Биология ва тиббиёт муаммолари 2024 №6 (157)

Subject of the article

ИСТОЧНИКИ РЕЦИДИВОВ ВАРИКОЗНОГО РАСШИРЕНИЯ ВЕН НИЖНИХ КОНЕЧНОСТЕЙ И СОВРЕМЕННЫЕ МЕТОДЫ ИХ УСТРАНЕНИЯ (351-359)

Authors

Суюмов Азамат Сайфуллаевич, Умаров Фарход Равшанович

Institution

1 - Республиканский специализированный научно-практический медицинский центр хирургии им. академика В.Вахидова, Республика Узбекистан, г. Ташкент; 2 - Клиника современной флебологии «VarikozOFF», Республика Узбекистан, г. Ташкент

Abstract

Рецидив варикозного расширения вен нижних конечностей (ВРВНК) представляет собой значительную проблему современной флебологии и требует комплексного подхода к изучению причин и разработке методов лечения. В статье мы провели глубокий анализ причин рецидивов после хирургическо-го и малоинвазивного лечения ВРВНК. Несмотря на развитие современных технологий, таких как эндове-нозная лазерная облитерация (ЭВЛО), радиочастот-ная абляция (РЧА), склеротерапия и цианакрилатная облитерация, все эти методы имеют свои ограниче-ния. Исследования показывают, что хотя ЭВЛО и РЧА демонстрируют лучшие результаты по сравнению с другими методами, они также связаны с рецидивами из-за анатомических особенностей венозной системы и сложности полной облитерации пораженных вен. В частности, такие факторы, как длина и форма культи БПВ, расположение перфорантных вен, а также потенциальные осложнения, ограничивают эффективность этих методов в долгосрочной пер-спективе. Это подчёркивает необходимость регуляр-ного послеоперационного наблюдения, в том числе с применением ультразвукового контроля для своевре-менного выявления и устранения рецидивных измене-ний.

Key words

рецидив варикоза, большая подкожная вена, перфорантные вены, лазерная облитерация, радиочастотная облитерация, склеротерапия, цианокрилат, профилактика варикоза.

Literature

1. Countrymeters. Население Узбекистана. 2024. 2. Мазайшвили КВ, Чен ВИ. Распространенность хро-нических заболеваний вен нижних конечностей в Пе-тропавловске-Камчатском. Флебология 8AD; 2 (4):52--54. 3. Zolotukhin IA, Seliverstov EI, Shevtsov YN, et al. Prev-alence and Risk Factors for Chronic Venous Disease in the General Russian Population. European Journal of Vascular and Endovascular Surgery 2017; 54 (6):752–8. 4. Criqui MH. Chronic Venous Disease in an Ethnically Diverse Population: The San Diego Population Study. Am J Epidemiol 2003; 158 (5):448–56. 5. Rabe E, Guex JJ, Puskas A, et al. Epidemiology of chronic venous disorders in geographically diverse popula-tions: Results from the Vein Consult Program. Internation-al Angiology 2012; 31 (2):105–15. 6. STANHOPE JM. Varicose Veins in a Population of Lowland New Guinea. Int J Epidemiol 1975; 4 (3):221–5. 7. Callam MJ. Epidemiology of varicose veins. British Journal of Surgery 1994. 8. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15 (3):175–84. 9. Савельев ВС. Флебология. Москва: Медицина, 2001. 10. Anon. Российские клинические рекомендации по диагностике и лечению хронических заболеваний вен. Флебология 2018; (3):146–240. 11. Rabe E, Breu F, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology: The Journal of Venous Disease 2014. 12. Lawson JA, Toonder IM. A review of a new Dutch guideline for management of recurrent varicose veins. Phlebology 2016; 31:114–24. 13. Nicolaides AN. Clinical Investigation and Reports In-vestigation of Chronic Venous Insufficiency A Consensus Statement. Circulation 2000; 102:126–63. 14. Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg 2009; 49 (2). 15. Perrin M, Eklöf B, Van Rij A, et al. Venous symptoms: The SYM Vein Consensus statement developed under the auspices of the European Venous Forum. International Angiology 2016; 35 (4):374–98. 16. Bergan J. The Vein Book., 2007. 17. Gloviczki P. HANDBOOK OF VENOUS AND LYMPHATIC DISORDERS., 2017. 18. Стойко ЮМ, Талибов ОБ, Яшкин МН, et al. Мно-гоцентровое наблюдательное исследование примене-ния флебодиа 600 у больных с хроническими заболе-ваниями вен классов СО-СЗ по СЕАР. Ангиол и сосуд хир 2018; 24 (1):107–14. 19. Raivio P, Perhoniemi V, Lehtola A. Long-term results of vein sparing varicose vein surgery. World J Surg 2002; 26 (12):1507–11. 20. Allegra C, Antignani PL, Carlizza A. Recurrent Vari-cose Veins Following Surgical Treatment: Our Experience with Five Years Follow-up. European Journal of Vascular and Endovascular Surgery 2007; 33 (6). 21. Nelzén O, Fransson I. Varicose vein recurrence and patient satisfaction 10-14 years following combined super-ficial and perforator vein surgery: A prospective case study. European Journal of Vascular and Endovascular Surgery 2013; 46 (3):372–7. 22. Kostas T, Ioannou C V., Touloupakis E, et al. Recur-rent varicose veins after surgery: A new appraisal of a common and complex problem in vascular surgery. Euro-pean Journal of Vascular and Endovascular Surgery 2004; 27 (3). 23. Neged D. Recurrent varicose veins: a national problem. British Journal of Surgery 1993; 80 (7):823–4. 24. Perrin MR, Guex JJ, Ruckley C V., et al. Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg 2000; 8 (4):233–45. 25. Perrin MR, Labropoulos N, Leon LR. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg 2006; 43 (2):327–34. 26. Perrin M, Allaert FA. Intra- and Inter-observer Repro-ducibility of the Recurrent Varicose Veins after Surgery (REVAS) Classification. European Journal of Vascular and Endovascular Surgery 2006; 32 (3):326–32. 27. Gloviczki P, Lawrence PF, Wasan SM, et al. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical prac-tice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord 2024; 12 (1). 28. Mazayshvili K. Endovenous Laser Ablation: А Fifteen-Year Experience and More Than 10,000 Procedures. URSS, 2022. 29. Rima T. Sulla causa prossima delle varici alle estremità inferiori, e sulla loro cura radicale . Giornale per servire ai progressi della patologia e della materia medica 1836; (5):265–301. 30. Trendelenburg F. Über die Unterbindung der Vena saphena magna bei Unterschenkelvaricen. Beitr Klin Chir 1890; (7):195–210. 31. Правдолюбов В. К вопросу об оперативном лече-нии варикозных расширений вен нижних конечностей по способу Trendelenburg’a. 1892. 32. Moore W. The operative treatment of varicose veins, with specialreference to a modification of Trendelenburg’s operation. Intercolonial Med J Aust 1896; (1):393–7. 33. Мазайшвили КВ. Два периода и три концепции в истории лечения варикозной болезни вен нижних ко-нечностей. Вестник НМХЦ им НИПирогова 2012; 7 (1):32–6. 34. Мазайшвили КВ, Акимов СС, Хлевтова ТВ, Суха-нов АВ, Ангелова ВА, Семкин ВД. СЛУЧАЙНОСТИ, ОПАСНОСТИ, ВРАЧЕБНЫЕ ОШИБКИ И ОСЛОЖНЕНИЯ ПРИ ЭНДОВЕНОЗНОЙ ЛАЗЕРНОЙ ОБЛИТЕРАЦИИ У ПАЦИЕНТОВ С ВАРИКОЗНОЙ БОЛЕЗНЬЮ. Флебология 2017; 11 (1):37–46. 35. Хубулава ГГ, Шайдаков ЕВ. К истории российской флебологии: А.А. Троянов. Флебология 2010; 4 (4):38–41. 36. Meyer FG. Zur Varizenbehandlung, insbesondere nach Rindfleisch. Deutsche Medizinische Wochenschrift 1924; (41):1410–1. 37. Babcock WW. A new operation for the exstirpation of varicose veins. New York Med J 1907; 23:153–6. 38. Блинов НИ. Отдаленные результаты хирургическо-го лечения варикозных расширений вен нижних ко-нечностей. Журнал современной хирургии 1927; 2 (1):107–17. 39. Nebylitsyn YuS, Nazaruk AA. History of phlebology (Part II). IPPavlov Russian Medical Biological Herald 2017; 25 (3):484–500. 40. Dodd H, Cockett F. The pathology and Surgery of the veins of Lower Limb. London, 1956. 41. Linton RR. The communicating veins of the lower leg and the operative technic for their ligation. Ann Surg 1938; 107 (4):582–93. 42. Веденский АН. Варикозная болезнь. Ленинград, 1983. 43. Тальман ИМ. Варикозное расширение вен нижних конечностей. Ленинград, 1961. 44. Мамамтавришвили ДГ. Болезни вен. Москва, 1964. 45. Mcelwee RS, Maisel B. A Study of the Results of the Surgical Treatment of Varicose Veins. Ann Surg 1947; 126 (3):350–7. 46. Moore SW, Craver WL, York MDN. Varicose veins; results of surgical treatment. Ann Surg 1956; 143 (4):500–3. 47. Brown DB, Irvine RW, Forrest H. Long-Term Results of ‘High Ligation’ for Varicose Veins. Scot med, J 1961; (6):322–6. 48. Веденский АН. Посттромботическая болезнь. Л.: Медицина, 1986. 49. Веденский АН. Варикозная болезнь. Ленинград, 1983. 50. Мазайшвили КВ, Климова НВ, Дарвин ВВ, Дрож-жин ЕВ, Шебряков ВВ, Мамедов РЭ. Возможности магнитно-резонансной флебографии при посттромбо-тической патологии нижней полой вены и подвздош-ных вен. Вестник СурГУ Медицина 2017; 34 (4):11–6. 51. Покровский АВ, Игнатьев ИМ, Градусов ЕГ. Ре-конструктивные и эндоваскулярные операции на глу-боких венах при посттромботической болезни. Москва, 2017. 52. Шевела АИ, Егоров ВА. Варикозная болезнь - прошлое, настоящее, перспективы. Вопросы реконст-руктивной и пластической хирургии 2006; 19 (4):54–7. 53. Kistner R. Deep venous valve reconstruction. Cardio-vascular Surgery 1995; 3 (2):129–40. 54. Labropoulos N, Tassiopoulos AK, Kang SS, Mansour MA, Littooy FN, Baker WH. Prevalence of deep venous reflux in patients with primary superficial vein incompe-tence. J Vasc Surg 2000; 32 (4):663–8. 55. Danielsson G, Eklof B, Grandinetti A, Lurie F, Kistner RL, Honolulu H. Deep axial reflux, an important contribu-tor to skin changes or ulcer in chronic venous disease. J Vasc Surg 2003; 38 (6):1336–41. 56. Kistner RL. Primary venous valve incompetence of the leg. Am J Surg 1980; 140 (2):218–24. 57. Kistner RL, Ferris EB, Randhawa G, Kamida C. A method of performing descending venography. J Vasc Surg 1986; 4 (5):464–8. 58. Herman RJ, Neiman HL, Yao JS, Egan TJ, Bergan JJ, Malave SR. Descending venography: a method of evaluating lower extremity venous valvular function. Radiology 1980; 137 (1 Pt 1):63–9. 59. Mendoza E, Lattimer CR, Morrison N. Duplex ultra-sound of superficial leg veins. Duplex Ultrasound of Su-perficial Leg Veins 2014; (February):1–332. 60. Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex Ultrasound Investiga-tion of the Veins in Chronic Venous Disease of the Lower Limbs—UIP Consensus Document. Part I. Basic Princi-ples. European Journal of Vascular and Endovascular Surgery 2006; 31 (1):83–92. 61. Cavezzi, Labropoulos, Partsch, et al. Duplex ultra-sound investigation of the veins in chronic venous disease of the lower limbs-UIP consensus document. Part II. Anatomy. Vasa 2007; 36 (1):62–71. 62. Мазайшвили КВ. Пропедевтика для флеболога: книга о том, как собирать пазлы из симптомов в еди-ную картину болезни: Методы диагностики заболева-ний вен. Основы клинического мышления. Правила формулировки диагноза. Москва: URSS, 2022. 63. Royle JP. Recurrent Varicose Veins. World J Surg 1986; 10 (6):944–53. 64. Bradbury AW, Stonebridge PA, Ruckley C V, Beggs I, Bradbury MAW. Recurrent varicose veins: correlation between preoperative clinical and hand-held Doppler ultrasonographic examination, and anatomical findings at surgery. Butterworth-Hememann Ltd, 1993. 65. Mazayshvili K. Four Brush Stroke to Phlebology His-tory. Kindle Edition. Amazon, 2021. 66. Zolotukhin IA, Porembskaya OYa, Smetanina MA, Sazhin A V., Filipenko ML, Kirienko AI. Varicose veins: on the verge of discovering the cause? Annals of the Russian academy of medical sciences 2020; 75 (1):36–45. 67. Hoggan BL, Cameron AL, Maddern GJ. Systematic review of endovenous laser therapy versus surgery for the treatment of saphenous varicose veins. Ann Vasc Surg 2009; 23:277–87. 68. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic ve-nous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53. 69. Lurie F. Neovascularization and Recurrent Varicose Veins: More Histologic and Ultrasound Evidence. Year-book of Vascular Surgery 2006; 2006. 70. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology 2009; 24 (4). 71. De Maeseneer MGR. The role of postoperative neo-vascularisation in recurrence of varicose veins: From his-torical background to today’s evidence. Acta Chir Belg 2004; 104 (3). 72. Van Rij AM, Jones GT, Hill GB, Jiang P. Neovascular-ization and recurrent varicose veins: More histologic and ultrasound evidence. J Vasc Surg 2004; 40 (2). 73. De Maeseneer MG, Giuliani DR, Van Schil PE, De Hert SG. Can interposition of a silicone implant after sapheno-femoral ligation prevent recurrent varicose veins? European Journal of Vascular and Endovascular Surgery 2002; 24 (5). 74. De Maeseneer MG, Philipsen TE, Vandenbroeck CP, et al. Closure of the Cribriform Fascia: An Efficient Ana-tomical Barrier Against Postoperative Neovascularisation at the Saphenofemoral Junction? A Prospective Study. European Journal of Vascular and Endovascular Surgery 2007; 34 (3). 75. Brake M, Lim CS, Shepherd AC, Shalhoub J, Davies AH. Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg 2013; 57 (3):860–8. 76. Theivacumar NS, Darwood R, Gough MJ. Neovascu-larisation and Recurrence 2 Years After Varicose Vein Treatment for Sapheno-Femoral and Great Saphenous Vein Reflux: A Comparison of Surgery and Endovenous Laser Ablation. European Journal of Vascular and Endo-vascular Surgery 2009; 38 (2). 77. Lurie F, Creton D, Eklof B, et al. Prospective random-ised study of endovenous radiofrequency obliteration (clo-sure) versus ligation and vein stripping (EVOLVeS): Two-year follow-up. European Journal of Vascular and Endo-vascular Surgery 2005; 29 (1). 78. Kianifard B, Holdstock JM, Whiteley MS. Radiofre-quency ablation (VNUS closure®) does not cause neo-vascularisation at the groin at one year: Results of a case controlled study. Surgeon 2006; 4 (2). 79. Whing J, Nandhra S, Nesbitt C, Stansby G. Interven-tions for great saphenous vein incompetence. Cochrane Database of Systematic Reviews 2021; 2021 (8). 80. Nordon IM, Hinchliffe RJ, Brar R, et al. A Prospective Double-Blind Randomized Controlled Trial of Radiofre-quency Versus Laser Treatment of the Great Saphenous Vein in Patients With Varicose Veins. Ann Surg 2011; 254 (6):876–81. 81. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. British Journal of Surgery 2011; 98 (8):1079–87. 82. Shepherd AC, Gohel MS, Brown LC, Metcalfe MJ, Hamish M, Davies AH. Randomized clinical trial of VNUS® ClosureFASTTM radiofrequency ablation versus laser for varicose veins. British Journal of Surgery 2010; 97 (6):810–8. 83. Sydnor M, Mavropoulos J, Slobodnik N, Wolfe L, Strife B, Komorowski D. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein. Phlebology 2017; 32 (6). 84. Bozkurt AK, Yılmaz MF. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treat-ment of venous insufficiency. Phlebology: The Journal of Venous Disease 2016; 31 (1_suppl):106–13. 85. Almeida JI, Murray SP, Romero ME. Saphenous vein histopathology 5.5 years after cyanoacrylate closure. J Vasc Surg Venous Lymphat Disord 2019:1–5. 86. Jones AD, Boyle EM, Woltjer R, Jundt JP, Williams AN. Persistent type IV hypersensitivity after cyanoacrylate closure of the great saphenous vein. J Vasc Surg Cases Innov Tech 2019; 5 (3):372–4. 87. Almeida JI, Min RJ, Raabe R, McLean DJ, Madsen M. Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results. Vasc Endovascular Surg 2011; 45 (7):631–5. 88. Witte ME, Zeebregts CJ, de Borst GJ, Reijnen MMPJ, Boersma D. Mechanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review. Phlebology 2017; 32 (10):649–57. 89. Bishawi M, Bernstein R, Boter M, et al. Mechanochemical ablation in patients with chronic venous disease: A prospective multicenter report. Phlebology: The Journal of Venous Disease 2014; 29 (6):397–400. 90. Tang T, Kam J, Gaunt M. ClariVein® – Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins. Phlebology: The Journal of Venous Disease 2017; 32 (1):6–12. 91. Whiteley MS, Dos Santos SJ, Lee CT, Li J-M. Mechanochemical ablation causes endothelial and medial damage to the vein wall resulting in deeper penetration of sclerosant compared with sclerotherapy alone in extrafascial great saphenous vein using an ex vivo model. J Vasc Surg Venous Lymphat Disord 2017; 5 (3):370–7. 92. Çallk ES, Arslan Ü, Erkut B. Ablation therapy with cyanoacrylate glue and laser for refluxing great saphenous veins-A prospective randomised study. Vasa - European Journal of Vascular Medicine 2019; 48 (5). 93. Мазайшвили КВ, Агаларов РМ. Этапы жизни ме-дицинской технологии по J. McKinlay на примере эн-довенозной лазерной облитерации. Флебология 2019; 13 (2):146–53. 94. Flessenkämper I, Hartmann M, Hartmann K, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 2016; 31 (1). 95. Ross RL. Recurrent Varicose Veins. Calif Med 1957; 87 (3):168–70. 96. Nyamekye I, Shephard NA, Davies B, Heather BP, Earnshaw JJ. Clinicopathological evidence that neovascu-larisation is a cause of recurrent varicose veins. European Journal of Vascular and Endovascular Surgery 1998; 15 (5):412–5. 97. Egan B, Donnelly M, Bresnihan M, Tierney S, Feeley M. Neovascularization: An “innocent bystander” in recur-rent varicose veins. J Vasc Surg 2006; 44 (6). 98. Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. In: Journal of Vascular Surgery.Vol 58., 2013. 99. Bush RG, Bush P, Flanagan J, et al. Factors associated with recurrence of varicose veins after thermal ablation: Results of the recurrent veins after thermal ablation study. The Scientific World Journal 2014; 2014. 100. Bozoglan O, Mese B, Eroglu E, Ekerbiçer HC, Yasim A. Comparison of endovenous laser and radiofrequency ablation in treating varices in the same patient. J Lasers Med Sci 2017; 8 (1). 101. Georgiev M, Myers KA, Belcaro G. The thigh exten-sion of the lesser saphenous vein: From Giacomini’s ob-servations to ultrasound scan imaging. J Vasc Surg 2003; 37 (3). 102. Theivacumar NS, Darwood RJ, Dellegrammaticas D, Mavor AID, Gough MJ. The clinical significance of below-knee great saphenous vein reflux following endovenous laser ablation of above-knee great saphenous vein. Phlebology 2009; 24 (1). 103. Roka F, Binder M, Bohler-Sommeregger K. Mid-term recurrence rate of incompetent perforating veins after combined superficial vein surgery and subfascial endo-scopic perforating vein surgery. J Vasc Surg 2006; 44 (2). 104. Rutherford EE, Kianifard B, Cook SJ, Holdstock JM, Whiteley MS. Incompetent perforating veins are associated with recurrent varicose veins. European Journal of Vascular and Endovascular Surgery 2001; 21 (5). 105. Cavallini A, Marcer D, Ferrari Ruffino S. Endovenous laser treatment of groin and popliteal varicose veins recurrence. Phlebology 2018; 33 (3):195–205. 106. Sybrandy JEM, Van Gent WB, Pierik EGJM, Wittens CHA. Endoscopic versus open subfascial division of in-competent perforating veins in the treatment of venous leg ulceration: Long-term follow-up. J Vasc Surg 2001; 33 (5). 107. Puggioni A, Kalra M, Gloviczki P. Superficial vein surgery and SEPS for chronic venous insufficiency. Semin Vasc Surg 2005; 18 (1 SPEC. ISS.). 108. Pesta W, Kurpiewski W, Kowalczyk M, et al. The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treat-ment. Wideochirurgia I Inne Techniki Maloinwazyjne 2011; 6 (4). 109. Haruta N. Recent Progress of Varicose Vein Treat-ment Especially about Endovascular Heat Ablation, SEPS and Foam Sclerotherapy. Ann Vasc Dis 2018; 11 (1). 110. Lee DWH, Chan ACW, Lam YH, et al. Subfascial endoscopic perforator vein surgery (SEPS) using the ultra-sonic scalpel. Surg Endosc 2001; 15 (12). 111. Luebke T, Brunkwall J. Meta-analysis of subfascial endoscopic perforator vein surgery (SEPS) for chronic venous insufficiency. Phlebology 2009; 24 (1). 112. Masuda EM, Kessler DM, Lurie F, Puggioni A, Kistner RL, Eklof B. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006; 43 (3). 113. Prasad BP K, Joy B, Toms A, Sleeba T. Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy. Phlebology 2018; 33 (4):242–50. 114. El-shafei MAM, Abdelbary MSM, Basta MGZ, Ali Abdelrahman OAA. Efficacy of Ultrasound Guided Foam Sclerotherapy of Incompetent Ankle Perforators on Heal-ing of Chronic Venous Ulcers with Deep Venous Reflux. (A Comparative Study). QJM: An International Journal of Medicine 2021; 114 (Supplement_1). 115. Ozsvath K, Hager E, Harlander-Locke M, Masuda E, Elias S, Dillavou ED. Current techniques to treat patholog-ic perforator veins. J Vasc Surg Venous Lymphat Disord 2017; 5 (2). 116. Kishore R, Sankar TB, Anandi A, Nedunchezhian S, Murugan V. A Prospective Study in Comparison of Ambu-latory Phlebectomy and Duplex Guided Foam Sclerotherapy in the Management of Varicosities with Iso-lated Perforator Incompetence. Indian Journal of Surgery 2016; 78 (5). 117. Mohammed A, Alhewy M, Tawfiek A. Comparative study of ambulatory phlebectomy and foam sclerotherapy in the treatment of primary non-axial varicose veins. Minia Journal of Medical Research 2022; 0 (0). 118. Hager ES, Washington C, Steinmetz A, Wu T, Singh M, Dillavou E. Factors that influence perforator vein clo-sure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy. In: Journal of Vascular Surgery: Ve-nous and Lymphatic Disorders.Vol 4., 2016. 119. Kiguchi MM, Hager ES, Winger DG, Hirsch SA, Chaer RA, Dillavou ED. Factors that influence perforator thrombosis and predict healing with perforator sclerotherapy for venous ulceration without axial reflux. J Vasc Surg 2014; 59 (5). 120. Bacon JL, Dinneen AJ, Marsh P, Holdstock JM, Price BA, Whiteley MS. Five-year results of incompetent perfo-rator vein closure using TRans-Luminal Occlusion of Per-forator. Phlebology 2009; 24 (2). 121. Marsh P, Price BA, Holdstock JM, Whiteley MS. One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device. Phlebology 2010; 25 (2). 122. Zerweck C, von Hodenberg E, Knittel M, Zeller T, Schwarz T. Endovenous Laser Ablation of varicose perfo-rating veins with the 1470-nm diode laser using the radial fibre slim. Phlebology 2014; 29 (1). 123. Ozkan U. The fate of calf perforator veins after sa-phenous vein laser ablation. Diagnostic and Interventional Radiology 2015; 21 (5). 124. Proebstle TM, Herdemann S. Early results and feasi-bility of incompetent perforator vein ablation by endovenous laser treatment. Dermatologic Surgery 2007; 33 (2). 125. Ozkan U. Endovenous laser ablation of incompetent perforator veins: A new technique in treatment of chronic venous disease. Cardiovasc Intervent Radiol 2009; 32 (5). 126. Shi H, Liu X, Lu M, Lu X, Jiang M, Yin M. The effect of endovenous laser ablation of incompetent perforating veins and the great saphenous vein in patients with primary venous disease. European Journal of Vascular and Endovascular Surgery 2015; 49 (5). 127. Seren M, Dumantepe M, Fazliogullari O, Kucukaksu S. Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers. Phlebology 2017; 32 (5). 128. Giannopoulos S, Rodriguez L, Chau M, et al. A sys-tematic review of the outcomes of percutaneous treatment modalities for pathologic saphenous and perforating veins. J Vasc Surg Venous Lymphat Disord 2022; 10 (5). 129. Toonder IM, Lam YL, Lawson J, Wittens CHA. Cy-anoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology 2014; 29 (S1):49–54. 130. Kiguchi M, Kochubey M, Reynolds K, et al. Second-ary Procedures After Saphenous Closure in Clinical, Etiol-ogy, Anatomy, and Pathophysiology Class 6 Patients: A Comparison of VenaSeal Versus Radiofrequency Ablation. J Vasc Surg 2020; 72 (5). 131. Mordhorst A, Yang GK, Chen JC, Lee S, Gagnon J. Ultrasound-guided cyanoacrylate injection for the treat-ment of incompetent perforator veins. Phlebology 2021; 36 (9):752–60. 132. Семкин ВД, Акимов СС, Мазайшвили КВ. Подхо-ды к лечению рецидива варикозной болезни после эн-довенозной лазерной облитерации . Вестник СурГУ Медицина 2020; 45 (3):43–9. 133. Шевченко ЮЛ, Стойко ЮМ, Батрашов ВА, Са-бельников ВВ, Мазайшвили КВ. Ятрогенные повреж-дения проксимальных отделов магистральных вен в хирургии варикозной болезни. Вестник НМХЦ имНИ-Пирогова 2012; 7 (2):9–13. 134. Чен ВИ. Оптимизация выбора лечебной тактики при варикозной болезни вен нижних конечностей в амбулаторных условиях. - Автореф. дис. . канд. мед. наук. 2011. 135. Mazayshvili K, Akimov S. Early complications of endovenous laser ablation. Int Angiol 2019; 38 (2):96–101. 136. Müller L, Alm J. Feasibility and technique of endovenous laser ablation (EVLA) of recurrent varicose veins deriving from the sapheno-femoral junction—A case series of 35 consecutive procedures. PLoS One 2020; 15 (7). 137. Lurie F, Passman M, Meisner M, et al. The 2020 up-date of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord 2020; 8 (3):342–52. 138. Пахомов Е, Мазайшвили К, Маркин С. Программа для кодировки диагноза по классификации СЕАР. 2021.