[Saint Petersburg Venous Forum 'Christmas Meetings' - 10th anniversary]

The article is a review of the reports delivered at the annual Saint Petersburg Venous Forum 'Christmas Meetings'. In 2017 it was held for the 10th time. Widely covered at the Forum were problems concerning non-tumescent methods of treatment of varicose veins, methods of diagnosis and treatment of deep-vein diseases, problems of pathogenesis of post-thrombotic disease, terminology in problems of phlebology.

[Endovascular treatment of a patient with post-thrombotic disease and obstruction of a cava filter]

Balloon angioplasty and stenting have increasingly been gaining widespread application for treatment of post-thrombotic alterations in the system of the vena cava. Endovascular ultrasonographic examination makes it possible with the utmost degree of reliability to determine both the extension and degree of the narrowing of venous segments, thus proving a possibility of choosing a venous stent of an appropriate diameter. Restoration of an adequate venous lumen leads to normalization of blood flow and elimination of venous hypertension. However, unsolved as yet remains the problem concerning proper management of post-thrombotic obstructions of the inferior vena cava at the level of a cava filter. Owing to a wide variety of configurations of cava filters to deploy, there are no common approaches to elimination of such obstruction. Presented herein is a clinical case report regarding successful endovascular treatment of a patient diagnosed with post-thrombotic disease secondary to endured thrombosis. The findings of both phlebography and endovascular ultrasonographic examination made it possible to diagnose obstruction of the left common iliac vein, external iliac vein, and inferior vena cava to the level of the cava filter previously deployed. In the segment of the inferior vena cava at the level of the cava filter also revealed was a pronounced luminal narrowing exceeding 90% of its diameter. We carried out stenting of the common and external iliac veins, inferior vena cava, and the cava filter. Swelling of the left leg subsided spontaneously within 2 weeks and the first postoperative month was accompanied by gradual disappearance of the previously existing feeling of heaviness in the lower limbs and a dramatic decrease in fatigue by the end of the working day.

[First experience with intravascular ultrasonographic examination in diagnosis of post-traumatic obstruction of deep veins]

Intravascular ultrasonography (IVUS) is a highly effective method of diagnosis of post-thrombotic obstructions. Its possibilities by determining the degree and extension of obstructions of deep veins are superior to those of not only non-invasive methods of examination (ultrasonography, CT and MRI) but of phlebography whose results until recently were considered fundamental in diagnosis of the disease concerned. Limited possibilities of phlebography often lead to diagnostic errors when determining the degree and extension of post-thrombotic obstructions. Intravascular ultrasonography makes it possible to obtain a maximally objective picture of the degree of intravascular alterations in post-thrombotic diseases, as well as to determine the indications for performing balloon dilatation and stenting of deep veins. First experience in using intravascular ultrasonography in the Clinic of the Institute of Experimental Medicine confirmed these provisions. A total of 15 patients diagnosed with post-thrombotic disease while examination were subjected to antegrade transfemoral phlebography in the direct and lateral projections and IVUS. Significant post-thrombotic obstruction was revealed by phlebography in 3 (20%) of the 15 patients and confirmed by the findings of IVUS. In 12 (80%) patients only carrying out IVUS made it possible to detect pronounced obstruction of veins (more than 50% of its diameter) remaining undiagnosed by phlebography. Unnoticed in phlebography turned out to be May-Thurner syndrome in a female patient. Compression of the left common iliac vein by the right common iliac artery exceeding during systole 70% of the initial diameter of the vein was also revealed while performing IVUS. At the same time phlebography remains an indispensable method of examination while assessing collateral blood flow, thus making it possible to recommend its performing in combination with IVUS for obtaining the most complete notion on post-thrombotic alterations in deep veins of the inferior vena cava system.

[Experience with using cyanoacrylate glue in endovascular treatment of varicose veins]

The method of cyanoacrylate-mediated obliteration of subcutaneous veins is known to be an alternative to thermal endovascular obliteration and eliminates the need for tumescent anaesthesia. This technique is based on glue-induced damage to the venous intima, followed by immune response according to the delayed-type hypersensitivity principle. The authors report herein their first experience with using cyanoacrylate-mediated embolization in treatment of patients presenting with varicose veins. The operation was carried out using the VenaSeal closure system (Medtronic). Under ultrasonographic guidance, we performed cyanoacrylate-mediated obliteration of the trunk of the great saphenous vein, without tumescence. The procedure turned out to be well tolerated, with no pain in the zone of cyanoacrylate obliteration reported by the patients in the postoperative period. By means of ultrasonographic control carried out within 1-month of follow up we assessed obliteration of the vein, with the diameter of the obliterated portion amounting to 0.3-0.4 cm. No phlebitis, allergic reactions, nor evidence of deep vein thrombosis were observed. We also performed a morphological study of the removed suprafascial segment of the vein, containing the cyanoacrylate adhesive. The obtained findings demonstrated detachment and destruction of the intima, swelling and loosening of the media, as well active degranulation of mast cells, thus making it possible to suppose the presence of toxic damage to the venous wall induced by cyanoacrylate glue. Hence, the experience thus gained appears to be unequivocally suggestive of remarkable simplicity of performing cyanoacrylate-mediated embolization whose indisputable advantages include the painless nature of the procedure and no need for tumescent anaesthesia. In order to assess efficacy and safety of this technique, further studies are required.

[Review of materials of the Fourth European Venous Forum (Stockholm, Sweden)]

The article provides a brief review of the opinions and experience of the leading phlebologists from various countries, reflecting the latest updates and current problems regarding state-of-the-art management of diseases of major veins of lower extremities. Special attention is focussed on deep vein thromboses and consequence thereof, as well as varicose disease. This is followed by description of novel approaches to treatment of the pathology concerned.

[Open thrombectomy in treatment of acute thromboses of lower-limb deep veins]

Thrombosis of lower-limb deep veins is one of the most common vascular diseases in the world. For a long time the generally accepted treatment policy was conservative therapy with anticoagulants. The article is a review of the literature containing the results of studies carried out over the past two decades and confirming efficacy of surgical treatment for acute venous thrombosis. Presented are the data showing that thrombectomy performed within the first 10-14 days from the onset of the disease, improving quality of life of patients and preventing invalidization thereof. The gained world experience makes it possible to work out the most effective approaches to treatment of acute venous thromboses.

[Proximal limits of resection and the role of mediastinal lymph dissection in surgical treatment of gastroesophageal cancer]

An analysis of results of treatment of 37 patients allowed a conclusion that differential approach is possible in choice of the level of resection of the esophagus in patients with gastroesophageal cancer (GEC). Resection of the esophagus within the limits of 2-3 cm from the proximal edge of the tumor can be performed for GEC in the absence of data of spread of the tumor outsides the limits of the organ wall and pronounced lymphogenic dissemination. Extension of the resection limits to 4 cm and more is necessary in performing radical operations in patients with late stages of the disease. Ablation of the lymph nodes of the lower mediastinum is a necessary component of radical operative interventions in treatment of patients with GEC.