The presented paper reviews the monograph Strategies to improve outcomes of minimally invasive treatment of varicose veins of the lower extremities by D.A. Borsuk and A.A. Fokin intended to be used by surgeons, cardiovascular surgeons, ultrasonic medical investigation specialists, resident physicians, graduate students and students of medical universities. The need to publish the book is determined by the urgency of the problem at issue. The reviewer discusses the results presented by the authors of their own comparative and non-comparative, randomized and non-randomized, prospective and retrospective, clinical and morphological single-centre trials. The monograph’s review summarized its theoretical and practical value for treatment and preventive surgery facilities providing care to patients with lower extremity varicose vein disease.

Introduction. Despite modern advances in technologies for the treatment and prevention of varicose veins, there is currently no radical treatment for varicose veins. The probability of recurrence of dilated veins, according to various authors, ranges from 5 to 70%. Along with the well-established concept of recurrence of varicose veins, the term progression of varicose veins is increasingly common in everyday life.

Aim. To study the current understanding of the term relapse and the practical attitude of specialists involved in the treatment of varicose veins to it.

Material and methods. In 2023, a survey of 117 specialists on the recurrence/progression of varicose veins was conducted. The respondents were doctors involved in the treatment of varicose veins: vascular surgeons 22.4%, phlebologists 50%, general surgeons 19.8%, specialists in ultrasound/functional diagnostics 7.8%, X-ray endovascular surgeon 0.85%. The questionnaire included 18 questions regarding the frequency of visits of patients with relapse/progression of varicose veins; views on tactics, as well as the attitude of specialists to the issue of progression and recurrence of varicose veins in patients after its surgical treatment.

Results and discussion. The concept of recurrence and progression of varicose veins among specialists dealing with this pathology is not always comparable. There are differences in views both on the predisposing factors for the recurrence of dilated veins, and, accordingly, on the tactics of treatment and preventive measures. In some cases, according to statistics, they are due to specialization.

Conclusions. The incidence of relapse and progression at the reception of the respondents has a slight difference. Despite the fact that there are opinions that do not correspond to generally accepted and abhorrent collegiality, mostly specialists try to separate these concepts, see differences in provoking factors and, accordingly, in recommendations.

Introduction. Development of venous pathology of the lower extremities is based on morphological changes in the vascular wall. Further structural restructuring of the vein wall in chronic venous insufficiency will depend on the initially present differences in the structure of their walls.

Aim. To conduct a comparative analysis of morphological and morphometric features of the structure of the walls of the main venous collectors of the lower leg: the great saphenous vein, intramuscular veins, posterior tibia veins and poplitea vein.

Materials and methods. Histological studies were carried out on autopsy material of the veins of 32 people who died from various causes aged 35 to 50 years and 10 amputated limbs. Morphological studies of the venous wall were carried out by light microscopy with digital photo processing.

Results. A quantitative comparative analysis of morphological changes with the determination of the volume fraction of smooth muscle and connective tissue elements of various membranes of the venous wall, as well as measurement of the total thickness of the vascular wall and its ratio to the lumen of the veins showed statistically significant differences at a significance level of p < 0.05.

Discussion. Despite the similarity of the general morphological picture of the structure of various venous collectors of the lower leg, structural differences were established, which concerned the volume fraction of the presence of both smooth muscle and connective tissue elements.

Conclusion. The comparative qualitative and quantitative statistical analysis of morphological and morphometric features of the structure of the walls of the main venous collectors of the lower leg allows us to make an assumption about the unequal role of individual main venous collectors in the work of the muscular-venous pump of the lower leg as a whole.

Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux. Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.

Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.

Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.

Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.

Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Introduction. The combination of endovasal laser coagulation and miniphlebectomy is actively used in the treatment of Chronic venous diseases, however, the question of improving the management of such patients in the postoperative period remains actual.

Aim. To evaluate the effectiveness of the combined use of oral and topical forms of phlebotonics after endovasal laser coagulation.

Materials and methods. The study was conducted in 60 patients after surgery divided into 2 comparable (n = 30). The group 1 was treated with MPFF 1000 mg (Detralex) once a day during the perioperative period (10 days before surgery and up to 2 months after) and additionally topical Detragel daily 3 times a day for 10 days after the intervention. The group 2 used heparin topical form for 10 days after surgery. Control was carried out on the 1st day, 10th day after surgery, as well as after 3 and 6 months.

Results. In group 1, there was a statistically more significant decrease in the level of pain on days 1 and 10 after surgery (p ≤ 0.05), while the frequency of hyperpigmentation at months 3 and 6 after surgery was also less presented.

Conclusions. The combination of endovasal laser coagulation and miniphlebectomy while taking MPFF and a gel based on heparin, escin and essential phospholipids is accompanied by less severe pain and the level of hyperpigmentation in the postoperative period.

The problem of finding an ideal method for the correction of vertical venous reflux in lower extremity varicose disease is highly relevant due to the rapid development of technologies and the opening of new treatment methods, including minimally invasive ones. According to many researchers, the main parameters for choosing the optimal surgical technique should be low invasiveness, compliance with the anatomical, including ultrasound, picture, the possibility of using local anesthesia, taking into account concomitant pathology and individual intolerance of various drugs by patients, effectiveness of venous vessel obliteration, and minimal risk of possible complications. The review considers a comparative characterization of endovascular treatment methods for varicose disease, as well as lists the main possible complications of each of them. In terms of obliteration effectiveness and the least pronounced complications, the leading position is occupied by the method of cyanoacrylate obliteration. There is an increasing amount of information in the literature about the use of cyanoacrylate composite in the treatment of lower extremity varicose disease. Since this method is relatively new, the number of publications describing complications of this procedure is increasing. We describe a number of specific adverse events that occur during this surgery (extravasation of cyanoacrylate composite with the formation of aseptic granulomas and, in some cases, phlebitis-like phenomena, formation of rigid subcutaneous bands limiting mobility in the knee joint, migration of cyanoacrylate into the deep venous system of the lower extremities), possible mechanisms of their occurrence, and various approaches to treatment. Special attention is paid to proximal migration of cyanoacrylate composite into the area of the saphenofemoral junction, with a description of a specific clinical case and a discussion of further management tactics for this category of patients.

Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.

This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m² or more, and overweight as a BMI from 25 to 30 kg/m² according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.

Introduction. Roux-en-Y gastric bypass (RYGB) is one of the most popular bariatric procedures. However, the Impact of alimentary and biliopancreatic loops lengths on the results of Roux-En-Y Gastric Bypass with a maximum restrictive component remains insufficiently studied.

Aim. To compare the long-term results of RYGB with a maximum restrictive component at different lengths of alimentary and biliopancreatic loops.

Materials and methods. Our retrospective study included 170 patients: 98 (57.6%) in the group with long alimentary and biliopancreatic loops, 72 (42.4%) in the group with short loops. Follow-up examinations were carried out with a follow-up period of at least 24 months (median follow-up 38 months). In the first group, the lengths of the alimentary and biliopancreatic loops were 150 and 100 cm, in the second group – 100 and 60 cm respectively. In the preoperative period, all patients underwent a standard set of examinations with an obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. The size of the gastroenteroanastomosis was assessed 12 months after surgery using fibrogastroscopy.

Results. Both groups showed good results in weight loss and control of associated diseases. The prevalence of moderate sarcopenia in the group of RYGB with long loops was 24.5% (19.4% in the preoperative period), severe sarcopenia was observed in 3% of the subjects (initially severe sarcopenia was not detected in any patient). In the group of RYGB with short loops, the incidence of sarcopenia increased from 13 to 16% (the difference is statistically insignificant). No pronounced sarcopenia was detected in this group after surgery.

Conclusion. If patients have signs of moderate sarcopenia according to bioelectrical impedance analysis, type 2 diabetes mellitus, as well as in the elderly, it is advisable to perform RYGB with a minimal malabsorptive and maximum restrictive component.

In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.

Introduction. “One-day surgery” expands the possibilities of providing surgical care in a polyclinic with hospitalization for just one day. This area of medicine allows you to use the most effective method of treating hemorrhoids in a polyclinic – the operation hemorrhoidectomy.

Aim. To substantiate the effectiveness of performing hemorrhoidectomy surgery in patients with stage 3–4 hemorrhoids in a day hospital of a polyclinic under the program “One-day surgery” with accelerated recovery of patients.

Materials and methods. The main principle for performing hemorrhoidectomy surgery in a day hospital is a careful selection of patients. Closed hemorrhoidectomy with restoration of the anal canal mucosa (by Parks – Milligan – Morgan’s in the second modification of the State Research Center of Coloproctology) under spinal or general anesthesia is the surgery of choice for hemorrhoids treatment in the day patient department of a clinic. 138 surgeries were performed in the day patient department during 2 years and 10 months. After surgery, patients were placed in the surgical day-patient department wards for 3–5 hours until full activation. Then they were allowed to go home without being accompanied by a medical worker. The satisfaction of patients with the program was analyzed by a survey with a 5-point scale.

Results. The timing of scheduled operations for patients has been shortened. The number of complications after hemorrhoidectomy in the early postoperative period was decreased, without long-term postoperative complications. The treatment of such patients in the surgical day-patient department demonstrated a good economic effect. The overall satisfaction with the one-day surgery program was very high (4.82). The results confirmed the effectiveness of this area of medicine.

Discussion. Our experience of performing hemorrhoidectomy operations in a day surgical hospital for 3 years confirms the existence of a number of advantages over treating patients in a 24-hour hospital.

Conclusions. The “One-day Surgery” and accelerated patient recovery programs expand the possibilities for treating patients with stage 4 hemorrhoids directly in the polyclinic, and thus reduce the burden on the surgical hospital.

Introduction. Anal contact or conduction in the anal canal and rectum is a common condition in the coloproctological field, occurring in 5% of the population that affects this country. Treatment consists of hygiene and the use of topical steroids, antibacterial and antifungal agents. No generally accepted attitude towards a private person has been developed.

Aim. To study the effectiveness of using homeopathic ointment in the treatment of patients with anal itching.

Material and methods. A prospective comparative randomized study was conducted in a specialized advisory center of the Clinics of Samara State Medical University. The study included 96 patients with anal itching without fungal infection of the perianal skin and concomitant purulent pathology. In the main group (n = 46), treatment was carried out using homeopathic ointment in the perianal area 2–3 times a day for 14 days. In the control group (n = 50), treatment was carried out with topical steroid ointments 2–3 times a day for 14 days.

Results and discussion. From the data obtained on the use of homeopathic ointment, it follows that it is not inferior in effectiveness to topical steroid ointments in reducing symptoms of the disease (Student’s t-test = 0.35; p > 0.05 and Student’s t-test = 0.28; p > 0.05), and by the number of relapses (χ² = 0.535; p > 0.05).

Conclusion. The use of homeopathic ointment for topical application appears to be a promising new treatment for patients with anal itching and is as effective as topical steroid ointments.

Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.

Introduction. In recent years, surgeons have increasingly used combined operations in patients with inguinal hernias and recurrent varicose veins. However, it is necessary to justify the choice of the type and volume of the main and concomitant stages of combined surgery, depending on the individual characteristics of both diseases.

Aim. Optimization of surgical treatment of patients with inguinal hernias in combination with relapses of varicose veins.

Materials and methods. The study included 39 patients aged 35 to 78 years with inguinal hernias and RVB. Of these, 21 patients who underwent combined operations were included in the main group. The control group included 18 patients who underwent staged hernioplasty, and then after 1–26 months, operations for RVB, or interventions were performed in reverse order. A comparative assessment of the duration of operations, the level of postoperative pain, immediate and long-term results, and the number of complications of uncorrected diseases in two-stage treatment was carried out.

Results and discussion. Performing combined operations in this category of patients does not lead to an increase in the level of postoperative complications, it is accompanied by an average increase in the duration of surgery by 33.6 minutes and an increase in the intensity of postoperative pain by 0.8 points, a decrease in temporary disability by 1.2 times.

Conclusions. Performing combined operations is the optimal intervention in patients with inguinal hernias with concomitant recurrence of varicose veins. The use of combined operations makes it possible to simultaneously eliminate both diseases and exclude the development of complications from an uncorrected disease, which, with two-stage treatment, was observed in 11.1% of cases and required emergency operations.

Introduction. Currently, along with the improvement of the scheme of combined drug therapy with first-line anti-inflammatory drugs, important importance is attached to adjuvant topical methods of treating diseases of the distal colon of various inflammatory genesis.

Aim. Evaluate the clinical efficacy of the drug on sodium hyaluronate as an adjuvant topical agent in the complex treatment of patients with diseases of the distal colon.

Materials and methods. A comparative analysis of the results of drug treatment of 97 patients with diseases of the distal colon of various inflammatory genesis, which were divided into two groups, was carried out. In 46 (47.4%) patients of the I (control) group, standard drug therapy with basic anti-inflammatory drugs was performed; 51 (52.6%) patients – II (main) group, the standard program of drug treatment was supplemented with instillations into the rectum of the drug on sodium hyaluronate (0.8 mg of hyaluronic acid in 1 ml). The comparative assessment of the results of treatment took into account the severity of clinical, laboratory and endoscopic manifestations of the disease.

Results. In patients of the main group, there was a significant reduction in the healing time of erosions and ulceration of the mucous membrane of the distal colon compared with patients in the control group (29.4 ± 5.7 days, respectively, versus 52.8 ± 6.2 days). Also, in patients of the main group, it was possible to achieve stable clinical and laboratory remission of the disease at an earlier time, restoration of patients’ ability to work, and improvement of their quality of life.

Conclusion. The results obtained by us allow us to recommend the drug on sodium hyaluronate as an additional topical drug for the medical treatment of chronic diseases of the distal colon of various inflammatory genesis in outpatient settings.

RETRACTED ARTICLE

Introduction. Varicose veins of the lower extremities are one of the most common diseases, affecting 20 to 40% of the population. One of the most common treatment methods is endovenous laser coagulation (EVLC).

Aim. To evaluate the effectiveness of local gel therapy based on escin, heparin and essential phospholipids in the postoperative administration of patients after endovenous laser coagulation.

Materials and methods. A complex treatment of 53 patients with varicose veins of the lower extremities of classes C2-C3 according to the CEAP nomenclature was carried out. Patients were divided into 2 statically homogeneous groups with an equal number. All patients underwent endovenous laser obliteration of the trunk of the great saphenous vein in combination with miniphlebectomy of tributaries on the thigh and lower leg.

Results. In both groups, the largest number were patients with incompetence of the GSV trunk up to the border in /3 and c/3 of the lower leg, with further discharge along the tributaries of the GSV along the medial surface of the lower leg. The failure of the GSV trunk to the level of the knee joint gap was accompanied by the presence of varicose-transformed tributaries along the anterior surface of the thigh, in the area of the knee joint. The addition of Detragel led to the relief of phlebitis and hematomas, a pronounced decrease in pain and edematous syndrome.

Discussion. Transdermal drug delivery has great promise as an alternative to oral and intravenous treatment, especially for patients suffering from chronic diseases. The three-component composition allows you to influence all parts of the pathogenesis of the disease.

Conclusion. The data obtained on the use of local gel therapy based on escin, heparin and essential phospholipids after EVLO of the GSV indicate the need for local therapy to improve the quality of life of patients, their rapid rehabilitation and improve immediate and long-term results.

The problem of studying the pathology of mesenteric fat of the small intestine in surgical practice has not yet received enough attention. A number of questions remain unresolved regarding the etiology and pathogenesis of mesenteric diseases, their possible connection with benign and malignant diseases, methods of their laboratory and instrumental diagnosis, possible options for conservative and surgical treatment, as well as systematization and structuring of the classification. One of the poorly studied representatives of diseases of the mesentery of the small intestine continues to be Sclerosing mesenteritis, characterized by various histological variants of damage to mesenteric fat and a varied nonspecific clinical picture. Taken together, this leads to certain difficulties in diagnosis, patients seeking access to doctors of various profiles, which ultimately negatively affects the results of treatment and can lead to social maladjustment and possible disability. Reports on the occurrence of this pathology in the medical literature are few and, as a rule, describe extremely rare clinical cases. However, in recent years, the frequency of detection of this pathology continues to grow steadily, which is associated with the progressive aging of the population, a high degree of surgical activity in relation to urgent diseases of the abdominal organs, and the improvement of instrumental diagnostic methods. Issues of etiology, pathogenesis, differential diagnosis of this disease and its possible connection with the paraneoplastic process currently continue to cause debate. Further accumulation of clinical experience, a better understanding of the pathogenesis of the disease, and improvement of imaging techniques will allow us to develop clearer diagnostic and clinical criteria, narrow the diagnostic search and, ultimately, improve and standardize treatment. The article provides a review of the literature on this rare surgical pathology, presents our own clinical observation, and discusses diagnostic issues and treatment options for this disease.

Cyanoacrylate adhesive closure (CAC) is currently one of the main non-thermal ablation modalities of incompetent saphenous veins. High efficacy and safety of the method is supported by international clinical practice guidelines as well as the real-world practice. In contrast to thermal ablation, CAC is advantageous in terms of low periprocedural pain and bruising, fast procedure time and postprocedural recovery, high patient comfort and satisfaction rates as well as avoidance of postprocedural compression. This publication summarises the practical tips and tricks of glue ablation procedure based on 5-year experience (2019–2023) at the “SM-Clinic” Phlebology Centre, Moscow. Indications for the preferred use of CAC are formulated, such as: low pain threshold; contraindications (or unwillingness) to postprocedural compression; extensive comorbidity and fragile patients; concomitant morbid obesity; the presence of axial reflux along the saphenous veins; the need for simultaneous ablation of several incompetent truncal veins; below-the-knee incompetence of saphenous veins, including recurrent varicose veins; extensive lipodermatosclerosis and/or venous leg ulcer; patient’s HIV and viral hepatitis positive status. A step-by-step interventional protocol of glue ablation is described, including the modified protocols of the procedure. The immediate and long-term outcomes of the CAC according to current data are discussed. Special attention is paid to adverse events following CAC, as well as technical aspects of their prevention. Despite high efficacy and safety profile, today’s limitations for adoption and wider use of CAC are cost issues and lack of reimbursement.

Healthcare-associated infections are the most common and relevant to all healthcare facilities of all types. Surgical site infections are the most frequently reported type of healthcare-associated infections. Surgical site infections are also one of the main causes of prolonged hospital stays, prolonged antibiotic therapy, unplanned re-hospitalizations, worsened long-term patient outcomes and the prescription of additional surgical interventions. At present, it is prevention that has been identified as the single most important strategy to combat surgical site infection. The proposed three-stage model combines perioperative interventions as well as interdisciplinary collaboration to continuously improve the quality of care. This approach includes preoperative, intraoperative, and postoperative prevention methods. Current preoperative strategies for the prevention of surgical site infections can significantly reduce the risk of developing this nosology; one important aspect of preoperative prophylaxis includes the identification, elimination, and/or correction of modifiable as well as non-modifiable risk factors. In addition, it is possible to identify intraoperative risk factors, of which the duration of surgical intervention is fundamentally important. Postoperative risk factors include hyperglycemia and diabetes mellitus, postoperative wound care and blood transfusion. Many effective ways of preventing surgical site infections have been developed, which include separate methods of preoperative, intraoperative and postoperative prophylaxis, however, only through the implementation of a comprehensive model that combines all perioperative measures, health care institutions will be able to effectively reduce the incidence of healthcare-associated infections and improve patient outcomes. Despite the fact that currently there is an active development of new methods of surgical site infections prophylaxis, the direct implementation of these technologies in the practical activity of specialists is of primary importance.