[Incidence of peptic ulcers accompanied by gastrointestinal bleeding after surgery for critical lower limb ischemia]. / Vstrechaemost' erozivno-yazvennykh porazhenii zheludochno-kishechnogo trakta i krovotechenii u bol'nykh, operirovannykh na arteriyakh nizhnikh konechnostei po povodu kriticheskoi ishemii.

OBJECTIVE: To study the incidence of peptic ulcers accompanied by gastrointestinal bleeding after surgery for critical lower limb ischemia and their relationship with the factors predisposing to mucous membrane damage. MATERIAL AND METHODS: The study involved 94 patients with critical lower limb ischemia who were eligible for open bypass surgery. All patients underwent preoperative gastro- and duodenoscopy. The patients were followed up for 1 year, while the relationship between the nature of the lesion of the proximal gastrointestinal tract mucosa and the duration of pain syndrome against the background of ischemia, painkiller consumption and redo surgery. RESULTS: All study participants had lesions of the mucous membrane of the stomach and duodenum: inflammatory changes were identified in 92.6% of patients, ulcerative defects in 7.4%. When conducting a correlation analysis, we obtained a weak and moderate strength of the relationship between the duration of rest pain and severity of mucous membrane lesion and strong correlation between painkiller consumption and endoscopic data. Postoperative gastrointestinal bleeding was more common after redo reconstructive surgery or amputation compared to one intervention (7.7% and 1.8%, respectively). CONCLUSION: Various lesions of gastrointestinal mucous membrane are diagnosed in all patients with critical lower limb ischemia. It is associated with the underlying disease and painkiller consumption. Risk of bleeding is higher after redo surgery and amputations. Prevention of lesions requires comprehensive examination of patients and individual approach.

[Aneurysms of arteries forming the minor arc of Riolan with occlusion of the celiac trunk]. / Anevrizmy arterii, obrazuiushchikh maluiu dugu Riolana, s okkliuziei chrevnogo stvola.

Analysed in the article is a clinical case report regarding a female patient suffering from chronic abdominal pain and undergoing treatment for a disease with the respective clinical pattern. The initially determined cause of pain turned out either erroneous or was not the only correct one. During examination based on the physical findings she was suspected as having chronic abdominal ischaemia syndrome. Imaging techniques made it possible to verify and confirm the presence of severe concomitant pathology of the visceral branches of the abdominal aorta: multiple aneurysms of visceral arteries and occlusion of the celiac trunk. We present the protocol of the operative intervention, also demonstrating the outcomes of surgical treatment, postoperative follow up, and control examination. This is followed by description of the remaining aneurysms and the results of repeat treatment.

[Results of treatment with oral anticoagulants in patients with lower limb deep vein thrombosis]. / Rezul'taty lecheniia peroral'nymi antikoaguliantami patsientov s trombozami glubokikh ven nizhnikh konechnostei.

Analysed herein is the incidence rate of decompensated forms of venous insufficiency in patients who endured lower limb deep vein thrombosis and were prescribed either warfarin, rivaroxaban in therapeutic doses or rivaroxaban in a preventive dose. The study enrolled a total of 129 patients presenting with thrombotic lesions of deep veins of the lower limbs. The patients were divided into three groups depending on the anticoagulant therapy prescribed. Patients of the first and second groups for 6 months received warfarin and rivaroxaban, respectively, in therapeutic doses, and group three patients continued taking rivaroxaban in a therapeutic dose for a long time. RESULTS: Eighteen (36%) patients from the first group and two (4.5%) patients from the second group discontinued taking the anticoagulant before the scheduled date. Relapses of venous thromboembolic complications were observed in 11 (22%) group one patients and in 7 (15.9%) group two patients, with no relapses observed in the third group. Negative dynamics of the ultrasonographic picture was observed in two groups: 16% of group one patients and 9.1% of group two patients were found to develop signs of damage of previously unaltered veins or occlusion of a previously patent vein after endured thrombosis without clinical manifestation. Trophic disorders were observed in a third of patients of the first group and in one patient of the second group by the fourth year of follow up. None of the third group patients developed trophic ulcers. Statistically significant differences in the examined groups were obtained for such parameters as adherence to treatment and the degree of severity of venous insufficiency, in favour of rivaroxaban, with quality of recanalization being significantly better in the third group. A conclusion was drawn that prolonged preventive administration of new oral anticoagulants did not lead to the development of decompensated forms of venous insufficiency.

[Prevalence of thrombophilic conditions and genetic carrier status in neuroischaemic form of diabetic foot]. / Rasprostranennost' trombofilicheskikh sostoianii i nositel'stva genov pri neiroishemicheskoi forme diabeticheskoi stopy.

BACKGROUND: Diabetes mellitus a commonly encountered pathology in the whole world and has a tendency towards steady growth of morbidity and development of vascular complications. The presence of haemostatic disorders and genetic susceptibility to thrombosis in patients with diabetes mellitus increases the risk for the development of thrombotic complications. AIM: The purpose of the study was to determine the incidence rate of thrombophilic conditions (TC) and thrombosis-associated gene carrier status (TAGCS) in patients suffering from neuroischaemic form of diabetic foot. PATIENTS AND METHODS: The study enrolled a total of 38 patients undergoing treatment at the Department of Vascular Surgery for critical ischaemia of lower limbs combined with diabetes mellitus during the period from 2016 to 2018. There were 29 (76.3%) men and 9 (23.7%) women. The mean age amounted to 58.9±7.3 years. The diagnosis of TC and TAGCS was made based on the study for the presence of the markers of antiphospholipid syndrome, level of homocysteine and antithrombin III, proteins C and S, as well as comprehensive genetic study in order to reveal gene polymorphisms (prothrombin, Leiden mutation, MTHFR gene, MTR gene and others). Based on the obtained findings we calculated the incidence rate of TC and TAGCS, as well as their combinations in the examined patients. RESULTS: In the studied group of patients we revealed various incidence of TC and TAGCS, and, most importantly, that of a combination of these conditions. All cases of thrombophilias were combined with TAGCS. Hyperhomocysteinemia was most commonly combined with the MTRR 66 A>G gene mutation, the presence of lupus anticoagulant - with PAI-1 675 5G>4G, whereas thrombophilic conditions - with MTRR 66 A>G and PAI-I - 675 5G>4G. Two patients were found to be carriers of the factor V Leiden mutation. CONCLUSION: The examined patients were diagnosed as having TC or TAGCS, as well as their combinations in one form or another, thus increasing the risk for the development of thromboses and embolisms in such patients.

[Treatment of Patients with Stable Manifestations of Atherosclerotic Vascular Disease: New Possibilities (Conclusion of the Council of Experts from November 16, 2018, Rostov-on-Don)].

In the conclusion of the council of experts (list of participants see text) the following issues are discussed: regional specifics of diagnostics and therapy of patients with ischemic heart disease (IHD) and / or peripheral arterial disease (PAD), methods of risk assessment in patients with stable course of atherosclerotic disease, pathogenetic validity of simultaneous inhibition of coagulation and platelet thrombus formation, as well as clinical significance of a novel therapeutic approach - combined use of rivaroxaban and acetylsalicylic acid (ASA). Possible problems and ways to their solution at implementation in clinical practice of the novel scheme of antithrombotic therapy are presented. Importance of multidisciplinary approach to management of patients with IHD and concomitant diseases is stressed. Experts have noted that after registration of the corresponding indication therapy with rivaroxaban 2.5 mg twice daily and ASA 75-100 mg once daily might be recommended to majority of patients with atherosclerotic involvement of blood vessels. In real clinical practice prescription of this therapy is appropriate first of all in patients with IHD and high risk of complications - with multifocal atherosclerosis, with history of myocardial infarction after stoppage of dual antiplatelet therapy, - patients with concomitant diabetes, heart failure, and other prognosis worsening comorbid diseases. Experts express hope that in the nearest time combined antithrombotic therapy will be included into corresponding national clinical recommendations.

[Contemporary data on efficacy of anticoagulant therapy in recanalization of deep veins]. / Sovremennye dannye ob éffektivnosti antikoaguliantnoi terapii pri rekanalizatsii glubokikh ven.

The article is a literature review containing a detailed description of anticoagulant therapy variants, their efficacy in recanalization of deep veins, as well as patients' compliance to treatment. Russian specialists have demonstrated that the processes of active re-organization of thrombotic masses, in some cases leading to complete clearing of the vessel's lumen from a thrombus, may be observed at terms from 3 to 6 months, with a failure to occur within the above period reportedly followed by formation of irreversible cicatricial-sclerotic alterations in the veins. That is why adequate anticoagulant therapy should be initiated promptly in order to prevent the development of irreversible alterations and a decompensated form of chronic venous insufficiency. The process of recanalization of the venous segments involved appears to primarily depend on efficacy of anticoagulant therapy. Of special attention is a class of novel oral anticoagulants characterised by high clinical efficacy, prolonged and relatively safe administration, as well as thrombolytic activity. The use of anticoagulant therapy, as well as adherence of patients to treatment make it possible to significantly decrease the frequency of a decompensated form of venous insufficiency and the need for reconstruction of the major veins.

[Pathogenesis and prevention of venous and arterial thromboembolic events in patients after deep vein thrombosis of lower extremities]. / Patogenez i profilaktika venoznykh i arterial'nykh tromboémbolii u bol'nykh, perenesshikh tromboz glubokikh ven nizhnikh konechnostei.

AIM: To define the role of thrombophilic and other procoagulant conditions in pathogenesis of deep vein thrombosis and the effectiveness of pathogenetic secondary prevention of venous and arterial thromboembolic events. MATERIAL AND METHODS: The study included 107 patients for the period 2007-2016 who were divided into 3 groups. The main group (n=40) - lifelong individual antithrombotic therapy with warfarin predominantly; the second (control) group (n=39) - warfarin administration for 3-6 months; the third (additional) group (n=28) - specific life-long therapy depending on procoagulant status which was assessed according to original scale. The main anticoagulants were rivoroxaban or dabigatran etexilate. Recurrent venous thromboembolic complications (RVTE) were observed in one (2.5%) patient of the first group and in 8 (20.5%) cases of the second group. In the third group RVTE were absent (significant differences, p<0.03 and 0.001, respectively). Arterial thromboembolic diseases were noted in 1 (2.5%) patient of the first group, in 4 (10.25%) cases of the second group and in none of the third group (significantly only for group II vs. group III, p<0.01). RESULTS: Individual antithrombotic therapy reduces the incidence of recurrent venous and arterial thromboembolic events in patients with idiopathic deep vein thrombosis.

[Pathogenesis and prevention of secondary thromboses and thromboembolic complications in patients with endured lower limb deep vein thrombosis].

The study was aimed at revealing the role of thrombophilic states in the pathogenesis of deep vein thrombosis and determining efficacy of pathogenetic prevention of venous thromboembolic complications. The study included a total of 84 patients presenting with lower limb deep vein thrombosis. The patients were subdivided into two groups. The patients of the Study Group (n=44) were examined for thrombophilic states, revealing of which was followed by prescribing specific lifelong therapy aimed at correction of the alterations revealed. The Control Group patients (n=40) received a carefully selected therapeutic dose of warfarin (until the value of the International Normalized Ratio was within the therapeutic range from 2 to 3) and were given recommendations on taking this agent for 6 months followed by discontinuation. The Study Group patients demonstrated less relapses of deep vein thromboses as compared with the Control Group patients. The symptoms of chronic venous insufficiency in the Study Group were also less pronounced. These results are in accord with the findings of ultrasonographic duplex scanning in the remote period after endured thrombosis. A conclusion was drawn on the necessity of carrying out further studies aimed at altering the recommended therapeutic regimen for patients in the remote period after sustained deep vein thrombosis.

[Assessing the prognostic significance of morphometric parameters of vascular wall inflammation for remote results of reconstructive operations in the aortoiliac zone in patients with atherosclerosis obliterans].

The study was aimed at assessing the relationship between the activity (including the inflammatory one) of the atherosclerotic process in the zone ofarterial reconstruction in patients under-going surgery on the aortoiliac arterial segment and long-term thrombotic reocclusions. The study comprised a total offorty-nine patients, with the postoperative follow-up period amounting to 5 years. We carried out morphological studies of the aortic wall in the zone of the proximal anastomosis and the walls of the common femoral arteries in the zone of distal anastomoses. It was determined that the presence of morphometric sign of inflammation and atherosclerotic deformity in the preparations of the aortic and arterial walls was accompanied and followed by increased incidence of long-term thrombotic complications in the reconstruction zone with more pronounced progression of the thrombotic process in the arteries of the peripheral bed distal to the reconstruction site.

[Prognosis of complications after reconstructive surgeries on the aorto-iliac segment]. / Prognozirovanie oslozhnenii posle rekonstruktivnykh operatsii na aortopodvzdoshnom segmente.

Evaluation of efficacy of neuronet technologies for prognosis of specific complications after reconstructive surgeries on aorto-iliac segment was made. A learning sample consisted of 500 reconstructive surgeries, a test one - 161. High efficacy of analog neuron nets was revealed. Prognosis of early thrombosis, postoperative bleeding and also of lethal outcome demonstrated better results, mistake of prognosis was 3.7, 1.2 and 4.6%, respectively. Prognosis of infectious complications and long-term outcomes demonstrated worse results, mistake of prognosis was 7.0 and 10.5%, respectively.

Effect of Buerger's thromboangiitis activity on the outcomes of vascular reconstructions.

Altogether 39 patients suffering from thromboangiitis obliterans were under observation. The vasculitis activity score (VAS) developed by R.A. Luqmain et al. (1994) was used as a criterion for thromboangitis activity. The patients were distributed into 2 groups: the first group included patients in the period of remission and the second, group comprised patients in the period of exacerbation. The patients underwent different types of vascular reconstructions. On examination of hemostasis and hemorheology the second group patients demonstrated potentiation of platelet function, inhibition of antiaggregation activity of the arterial wall, the rise of aggregation activity of red blood cells, and inhibition of blood fibrinolytic activity. The tendency toward hypercoagulation and hyperaggregation revealed in the second group patients led to deterioration of the immediate outcomes of reconstructive operations. Thrombosis of the reconstructed area was recorded in 5 (26.31%) first group patients and in 7 (35%) second group patients. In the first group, the high limb amputation was accomplished in one (5.26%) patient whereas in the second group, amputation was performed in 6 (30%) cases. So, the VAS according to R. A. Luqmain et al. (1994) is a reliable predictor which allows to carry out the screening of patients with Buerger's thromboangiitis for vascular reconstructions. The presence of the clinical signs of vasculitis activity in Buerger's thromboangitis requires preliminary preliminary preparation aimed at the removal of inflammation and correction of hemorheologic and hemostatic disorders.

[Effects of the anticoagulation therapy regimen on frequency of early thrombohemorrhagic complications after operations on major arteries of lower extremities]. / Vliianie rezhima antikoaguliantnoi terapii na chastotu rannikh trombogemorragicheskikh oslozhnenii posle operatsii na magistral'nykh arteriiakh nizhnikh konechnostei.

The results of 295 reconstructive operations on the major vessels of lower extremities were analyzed. The patients were divided into 4 groups depending on the scheme of anticoagulation therapy in the postoperative period. Under investigation was the state of hemostasis and hemorheology. The frequency of thrombohemorrhagic complications was assessed. It was found that the regimen based on the administration of low molecular weight heparins during the nearest 5 days after the intervention was the most rational regimen of anticoagulation therapy after reconstructive operations on the major arteries of lower extremities.