Objective. To elaborate the algorithm for preoperative diagnosis of combined varicose dilation in the lower extremities (LE) and pelvis with the aim to select and use the elective planning of surgical treatment. Маterials and methods. The results of examination of 301 women-patients of a reproduction age, suffering varicose dilation of the LE veins in a 2012 - 2017 yrs period, were analyzed. Results. The elaborated algorithm application made possible to diagnose a pelvic varicosis with reflux in 14 women-patients, what was confirmed by results of phlebography. Conclusion. Sensitivity of transvaginal ultrasound investigation in diagnosis of pelvic varicose constitutes 100%. Women-patients, complaining on pelvic pain, mostly have nonsaphenous varicosis.

Научно-практический центр профилактической и клинической медицины, г. Киев, Украина Цель. Оценить эффективность эндоваскулярных вмешательств при лечении несафенового варикозного расширения вен нижних конечностей у женщин с синдромом тазового полнокровия.Материал и методы. Проведен анализ лечения несафенового варикозного расширения вен нижних конечностей, сочетающегося с синдромом тазового полнокровия, у 25 женщин. Основную группу составили 10 пациенток с несафеновым варикозом, варикозом малого таза и клинически выраженным синдромом тазового полнокровия. В данной группе пациенткам проводили тазовую флебографию с эмболизацией левой яичниковой вены и минифлебэктомию несафенового варикоза. Контрольная группа -15 пациенток с несафеновым варикозом, варикозом малого таза и со слабовыраженной или отсутствующей клиникой синдрома тазового полнокровия. В этой группе выполняли только минифлебэктомию несафенового варикоза. Результаты лечения оценивались в течение 2 лет. Оценивалось появление рецидивов варикозного расширения варикозных вен и тазовых болей.Результаты. При наблюдении в течение 2 лет у 8 пациенток основной группы клинические симптомы тазового полнокровия регрессировали или значительно уменьшились. У 2 пациенток хроническая тазовая боль рецидивировала до интенсивности догоспитального периода. Рецидивов варикозного расширения вен нижних конечностей не выявлено. В контрольной группе в те же сроки наблюдения у 1 (6,7%) пациентки был зарегистрирован рецидив несафенового варикозного расширения вен нижних конечностей и у 1 (6,7%) пациентки -рецидив в системе большой подкожной вены. У 2 (13%) пациенток интенсивность тазовой боли увеличилась.Заключение. Эмболизация левой яичниковой вены у пациенток с синдромом тазового полнокровия, по данным исследования, эффективна в 80% случаев. Выполнение гибридного вмешательства при варикозном расширении вен нижних конечностей и синдроме тазового полнокровия является эффективным методом коррекции патологической флебогемодинамики у пациенток с хроническим заболеванием вен нижних конечностей и таза.Ключевые слова: несафеновое варикозное расширение поверхностных вен нижних конечностей, синдром тазового полнокровия, тазовая флебография, эмболизация, минифлебэктомия Objective. To evaluate the effectiveness of endovascular interventions in the treatment of non-saphenous varicose veins of lower limbs in women with pelvic congestion syndrome.Methods. The treatment analysis of non-saphenous varicose veins of the lower limbs combined with the pelvic congestion syndrome was conducted in 25 women. The main group consisted of 10 patients with nonsaphenous varicose veins, pelvic varices and clinically expressed pelvic congestion syndrome. In this group, patients underwent pelvic phlebography with embolization of the left ovarian vein and miniphlebectomy of non-saphenous varicose veins. Control group included 15 patients with non-saphenous varicose veins, pelvic varices and with poorly expressed or absent clinic of pelvic congestion syndrome. In this group only miniphlebectomy of non-saphenous varic...

Backgroud. Recurrence development of varicouse disease of lower extremities continues to be a topical issue and requires further study from both the surgeons and the morphologists. Neovascularization is considered one of the main causes of the recurrence develoment of varicose veins of the lower extremities. Objective. The aim is to study the morphological features of recurrent veins in the stump region of the great saphenous vein. Methods. A morphological study of varicose veins was performed in 12 patients after the surgical treatment of non-saphenous recurrent varicose veins of the lower extremities. Results. The hypertrophy and sclerosis of the walls with a predominance of changes in the muscle layer of the vascular wall was found. The subendothelial layer was unevenly thickened due to the hypotrophy of smooth muscle fibers and the development of sclerotic changes with diffuse proliferation of collagen and elastic fibers. The outer shell was thickened due to the hypertrophy of the longitudinal bundles of smooth myositis and the thickening of the connective tissue part of the shell. It was noted uneven thickening of the veins' walls. We observed both veins with a typical three-layer wall, and "defective" vessels with a thin wall. In the veins with a three-layer wall, local thickening and thinning of the wall were observed, and the wall was crimped. In some vessels there was no middle shell. In part of the veins, detachment of the endothelium was noted with the formation of structures by the type of thin-walled vessels inside the lumen of the veins. There were also single "defective" vessels formed with a thin wall, an elongated lumen, which were among the connective and adipose tissue. In one case, the vessels in the lymph node were found-elongated, with a thin wall, with a slit lumen, and also dilated, sometimes with a thin wall, with an irregularly shaped lumen. Conclusion. Neovascularization is the process of the formation of vessels of different caliber, with a different histological structure-from defective vessels with a thin wall to vessels with a three-layer wall structure. It is important to observe the formation of blood vessels in the lymph nodes.

Objective. To study up the haemodynamical mechanisms of the recurrence development of the lower extremities varicose veins in women–patients, suffering pelvic varicose veins. Маerials and methods. Analysis of the operative treatment results was conducted in 50 patients of reproductive age, in whom in 2012 – 2014 yrs endovenous laser ablation (ЕVLA) of large saphenous vein (LSV) was performed. In 3 patients the lower extremities varicosities recurrence was observed while the 3–year follow–up. Results. Reflux from internal iliac veins through v.obturatoria extends on v. pudenda externa and the LSV mouth. Because the LSV trunk is occluded after previously performed ЕVLA, the pathological reflux is drained into lateral branches – anterior additional vein or Giacomini vein. Some forms of primary extrasystemic varicosities of the lower extremities are developed in accordance to the same haemodynamical mechanisms. Conclusion. Pelvic venous reflux promotes the lower extremities varicosities in 6% patients (95%–trustworthy іnterval 1,1% – 14,4%) after ЕVLA in the 3 years follow–up period. While presence of the blood reflux into internal iliac veins the crossectomy performance is recommended with the objective to lower the occurrence risk for recurrence of the lower extremities varicosities in future.

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.