Evolution of surgical treatment methods for patients with varicose veins

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Abstract

INTRODUCTION: Treatment of varicose veins (VV) and their complications has history of several centuries. Throughout the 20th century, the surgery of choice was phlebectomy in different modifications. In recent decades, minimally invasive techniques have become the priority, which has been facilitated by technological advances and the advent of high-precision equipment minimizing surgical trauma.

AIM: To conduct a comparative analysis of existing surgical treatment methods for varicose veins of the lower extremities based on literature data in terms of recurrence rates, complications, morbidity, and cost-effectiveness.

An analysis of Russian and foreign publications (n=163) devoted to the surgical treatment of VV has been conducted. The search was conducted in the eLibrary and PubMed databases of biomedical publications for the past 8 years using the following keywords: varicose veins of the lower extremities, varicose vein surgery, phlebectomy, laser vein removal, endovenous laser obliteration, radiofrequency ablation, miniphlebectomy, endovenous laser ablation, mechanochemical endovenous ablation, surgery for treatment, cyanoacrylate embolization, radiofrequency ablation. From the results of the primary search, 86 articles were excluded as non-corresponding to the aim of the study. In addition, 17 articles from the period 2004–2017 were used to highlight less-used but still relevant methods.

The analysis showed that the number of open interventions on the venous system has significantly decreased in recent years. Modern innovative treatment methods for patients with VV to a more extent take into account the pathogenesis of their development and physiology of venous outflow. Innovative technologies have been demonstrated to improve the quality of patients’ life both in the early and late postoperative periods, and also to reduce the incidence and severity of complications. Various novel, minimally invasive surgical treatment methods for VV are being introduced in the clinical practice of hospitals, outpatient clinics and are included in the clinical guidelines. An individual approach is important in choosing the optimal variant from the wide range of modern surgical treatments for VV.

CONCLUSION: Minimally invasive treatment methods for VV are comparable in effectiveness with open phlebectomy, but have fewer complications. They are less traumatic, but more cost-effective, and thus can be referred to hospital-substituting technologies with transfer of surgical treatment for VV to an outpatient setting.

About the authors

Sergei N. Derkachev

Clinic of High Medical Technologies named after N.I. Pirogov of the Saint Petersburg State Medical University

Author for correspondence.
Email: docderkachev@mail.ru
ORCID iD: 0000-0001-8239-1508
SPIN-code: 4055-6963

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Igor G. Kobzar

Multidisciplinary Medical Center 'Lancet Clinic'

Email: kobzarig@lancet.ru
ORCID iD: 0000-0002-7307-1972
Russian Federation, Gelendzhik

Shamshi V. Selimov

Clinic of High Medical Technologies named after N.I. Pirogov of the Saint Petersburg State Medical University

Email: shamshi.selimov01@mail.ru
ORCID iD: 0009-0004-1915-8710
SPIN-code: 4932-6802
Russian Federation, Saint Petersburg

Maria A. Figurkina

Clinic of High Medical Technologies named after N.I. Pirogov of the Saint Petersburg State Medical University

Email: mariya.figurkina@mail.ru
ORCID iD: 0000-0002-9519-9061
SPIN-code: 4855-0720
Russian Federation, Saint Petersburg

Igor A. Suchkov

Ryazan State Medical University

Email: suchkov_med@mail.ru
ORCID iD: 0000-0002-1292-5452
SPIN-code: 6473-8662

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Ryazan

References

  1. Elzefzaf N, Elfekky MA, Elshatlawy KM, et al. Evaluation of Endovenous Laser Ablation in the Management of Varicose Veins. Cureus. 2023;15(9):e45096. doi: 10.7759/cureus.45096 EDN: NULJME
  2. Zubritskiy VF, Chernookov AI, Kuznetsov MR, et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231. doi: 10.32364/2587-6821-2023-7-4-225-231 EDN: LYJTHP
  3. Rabe E, Guex JJ, Puskas A, et al.; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31(2):105–115.
  4. Saveliev VS, Kirienko AI, Zolotukhin IA, Seliverstov EI. Prospective observational study SPECTRUM: the registry of patients with chronic venous diseases. Journal of Venous Disorders. 2012;6(1):4–9. EDN: PDTWAP
  5. Seliverstov EI, Avak’yants IP, Nikishkov AS, Zolotukhin IA. Epidemiology of Chronic Venous Disease. Journal of Venous Disorders. 2016;10(1):35–43. doi: 10.17116/flebo201610135-42 EDN: VQDFNB
  6. Piazza G. Varicose veins. Circulation. 2014;130(7):582–587. doi: 10.1161/circulationaha.113.008331
  7. Egorova EA, Kalinin RE, Suchkov IA. Complications after Laser Treatment. Journal of Venous Disorders. 2024;18(4):317–327. doi: 10.17116/flebo202418041317 EDN: CXNDLL
  8. Raetz J, Wilson M, Collins K. Varicose Veins: Diagnosis and Treatment. Am Fam Physician. 2019;99(11):682–688.
  9. Whiteley MS. High intensity focused ultrasound (HIFU) for the treatment of varicose veins and venous leg ulcers - a new non-invasive procedure and a potentially disruptive technology. Curr Med Res Opin. 2020;36(3):509–512. doi: 10.1080/03007995.2019.1699518
  10. Tauraginskii RA, Lurie F, Simakov S, et al. Human lower leg muscle pump acts like a stream diversion pump during locomotion. BioRxiv [Preprint]. 2023. doi: 10.1101/2023.09.25.559436
  11. Nael R, Rathbun S. Treatment of varicose veins. Curr Treat Options Cardiovasc Med. 2009;11(2):91–103. doi: 10.1007/s11936-009-0010-z EDN: NPKWNQ
  12. Sanbaev AK, Chabbarov RG, Pyatnitsky AG, Maslyakov VV. Modern surgical methods for the treatment of patients with varicose veins of the lower extremities. Bulletin of the Medical Institute “REAVIZ” (REHABILITATION, DOCTOR AND HEALTH). 2022;(1):66–76. doi: 10.20340/vmi-rvz.2022.1.CLIN.9 EDN: IWLNQF
  13. Becker F. Current treatment of varicose veins. Curr Treat Options Cardiovasc Med. 2006;8(2):97–103. doi: 10.1007/s11936-006-0001-2
  14. Kamaev AA, Bulatov VL, Vakhratyan PE, et al. Varicose Veins. Journal of Venous Disorders. 2022;16(1):41 108. doi: 10.17116/flebo20221601141 EDN: PXEUUQ
  15. De Franciscis S, Serra R. Venous Disorders of the Leg. In: Crucitti A, editor. Surgical Management of Elderly Patients. Springer, Cham; 2018. P. 287–295. doi: 10.1007/978-3-319-60861-7_19
  16. Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg. 2004;40(4):634–639. doi: 10.1016/j.jvs.2004.07.003
  17. Davydenko VV, Galileeva AN, Ivanova OP, et al. The experience of hospital-replacing surgery for varicose veins in St Petersburg outpatient clinics. Ambulatory Surgery (Russia). 2020;(3–4):124–129. doi: 10.21518/1995-1477-2020-3-4-124-129 EDN: MANWED
  18. Alukhanyan OA, Gabibullaev RE, Alukhanyan AO, et al. The significance of minimally invasive treatment methods in the single-stage elimination of varicose vein disease of the great and small saphenous veins of the lower limbs and their branches. Ambulatory Surgery (Russia). 2022;19(2): 152–158. doi: 10.21518/1995-1477-2022-19-2-152-158 EDN: GGQQTI
  19. Böhler K. Surgery of varicose vein insufficiency. Wien Med Wochenschr. 2016;166(9–10):293–296. (In German). doi: 10.1007/s10354-016-0486-6 EDN: FCDMYK
  20. Malskat WSJ, Engels LK, Hollestein LM, et al. Commonly Used Endovenous Laser Ablation (EVLA) Parameters Do Not Influence Efficacy: Results of a Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2019;58(2):230–242. doi: 10.1016/j.ejvs.2018.10.036
  21. Derkachev SN, Fedotov YuN, Figurkina MA, et al. Laser Ablation of Varicose Tributaries of the Great Veins (skewer ablation). Journal of Venous Disorders. 2022;16(3):195–202. doi: 10.17116/flebo202216031195 EDN: HSPBQA
  22. Seliverstov EI, Zakharova EA, An ES, et al. The Risk Factors of Reflux Persistence and Recurrence of Varicose Veins After Isolated Phlebectomy in Patients with Incompetent Great Saphenous Vein. Journal of Venous Disorders. 2017;11(1):10–16. doi: 10.17116/flebo201711110-14 EDN: YHTREX
  23. Patent RUS No. 2665546. 28.06.2017. Byul. No. 25. Akhadov RA. Method of performing Trojanov–Trendelenburg surgery with varicose veins. Available from: https://patents.google.com/patent/RU2665546C1/ru. Accessed: 06.07.2025. EDN: EPFZCS
  24. Disselhoff BCVM, der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomized clinical trial comparing endovenous laser ablation with cryostripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1107–1111. doi: 10.1002/bjs.7542
  25. Zamboni P, Cisno C, Marchetti F, et al. Reflux Elimination Without any Ablation or Disconnection of the Saphenous Vein. A Haemodynamic Model for Venous Surgery. Eur J Vasc Endovasc Surg. 2001;21(4):361–369. doi: 10.1053/ejvs.2001.1338
  26. Pittaluga P, Rea B, Barbe R. P18 Méthode asval (ablation sélective des varices sous anesthésie locale): principes et résultats préliminaires. Journal des Maladies Vasculaires. 2005;30(4):44. doi: 10.1016/S0398-0499(05)86322-X
  27. Sharafeev AZ, Khalirakhmanov AF, Sharafutdinov BM, Hizriev SM. Methods radiofrequency obliteration of the veins of the lower limbs under angiographic control. The Bulletin of Contemporary Clinical Medicine. 2015;8(6):90–94. EDN: VBGFCJ
  28. Rajabov DR, Rahmonov DA, Sultanov DD, et al. Endoscopic dissection of perforant veins in treatment of chronic venous insufficiency of the lower limbs. Health Care of Tajikistan. 2020;(3):46–51. EDN: LJXTWZ
  29. Zubritskiy VF, Chernookov AI, Kuznetsov MR, et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231. doi: 10.32364/2587-6821-2023-7-4-225-231 EDN: LYJTHP
  30. Potapov MP, Staver EV, Dyakiv AD, Parashchenko AF. Characteristics venous hemodynamics in patients with recurrences of lower limbs varicose disease. The Journal of scientific articles “Health and Education Millennium”. 2017;19(1):43–47. EDN: XTCSYD
  31. Potapov MP. The possibilities of endovenous laser obliteration in the implementation of the hemodynamic program of surgical treatment of lower limbs varicose disease. The Journal of scientific articles “Health and Education Millennium”. 2018;20(1):134–138. EDN: YLVNSC
  32. Tsaregorodtsev AA. Recurrent varicosis after surgical treatment. I.P. Pavlov Russian Medical Biological Herald. 2007;(1):119–122. EDN: HZVPCJ
  33. Botashev RN. Surgical treatment of patients with varicose veins of the lower extremities from the origins to the present day. Clinical Medicine (Russian Journal). 2024;102(7):518–522. doi: 10.30629/0023-2149-2024-102-7-518-522
  34. Zubritskiy V.F., Chernookov A.I., Kuznetsov M.R. et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231. doi: 10.32364/2587-6821-2023-7-4-225-231 EDN: LYJTHP
  35. Chapagain D, Shrestha KP, Thapa Magar D, et al. Recurrence of Varicose Vein after Endovenous Laser Therapy in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2021;59(235):267–270. doi: 10.31729/jnma.6163 EDN: YCXECR
  36. Dermody M, O'Donnell TF, Balk EM. Complications of endovenous ablation in randomized controlled trials. J Vasc Surg Venous Lymphat Disord. 2013;1(4):427–436.e1. doi: 10.1016/j.jvsv.2013.04.007
  37. Tuncer Çoban P, Dirimeşe E. Evaluation of quality of life after minimally invasive varicose vein treatment. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27(1):49–56. doi: 10.5606/tgkdc.dergisi.2019.16867
  38. Vuylsteke ME, Klitfod L, Mansilha A. Endovenous ablation. Int Angiol. 2019;38(1):22–38. doi: 10.23736/s0392-9590.18.04047-6
  39. Pavei P, Spreafico G, Bernardi E, et al. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021;9(2):352–360. doi: 10.1016/j.jvsv.2020.06.015 EDN: UVZUJA
  40. Arslan Ü, Çalık E, Tort M, et al. More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application. Ann Vasc Surg. 2017;45:166–172. doi: 10.1016/j.avsg.2017.06.042
  41. Van Eekeren RRJP, Boersma D, Holewijn S, et al. Mechanochemical endovenous Ablation versus RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA): study protocol for a randomized controlled trial. Trials. 2014;15:121. doi: 10.1186/1745-6215-15-121 EDN: TUHBHR
  42. Makarov DV, Dzhordzhikiia RK, Larionov MV, et al. Radiofrequency obliteration in the treatment of varicose disease of the lower extremities. Practical Medicine. 2018;(2):91–95. EDN: YXORUI
  43. Shaidakov EV, Grigorian AG, Ilyukhin EA, et al. The comparison of radiofrequency ablation and stripping: a comparative multicenter prospective non-randomized study. Journal of Venous Disorders. 2013; 7(1):47–54. EDN: PYTNET
  44. He G, Zheng C, Yu M-A, Zhang H. Comparison of ultrasound-guided endovenous laser ablation and radiofrequency for the varicose veins treatment: an updated meta-analysis. Int J Surg. 2017;39:267–275. doi: 10.1016/j.ijsu.2017.01.080
  45. Shanayev IN, Korbut VS, Khashumov RM. Atypical Forms of Lower Limb Varicose Vein Disease: Features of Diagnosis and Surgical Treatment. I.P. Pavlov Russian Medical Biological Herald. 2023;31(4):551–562. doi: 10.17816/PAVLOVJ107079 EDN: FSBRAA
  46. Potapov MP, Staroverov IN. Analysis of Prevalence of Lower Extremity Varicose Vein Disease of in One of Major Regions of Central Federal District of Russian Federation Using Multi-Variant Approach. I.P. Pavlov Russian Medical Biological Herald. 2023;31(3):367–380. doi: 10.17816/PAVLOVJ129204 EDN: RGDKGG
  47. Raskin VV, Semenov AYu, Kurginyan KhM. Endovenous laser obliteration in the prevention of recurrence of varicose veins in the anterior saphenous vein pool. Russian Journal of Preventive Medicine. 2020;23(3):98–103. doi: 10.17116/profmed20202303198 EDN: ZBNMQB
  48. Chernookov AI, Kandyba SI, Silchuk ES, et al. Endovascular laser coagulation in varicose vein relapses in the lower extremities. Laser Medicine. 2022;26(2):8–14. doi: 10.37895/2071-8004-2022-26-2-8-14 EDN: YXSWKQ
  49. Tauraginskii RA, Lurie F, Simakov S, et al. Gravity forse is not a sole explanation of reflux flow in incompetent great saphenous vein. J Vasc Surg Venous Lymphat Disord. 2019;7(5):693–698. doi: 10.1016/j.jvsv.2019.04.012 EDN: NBJPEC
  50. Kaitova ZS, Rajabzoda RS, Bytdaev RR, et al. Modern tactics of surgical treatment of patients with varicose disease of the lower extremities. Medical & Pharmaceutical Journal “PULSE”. 2024;26(5):122–127. doi: 10.26787/nydha-2686-6838-2024-26-5-122-127 EDN: CNQLMJ
  51. Chernookov A, Ramishvili V, Dolgov S, et al. Actual strategy of treatment varicose veins recurrence after endovenous intervention. Georgian Medical News. 2021;(4):26–33.
  52. Whiteley MS. High intensity focused ultrasound (HIFU) for the treatment of varicose veins and venous leg ulcers — a new non-invasive procedure and a potentially disruptive technology. Curr Med Res Opin. 2020;36(3): 509–512. doi: 10.1080/03007995.2019.1699518
  53. Whiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol. 2022;15:567–583. doi: 10.2147/ccid.s294990 EDN: GUDEEX
  54. Rabe E, Breu FX, Flessenkämper I, et al. Sclerotherapy in the treatment of varicose veins. Hautarzt. 2021;72(Suppl 2):23–36. doi: 10.1007/s00105-020-04705-0 EDN: ICHDQY
  55. Lorenz MB, Gkogkolou P, Goerge T. Sclerotherapy of varicose veins in dermatology. J Dtsch Dermatol Ges. 2014;12(5):391–393. doi: 10.1111/ddg.12333 Erratum in: J Dtsch Dermatol Ges. 2014;12(7):643.
  56. Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27(Suppl 1):46–51. doi: 10.1258/phleb.2012.012s09
  57. Parsi K, Hannaford P. Intra-arterial injection of sclerosants: Report of three cases treated with systemic steroids. Phlebology. 2016;31(4): 241–250. doi: 10.1177/0268355515578988 EDN: WSCSSL
  58. Klimakova YuR, Pshennikov A. S., Povarov V. O., Kamayev A. A. The Role of Endothelial Dysfunction and Inflammation in Chronic Lower Limb Vein Disease (Literature Review). Science of the Young (Eruditio Juvenium). 2023;11(2):241–256. doi: 10.23888/HMJ2023112241-256 EDN: SGLMZV
  59. Morrison N, Gibson K, McEnroe S, et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015;61(4):985–994. doi: 10.1016/j.jvs.2014.11.071
  60. Elias S, Raines JK. Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial. Phlebology. 2012;27(2):67–72. doi: 10.1258/phleb.2011.010100
  61. Khryshchanovich VYa, Klimchuk IP, Proczka R, et al. Results of Truncal Endovenous Mechano-Chemical Ablation in Varicose Disease. Novosti Khirurgii. 2019;27(6):630–639. doi: 10.18484/2305-0047.2019.6.630 EDN: MKCMFP
  62. Tang TY, Kam JW, Gaunt ME. ClariVein® — Early results from a large single-centre series of mechano-chemical endovenous ablation for varicose veins. Phlebology. 2017;32(1):6–12. doi: 10.1177/0268355516630154
  63. Gaibov AD, Ne’matzoda O, Burieva ShM, Kalmykov EL. Experience of application of mechanochemical scleroobliteration in treatment for recurrence of lower extremity varicose vein disease. I.P. Pavlov Russian Medical Biological Herald. 2020;28(1):57–66. doi: 10.23888/PAVLOVJ202028157-66 EDN: QEVDJL
  64. Boldin BV, Bogachev VYu, Rodionov SV, et al. Possible complications associated with the use of cyanoacrylate obliteration in patients with varicose veins. Ambulatory Surgery (Russia). 2024;21(1):48–54. doi: 10.21518/akh2024-002 EDN: GSWNFM
  65. Yang GK, Parapini M, Gagnon J, Chen JC. Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins. Phlebology. 2019;34(4):278–283. doi: 10.1177/0268355518794105
  66. Murzina EL, Lobastov KV, Bargandzhiya AB, et al. Mid-Term Results of Cyanoacrylate Embolization of Saphenous Veins. Journal of Venous Disorders. 2020;14(4):311–321. doi: 10.17116/flebo202014041311 EDN: MIJEQU
  67. Shirinbek O, Mnatsakanyan GV, Odinokova SN. Cyanoacrylate Adhesive Closure in the Real-World Practice: 2-Year Results of Varicose Vein Treatment. Ambulatory Surgery (Russia). 2022;19(1):132–139. doi: 10.21518/1995-1477-2022-19-1-132-139 EDN: RBEPKI
  68. Christenson JT, Gueddi S, Gemayel G, Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg. 2010;52(5):1234–1241. doi: 10.1016/j.jvs.2010.06.104
  69. Zollmann M, Zollmann Ch, Zollmann Ph, et al. Recurrence types 3 years after endovenous thermal ablation in insufficient saphenofemoral junctions. J Vasc Surg Venous Lymphat Disord. 2021;9(1):137–145. doi: 10.1016/j.jvsv.2020.04.021 EDN: GEYIPW
  70. Abud B, Kunt AG. Midterm varicose vein recurrence rates after endovenous laser ablation: comparison of radial fibre and bare fibre tips. Interact Cardiovasc Thorac Surg. 2021;32(1):77–82. doi: 10.1093/icvts/ivaa219 EDN: CRGWYP
  71. Gafurova DR, Kulikova AN, Chabbarov RG, Pyatnitsky AG. Sclerosurgical and surgical treatment of patients with lower extremity varicose vein disease: analysis of results in a long-term period of observation. Saratov Journal of Medical Scientific Research. 2017;13(4):839–845. EDN: XRGAJN
  72. Makhnev AV, Schneider VE, Nizamov FH, et al. Radiofrequency ablation of the great saphenous vein (GSV) in combination with stem sclerosis of its tributaries. Medical Science and Education of Ural. 2022;23(4):141–144. doi: 10.36361/18148999_2022_23_4_141 EDN: VOUYNS
  73. Gavrilenko AV, Vakhrat’yan PE, Kotaev AYu, et al. Vein-Sparing and Radical Principles in the Surgical Treatment of Varicose Veins of the Lower Extremities. Journal of Venous Disorders. 2018;12(4):300–305. doi: 10.17116/flebo201812041300 EDN: YOLZFR
  74. Derkachev SN, Figurkina МА, Fedotov YuN, et al. Endovenous Laser Ablation of the Surface Tributaries of the Main Veins. Am J Biomed Sci & Res. 2023;17(2):666–673. doi: 10.34297/AJBSR.2023.18.002412
  75. Patent RUS No. 2806873. 08.11.2023. Derkachev SN, Figurkina MA, Fedotov YuN, et al. Method of laser obliteration of superficial convoluted veins. Available from: https://patents.google.com/patent/RU2806873C2/ru. Accessed: 06.07.2025. EDN: KBNMGS
  76. Patent RUS No. 2817685. 18.04.2024. Lukovkin AV, Derkachev SN, Fedotov IuN, Dmitrichenko VV. Device for endovenous laser obliteration of convoluted tributaries of greater and lesser saphenous veins of lower extremities. Available from: https://patents.google.com/patent/RU2817685C1/ru. Accessed: 06.07.2025. EDN: CWFERE
  77. Pshennikova KS, Shanaev IN, Pshennikov AS, Yudin VA. Surgical Methods of Treatment of Varicose Vein Disease in the Small Saphenous Vein System. Modern State of the Problem. Science of the Young (Eruditio Juvenium). 2025;13(3):505–514. doi: 10.23888/HMJ2025133505-514 EDN: QDIPRD

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