pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2025_20_3_37pirogovestnik-356Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESРЕЗУЛЬТАТЫ ЦИАНОАКРИЛАТНОЙ КЛЕЕВОЙ ОБЛИТЕРАЦИИ ВАРИКОЗНЫХ ВЕНRESULTS OF CYANOACRYLATE ADHESIVE СLOSURE OF VARICOSE VEINШиринбекО.ShirinbekO.

 Москва 

 Moscow 

olims@mail.ruБлиновД. В.BlinovD. V.

Москва

Железнодорожный

 Moscow 

Zheleznodorozhniy

МнацаканянГ. В.MnatsakanyanG. V.

 Москва 

 Moscow 

ОдиноковаС. Н.OdinokovaS. V.

 Москва 

 Moscow 

Многопрофильный медицинский холдинг «СМ-Клиника»Россия«SM-Clinic» Multiprofile Medical HoldingRussian FederationМногопрофильный медицинский холдинг «СМ-Клиника»; Флебологический центр «Веносан»Россия«SM-Clinic» Multiprofile Medical Holding; Phlebology Center «Venosan»Russian FederationФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation2025290820252033741Copyright © Ширинбек О., Блинов Д.В., Мнацаканян Г.В., Одинокова С.Н., 20252025Ширинбек О., Блинов Д.В., Мнацаканян Г.В., Одинокова С.Н.Shirinbek O., Blinov D.V., Mnatsakanyan G.V., Odinokova S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/356

Цель: оценить непосредственные и среднесрочные результаты применения цианоакрилатной клеевой облитерации (ЦКО) в лечении пациентов с варикозной болезнью нижних конечностей (ВБНК) в условиях одного медицинского центра.Материал и методы: исследование выполнено на базе Флебологического центра «Веносан», г. Железнодорожный (Московская область). Критерием включения пациентов в данное исследование являлось наличие ВБНК (классы ХЗВ С2-С6), с несостоятельностью соустий, с наличием аксиального рефлюкса длительностью более 0,5 с в бассейне целевой вены, диаметром ствола подкожной вены ≥5 мм и наличием варикозно измененных притоков). Всем пациентам выполнена ЦКО по методике VenaSeal. Во всех случаях выполнена изолированная ЦКО без вмешательства на притоках и без использования компрессионного трикотажа. Интраоперационная боль оценивалась по визуально-аналоговой шкале (ВАШ). Контрольная УЗАС вен нижних конечностей выполнена на 3-и сутки, 1, 3, 6 и 12, 24 и 36 месяцев после вмешательства. Эффективность лечения оценивалась по наличию анатомического успеха в виде окклюзии целевой вены, безопасность процедуры характеризовалась отсутствием осложнений. Оценка частоты окклюзии проведена по методу Каплан-Мейера. Качество жизни пациентов оценена по шкале AVVQ.Результаты: в период с 2021 по 2024 гг. ЦКО выполнена 11 пациентам (20 нижних конечностей и 23 венозных бассейна), женщин было 9 (82%), мужчин – 2 (18%). Средний возраст пациентов составил 59.2±15.4 лет. Распределение пациентов по классам хронических заболеваний вен: С2 – 6 (54%); С3 – 1 (9%), С4 – 4 (36%) и С6 – 1 (9%). Средний диаметр БПВ составил 10,1±3,6 мм, МПВ – 9,8±3,5 и ПДПВ – 8,5±0,7 мм. Облитерация вен на 30-е сутки достигнута у всех 100% пациентов. Реканализация целевых вен за период наблюдения отмечена у 1 пациента (4% от всех пролеченных вен). У 1 (9%) больных вмешательство проведено на одном бассейне, у 7 (63%) – одномоментно на 2-х бассейнах, у 2 (18%) – одномоментно на 3-х бассейнах. Среднее время вмешательства составило 55,9± 9,7 мин. Интраоперационная боль по ВАШ у 93% пациентов составила менее 3 баллов. Миграция клея с пролабированием в глубокую вену выявлена у 1 пациента (4%), образование гранулемы мягких тканей отмечена у 1 больного (4% от всех пролеченных вен). Флебитическая реакция кожи зарегистрирована в сроки от 7 до 21 дня после вмешательства у 2 (18%) пациентов. Случаев парестезии, тромбозов глубоких, поверхностных вен и ТЭЛА у наших пациентов не наблюдалось.Выводы. Клеевая облитерация показала высокую эффективность и безопасность в лечении больных ВБНК, с частотой окклюзии целевых вен 90% в сроки наблюдения до 3 лет.

Objective. To evaluate the immediate and medium-term results of cyanoacrylate adhesive closure (CАС) in the treatment of patients with varicose veins at one medical center setting.Material and methods. The study was performed at the “Venosan” Phlebological Center (Zheleznodorozhny city, Moscow region). The inclusion criteria were: CEAP classes C2-C6, junctional incompetence and axial reflux lasting more than 0.5 sec, the diameter of the trunk of the saphenous vein ≥ 5 mm and the presence of varicose tributaries. All patients underwent VenaSeal procedure. In all cases, an isolated truncal ablation was performed without intervention on side bracnches excluding the use of compression stockings. Intraoperative pain was assessed using a standard Visual Analog Scale (VAS). The effectiveness of the treatment was assessed by its anatomical success in target vein occlusion, the safety of the procedure was characterized by the absence of complications. Occlusion rate was assessed by Kaplan-Mayer method and patients’ quality of life was measured by AVVQ.Results. Between 2021 and 2024, CAC was performed in 11 patients (20 lower extremities and 23 venous trunks) – 9 women (82%) and 2 men (18%). Their mean age was 59.2±15.4 years. The distribution of patients according to CEAP was: C2 – 6 (54%); C3 – 1 (9%), C4 – 4 (36%) and C6 – 1 (9%). The mean diametre of the GSV was 10.1±3.6 mm, the diametres of the SSV and the AASV were 9.8±3.5 mm and 8.5±0.7 mm respectively. The control duplex ultrasound was performed on the 3rd day, 1st and 3rd months after the intervention. Vein occlusion on the 30th day was achieved in all 100% of patients. Recanalization of the target veins during the follow-up period was noted in 1 patient (4% of all treated veins). In 1 (9%) patient, one truncal vein was ablated, in 7 (63%) – two and in 2 (18%) patients – three trunks were ablated simultaneously. The mean intervention time comprised 55.9± 9.7 minutes. Intraoperative VAS in 93% of patients was less than 3 points. Migration of glue with its propagation into the deep vein was detected in 1 patient (4%), the formation of soft tissue granuloma was noted in 1 patient (4% of all treated veins). Phlebitic skin reaction was registered within 7 to 21 days after the intervention in 2 (18%) patients. There were no cases of paresthesia, deep or superficial vein thrombosis, nor PE in our patients.Сonclusion. CAC has shown high efficacy and safety in our group of patients with occlusion rate of up to 90% in 3 year period.

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The authors declare that there are no conflicts of interest present.