Scientific conference "A patient with venous pathology at a surgical appointment", Moscow, 19.09.2020.
On September 19, 2020 in Moscow, in the Congress Center Technopolis "Moscow", a scientific-practical conference "A patient with venous pathology at a surgical appointment: from varicose veins to post-thrombotic syndrome" was held.
Doctor Semenov A.Yu. with speakers of the conference Kh.M. Kurginyan and Petrikov A.S.
Leading phlebologists of the Moscow City Center of Phlebology acted as speakers at the event: head of the center, vascular surgeon, phlebologist, candidate of medical sciences, Artyom Yurievich Semyonov (Moscow), leading phlebologist, candidate of medical sciences, Dmitry Anatolyevich Fedorov (Moscow, Obninsk), vascular surgeon , Candidate of Medical Sciences, Vladimir Vyacheslavovich Raskin (Moscow).
Olga Yaroslavna Porembskaya, Candidate of Medical Sciences, surgeon, phlebologist, Senior Researcher of the Laboratory of Systemic and Regional Blood Circulation, NIIEM, (St. Petersburg), presented the message: “Varicose veins of the small pelvis. The cause of the pelvic pain?
“Varicose veins of the small pelvis. The cause of pelvic pain? " - reports Porembskaya O. Ya. (St. Petersburg)
Olga Aleksandrovna turned to such pathology as pelvic varicose veins. Complaints about chronic pelvic pain of the patient are voiced at the appointment with a gynecologist. The cause of such complaints in a third of cases is pelvic varicose veins. The latter refers to a phlebological problem and is manifested by the following symptoms:
- Dysuria (frequent urination).
- Dysmenorrhea (menstrual irregularities).
- Hematuria (appearance of blood in the urine).
- Feeling of heaviness and discomfort in the lower abdomen.
- Dyspareunia is the occurrence of pain during and after intercourse. A feature of this pain is its duration from 30 minutes to a day.
- Psycho-emotional disorders (irritability, insomnia, depression).
The above convincingly proves that varicose veins of the small pelvis deserves attention from the professional community. What can I say, these symptoms not only worsen a woman's well-being, but also interfere with normal life. We would like to hope that the professional gynecological community is well aware of the problem of pelvic varicose veins.
Dr. Porembska focused the audience's attention on the modern conservative treatment of chronic pelvic pain with venotonic drugs. Therapy with these drugs allows you to achieve a stable clinical effect lasting up to six months.
Anastasia Andreevna Akulova, Candidate of Medical Sciences, cardiovascular surgeon, endovascular surgeon, head of the department of vascular surgery at the ChUZ TsKB RZD-medicine (Moscow), presented the message: "When should an endovascular surgeon intervene?"
"When should an endovascular surgeon intervene?" - reports A.A. Akulova (Moscow city)
Anastasia Andreevna continued the topic of pelvic varicose veins in women. Dr. Akulova turned to endovascular treatment for this pathology. Anastasia Andreevna presented diagnostic algorithms and a tactical approach to the treatment of pelvic varicose veins. The clinical case of the treatment of a 27-year-old patient presented by the doctor deserves special attention. The patient underwent endovascular treatment of pelvic varicose veins. Today, there is not so much data on such operations, so the message of Dr. Akulova, of course, did not leave the audience indifferent.
Artur Gagikovich Bagdasaryan, Ph.D., Phlebologist surgeon, expert in the field of aesthetic phlebology (Moscow), presented the message: "Transcutaneous lasers in professional recommendations."
“Transcutaneous lasers in professional recommendations” - reports AG Bagdasaryan. (Moscow)
Dr. Baghdasaryan addressed the modern removal of small diameter superficial venous vessels, telangiectasias and reticular veins in the context of international guidelines. Transcutaneous laser removal of vascular formations today in Western Europe, the USA and Russia is significantly inferior to sclerotherapy, both in terms of the number of interventions and supporters of laser technology in professional phlebological communities. Artur Gagikovich conducted a good detailed analysis of the recommendations of the world's leading phlebological organizations: the European Society for Vascular Surgery (ESVS) and the American Venous Forum (AVF). Dr. Baghdasaryan pointed out obvious shortcomings in the modern recommendations of the latter:
- The recommendations of both the European and American societies are based on studies that do not objectively reflect the capabilities of modern laser equipment.
- In their current form, the recommendations of the world's leading phlebological communities lag behind the already existing practical and theoretical developments, as well as the level of modern equipment.
A very serious report, worthy of attention not only to domestic but also foreign audiences.
Igor Anatolyevich Zolotukhin, professor, head of the course of cardiovascular surgery and phlebology of FUV, member of the expert council of the Higher Attestation Commission for Surgical Sciences, (Moscow), presented the message: "Venous thrombosis 2020: what's new for surgical practice."
"Venous thrombosis 2020: what's new for surgical practice" - reports Zolotukhin (Moscow)
Igor Anatolyevich spoke about the problems of modern randomized clinical trials (RCTs). It is on the latter that national and multinational clinical guidelines are based, according to which each individual specialist should act. What is wrong with modern RCTs:
- Patients in RCTs are almost always different from those in the general population.
- RCT research physicians, not equal to field physicians
- RCT centers are not always analogous to conventional healthcare facilities.
- Diagnosis in RCTs is not analogous to common mass practice.
- Patient monitoring in RCTs differs from that in routine practice.
What practice says:
- The use of anticoagulants in full accordance with clinical guidelines leads to an excess of deaths from large bleeding than from pulmonary embolism.
- There is a need for special studies that will involve patients at high risk of bleeding.
Regarding the problem of deep vein thrombosis in thrombosis, the latter has the following features:
- Increased risk of recurrence, both due to the effect of procoagulation of the oncological process and antitumor treatment (surgery, chemotherapy, radiation therapy, etc.)
- The tumor process gives a high risk of bleeding.
Anticoagulant therapy is necessary for cancer patients, since the development of thrombosis in them reduces the one-year survival rate from 36 to 12%. It should be borne in mind that tumors of different localization have a different risk of developing VTEC and bleeding. Therefore, when prescribing a specific anticoagulant therapy, one must bear in mind the localization and type of tumor, the degree of its decay. Onco-associated thrombosis is not an independent pathology and when the tumor is cured, anticoagulant therapy should be discontinued after 3 or 6 months.
Sergey Viktorovich Sapelkin, Doctor of Medical Sciences, phlebologist, leading researcher of the Department of Vascular Surgery of the FSBI "NMITs" of Surgery named after A.V. Vishnevsky, (Moscow), presented the message: "Is pharmacotherapy necessary in aesthetic phlebology?"
"Is pharmacotherapy necessary in aesthetic phlebology" - reports S.V. Sapelkin. (Moscow city)
Sergey Viktorovich gave a very good lecture on the need for pharmacological support of aesthetic procedures in modern phlebology. As you know, there are no trifles in aesthetics. Therefore, both specialists and pharmaceutical companies strive to offer patients the maximum of available funds. Most of the data on the benefits of pharmacological support have been accumulated regarding drugs of the diosmin group (Detralex). Still, more voluminous multicenter RCTs are needed to strengthen the position of pharmacotherapy in the segment of aesthetic phlebology.
Olga Vadimovna Jenina, Candidate of Medical Sciences, Leading Phlebologist of the First Phlebological Center (Moscow), presented the message: “A patient at an outpatient surgeon's appointment. Questions and answers".
“A patient at an outpatient surgeon's appointment. Questions and Answers "- reports OV Jenina. (Moscow city)
Olga Vadimovna told about the specifics of the treatment of thrombosis in patients taking COC (combined oral contraceptives). Dr. Jenina turned to authoritative guidelines, RCT findings, and her own clinical experience. Summarizing the data, Olga Vadimovna recommended that patients with COC-associated thrombosis should be treated with direct oral anticoagulants (OCs). The optimal choice from this group of drugs will be Apixaban, since according to modern research, it is he who has sufficient efficacy with the lowest risks for women.
Vladimir Vyacheslavovich Raskin, Candidate of Medical Sciences, Leading Phlebologist of the Moscow Innovative Phlebological Center, (Moscow), presented the message: “How to minimize complications during EVLK”.
“How to minimize complications during EVLK” - reports VV Raskin. (Moscow)
Vladimir Vyacheslavovich turned to possible problems during treatment with modern phlebological procedures. Even the most experienced and responsible specialists are not immune from treatment complications. Still, a good doctor has minimal complications. How can you avoid them? What are the requirements for a modern doctor?
A modern phlebologist should be able to:
- Understand both venous and concomitant pathology
- Work with an ultrasound machine
- Communicate correctly with the patient
- Possess the relevant technical and surgical data for EVLK.
In order to avoid most of the possible complications, special attention should be paid to the following points:
- Correct communication with the patient. Justify expectations (do not promise the impossible, tell about the risks and possible problems)
- Consider risk factors for venous problems and comorbidities
- Do not take a patient if there is a problem "not clear" to the doctor. Collegiate solutions.
- Do not run on outdated, poorly functioning equipment
- Personally check ALL stages of patient preparation for EVLK (especially preparation of tumescent solution)
- Competently solve emerging problems at the operational and postoperative stages.
The above, as well as good training of the medical staff, competent logistics, make the doctor's life easier and more comfortable.
Sergey Nikolaevich Yakushkin, Candidate of Medical Sciences, chief specialist in the direction of phlebology at the Semeynaya clinic, (Moscow), presented the message: "Surgery against the therapy of venous ulcers."
“Surgery versus therapy of venous ulcers” - reports SN Yakushkin. (Moscow city)
Surgery of trophic ulcers has never been an easy task and the opinion of an expert in this field is very relevant. Today, the most relevant techniques for plastics of ulcer defects are the following:
- Shave therapy + SAPP
- Propeller plastic
- Plastic surgery with displaced tissues.
The best approach is needed for each specific case.
Dr. Yakushkin presented clinical situations when surgery is a necessity. The following types of trophic ulcers require surgical treatment:
- Giant ulcers;
- Ulcers resistant to conservative treatment;
- Ulcers with lymphovenous insufficiency;
- Ulcers of the ankle region;
- Often recurrent ulcers;
- Ankle ulcers
- Ulcers with severe cicatricial deformity;
- Complex ulcers.
Sergey Nikolaevich shared practical examples from clinical practice of working with the most complex venous ulcers. The good results impressed the audience.
Artyom Yuryevich Semyonov, Candidate of Medical Sciences, Head of the Moscow Innovative Phlebological Center, (Moscow) presented the message: "1470 & 1940: Comparative and Long-Term Results". Artyom Yuryevich spoke about the comparison of two endovascular technologies.
"1470 & 1940: Comparative and Long-Term Results" - reports A.Yu.
Dmitry Anatolyevich Fedorov, Candidate of Medical Sciences, Leading Phlebologist of the Moscow Innovation Center (Moscow, Obninsk), presented the message: “Total EVLO. Results".
“Total EVLO. Results "- reports D.A. Fedorov.
Dmitry Anatolyevich shared the results of using the technology of total laser coagulation.