[The effects of diosmin and hesperidin on capillary blood flow of upper limbs in patients with secondary Raynaud's syndrome]. / Vozdeistvie diosmina i gesperidina na kapilliarnyi krovotok verkhnikh konechnostei u patsientov s vtorichnym sindromom Reino.

The article discusses the effects of diosmin and hesperidin on capillary blood flow in patients with secondary Raynaud's syndrome (RS). Raynaud's syndrome a difficult problem of modern angiology, since in its development there is a large range of disorders of the capillary blood flow of the limbs. Currently, the main way of therapy in patients with secondary Raynaud's syndrome is the use of either calcium channel blockers (if angiospastic stage of the disease), or prostaglandins of group E1 (with tropho-paralytic stage of secondary RS). However, pharmacological effects of calcium channel blockers (vasodilation) and prostaglandins (vasodilation, antiproliferative, anti-inflammatory etc.) do not allow impact on all violations of capillary blood flow, occurs when the Raynaud's syndrome. In this regard, the task was to study the reaction of capillary blood flow of the fingers of the hands on the concomitant use of drugs based on diosmin and hesperidin. A prerequisite for the use of a combination of diosmin and hesperidin in the treatment of RS was based on data about their impact on the state of the venous segment of the capillary bed and perivascular oedema. To conduct the study was established two groups of patients (22 in each group). The main criterion for inclusion of patients in the study was the presence of newly identified Raynaud's syndrome of angiospastic or tropho-paralytic stage of the disease. The main exclusion criteria was the presence of necrotic stage of the disease. In the first group of patients therapy was carried out using only vasodilators. In the second group (comparison group) with the addition of a combination of diosmin and hesperidin (tablets Venarus used in a dose 500 mg 2 times per day). The condition of capillary blood flow in this study was estimated by the method of videocapillaroscopy (VCS). Statistical data processing was performed using a criterion of statistical significance (P-value). The study revealed the significant impact of a combination of diosmin and hesperidin for parameters of capillary blood flow that correlated with clinical improvements - reduction of oedema of the fingers of the hands.

[Epidemiology of chronic critical limb ischemia].

Peripheral artery diseases amount to more than 20% of all types of cardiovascular diseases, which corresponds to 2-3% of the total population. 15 to 30% of the population of Russian Federation over 65 years have signs of obliterating arteriopathy. Advance of arterial insufficiency in some cases leads to development of special state - chronic critical limb ischemia (CLI). This article presents a review of statistical data from different sources, showing high prevalence of this severe issue, as well as data of amputations rate, performed in different countries due to CLI, reflecting the extreme relevance of the search for new methods of CLI treatment.

[Effect of drug therapy for chronic obliterating diseases of lower-limb arteries on the state of the microcirculatory bed].

UNLABELLED: Search for an optimal method of conservative treatment of patients presenting with chronic obliterating disease of lower limb arteries (CODLLA) still remains an important and hitherto unsolved problem. Comparative studies of different drugs and objective assessment of their efficacy may be carried out using the method of laser Doppler flowmetry (LDF) with wavelet analysis of fluctuations in blood flow. OBJECTIVE: The study was aimed at assessing efficacy of using Actovegin in conservative treatment of patients presenting with chronic obliterating disease of the lower extremities induced by occlusive and stenotic lesions of the arterial bed. MATERIAL AND METHODS: The study included a total of 80 patients with stage 2B chronic ischaemia of the lower limbs. The patients were subdivided into two groups. Group One comprised 40 patients undergoing a course of intravenous infusions of Actovegin (at a dose of 250 ml, 4 mg/ml) as monotherapy for 10 days. Group Two comprised 40 patients receiving intravenous infusion of dextranes, as well as pentoxyphyllin at a dose of 100 mg/day. The state of microcirculation before and after the course of the infusion therapy was assessed by means of LDF with wavelet analysis of blood follow fluctuations. The basal blood flow was registered at a temperature of + 32° C for 10 minutes followed by a thermal test, i. e., heating to + 42oC for 30-40 minutes. RESULTS: The course of infusion therapy in Group One patients was followed by an increase of the amplitude of myogenic fluctuation by 56% (p=0.006) and a decrease in the index of blood flow shunting (p=0.1) with basal perfusion, as well as an increase in the maximum level of perfusion (p=0.006). Group Two patients showed were found to have only statistically significant shortening of the time of reaching the maximum level of thermal hyperaemia. The increase of the pain-free walking distance averagely amounted to 58.8% in Group One patients and 60.7% in Group Two (p=0.068). Patients of the both groups showed satisfactory tolerance of the carried out therapy. No undesirable adverse events were observed. CONCLUSION: LDF with wavelet analysis of fluctuations of blood flow makes it possible to thoroughly study the mechanisms of action of therapeutic agents on microcirculation in patients with CODLLA . The use of Actovegin as monotherapy in CODLLA patients leads to a decrease in the myogenic tonus of precapillary arterioles and capillary sphincters, to a decrease in the arteriolar-venular shunting of blood flow with predominant supply of blood to the capillary bed, to an increase in the oxide-synthase function of the endothelium of microvessels (endothelioprotective effect), as well as to an increase in the maximum level of thermal vasodilatation. Hence, Actovegin may be considered as a promising therapeutic agent for pharmacotherapy of CODLLA.

[Ultrasound assessment of alterations in venous haemodynamics in patients with post-thrombotic disease permanently taking phlebotonics].

OBJECTIVE: The study was aimed at using ultrasound duplex scanning for determining the sequence and terms of formation of venous haemodynamics impairments in the affected lower extremity in patients after endured acute thrombosis of deep veins and assessing the effect of phlebotonic drugs on the course of these processes. MATERIAL AND METHODS: We examined and treated a total of 66 patients presenting with newly onset acute thrombosis of deep veins of lower limbs without concomitant varicose disease. Group I patients (n = 22) received the standard course of angiotropic and metabolic infusion therapy, direct and indirect anticoagulants, as well as used elastic compression. Group II patients (n = 22) in addition to the similar course of treatment received a phlebotonic drug (Venarus) according to the standard regimen: 1,000 mg daily for two months every half year. Group III patients (n = 22) additionally to the same standard treatment regimen were also given VenarusR at a dose of 1,000 mg daily but taken uninterruptedly and constantly during the whole period of follow up. All patients were subjected to ultrasound duplex scanning of deep veins of lower limbs initially at admission, then 3 weeks, 3, 6, 12 and 18 months after making the diagnosis of acute thrombosis. RESULTS: Group II and III patients additionally taking the phlebotonic were found to have acceleration of processes of recanalization averagely by 15-20% as compared with Group I patients. Group III patients taking the phlebotonic agent permanently demonstrated deceleration of the processes of formation of horizontal and vertical veno-venous refluxes on the background of more adequate recanalization by the end of the follow-up period. CONCLUSION: Permanent taking of phlebotonics increases the rate and scope of recanalization of the thrombosed deep veins of lower limbs, as well as dramatically decreases the development of the horizontal and vertical reflux, decreasing clinical manifestations of chronic venous insufficiency.

[Cardiosynchronized sequential antegrade pneumocompression in treatment of patients with multifocal atherosclerosis].

The work was aimed at assessing efficacy and safety of indications for and contraindications to a promising method of treatment for multifocal atherosclerosis - enforced external counterpulsation, suggesting a new noninvasive method of treatment of chronic obliterating diseases of lower-limb arteries - cardiosynchronized sequential antegrade pneumocompression.

[Peculiarities of performing hybrid operation in a patient with atherosclerosis of lower limbs and developed critical ischaemia].

Currently, there is a tendency towards an increase in the incidence rate of cardiovascular disease. According to the data of the World Health Organization the incidence rate of obliterating diseases of peripheral arteries varies from 5 to 10%. Diseases of peripheral arteries manifest themselves by such a severe condition as lower-limb critical ischaemia. Most often lower-limb chronic critical ischaemia develops in patients with multi-level lesions of the arterial bed. Treatment of such patients constitutes a serious problem since it requires large-scope revascularization. The authors describe a clinical example of a hybrid operation in a patient with atherosclerosis of lower-limb arteries on the background of critical ischaemia of the lower extremities on the background of type 2 diabetes mellitus. The hybrid intervention was performed in the scope of balloon angioplasty and stenting of the right deep femoral artery with simultaneous loop semiclosed thromboendarterectomy from the right common femoral artery, superficial femoral and popliteal artery with balloon angioplasty of the right superficial femoral artery with mechanic recanalization and balloon angioplasty of the popliteal artery, anterior tibial artery, and peroneal artery. The next stage consisted in amputation of the anterior portion of the right foot according to the Chopart s technique with skin plasty. Resulting from the operation on the background of further angiotropic and rheological active therapy with PGE-1 preparation VAP-20 we managed to save the patient s limb and to limit to minor amputation. Hybrid operative interventions should be carried out in order to achieve maximal revascularization when it is not possible to obtain a favourable result by a reconstructive or endovascular intervention alone.

[A clinical example of operative intervention on previously stented peripheral artery in a patient with critical ischaemia of lower limbs].

The problem of open surgery of peripheral arteries after previously performed interventions is currently of considerable interest. This is associated with the development of roentgenoendovascular technologies, on the one hand, and with the fact that it is not always possible to use them properly, on the other. Nowadays, one may single out a small group of patients having endured balloon angioplasty and stenting of the arterial segment followed by open operation. Of special interest are patients with critical ischaemia of lower extremities. No results of randomized studies dedicated to this problem have yet been published. The present article deals with a clinical case concerning a patient having endured multiple interventional therapeutic procedures including stenting of the iliac-femoral segment. The consequent development of critical ischaemia of lower limbs required emergency revascularization by an open method on the previously stented vessels. The duration of postoperative follow up is more than 12 months.

[Comparative characteristics of the open and endovascular methods of treatment for carotid artery stenoses].

The article is dedicated to the problem concerning treatment for stenoses of the extracranial portions of carotid arteries. From March 2004 to November 2009 at the Department of Vascular Surgery No 2 of the N. A. Semashko Central Clinical Hospital No 2 we treated a total of 364 patients presenting with stenotic lesions of the extracranial portion of the carotid arteries. Of these, 176 patients underwent revascularization of the carotid basin: 120 patients endured open carotid endarterectomy (CEAE), 56 patients sustained carotid angioplasty and stenting (CAS), with a total of 128 CEAE and 67 CAS interventions performed. The following conclusion was made: with high skill of surgeons and broad experience in carrying out revascularization of the carotid basin, the CEAE and CAS procedures possess comparable efficacy and safety with CEAE possessing reliable advantage in terms of the parameters of the patient's quality of life.

[Sequence of venous blood flow alterations in patients after recently endured acute thrombosis of lower-limb deep veins based on the findings of ultrasonographic duplex scanning].

This study was undertaken to investigate the sequence of alterations in the venous blood flow to have occurred within the time frame of one year after sustained acute thrombosis of the lower-limb deep veins, which was carried out using the standard technique of ultrasonographic duplex scanning. A total of thirty-two 24-to-62-year-old patients presenting with newly onset acute phlebothrombosis were followed up. All the patients were sequentially examined at 2 days, 3 weeks, 3 months, 6 months and 12 months after the manifestation of the initial clinical signs of the disease. Amongst the parameters to determine were the patency of the deep veins and the condition of the valvular apparatus of the deep, superficial and communicant veins. According to the obtained findings, it was as early as at the first stage of the phlebohaemodynamic alterations after the endured thrombosis, i. e., during the acute period of the disease, that seven (21.9%) patients were found to have developed valvular insufficiency of the communicant veins of the cms, manifesting itself in the formation of a horizontal veno-venous reflux, and 6 months later, these events were observed to have occurred in all the patients examined (100%). Afterwards, the second stage of the phlebohaemodynamic alterations was, simultaneously with the process of recanalization of the thrombotic masses in the deep veins, specifically characterized by the formation of valvular insufficiency of the latter, manifesting itself in the form of the development of a deep vertical veno-venous reflux, which was revealed at month six after the onset of the disease in 56.3% of the examined subjects, to be then observed after 12 months in 93.8% of the patients involved. Recanalization of thrombotic masses was noted to commence 3 months after the onset of thrombosis in twelve (37.5%) patients, and after 12 months it was seen to ensue in all the patients (100%), eventually ending in complete restoration of the patency of the affected veins (to have occurred in 25% of the cases). Of special interest was the finding that insufficiency of the ostial valve of the great saphenous vein, manifesting itself by a superficial vertical veno-venous reflux, was revealed only in two (6.25%) patients examined 12 months after the onset of the disease, which may be regarded as the third stage of the phlebohaemodynamic alterations. That low prevalence and no evidence of varicose transformation of superficial veins appear to suggest an important part they play in compensation of the venous outflow from the extremity affected.

[Administration of prostaglandin E1 in the treatment of patients with chronic lower limbs critical ischemia with concomitant ischemic heat disease]. / Lechenie bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei s primeneniem prostaglandina E1 na fone soputstvuiushchei ishemicheskoi bolezni serdtsa.

Drug treatment of chronic lower limbs critical ischemia (CLLCI) remains an important problem, particularly in patients with concomitant ischemic heart disease treated with prostaglandins E1 (PGE1). Experience in treatment of these patients with alprostadil is presented. Symptoms of a high risk of coronary events are demonstrated, prophylactic measures are proposed.

[Disorders of rheologic properties of blood and their correction in postthrombophlebitic syndrome]. / Narushenie reologicheskikh svoistv krovi i ikh korrektsiia pri posttromboflebiticheskom sindrome.

Pathogenetic mechanisms of disorders of rheologic properties of blood in postthrombophlebitic syndrome (PTPS) are analyzed. Thirty-six patients were examined and divided into 2 groups. In combined therapy of the study group (18 patients) pentoxyfillin tablets were included. In the control group derivatives of xantin were used. Good clinical effect of pentoxyfillin based on positive influence on rheologic properties of blood was demonstrated. In the study group significant reduction of edema was in 72,2% patients, of pains - in 83,3%. In the control group positive results were achieved only in 55,6% patients.