Keywords
varicose veins
minimally invasive interventions
sclerotherapy
post-thrombotic syndrome
healthcare accessibility
How to Cite
Abstract
In press
Background. Chronic Venous Insufficiency (CVI) remains a prevalent vascular pathology: the annual increase reaches up to 26% in women and 19% in men in developed countries, which determines a substantial medical, social, and economic burden due to the high cost of diagnostic procedures, pharmacotherapy, and surgical and endovascular interventions.
Aim. To analyze modern surgical methods of treating complications of chronic venous insufficiency and assess the dynamics of providing surgical care in the Dnipropetrovsk region for 2022–2025.
Materials and Methods. The study was conducted using bibliosemantic and comparative methods, as well as a systems analysis approach. Data on the incidence of reticular varicose veins of the lower extremities were analyzed for six districts of the Dnipropetrovsk region (Kryvyi Rih, Kamianske, Nikopol, Pavlohrad, Synelnykove, Samar) and the city of Dnipro for the period 2022–2025 were analyzed. The research was carried out within the framework of the research project "Scientific substantiation of strategies for the preservation and restoration of public health through influencing the determinants of healthcare system efficiency", state registration No.0123U104849.
Research Ethics. The study was carried out in accordance with the requirements of the World Medical Association Declaration of Helsinki (1964–2024), the local ethics committee. The research design and methods were approved by the Bioethics Committee of Dnipro State Medical University (Protocol No.32 of November 15, 2025).
Results. Minimally invasive treatment is represented by phlebobliteration techniques, including chemical methods (sclerotherapy) and physical methods (laser, radiofrequency, electrowelding, and steam ablation). Analysis of care delivery for patients with CVI in the Dnipropetrovsk region during 2023–2025 revealed a disparity between the regional center and peripheral districts, with increased hospitalizations (2.1-fold in the Kryvyi Rih district) and higher activity among the rural population. In the city of Dnipro, the number of surgeries for post-thrombophlebitic syndrome increased 19-fold, reflecting a concentration of resources. At the same time, decreased surgical activity was observed in the Synelnykove, Samar, and Nikopol districts, which is associated with Russian aggression that has limited the provision of highly specialized care at the local level.
Conclusions. There is a centralization of surgical care in the regional center against the background of limited access in peripheral districts. The implementation of conservative treatment protocols and patient support is necessary until full medical infrastructure is restored.
Keywords: social medicine, varicose veins, minimally invasive interventions, sclerotherapy, post-thrombotic syndrome, healthcare accessibility.
References
Attaran RR, Babapour G, Mena-Hurtado C, Ochoa Chaar CI. Chronic Venous Insufficiency and Management. Interv Cardiol Clin. 2025;14(2):283-96. DOI: 10.1016/j.iccl.2024.11.013. PMID: 40049854.
Hirsch T, Wahl U, Rabe E. Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies. Vasa. 2024;53(3):172-84. DOI: 10.1024/0301-1526/a001116. PMID: 38536202.
Kienzl P, Deinsberger J, Weber B. Chronic Venous Disease: Pathophysiological Aspects, Risk Factors, and Diagnosis. Hamostaseologie. 2024;44(4):277-86. DOI: 10.1055/a-2315-6206. PMID: 38991541.
Azar J, Rao A, Oropallo A. Chronic venous insufficiency: a comprehensive review of management. J Wound Care. 2022;31(6):510-9. DOI: 10.12968/jowc.2022.31.6.510. PMID: 35678787.
Novak CJ, Khimani N, Kaye AD, Jason Yong R, Urman RD. Current Therapeutic Interventions in Lower Extremity Venous Insufficiency: a Comprehensive Review. Curr Pain Headache Rep. 2019;23(3):16. DOI: 10.1007/s11916-019-0759-z. PMID: 30830460.
Fedusyak VJa. The current status of the etiopathogenesis of chronic venous insufficiency and the formation of trophic ulcer. Scientific Bulletin of Uzhhorod University. Series: Medicine. 2022;2(66):29-33. DOI: 10.32782/2415-8127.2022.66.5. [In Ukrainian].
Mangwani J, Roberts V, Shannak O, Divall P, Srinivasan A, Dias J. Epidemiology and Diagnosis of Post-Thrombotic Syndrome: Qualitative Synthesis with a Systematic Review. J Clin Med. 2023;12(18):5896. DOI: 10.3390/jcm12185896. PMID: 37762837.
Kolluri R, Lugli M, Villalba L, Varcoe R, Maleti O, Gallardo F, et al. An estimate of the economic burden of venous leg ulcers associated with deep venous disease. Vasc Med. 2022;27(1):63-72. DOI: 10.1177/1358863X211028298. PMID: 34392750.
Chan DYS, Surendra NK, Ng YZ, Lee SH, Yong E, Hong Q, et al. Prospective study on the clinical and economic burden of venous leg ulcers in the tropics. J Vasc Surg Venous Lymphat Disord. 2023;11(5):954-63. DOI:10.1016/j.jvsv.2023.05.009. PMID: 37209840.
Annual report on the state of health of the population of Ukraine and the epidemic situation for 2023. Kyiv: Ministry of Health of Ukraine; 2024. 78 p. Available at: https://surl.lu/dinqat [accessed 20.02.2026]. [In Ukrainian].
Lerman M, Gaebler JA, Hoy S, Izhakoff J, Gullett L, Niecko T, et al. Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema. J Vasc Surg. 2019;69(2):571-80. DOI:10.1016/j.jvs.2018.04.028. PMID: 29914829.
Melnychuk HO. Minimally invasive surgery for chronic venous disease: current perspectives. Medical case. 2025;3:120-7. DOI: 10.31640/LS-2025-3-14. [In Ukrainian].
Friedmann DP, Liolios AM, Wu DC, Goldman MP, Eimpunth S. A Randomized, Double-Blind, Placebo-Controlled Study of the Effect of a High-Potency Topical Corticosteroid After Sclerotherapy for Reticular and Telangiectatic Veins of the Lower Extremities. Dermatol Surg. 2015;41(10):1158-63. DOI:10.1097/DSS.0000000000000467. PMID: 26359998.
Bertanha M, Sobreira ML, Pinheiro Lúcio Filho CE, de Oliveira Mariúba JV, Farres Pimenta RE, Jaldin RG, et al. Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial. Trials. 2014;15:497. DOI: 10.1186/1745-6215-15-497. PMID: 25527165.
Samoilyk YuV, Afonin DM, Dundiuk IV, Burachyk AI, Zhurba OA, Tiutiunnik OA. Surgical treatment of varicose veins of the lower extremities in the context of modern medicine. Prospects and Innovations of Science. 2025;4(50):2527-36. DOI: 10.52058/2786-4952-2025-4(50)-2527-2536. [In Ukrainian].
Nyamekye IK. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. J Med Vasc. 2022;47(2):53-5. DOI: 10.1016/j.jdmv.2022.04.003. PMID: 35691663.
Farah MH, Nayfeh T, Urtecho M, Hasan B, Amin M, Sen I, et al. A systematic review supporting the Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society guidelines on the management of varicose veins. J Vasc Surg Venous Lymphat Disord. 2022;10(5):1155-71. DOI: 10.1016/j.jvsv.2021.08.011. PMID: 34450355.
Brittenden J, Cooper D, Dimitrova M, Scotland G, Cotton SC, Elders A, et al. Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. N Engl J Med. 2019;381(10):912-22. DOI: 10.1056/NEJMoa1805186. PMID: 31483962.
Paravastu SC, Horne M, Dodd PD. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016;11(11):CD010878. DOI: 10.1002/14651858.CD010878.pub2. PMID: 27898181.
Oud S, Alozai T, Jamaludin FS, van Dieren S, Schreve MA, Mooij MC, et al. Anatomic Success of Treatment Modalities for Small Saphenous Vein Incompetence: A Systematic Review and Network Meta-analysis. Eur J Vasc Endovasc Surg. 2026;71(1):135-45. DOI: 10.1016/j.ejvs.2025.05.047. PMID: 40449724.
Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, et al. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice 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):101670. DOI: 10.1016/j.jvsv.2023.08.011. PMID: 37652254.
Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, et al; UIP. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP consensus document. Part II. Anatomy. Vasa. 2007;36(1):62-71. DOI: 10.1024/0301-1526.36.1.62. PMID: 17323301.
Whiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol. 2022;15:567-83. DOI: 10.2147/CCID.S294990. PMID: 35418769.
Rusyn VI, Pavuk FM, Borsenko MI, Popovych NM, Rusyn VV. Long-term outcomes of treatment of varicose veins of the lower extremities. The Ukrainian Journal of Clinical Surgery. 2025;92(2):27-33. DOI: 10.26779/2786-832X.2025.2.27. [in Ukrainian].
Bobrova AO. Indications rationale and method selection of surgical treatment of patients with recurrent varicose veins disease of the lower limbs. Hospital Surgery. 2017;2:21-5. DOI: 10.11603/2414-4533.2017.2.7622. [In Ukrainian].
Bogale B, Scambler S, Mohd Khairuddin AN, Gallagher JE. Health system strengthening in fragile and conflict-affected states: A review of systematic reviews. PLoS One. 2024;19(6):e0305234. DOI: 10.1371/journal.pone.0305234. PMID: 38875266.
Kondratyeva IM. Development of rural medicine in Ukraine in modern conditions. State Formation. 2022;2(32):118-27. DOI: 10.26565/1992-2337-2022-2-11. [in Ukrainian].
Kemp MT, Obi AT, Henke PK, Wakefield TW. A narrative review on the epidemiology, prevention, and treatment of venous thromboembolic events in the context of chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2021;9(6):1557-67. DOI: 10.1016/j.jvsv.2021.03.018. PMID: 33866055.
Landry MD, Giebel C, Cryer TL. Health system strengthening in fragile and conflict-affected states: a call to action. BMC Health Serv Res. 2021;21(1):726. DOI: 10.1186/s12913-021-06753-1. PMID: 34301243.
Anthony Jnr B. Investigating the implementation of telehealth and digital technologies during public health crisis: A qualitative review. Int J Health Plann Manage. 2023;38(5):1212-27. DOI: 10.1002/hpm.3681. PMID: 37452470.
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