Варикозные вены в пожилом и старческом возрасте: проблемы и перспективы

Ширинбек О.¹, Мнацаканян Г.В.¹, Одинокова С.Н.²

Варикозная болезнь нижних конечностей (ВБНК) достаточно распространена у пациентов пожилого и старческого возраста. Степень тяжести данного состояния определяется индивидуальной переносимостью симптомов варикозной болезни с учетом естественного старения организма и присутствующего коморбидного фона. Проведен обзор проблемы ВБНК в целом и сквозь призму пациентов старшей возрастной группы. Также рассмотрены преимущества и ограничения различных подходов к диагностике и лечению варикозных вен в геронтологической популяции. Среди современных методов рассмотрены эндовенозные технологии, в частности, клеевая облитерация, открывающая новые горизонты безболезненного и радикального лечения ВБНК у пациентов пожилого и старческого возраста.

1. Azar J, Rao A, Oropallo A. Chronic venous insufficiency: a comprehensive review of management. Journal of Wound Care. 2022; 31(6): 510-519. doi: 10.12968/jowc.2022.31.6.510.

2. Ortega MÁ, Fraile-Martínez Ó, García-Montero C, et al. Understanding Chronic venous Disease: A Critical Overview of its pathophysiology and medical management. Journal of Clinical Medicine. 2021; 10(15): 3239. doi: 10.3390/jcm10153239.

3. Azhdari M, Zilaee M, Karandish M, et al. Red vine leaf extract (AS 195) can improve some signs and symptoms of chronic venous insufficiency, a systematic review. PTR Phytotherapy Research (Print). 2020; 34(10): 2577-2585. doi: 10.1002/ptr.6705.

4. Mayrovitz HN, Aoki KC, Colón JLL. Chronic venous insufficiency with emphasis on the geriatric population. Curēus. June 2023. doi: 10.7759/ cureus.40687.

5. Shehab AW, Eleshra A, Fouda E, Elwakeel H, Farag MK. Randomized prospective comparative study of platelet-rich plasma versus conventional compression in treatment of post-phlebitic venous ulcer. Vascular. 2022; 31(6): 1222-1229. doi: 10.1177/17085381221104629.

6. Helmy Y, Farouk N, Ali Y, et al. Objective assessment of Platelet- Rich Plasma (PRP) potentiality in the treatment of Chronic leg Ulcer: RCT on 80 patients with Venous ulcer. Journal of Cosmetic Dermatology (Print). 2021; 20(10): 3257-3263. doi: 10.1111/jocd.14138.

7. Weller C, Bouguettaya A, Team V, Flegg JA, Kasza J, Jayathilake C. Associations between patient, treatment, or wound- level factors and venous leg ulcer healing: Wound characteristics are the key factors in determining healing outcomes. Wound Repair and Regeneration. 2019; 28(2): 211-218. doi: 10.1111/wrr.12773.

8. Longobardi P, Hartwig V, Santarella L, et al. Potential markers of healing from near infrared spectroscopy imaging of venous leg ulcer. A randomized controlled clinical trial comparing conventional with hyperbaric oxygen treatment. Wound Repair and Regeneration. 2020; 28(6): 856-866. doi: 10.1111/wrr.12853.

9. Chinchalongporn W, Tanmit P, Pruekprasert K, et al. Prevalence and predictors of combined >50% iliocaval venous obstruction and superficial venous reflux in chronic venous insufficiency patients with healed or active venous leg ulcer. Journal of Vascular Surgery Venous and Lymphatic Disorders (Print). 2023; 11(3): 502-509. doi: 10.1016/j.jvsv.2022.11.006.

10. Vuylsteke M, Colman R, Thomis S, Guillaume G, Van Quickenborne D, Staelens I. An epidemiological survey of venous disease among general practitioner attendees in different geographical regions on the globe: The final results of the Vein Consult Program. Angiology. 2018; 69(9): 779-785. doi: 10.1177/0003319718759834.

11. Kim Y, Png CYM, Sumpio BJ, DeCarlo C, Dua A. Defining the human and health care costs of chronic venous insufficiency. Seminars in Vascular Surgery. 2021; 34(1): 59-64. doi: 10.1053/j.semvascsurg.2021.02.007.

12. Galsinh H, Singh K, Smith L. Lipodermatosclerosis: the common skin condition often treated as cellulitis. Journal of the Royal College of Physicians of Edinburgh. 2019; 49(1): 41-42. doi: 10.4997/jrcpe.2019.110.

13. Mayrovitz HN, Wong S, Mancuso C. Venous, arterial, and neuropathic leg ulcers with emphasis on the geriatric population. Curēus. 2023. doi: 10.7759/cureus.38123.

14. Łastowiecka-Moras E. Standing and sitting postures at work and symptoms of venous insufficiency – results from questionnaires and a Doppler ultrasound study. International Journal of Occupational Safety and Ergonomics. 2020; 27(4): 963-969. doi: 10.1080/10803548.2020.1834232.

15. Mahapatra S, Ramakrishna P, Gupta B, Anusha AM, Para MA. Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study. Indian Journal of Medical Research (New Delhi). 2018; 147(5): 471. doi: 10.4103/ijmr.ijmr_1844_16.

16. Yun MJ, Kim YK, Kang D, et al. A study on prevalence and risk factors for varicose veins in nurses at a university hospital. Safety and Health at Work (Seoul). 2018; 9(1): 79-83. doi: 10.1016/j.shaw.2017.08.005.

17. Lurie F, Passman MA, Meisner MJ, et al. The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery Venous and Lymphatic Disorders. 2020; 8(3): 342-352. doi: 10.1016/j.jvsv.2019.12.075.

18. Orhurhu V, Chu R, Xie K, et al. Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review. Cardiology and Therapy (Internet). 2021; 10(1): 111-140. doi: 10.1007/s40119-021-00213-x.

19. Shams E, Mayrovitz HN. Contrast-Induced Nephropathy: A review of mechanisms and risks. Curēus. 2021. doi: 10.7759/cureus.14842.

20. Blake A, Cruzval-O’Reilly E, Sayed C. Cellulitis mimics in the geriatric patient. Current Geriatrics Reports. 2020; 9(4): 192-198. doi: 10.1007/ s13670-020-00334-6.

21. Michener A, Heath B, Crnich C, et al. Infections in Older Adults: A Case-Based Discussion Series emphasizing antibiotic stewardship. MedEdPORTAL. September 2018. doi:10.15766/mep_2374-8265.10754.

22. Sudduth CL, Greene AK. Primary lymphedema: update on genetic basis and management. Advances in Wound Care (New Rochelle, NY Print). 2022; 11(7): 374-381. doi: 10.1089/wound.2020.1338.

23. Wong ML, Eaton PK, Zanichelli C, Moore C, Hegarty CE, MacDonald N. The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients. European Journal of Surgical Oncology. 2022; 48(5): 1167-1172. doi: 10.1016/j.ejso.2021.12.464.

24. Yoshihara M, Shimono R, Tsuru S, et al. Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study. European Journal of Surgical Oncology. 2020; 46(7): 1334-1338. doi: 10.1016/j.ejso.2020.01.033.

25. Rockson SG. Bioimpedance analysis of lower extremity lymphedema. Lymphatic Research and Biology. 2020; 18(2): 98. doi: 10.1089/lrb.2020. 29085.sr.

26. Mayrovitz HN, Arzanova E, Somarriba S, Eisa S. Factors affecting interpretation of tissue dielectric constant (TDC) in assessing breast cancer treatment related lymphedema (BCRL). Lymphology. 2019; 52(2): 92-102.

27. Mayrovitz HN. Assessing lower extremity lymphedema using upper and lower extremity tissue dielectric constant ratios: method and normal reference values. Lymphatic Research and Biology. 2019; 17(4): 457-464. doi: 10.1089/lrb.2018.0039.

28. Mayrovitz HN, Mikulka A, Woody D. Minimum Detectable Changes Associated with Tissue Dielectric Constant Measurements as Applicable to Assessing Lymphedema Status. Lymphatic Research and Biology. 2019; 17(3): 322-328. doi: 10.1089/lrb.2018.0052.

29. Mayrovitz HN, Arzanova E, Somarriba S, Eisa S. Reference values for assessing localized hand lymphedema using interhand tissue dielectric constant ratios. Lymphatic Research and Biology. 2018; 16(5): 442-445. doi: 10.1089/lrb.2017.0065.

30. Sharma SK, Mudgal SK, Mandal A. Thyroid disease in older people: Nursing perspectives. Thyroid Research and Practice. 2020; 17(3): 110-117, doi: 10.4103/trp.trp_25_20.

31. Sharma SK, Mudgal SK, Mandal A. Thyroid disease in older people: nursing perspectives . Thyroid Res Prac. 2020; 17: 110-117.

32. Kılınç F, Akbaş A, Şener S, Hayran Y, Aktaş A. Cutaneous findings in patients with chronic venous insufficiency. Journal of Cosmetic Dermatology (Print). 2021; 21(5): 2106-2112. doi: 10.1111/jocd.14337.

33. Mackie H, Thompson B, Suami H, et al. Differentiation of lipoedema from bilateral lower limb lymphoedema by imaging assessment of indocyanine green lymphography. Clinical Obesity (Print). 2023; 13(3). doi: 10.1111/cob.12588.

34. Rasmussen JC, Aldrich MB, Fife CE, Herbst KL, Sevick- Muraca EM. Lymphatic function and anatomy in early stages of lipedema. Obesity (Silver Spring, Md). 2022; 30(7): 1391-1400. doi: 10.1002/oby.23458.

35. Wollina U. Lipedema – An update. Dermatologic Therapy. 2018; 32(2): e12805. doi: 10.1111/dth.12805.

36. Silva WT, Ávila MR, De Oliveira LFF, et al. Differences in health-related quality of life in patients with mild and severe chronic venous insufficiency: A systematic review and meta-analysis. Journal of Vascular Nursing. 2021; 39(4): 126-133. doi: 10.1016/j.jvn.2021.09.002.

37. Poulose D, Deo K, Gogineni JM, et al. Correlation of venous clinical severity score with dermatology life quality Index among patients with chronic venous insufficiency: a Cross-Sectional study. Curēus. 2021. doi: 10.7759/cureus.17654.

38. Baylis RA, Smith NL, Klarin D, Fukaya E. Epidemiology and Genetics of venous thromboembolism and Chronic venous Disease. Circulation Research. 2021; 128(12): 1988-2002. doi: 10.1161/circresaha.121.318322.

39. Cires-Drouet R, Fangyang L, Rosenberger S, et al. High prevalence of chronic venous disease among health care workers in the United States. Journal of Vascular Surgery Venous and Lymphatic Disorders. 2020; 8(2): 224-230. doi: 10.1016/j.jvsv.2019.10.017.

40. Ansorge C, Miocic J, Schauer F. Skin diseases in hospitalized geriatrics: a 9-year analysis from a University Dermatology Center in Germany. Archives of Dermatological Research. 2021; 314(5): 427-437. doi: 10.1007/ s00403-021-02244-9.

41. Belmin J, Donadio C, Jarzebowski W, Genranmayeh K, Valembois L, Lafuente-Lafuente C. The value of B-type natriuretic peptide plasma concentrations in very old people with chronic peripheral oedema. Archives of Cardiovascular Diseases. 2020; 113(5): 332-340. doi: 10.1016/ j.acvd.2019.12.009.

42. Raffetto JD. Pathophysiology of chronic venous disease and venous ulcers. ˜the œSurgical Clinics of North America/Surgical Clinics of North America. 2018; 98(2): 337-347. doi: 10.1016/j.suc.2017.11.002.

43. Klonizakis M. The role of microcirculatory dysfunction in the pathophysiology and treatment of venous leg ulcers. JAMA Dermatology. 2019; 155(7): 861. doi: 10.1001/jamadermatol.2019.0591.

44. Zhang J, Yuan Z, Mo CK, et al. The global burden of cardiovascular diseases and type 2 diabetes attributable to low physical activity, 1990–2019: an analysis from the global burden of disease study. Frontiers in Cardiovascular Medicine. 2023; 10. doi: 10.3389/fcvm.2023.1247705.

45. Patton D, Avşar P, Sayeh A, et al. A meta- review of the impact of compression therapy on venous leg ulcer healing. International Wound Journal. 2022; 20(2): 430-447. doi: 10.1111/iwj.13891.

46. Akrivou D, Perlepe G, Kirgou P, Gourgoulianis K, Malli F. Pathophysiological Aspects of aging in Venous Thromboembolism: an update. Medicina. 2022; 58(8): 1078. doi: 10.3390/medicina58081078.

47. Ширинбек О. Справочник хирурга-флеболога. – Москва: ГЭОТАР-Медиа, 2024. – 144 с.

48. Ширинбек О., Мнацаканян Г.В., Одинокова С.Н. Цианоакрилатная клеевая облитерация варикозных вен в реальной клинической практике: двухлетние результаты лечения. Амбулаторная хирургия. – 2022. – №19(1). – С.132-139. doi: 10.21518/1995-1477-2022-19-1-132-139.

49. Ширинбек О., Одинокова С.Н. Цианоакрилатная клеевая облитерация подкожных вен // Флебология. – 2021. – №15(4). – С.297‑303. doi: 10.17116/ flebo202115041297.

50. Ширинбек О., Одинокова С.Н. Клеевая облитерация в лечении варикозной болезни у пациентов пожилого и старческого возраста // Ангиология и сосудистая хирургия. – 2021. – Т.27. – №2. – С.879-881.