Risk Factors of Ischaemic Heart Disease in 419 385 Outpatients: a Long-term Comparative Study.

AIM: To determine the incidence rate of risk factors in patients who visited polyclinics at their place of residence. MATERIAL AND METHODS: The study included 419,385 patients who visited polyclinics in 2018-2023, in whom the most easily measurable risk factors for ischemic heart disease (IHD) were identified: arterial hypertension, total cholesterol (TC) and blood plasma glucose. RESULTS: During 4 years of follow-up, the proportion of patients with blood pressure (BP) higher than 140/90 mm Hg decreased (35.9%). The proportion of patients with blood glucose higher than 6.1 mmol/l (4.2%) also significantly decreased. The proportion of patients with a TC level higher than 5.2 mmol/l as well as of patients with a body mass index higher than 30 kg/m2 did not significantly change (67.4% and 23.9%, respectively). An analysis of 274 deaths during the follow-up period showed that the main causes for death in patients with arterial hypertension were IHD (69.6%) and cerebrovascular diseases (30.3%). CONCLUSION: People who visited polyclinics at their place of residence retained a high incidence of easily measurable risk factors for IHD, including arterial hypertension, high TC and blood glucose. The proportion of patients with blood pressure higher than 140 and 90 mm Hg was 49.7%, the proportion of patients with TC higher than 5.2 mmol/l was 63.1%, and the proportion of patients with blood glucose higher than 6.1 mmol/l exceeded 10%.

[Are there alternatives to dual antiplatelet therapy after stenting of peripheral arteries?] / Est' li al'ternativy dvoinoi dezagregantnoi terapii posle stentirovaniia perifericheskikh arterii?

It is estimated that more than 200 million people worldwide suffer peripheral artery disease and the rate of amputations remains at a high level. The basis of treatment is timely revascularization wherein the fraction of interventions performed endovascularly has steadily been growing both in Russia and abroad. Nevertheless, the parameters of long-term patency of endovascular reconstructions of the infrainguinal segment are still inferior to open interventions. In order to select an optimal method of revascularization and to predict the duration of patency of the reconstruction modern clinical guidelines suggest using the GLASS and WIfI scales, which may improve the remote results of the intervention. Moreover, modern paclitaxel-coated stents and balloons may help increase primary patency of the reconstruction after endovascular procedures. A not less important method of improving remote results of endovascular treatment of patients with peripheral artery disease is considered to be the use of contemporary regimens of antithrombotic therapy. The VOYAGER PAD trial showed that in patients with peripheral artery disease after endured revascularization of lower limbs rivaroxaban prescribed at a dose of 2.5 mg twice daily in a combination with conventional antithrombocytic therapy made it possible to decrease the risk of such ischaemic complications as acute limb ischaemia, major amputation, myocardial infarction, ischaemic stroke and death of cardiovascular causes.

[Case of endovenectomy and stenting with functioning arteriovenous fistula in extended post-thrombotic occlusion of deep veins]. / Sluchai éndovenéktomii i stentirovaniia s funktsioniruiushchei arteriovenoznoi fistuloi pri protiazhennoi posttromboticheskoi okkliuzii glubokikh ven.

We describe herein a case of surgical treatment of a 32-year-old female patient presenting with multilevel post-thrombotic occlusion of deep veins of the left lower limb. Laboratory study revealed high-risk hereditary thrombophilia (homozygous mutation of PAI-1, MTR, heterozygous mutation of MTHFR, MTRR, ITGA2). The first stage included endovenectomy from the common femoral vein with creation of an arteriovenous fistula between femoral vessels. An attempt of endovascular stenting of iliac veins was initially unsuccessful. After 3 months, the woman was rehospitalized to undergo successful endovascular operation with stenting of the iliac veins and common femoral artery on the background of the functioning arteriovenous fistula. The clinical outcome of the operation was good. Follow-up ultrasonographic examinations (ultrasound duplex scanning) were performed at 3, 6, 10 and 13 months after the second operation. The findings of ultrasound duplex scanning at 13 months showed that the stented segments of deep veins were freely patent, with the arteriovenous fistula functioning well. There were no signs of impairments of central haemodynamics, with significant regression of clinical symptoms. The total score by the Villalta scale as compared with the baseline values decreased from 13 to 5. Given the pattern of deep vein lesions, complexity of open and endovascular operations, and the presence of thrombophilia, we decided to abstain from disuniting the arteriovenous fistula. This case report demonstrates possibility, efficacy and safety of long functioning of an artificial arteriovenous fistula in a particular patient cohort.

[Decreased retraction of blood clots in patients with venous thromboembolic complications]. / Umen'shenie retraktsii sgustkov krovi u bol'nykh s venoznymi tromboémbolicheskimi oslozhneniiami.

Haemostatic disorders play an important role in the pathogenesis of acute venous thrombosis. One of the least studied reactions of blood coagulation and thrombogenesis is spontaneous contraction of blood clots, which takes place at the expense of the contractility apparatus of activated blood platelets adhered to fibrin fibres. The work was aimed at studying the parameters of contraction of blood clots, formed in vitro, in blood of 41 patients with acute venous thromboses as compared with the same parameters in apparently healthy donors. We used a new instrumental method making it possible to determine the time from initiation to the beginning of contraction, as well as the degree and velocity of clot contraction. It was revealed that in patients with venous thrombosis the ability of clots to shrink was significantly reduced as compared with the control. We detected a statistically significant retardation of and decrease in of blood clot concentration in patients with venous thrombosis complicated by pulmonary artery thromboembolism as compared with contraction in patients with isolated deep vein thrombosis, witch may be important for early diagnosis and determination of the risk of thromboembolism. Besides, we revealed a statistically significant retardation of contraction in patients with proximal thrombosis as compared with contraction in patients with distal thrombosis, with similar values of the degree of contraction. Contraction was statistically significantly reduced in acute thrombosis (less than 21 days), whereas in subacute thrombosis (more than 21 days) the parameters of contraction were closer to normal values. The obtained findings suggest that reduction of blood clot contraction may be a new, hitherto unstudied pathogenetic mechanism deteriorating the course and outcome of venous thrombosis. The clinical significance of contraction and its impairments, as well as the diagnostic and prognostic value of the laboratory test for blood clot contraction would merit further study.

[Calcification of atherosclerotic plaques and assessment of their stability]. / Kal'tsifikatsiia ateroskleroticheskikh bliashek i otsenka ikh stabil'nosti.

Presented herein is a review of the literature concerning mechanisms of calcification of atherosclerotic plaques (ASP), showing molecular mechanisms of interaction of processes of calcification with the factors inducing instability of ASPs (anti-inflammatory cytokines, neoangiogenesis, increased level of matrix metalloproteinases, etc.), also describing the effect of the value of volume of scope of calcification on stability of ASPs, followed by discussing the problems related to the role of biominerals (hydroxyapatite calcium phosphate) and Mn2+ in calcification of ASPs and their impact upon stability of the plaque.

[Stagewise treatment of a giant false paraanastomotic aneurysm of the abdominal aorta].

The article deals with a case report concerning successful stagewise treatment of a patient presenting with a giant false abdominal aortic paraanastomotic aneurysm having developed 2 months after an operation of linear prosthetic repair for a juxtarenal aneurysm with reimplantation of the left renal artery. The secondary operation was carried out 3 months after aortic reconstruction. The first stage consisted in performing endovascular prosthetic repair of the abdominal aortic paraanastomotic pseudoaneurysm by means of a bifurcated stent graft Endurant II (Medtronic), with the second stage being laparotomy with the removal of the retroperitoneal haematoma. The postoperative period turned out uneventful. The patient was discharged from hospital on the 8th day after the second operation. The patient was examined 2 months later, presenting no complaints and returning to his previous work. According to the findings of the check-up duplex scanning, the graft was patient, with no evidence of a paraanastomotic aneurysm. This is followed by discussion of the problems regarding the use of surgical and endovascular technologies in treatment of paraanastomotic aortic aneurysms.

[Endovascular repair of an abdominal aortic aneurysm in a patient with horseshoe kidney].

Presented herein is a case report concerning successful endovascular treatment of a patient with an infrarenal abdominal aortic aneurysm combined with a horseshoe kidney. The diagnosis was verified by multispiral computed tomography. The patient underwent of endovascular repair of the abdominal aorta with a stent-graft AORFIX (Lombard Medical). The postoperative period turned out uneventful, with no complications. The patient was examined 3 years after the intervention. The findings of control check-up computed tomography showed no signs of either stent graft dislocation or endoleak.

[Manganese in atherogenesis: detection, origin, and role].

The role of transition metal ions in atherogenesis is controversial; they can participate in the hydroxyl radical generation and catalyze the reactive oxygen species neutralization reaction as cofactors of antioxidant enzymes. Using EPR spectroscopy, we revealed that 70% of the samples of aorta with atherosclerotic lesions possessed superoxide dismutase activity, 100% of the samples initiated Fenton reaction and demonstrated the presence of manganese paramagnetic centers. The sodA gene encoding manganese-dependent bacterial superoxide dismutase was not found in the samples of atherosclerotic plaques by PCR using degenerate primers. The data obtained indicates the perspectives of manganese analysis as a marker element in the express diagnostics of atherosclerosis.