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Foam sclerotherapy is an innovative method of treatment for varicose disease, including its truncal forms, making it possible in outpatient conditions to achieve favourable therapeutic and cosmetic outcomes. Analysed herein are the results of foam sclerotherapy of the great saphenous vein (GSV) and its tributaries in a total of 326 patients presenting with varicose disease of lower limbs (395 GSVs) according to the improved methodology (elevation of the extremity to 60°, crural bandage, use of a cooled sclerosant solution). 6-14 days after the first session of sclerotherapy, the control ultrasound examination confirmed occlusion of the GSV in its femoral segment with no reflux in 94.9% of cases (375 GSVs). At terms from 1 year to 5 years, occlusion was diagnosed in 91.1% of cases. Besides alterations in the ultrasound image of the venous superficial bed of the limb and reduction of the trunk of the GSV and its affluents, there was positive dynamics of the clinical symptomatology of the disease.

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The article contains a review of the materials presented at the XVII World Congress of the International Union of Phlebology held in Boston in September 2013. Analysed herein are the opinions and experience of phlebologists from various countries. The contributors discussed various aspects of using foam sclerotherapy and thermal methods of ablation, briefly representing the results of studies concerning thromboses and embolisms, anatomy of veins and methods of ultrasound examination, epidemiology of chronic venous diseases (CVDs), relapses of varicose veins, pharmacotherapy of CVDs, etc.

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The authors analysed the results of examination and dynamic follow up (from 2003 to 2011) of twenty-one 15-to-55-year-old male patients presenting with hypoplasia or aplasia of the inferior vena cava. The diagnosis was verified by means of SCT- or MRT-phlebography. The disease was newly diagnosed at the age of 15-55 years (mean 25.9±2.6). The pathology manifested itself as a clinical course of thrombosis of deep veins of lower limbs in 16 (76.2%) patients and by oedema thereof in 5 (23.8%) subjects. Of the 16 patients with symptomatology of deep vein thrombosis, 13 patients had proximal (iliofemoral) thrombosis and 3 patients had distal thrombosis. In the overwhelming majority of the patients, the pathological process was localized on the right. All the patients after 1.5-12 months developed signs of impaired patency of the IVC. 1.5-2.5 years later, the course of chronic venous insufficiency was complicated by the development of trophic ulcers of the crus in eight (38.1%) patients. Congenital abnormalities of the IVC are encountered predominantly in males, remaining for a long time latent to be newly manifested in the young age by symptoms of deep vein thrombosis (more often by right-sided iliac-femoral thrombosis). Suspecting this pathology should be followed by extended examination using SCT- or MRT-phlebography.

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Analyzed herein are the findings obtained following an examination and medical treatment of five 17-to-39-year-old male patients (average age 25.0+/-1.83 years) presenting with congenital abnormalities of the inferior vena cava. The diagnosis was made and the level of aplasia was determined based on the findings of a comprehensive instrumental examination (computed and magnetic resonance tomography of the abdominal cavity, duplex scanning of the veins of the lower extremities, of the pelvis and the retroperitoneal space, as well as on the data of pelvic phlebography, and retrograde cavography). In three of the five patients, the disease appeared to have for the first time manifested itself by a clinical picture of peripheral thrombosis (oedema of the crus and femur), and in the remaining two by an elevated body temperature and shivering, followed by oedema of the both lower limbs. Two patients were found to have aplasia of the infrarenal segment of the inferior vena cava, two subjects had aplasia of the infra-, renal and partially suprarenal portions of the vessel, and one patient suffered from aplasia of virtually the whole vena cava, excepting a small part of the suprahepatic portion, toward which converged the hepatic veins and the superior polar renal vein. With the purpose of early diagnosis of congenital abnormalities of the inferior vena cava, the protocol of examination of patients with venous diseases should include ultrasonographic mapping of the supra-, renal and infrarenal portions of the vena cava, and if agenesis is revealed, the use of computed or magnetic resonance tomography, retrograde cavography is strongly recommended. When the diagnosis of IVC aplasia is confirmed, primary medical treatment should consist in prescribing venotonic agents, elastic compression and in cases of deep veins thrombosis -anticoagulant therapy.

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Five male patients with congenital anomalies of the inferior vena cava aged 20 to 43 were examined. The diagnosis and the level of aplasia were established on the basis of complex instrumental examination (duplex scanning of inferior extremity veins, pelvic veins, and retroperitoneal veins; computed and magnetic resonance tomography of the abdominal cavity; pelvic phlebography; retrograde cavagraphy). Together with inferior vena cava anomalies, other malformations such as pulmonary arterial stenosis or duplication of renal collector system were diagnosed in two patients. In three or 60% of the patients the disease had first manifested by the clinical picture of peripheral thrombosis (shin and femoral edema); fever, chill and subsequent edema of both legs had been first manifestations in two patients. Aplasia of the infrarenal segment of the inferior vena cava was revealed in two patients; in other two patients aplasia of the infrarenal, renal, and partly suprarenal segments of this magistral vessel was found; in one patient the whole vein was aplastic except a small part of the suprarenal segment, where the hepatic veins and the right suprapolar renal vein flew into. To establish an early diagnosis of a congenital inferior vena cava anomaly, the protocol of examination of patients with venous diseases should include ultrasound mapping of the suprarenal and infrarenal segments of the vena cava; in cases of agenesia it should include computed and magnetic resonance tomography and retrograde cavagraphy.

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Results of examination of 5 male patients aged 20 to 43 years with congenital anomaly of inferior vena cava are analyzed. Complex special examination (CT, MRI, duplex scanning, pelvic phlebography, retrograde cavagraphy) was used for correct diagnosis. Primary treatment of agenesis of inferior vena cava should consist of elastic compression and phlebotonics; in cases of deep vein thrombosis anticoagulants must be used.

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Results of treatment of 102 patients with injuries of inferior vena cava (IVC) were analyzed. The causes of injury were penetrating stab-incised wounds of abdomen (67.5% patients), close trauma (28.2%), gunshot wounds (4.3%). Zone of confluence of iliac veins was injured in 7% patients, infrarenal and renal segments -- in 51.9%, suprarenal -- in 21.5%, supra- and retrohepatic -- in 19.6% patients. Injury of one wall of vein was revealed in 63.7% patients, both walls -- in 14.7%, complete disruption of vessel -- in 7.9%, avulsion or fissure of hepatic veins -- in 13.7%. In 96.2% patients trauma of IVC were associated with injuries of liver (37.2% cases), small intestine (26.4%), stomach (15.6%), pancreas (12.7%), duodenum (10.7%), large intestine (6.8%), and other organs (10.7%). The side suture (83.7%), circular one (5%), ligation of vein (6.2%), grafting (3.8%), and ligation of left hepatic vein (1.3%) were performed. Reconstructive surgery was carried out by general surgeon in 30% patients, and by vascular surgeon -- in 70%. Lethality was 53.9% (55 patients). Lethality after injuries of supra- and retrohepatic segments of IVC was 100%, suprarenal and renal segments -- 60.6%, infrarenal segment -- 30.6%.

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To examine the possibilities of replacing the great veins by Vitaflon grafts, an experimental study was made on 20 dogs. In the first group animals (n=10), a segment of the infrarenal posterior vena cava was replaced under conditions of routine blood flow. In the second group (n=10), an arteriovenous fistula closed after one month was formed on the thigh. The graft patency was checked by ascending phlebography. The observation period varied from 5 days to 11 months. After the animals were taken out of the experiment the grafts were inspected macro- and microscopically. It has been established that under conditions of routine blood flow all Vitaflon grafts were thrombosed for the first week. Acceleration of the flow provided for the patency of 10 grafts. The patent grafts took by means of formation of a connective tissue capsule on the exterior and formation of the neointima on their internal surface. The external capsule from the friable connective tissue emerged on the 2nd week of experiment; after 11 months it appeared as a thin layer of the solid fibrous connective tissue without evidence of inflammation which indicated the high biological inertness of the given type grafts. The neointima was formed from the parietal layer of fibrin organized in the direction from the area of anastomoses to the medium graft portion. No complete was recorded toward the end of experiment.

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A course of acute disturbance of mesenterial circulation (ADMC) in 346 patients (89% of them were over 50 years, mean age 68.4+/-3.6 years) was analyzed. Occlusive forms of ADMC occurred in 88% cases (91% of them were due to affection of intestinal arterial bed). Atherosclerosis of the aorta or/and it unpaired visceral branches was the main cause of ADMC in 96% patients. In 87.6% cases the causes of acute mesenterial ischemia were occlusive disease of intestinal vessels due to thrombosis and embolism of unpaired visceral branches of the abdominal aorta, thrombosis in porto-mesenterial bed. Circulatory disorders on the microcirculation level (non-occlusive ischemia) were among the causes in 7.5% cases.

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Acute disorder of mesenteric circulation (ADMC) is an emergency pathology of the abdominal organs. It occurs in 0.2% of general surgery patients. A total of 346 patients with verified (before, during operation and/or on autopsy) diagnosis of ADMC were analyzed retrospectively. There were 217 (62.7%) women and 129 (37.3%) men. The mean age of the patients was 68.4+/-3.6 years. In 50.7% of patients, ADMC was induced by thrombosis of the unpaired visceral branches of the abdominal aorta, in 29.1% -- by embolism of the superior mesenteric artery (SMA), in 7.8% -- by thrombosis of the portomesenteric bed, in 7.5% -- by non-occlusion mesenteric ischemia (NOMI), and in 4.9% by diseases of the parietal vessels of the bowel. The most prevalent risk factors of ADMC were: atherosclerosis of the aorta and its branches, previous reconstructions for occlusion-stenotic arterial lesions, episodes of arterial embolism in the anamnesis, congenital and acquired hemostatic disorders, oral contraception, thromboses of the deep veins and/or pulmonary embolism in the anamnesis, operations on the abdominal organs, different types of acute end chronic heart failure. In SMA thrombosis, occlusion most frequently affects the orifice (93.5%) and initial segment of the great vessel, In embolism it occurs before or at the level of the middle colic artery (in 57.9%). Disseminated bowel necroses are more frequently encountered in occlusions of the arterial bed (87.7% in thromboses and 83.3% emdolism) than in the venous system (8.3%).

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Autopsy and clinical data were analysed for 803 surgical patients whose death was due to pulmonary artery thromboembolism (PAT). PAT was diagnosed intravitally in 32% of the deceased. 87% of the patients with PAT symptoms died within 2 hours. 3/4 of PATs developed in uneventful postoperative period, 1/4--in complications. The cause of PAT in 99.3% of cases were thromboses in vena cava inferior. In 88.3% of cases these thromboses ran latently. Frequency of postoperative PAT as a cause of death was 1.4% in 1972-1973, 2.1% in 1990-1991, 1.3% in 1997. The fall of the death rate is explained by introduction of drug prophylaxis of PAT.

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Comparative analysis of results of venous thromboembolic complications prophylaxis (deep vein thrombosis--DVT1, pulmonary artery thromboembolism--PAT) in patients operated on abdominal organs during two periods--from 1980 to 1983 (when traditional methods were used--leg bandage, rarely--0.25-0.5 g aspirin 1-2 times a day 5-8 days after surgery) and from 1984 to 1998 (when in the operated patients with moderate, high and very high risk of DVT and PAT combination of physical methods of blood flow acceleration in leg deep veins with drugs was used--minidoses or individually selected doses of non-fractionated heparin, low-molecular heparin, dextrans) was carried out. Compared with first period the rate of manifested DVT decreased from 1 to 0.3%, fatal PAT (percentage of those who died from all operated)--from 0.3% in 1982-1983 to 0.026% in 1998, i.e. more than 10 times. In some years (1992-1993) there were no lethal outcomes of PAT.

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Treatment results in 87 patients (mean age 30.1 years) with traumatic injuries of major abdominal vessels were analyzed. 73 patients had stab-incised wounds, 9--blunt trauma, 5--gunshot wounds. Hemodynamics of the majority of hospitalized patients (66 from 87) was unstable. Inferior cava vein injury was revealed in 29 patients, aorta injury--in 21, iliac vessels injury--in 22, visceral vessels injury--in 15. One vascular wall was injured in 58 cases, two walls--in 27 cases, complete transection or separation of vessel was revealed in 6 cases. Major vessel injuries were associated with abdominal visceral trauma in 97% cases. Vascular operations (side suture--in 49 patients, circular suture--in 11, vein ligation--in 5, prosthesis--in 3) were performed in 17 (25%) patients by general surgeons, in the rest (75%)--by vascular surgeons. General mortality (including hospitalized but non-operated patients, and patients who died during the operation and in postoperative period) was 46%. It is necessary to teach vascular surgery to general surgeons for high-quality and timely care in patients with abdominal trauma complicated by major vessels injuries.

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Laparoscopic data on 74 patients with jejuno-ileal mesentery acute circulatory disturbance were analysed. Positive (diagnosis is confirmed) and negative (diagnosis is rejected) results of the investigation, reasons of false diagnosis and repeated laparoscopies were examined. Features of the jejuno-ileal mesentery acute circulatory disturbance laparoscopic picture are determined depending on its stage (ischemia, infarct, peritxnitis) and kinds (arterial thrombosis and embolism, venous thrombosis, unocclusive mesenteric ischemia).

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Pathologo-morphological and clinical records of 803 surgical patients have been analysed, in whom the thromboembolism of pulmonary artery (TEPA) was the only or the main cause of the death. Intravital diagnosis of TEPA was established in 32% of all the deceased. 87% of patients with evident symptoms of the embolism died during the first 2 hours, 52.3% died during 15-30 min. 67% of all TEPA were revealed in postoperative weak 1, 15%--in week 2, and 18%--on later terms (15-45 days). 82.6% of patients who died of TEPA underwent elective operations, and 17.4%--urgent operations. The indications were absolute in 67.3% of cases and relative--in 32.7%. 3/4 of all embolisms developed during the smooth p/o period, and 1/4--on the background of various complications. The rate of TEPA with lethal outcomes made up: 4.3% after the amputation of the lower limb for acute and chronic arterial circulatory disturbances, 2.4%--after transvesical adenomectomy of the prostate, 0.7% and 0.2%--after the operations on the biliary system and the stomach, respectively, and 0.14%--after appendectomy. 410 random purposeful autopsies detected that the sources of the TEPA in 99.3% of cases were thromboses in the system of inferior caval vein which developed silently in 88.3% of cases. In 90.9% of patients thrombus came from the deep veins of the shin, and in 9.1%--from iliac and femoral veins. The rate of postoperative TEPA as a cause of death, according to the autopsies data, has increased from 1.4% in 1972-1973 to 2.1% in 1990-1991. Up to 1997 the rate of this index decreased to 1.3%, the quantity of the autopsies (in operated patients--100%) being equal, and in conditions of increased surgical activity. The positive tendency in the dynamics of lethality of TEPA in conditions of a large industrial city, according to authors' view, is referred chiefly to implementation of drug prophylaxis of postoperative thrombosis of the deep veins of the lower extremities using mini-doses of heparine.

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Care results in 48 patients (male--38, female--10) with heart wounds (HW) were analyzed. 40 (83.2%) patients had stab-incised wounds, 7 (14.7%)--stab wounds, 1 (2.1%)--gunshot wounds. 23 (47.8%) patients were hospitalized in consciousness, 17 (35.3%)--in unconsciousness, 8 (16.9%)--in twilight state. The lethality among the latter two groups of the patients was 64%, in the former group--13%. 19 patients from 48 died: in preoperative period--3, during operation--10, in early postoperative period (more than 10 days)--2 patients. The suspected of HW patients must be transported in the nearest surgical hospital. In unstable hemodynamics it is necessary to carry out adequate infusion therapy, in obvious signs of heart tamponade the pericardium puncture must be performed. In agonizing patients, and in case of general anesthesia delay, it is necessary to begin thoracotomy before general anesthesia.

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Basing on roentgenological and morphological investigations the causes of the iliac veins passability disorder were studied up. In 45.1% of observations the stenosis was revealed of the left and in 1.2% of the right common iliac vein. Among the stenosis causes were osteal or cartilagenous prominences of vertebral column, intravascular structures (webs, membranes) in the left common iliac vein, the external iliac vein squeeze by internal iliac artery, retroperitoneal fibrosis, the right common iliac artery aneurysm, anomalous branching of parietal pelvic artery.

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324 patients operated on the organs of abdominal cavity small pelvis and retroperitoneal space were examined by the method of I-125-fibrinogen accumulation and contrast phlebography. In 109 (33.6%) patients thrombosis of deep veins of lower extremities was diagnosed, among which in 24 cases (7.5%) it was proximal. In most cases thrombosis was predisposed by postthrombotic disease and chronic venous insufficiency of lower extremities, circulatory disturbances of the 2-3 degree, tumors, obesity, preoperative thrombophilia. Combination of 2 and more risk factors increased possibility of intravascular thrombosis. The rate of clinically registered pulmonary artery embolism (14,833 general surgical patients were avau label) made up 1.2%; in 54 (0.3%) of operated patients it was the cause of death. Postoperative lethality of embolism made up 13%. Four risk levels of development of thrombo-embolic complications were established: low (common rate of thrombosis--10.3%, proximal--1.4%, clinically evidenced pulmonary artery embolism--0.7%, with lethal outcome--0.02%), medium (28.5; 6.5; 2; 0.76%, respectively), high (80.4; 17.8; 6; 2.8%, respectively) and very high (93.3; 26.6; approximately 8; approximately 4, respectively). The prevalence of thrombo-embolic complications in patients urge surgeons and reanimatologists to carrying out prophylactic to reduce the risk of intravascular thrombosis in pre- and postoperative period.

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