local infiltration anesthesia with Ultracaine were operated on by one surgeon. The duration of the intervention, the intensity of the pain syndrome, and the complications of treatment were studied.
Results. The median duration of the operation is 25 minutes, the intensity of pain during the operation on a 10-point scale is 2 points, on the 3^rd day of the postoperative period-2 points. Complications occurred in 6 (1.3%) people, in the 1^st urinary retention, paraproctitis, and in the 4^th – bleeding.
Discussion. The obtained results of a longer procedure in patients with stage II hemorrhoids are associated with the training period. The intensity of pain during the HAL-RAR procedure performed under local anesthesia, including in patients of stage III-IV and IV, was acceptable and was tolerated by patients satisfactorily. The structure of the complications that have arisen is limited by a narrow range of pathology: bleeding, acute urinary retention, paraproctitis.
Conclusion. Hemorrhoidal artery desarterization is an effective method of treating patients with chronic hemorrhoids on an outpatient basis: low duration ofsurgery, low frequency of complications. Local anesthesia during the ligation of hemorrhoidal arteries with mucopexia provides adequate anesthesia, patients tolerate the procedure and pain in the postoperative period, regardless of the stage of the disease, therefore, this method of treatment is advisable to use in outpatient practice.

The management of arteriovenous malformations of the hand is one of the most difficult problems in vascular surgery. It’s primarily related to the number of vessels and nerves involved in the pathological process on a very limited anatomical area. Commonly the required steps of the diagnostic process are the following: clinical examination, Doppler colour flow mapping, MRI with intravenous contrast, angiography and thermography. There are various methods ofsurgical treatment of patients with arteriovenous malformation of the hand. Generally, they might be classified as endovascular and open-surgical ones. Endovascular methods, such as embolization and sclerotherapy, are associated with the risk of severe complications such as soft tissue necrosis, distal vascular bed-specific thrombosis, along with both sensory and motor connectivity of the hand. However minimally invasive procedures do not always contribute to an appropriate clinical result. This article presents an example of successful surgical treatment of a patient with arterio-venous malformation of the thumb finger with severe pain syndrome and recurrent bleeding ulcers. A radical removal of the malformation-bearing tissue with preservation of the arterial blood supply was performed under an arterial tourniquet. At the one-year post-surgery follow-up examination, the patient noted the absence of pain syndrome and ulcers, restoration of mobility in the interphalangeal and metacarpophalangeal joints. Thus, the treatment of arteriovenous malformation of the hand should be based on the latest research findings and the most advanced testing technologies. This clinical case demonstrates that open surgery can be considered as an effective and sustainable clinical approach with a good medium-term outcome for the patients with arteriovenous malformation of the hand.

Introduction. The conducted epidemiological studies show a significant socio-economic burden borne by modern society due to the high prevalence of varicose veins of the lower extremities among the able-bodied population of developed countries.
Aim. Assessment ofthe influence ofthe factor of widespread use of minimally invasive inpatient replacement technologies on the prevalence of varicose veins of the lower extremities in a large region of the Central Federal District of the Russian Federation under the conditions of transformation of approaches to the treatment of varicose veins of the lower extremities.
Materials and methods. A retrospective study was conducted for 2011–2021 of statistical indicators of the work of medical organizations of the Yaroslavl region, namely: the total number of attached adult population, the dynamics of the number of attached population, the total number and dynamics of the number of patients with an established diagnosis of varicose veins of the lower extremities. 
Results and discussion. The total population weight of the sample in the Yaroslavl region for all periods of the study was 11 406 181 people. The fixed weighted average value of the prevalence of varicose veins of the lower extremities at the end of the year in the Yaroslavl region in the period 2011–2021, according to medical organizations providing medical care on a territorial-precinct basis, was 0.784% (CI: 0.779–0.789). At the same time, in 2011–2012 and 2018–2019, the frequency of varicose veins of the lower extremities event was higher than the average value, in 2013–2016 and 2020–2021.
Conclusion. It has been established that over the past decade there has been an annual decrease in the prevalence of varicose veins of the lower extremities in the region. At the same time, there was an increase in the share of medical care provided to patients by non-governmental medical organizations. The latter in their activities are focused on hospital-substituting technologies in the treatment of this disease.