Anatomic-hemodynamical types of recurrence of the lower extremities varicose disease

Objective. To improve the results of treatment in patients with postoperative recurrence of varicose disease of the lower extremities with the help of studying of peculiarities of disorders in regional venous hemodynamics and determination of anatomic-hemodynamic types of the disease. Materials and methods. There were examined 85 patients with postoperative recurrence of varicose disease of the lower extremities. Ultrasonic duplex scanning of veins was performed on apparatus «EnVisor», manufactured by «Philips» (Holland) using a multifrequency linear sensor with the 12 - 5 MHz frequency for subcutaneous veins and a convex sensor with the 5 - 2 MHz frequency - for deep veins. Results. There were delineated 8 anatomic-hemodynamical types of recurrences of varicose disease of the lower extremities. The investigation conducted have permitted to systematize the causes and signs of the disease. Objective criteria for prognostication of the varicose disease of the lower extremities recurrence may be applied for optimization of volume of primary surgical intervention and prophylaxis of its complications. Conclusion. The main causes of the recurrence development in varicose disease of the lower extremities are tactical and technical mistakes of surgeons during performance of primary surgical interventions in patients, suffering varicose disease of the lower extremities. Studying of peculiarities in development of recurrence of varicose disease of the lower extremities permits to elaborate the practical anatomic-hemodynamical classification, which systematizes the main causes of the varicose disease recurrence and constitutes the base for the reoperations tactics elaboration.

Developing a model of placental lesions prediction in varicose veins patients

The objective of the study was to identify predictive biomarkers and generate the model to predict placental lesions in women with varicose veins. We collected serial serum specimens from 128 women with varicose veins between 22 and 24 weeks’ gestation. The investigation includes ultrasound findings, blood analysis of endothelin-1, vascular endothelial growth factor (VEGF), CRP, coagulation factors as well as BMI. We used machine learning algorithm and multivariable logistic regression with Lasso method to predict placental lesions among the pregnant patients with varicose veins.A total of 47 (36.7 %) women with varicose veins subsequently developed placental insufficiency. Mean serum VEGF were higher in women who developed placental insufficiency – 29 (27–31) pg/ml, as compared with women without varicose disease – 24 (22–25) pg/ml, p < 0.001. The performance of the model trained with all the most valuable tests (VEGF, endothelin, CRP, D-dimers, fibrinogen, CEAP class) is admissible (AUC 0.94; CI 0.842–0.956; p < 0.001).We identified novel combination of clinical and laboratory predictive markers that provide pathophysiological insights and could help future improvements of diagnosis and treatment of placental lesions in women with varicose veins.

Pelvic congestion syndrome: historical aspects and a modern view on the problem (a literature review)

Pelvic congestion syndrome is a relatively recent, but actual and separate nosological form. Pelvic varicocele is a form of varicose disease, which is increasingly regarded as the main cause of chronic pelvic pain in women with various clinical manifestations. A woman with chronic pelvic pain is a difficult patient with combative behavior, who contacts with physicians in various specialties. There are many causes of chronic pelvic pain, but pelvic congestion syndrome has a special place. In recent years, in addition to widespread use of diagnostic radiology, the relevance of this pathology is beyond any doubt. The aim of the study was to summarize and present literature data on the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of pelvic congestion syndrome by analyzing the literature data. Materials and methods. A non-systematic review was conducted using PubMed, Web of Science, Google and Google Scholar databases. The review included free full-text articles published between 1974 and 2021 using key words: pelvic congestion syndrome, pelvic varices, pelvic venous disorders, pelvic varicocele, pelvic venous stasis, chronic pelvic pain, gonadal veins, ovarian veins, vena ovarica, Nutcracker syndrome, May–Thurner syndrome. Conclusions. Pelvic congestion syndrome is still a rarely diagnosed pathology in patients with chronic pelvic pain. Detailed medical history, physical examination as well as maintaining diagnostic algorithm would allow the disease to be diagnosed correctly and timely. The choice of method for surgical intervention is a key point in the treatment of patients with pelvic congestion syndrome, but today there are no criteria for the choice of one, so the problem is far from being resolved and requires further study and research.

Choice of X-ray surgical tactics for the treatment of venogenic erectile dysfunction in patients with pelvic varicose veins

The aim of the study was to develop an interventional approach for X-ray endovascular occlusion of the periprostatic plexus veins in patients with venogenic erectile dysfunction by systematizing X-ray phlebographic images obtained by standard dynamic pharmacocavernosography and dynamic multispiral computed cavernosography.Materials and methods. A comprehensive examination was carried out in 192 patients with venous erectile dysfunction. The age of the patients ranged from 19 to 66 (36.5 ± 0.73) years. The indication for occlusion of the veins of the periprostatic plexus was a combination of erectile dysfunctions on the IIEF-5 scale from 5 to 20 points and pathological venous drainage from the proximal cavernous bodies of the penis.Results. According to the Doppler ultrasound of the scrotum organs, TRUS of the prostate and the veins of the periprostatic plexus, all patients were diagnosed with pelvic varicose disease as a simultaneous combination of varicose veins of the gonadal veins and veins of the pelvic organs. Standard dynamic pharmacocavernosography was performed in 96 patients with erectile dysfunction. Pathological venous drainage was detected in 79 patients: proximal type - in 68 (86.0 %) of cases, distal type - in 4 (5.1 %) of cases and mixed type - in 7 (8.9 %) of cases. Periprostatic plexus vein occlusion was performed in 20 patients with venogenic erectile dysfunction with proximal pathological venous drainage. Complete disappearance of complaints of erectile dysfunction 6 months after X-ray surgical occlusion of the periprostatic plexus veins was noted in 81.0 % of cases (an increase in the index on the IIEF-5 scale from 12.7 ± 0.9 to 19.8 ± 0.9 points). The discrepancy between the data on the presence of venous leakage according to the results of standard pharmaco-Doppler sonography and the data on its absence according to the results of dynamic pharmacocavernosography in 19 patients determined the indications for dynamic multispiral computed pharmacocavernosography. The implementation of dynamic multispiral computed pharmacocavernosography made it possible to improve the visualization of variants of pathological venous outflow into the periprostatic venous plexus and the veins of the small pelvis from the cavernous bodies of the penis and to offer our own X-ray anatomical classification.Conclusion. The most common type of pathological venous drainage is its proximal type (86.0 % of cases). X-ray surgical occlusion of the veins of the periprostatic plexus is an effective method for the treatment of venogenic erectile dysfunction. Visualization of X-ray phlebographic images of the small pelvis during dynamic multispiral computed cavernosography with 3D reconstruction surpasses the results of standard dynamic pharmacocavernosography in the diagnosis of proximal, distal and mixed types of pathological venous drainage from the corpora cavernosa of the penis. Dynamic multispiral computed pharmacocavernosography with 3D reconstruction allows to determine the shape of the pathological venous drainage of the proximal type and determines the choice of antegrade or retrograde method of X-ray endovascular occlusion of the peripheryprostatic plexus veins in patients with venogenic erectile dysfunction.

HEMODYNAMIC DISORDERS IN VARICOSE VEIN DISEASE

Aim. Duplex ultrasound scanning (DUS) is a routine diagnostic procedure in patients with varicose vein disease. DUS mostly evaluates the qualitative (anatomical) parameters of the disease. Still, it is difficult to assess the microcirculatory parameters in trophic disorders based only on the anatomy, therefore assessment of quantitative blood flow parameters is needed. Our aim was to determine the potentials of conventional DUS in assessment of the hemodynamic disorders in patients with varicose disease. Materials and Methods. The study included 583 patients with varicose disease, 348 of which had trophic alterations. The patients were divided into 4 groups according to the CEAP clinical classes. Standard Valsalva and Siegel tests were performed during DUS. The following parameters were assessed in the superficial and deep veins: diameter of veins, antegrade blood flow velocity, retrograde blood flow velocity, reflux time; in the perforator veins (PV) – diameter, maximum velocity and average velocity of reflux. Peripheral resistance index (RI) in the arteries accompanying the PV was also analyzed. Results. A statistically significant difference in the diameter of the GSV was obtained between classes C2 and C3, C3 and C4, but not between class C5, 6 and class C4. Similar findings were observed in the assessment of diameter of the PVs and the velocity of retrograde blood flow through them. A gradual increase in these parameters could be seen with the progression of the disease, but a statistically significant difference was obtained only between classes C2 and C3 for the diameter of the PV and the peak velocity of retrograde blood flow. As for the average blood flow velocity, a statistically significant difference was obtained between classes C2 and C3, C3 and C4. Arteries in the perforator bundles demonstrated low RI which may be attributed to the presence of an arteriolo-venular bypass. Statistically significant differences were obtained for CEAP classes C2 and C3. Conclusions. Ultrasound duplex scanning of the study with use of Superb Micro-Vascular Imaging mode is an effective method in assessing the quantitative and microcirculatory parameters of hemodynamic disorders in patients with varicose vein disease of the lower extremities. Trophic ulcers in varicose vein disease are not an obligatory component of the disease, but only its complication.

Precision X-ray diagnosis of osteoporosis in representatives of risk groups for the appearance and development of varicose disease of the lower limbs

Introduction. Varicose disease of the lower limbs (VDLL) is an independent disease and is an important medical and social problem due to its widespread and tendency to progress among people of working age and mainly in the female half of the population. Features of professional activity are risks in the form of static loads of a constant nature or weightlifting and other risk factors (for example, genetic predisposition, hormonal imbalance during pregnancy and menopause, obesity, diabetes mellitus, hypercoagulation, treatment with hormonal drugs, irrational nutrition, alcohol abuse, the presence of osteopenia and osteoporosis (OP). A feature of the disease is the presence of concomitant (often combined) pathology of the musculoskeletal system, which is characterized, as a rule, by early manifestation, relatively rapid progression, and complicated course. Radiologically, relatively often revealed pathology of the feet (flat feet, hallux valgus and deformity of the 1st finger) and degenerative-dystopian changes in the spine (osteochondrosis, spondyloarthritis, spondylosis, scoliosis, kyphosis). The most pronounced combined pathology of the musculoskeletal system is observed in patients with active trophic disorders. Considering the comorbidity of the disease, changes in regional hemodynamics and microcirculation in the lower limbs undoubtedly affect the indicators of hemostasis, carbohydrate, lipid and mineral metabolism. Therefore, a significant interest to improve the diagnosis of OP are often present in the form of a clinical syndrome, which is characterized by decrease in bone density, a violation of their micro-and increased fragility, due to the metabolic disorders of bone tissue with a predominance of catabolism over the processes of bone formation and increased risk of fractures. The state of bone mineral saturation, in particular in the female half of the population, depending on the severity of venous insufficiency remains insufficiently studied. Treatment of VDLL and its concomitant OP syndrome is not always a solvable problem, so the optimization of the diagnosis of this disease, especially at the initial stages, as well as in the process of dynamic monitoring and control of the effectiveness of therapeutic and preventive measures remains relevant. The aim of the study was to study the diagnostic possibilities of using radiometry (radiocomparametry and digital osteodensitometry) for precision assessment of mineral saturation of the spongy structure of the calcaneus in patients at risk for the appearance and development of VDLL. Materials and methods. As part of the general clinical examination, special comparative X-ray studies of the state of mineral saturation and dimensional characteristics of bone trabeculae of the spongy structure of the calcaneus were performed in 129 women with clinical signs of VDLL, which in accordance with the international classification of CEAP were divided into stages: C1 - 36 people, C2 - 32 people, C3 - 39 people, C4 - 30 people, C5 - 22 people. The comparison group included 119 practically healthy women, comparable to the main group by age, work experience and morbid history. The X-ray diagnostic complex included, in addition to convective (routine) radiography of various parts of the osteoarticular apparatus, performed only according to indications, the following methods: interactive radiography (digital low-dose radiography) of the foot with a calibrated wedge-a standard of density, a posteriori testometric X-ray parametry of bone trabeculae of spongy structures of the calcaneus. Modern equipment was used: digital X-ray diagnostic complexes DR-GEBrivo), AXIOMLuminas (Siemens), dichromatic osteodensitometer "PRODIGY" (Lunar). Results. As part of the general clinical examination, X-ray examinations were performed before the implementation of therapeutic measures and after 24 months. Radiometric indicators of mineral saturation and thickness of trabeculae of the spongy structure of the calcaneus showed a direct dependence on age, reaching maximum values in the age category of 25-30 years with a clear tendency to decrease in older age groups. The mineralization parameters relative to the control were initially reduced, revealing variability depending on the severity of the main pathological process (from relatively high at C1 to relatively low at C5). There was also a pattern of increasing levels of mineralization and thickness of bone trabeculae depending on the period of observation (in fact, on the volume of complex therapeutic and preventive measures) in almost all patients, but mainly in groups C4, C5. Subjective symptoms and objective clinical picture of the condition of the examined patients with the presence of VDLL and OP syndrome correlated with the data of osteorentgenometry. Conclusions. The examined women, whose production activity makes them belong to the risk group for the appearance and development of VDLL, have a opioid structure of the calcaneus. The use in complex clinical and radiological diagnostics of the methodical technique of precision assessment of mineral saturation in (mg/mm2) and thickness of bone trabeculae (mm) makes it possible to objectify the reconstruction of the bone structure at the submacroscopic level of its visualization. Quantitative densitometric indicators of changes in the spongy structure of the calcaneus can be considered as markers of the severity of the condition and the direction of the course of VDLL with concomitant OP. Postprocessing radiometry the calcaneus performed on digital radiographs and the screens of computers using programs "LINS MAKHAON workstation of the DOCTOR" available, not associated with additional radiation exposure and, therefore, can be widely applied both at the stage of primary diagnosis of the health status of the studied patients and in monitoring the effectiveness of remedial measures.

Varicose disease and harmful production factors

Background. Varicose disease is the most wide-spread vascular disease of the lower extremities. The form of occupation and work conditions significantly affect the cardiovascular system due to regular and unavoidable action of the human body. Aim: to determine the influence of hazardous work conditions on the incidence of varicose veins of the lower extremities among the persons subjected to periodic medical examinations; to identify the most important factors in the development of this pathology; to propose methods for preventing the occurrence of varicose veins in the manufacturing sector with hazardous conditions. Methods. Analysis of the outpatient histories (account form No. 025 \ у-04) of employees having periodic medical examinations was performed, with 528 female and 1489 male patients in total. The analysis of the outpatient histories, as well as processing of the obtained material were accomplished using the universal statistical package of Statgraphics Plus for Windows. Results. It has been established that hazardous work conditions, such as vibration, increase the incidence of varicose veins of the lower extremities, and the hazardous work experience plays the main role in increasing the incidence of this pathology. Conclusion. Hazardous work factors affect the incidence of the varicose disease of the lower extremities towards its elevation. The age, hazardous work experience and conditions associated with vibration play the major role in the increase of the disease incidence. A set of measures aimed at the prevention of varicose disease in the manufacturing sector has been suggested as a result of the study.