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Introduction: Pelvic congestion syndrome (PCS) may be effectively managed with conservative treatment in certain patients. Treatment with venoactive drugs is common, but supportive data are limited. This study evaluated the clinical efficacy of micronized purified flavonoid fraction (MPFF) in women with PCS. Methods: In a single-blind, placebo-controlled study, women with duplex ultrasound diagnosis of pelvic varicose veins (PVV) and PCS were randomized to MPFF 1000 mg once daily or placebo for 2 months. Clinical manifestations of PCS were evaluated at baseline and end of treatment (M2) using three assessment tools: disease-specific quality of life (QoL) Pelvic Varicose Vein Questionnaire (PVVQ), Pelvic Venous Clinical Severity Score (PVCSS), and the Visual Analog Scale (VAS) for the main symptoms of the disease.

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Acute aortic dissection of type A is still one of the most difficult diseases faced by doctors of all specialties. The current review is based on an analysis of current literature data and clinical guidelines. It covers various aspects of outpatient patient management and focuses on conservative therapy. The lack of an adequate diagnostic algorithm often leads to complications and, ultimately, death. The dynamic nature of the disease, the variability of clinical manifestations and the course of the pathological process require special attention. Both short-term and long-term survival of the patient depends on careful observation. Postoperative management of patients with acute aortic dissection of type A is entirely entrusted to the outpatient unit, which, due to the absence of the main aspects of the strategy in modern clinical recommendations, is not always prepared for the curation of this complex cohort of patients. The lack of experience in managing this pathology by outpatient hospital doctors causes significant difficulties in interpreting instrumental diagnostic methods, which leads to further erroneous tactics with the development of long-term complications. Due to the lack of a unified scheme of drug therapy, the question of prescribing drugs in these patients, who often receive a fairly large range of medications for concomitant pathology, remains open. These factors contribute to polyprogmasia or vice versa – insufficient volume of drug therapy, which further leads to the progression of the disease. As a result of insufficient emphasis on the basics of outpatient management of this cohort of patients, a whole complex of problems arises, leading to unsatisfactory treatment results and increased healthcare costs for their subsequent solution. The purpose of the review is to highlight the main problems of this issue from the point of view of evidence-based medicine.

The histological differences in the structure of the ovarian vein and saphenous veins of the lower extremities during their varicose transformation have been insufficiently studied in the modern literature. The study aims to determine the morphological parallels of the structure of varicose veins in varicose veins of the pelvis and varicose veins of the lower extremities. Fifty histological biopsy specimens of removed veins were examined in women. Of these, 25 large saphenous veins were obtained from patients with varicose veins of the lower extremities and 25 preparations of a resected ovarian vein from 25 women with varicose veins of the pelvis. The preparation was stained with hematoxylin-eosin and by the Van Gieson method, studied by light microscopy. In the study of the preparations, significant structural changes were noted in all layers of the venous wall, both in varicose veins of the pelvis and in varicose veins of the lower extremities in the form of a combination of atrophic, fibroplastic and hypertrophic processes leading to the loss of its functional properties. Depending on the decompensation of pathological processes, 3 morphological forms of lesions of the venous wall structure were revealed. The hypertrophic form was found in 17 (34%) surgery perform women, fibrous - in 13 (26%), atrophic - in 20 (40%). In the group of patients with varicose veins of the pelvis compared with the group of patients with varicose veins of the lower extremities, the prevalence of initial forms of lesion was revealed. There was a correlation between the severity of venous vascular lesions with the duration of the disease and the patient's age, the number of risk predictors and a high body mass index, which was the determining factor in the occurrence of this phenomenon. The results of this study indicate the similarity of the pathological picture of venous lesions, both in varicose veins of the pelvis and in varicose veins of the lower extremities.

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