[Functional-anatomical prerequisites of revascularization of the femoro-popliteal arterial segment].

Improved results of surgical treatment of patients with critical ischemia of lower extremities can be obtained by using the collateral bed. The condition of the profound femoral artery and the popliteal artery, especially in the zone of its trifurcation, is of the greatest significance for the decision on the volume of surgery. The carrying capacity of the collateral bed of the profound femoral artery in occlusion of the femoral artery was on average 284 ml/min. A positive prognostic criterion of recovered circulation in the extremity using the profound femoral artery is preservation of the patent trifurcation of the popliteal artery and/or the anterior tibial artery. The blood flow volume along the profound femoral artery under the given functional-anatomical conditions should be not less than 150 ml/min. Semiclosed loop endarterectomy of the superficial femoral and popliteal arteries with multilevel lesions of the lower extremity arteries allows the main zones of the collateral bed of the femoro-popliteal-tibial segment to be included in the blood flow.

[Local tissue hypoxia consequence in the trophic venous ulceration in elderly patients].

This paper analyzes the data of examination and the results of the treatment of 25 patients aged over 80 years (mean age 68.5+/-7 years) suffering from varicosity with long nonhealing trophic ulcers of the distal limb segments (CVI CMP C6) and 20 patients of the same age groups with CVI CEAP stages 3-5. All patients with CVI underwent either full-scope phlebectomy (64.4%) or partial truncal phlebectomy (35.6%), in which the trunk of the greater saphenous vein was stripped up to the upper third of the leg. A TCM-3 outfit (RADIOmeter, Denmark) was employed to measure oxygen tension in limb tissues. Parameters of lipid peroxidation and antioxidant tissue defence were measured intraoperatively in the capillary blood of the fingers as well as in the venous blood withdrawn from the cubital vein and the greater saphenous vein in the lower third of the leg near ulcer). The data obtained evidenced that lipid peroxidation activity was most pronounced in the soft tissues of the lower third of the leg in the group of patients with remarkable chronic venous insufficiency without trophic venous ulcers (GVI CEAP C3-5) and was significantly depleted after formation of varicose ulcers (CVI CEAP C6) associated with remarkable tissue hypoxia (TepO2 1.7-7.0 mm Hg). In all patients with CVI, the syndrome of lipid peroxidation was associated with the lowering of antioxidant defence activity. Patients with trophic venous ulcers had the signs of active inflammation in the soft tissues of the leg. The data obtained in the course of the study made it possible to optimize the treatment policy for elderly patients with trophic venous ulcers. In addition to the lowering of venous hypertension, the treatment included correction of microcirculatory disorders related to local hypoxia. Of special importance was reperfusion attenuation in the postoperative period.

[Multilevel revascularization of the lower extremities using loop endarterectomy].

Results of 91 reconstructions of the ilio-femoro-popliteal segment in patients with multilevel injuries of the lower extremity arteries were analyzed. In 42 of the operations a method of operations associated with loop endarterectomy was used. The first stage in all the patients consisted of iliac deep femoral reconstructions or semi-closed loop endarterectomy from iliac arteries in order for inclusion in blood flow of the profound femoral artery. In the presence of the volumetric blood flow along the profound femoral artery less than 150 ml/min after the first stage of revascularization the operation volume was extended at the expense of the femoro-distal reconstructions and/or semi-closed loop endarterectomy from the femoral and popliteal arteries. It was found that revascularization of the ilio-femoral segment in combination with desobliteration of the popliteal artery allowed performing two-level reconstructions with little time and material costs followed by primary positive results in 92.9% of cases.

Evaluation of microcirculation in elderly patients with venous trophic ulcers.

Altogether 112 patients over 50 years of age suffering from varicosity and chronic trophic ulcers of the distal limb segments were examined. The work was based on an analysis of the microcirculatory flow in lower limb tissues (laser Doppler flowmetry, BLF 21 system, Transonic Systems Inc., USA) and on the evaluation of tissue metabolism by measuring partial oxygen and carbon dioxide tension (percutaneous polarography; TCM-3 system, Radiometry Company, Denmark). The postischemic and orthostatic tests were used to assess the functional microcirculatory reserve. The data obtained indicate local tissue hypoxia in elderly patients with venous trophic ulcers associated with an increase of the basal flow only in the lower third of the leg. Venous trophic ulcers are marked by a significant reduction of partial oxygen tension in the tissues adjacent to the area of trophic ulcers to 4.3+/-0.5 mm Hg on the average in the presence of the low functional microcirculatory reserve. Local tissue hypoxia in the area of trophic ulcers, which develops despite an increase of blood inflow to the microcirculatory bed evidences inhibition of tissue flow and activation of the arterio-venular bypasses. The results obtained in the course of the study allow to optimize the treatment policy in elderly patients suffering from venous trophic ulcers. In addition to the measures lowering venous hypertension, the treatment should include correction of microcirculatory disorders, which is to be carried out in the pre- and postoperative periods.

[Hemorheological disorders in patients with critical ischemia of the lower limbs of atherosclerotic genesis]. / Gemoreologicheskie rasstroistva u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskogo geneza.

A comparative analysis of hemorheological indices was carried out in 105 patients with different variants of the course of critical ischemia of extremities and in 35 patients with intermittent claudication (as a reference group). Disturbances of the rheological properties of blood were revealed in the extremity muscles and in 62.4-68.8% of patients with a low functional reserve of the extremity muscles. All the examined patients had a low level of total cholesterol against the background of dyslipoproteinemia characterized by a decreased level of cholesterol of high density lipoprotein with a mild elevation of the concentration of cholesterol of low and very low density lipoproteins.

[Evaluation of functional potentials of microcirculation in patients with obliterating diseases of lower limb vessels]. / Otsenka funktsional'nykh vozmozhnostei mikrotsirkuliatsii u bol'nykh s obliteriruiushchimi zabolevaniiami sosudov nizhnikh konechnostei.

An analysis of the data of laser doppler fluorometry in 136 patients has shown that different obliterating diseases have different typical fluorometric features of changes in microcirculation. Results of the postischemic test are of greater informative value in the noninvasive assessment of the functional state of microcirculation. The significance of the functional tests was particularly increasing in critical ischemia of the lower extremities. The intraoperative determination of the muscle blood flow allowed performing the control of the lower extremity revascularization and determining the optimum level of amputation.

[Surgical treatment of patients with critical ischemia of the lower limbs of atherosclerotic etiology]. / Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskogo geneza.

The authors analyze the results of conservative and operative treatment of 546 patients. The results of operative treatment (reconstructive operations on the arteries, osteo-trepanation) were shown to be considerably better in cases of critical ischemia than those of conservative treatment (infusion therapy, hemodilution, plasmapheresis).

[The treatment of posttraumatic and true arterial aneurysms of the extremities]. / Lechenie posttravmaticheskikh i istinnykh anevrizm arterii konechnostei.

The work presents an analysis of the nearest results of treatment of 82 patients with pulsating hematomas, false and true aneurysms of the upper and lower extremity vessels depending on the kond of the pulsating formation, variants of complications in the course of disease, the level and size of defects of the vessel as well as of the state of the distal bed. Most optimum operations are those with using autovenous transplants, patients with false aneurysms excluded. In all the operated patients the adequate blood circulation was restored and the extremity was saved.

[Clinical and ultrasonic validation for the intracavernous use of papaverin hydrochloride for the test screening of patients with arterial erectile impotence]. / Klinicheskoe i ul'trazvukovoe obosnovanie intrakavernoznogo primeneniia papaverina gidrokhlorida dlia skrining-testirovaniia bol'nykh s arterial'noi érektsionnoi impotentsiei.

Intracavernous administration of 2% papaverine hydrochloride solution, 4 ml, was conducted in 25 patients with various arterial erectile impotence and 25 patients with psychogenic impotence. The efficiency of the solution was judged from clinical findings and results of penile blood flow estimation via ultrasonic Doppler graphy 10 minutes after injection. Ultrasonic Doppler graphy involved calculation of the pulse wave acceleration measure and penile-brachial index of acceleration. In patients with psychogenic impotence the penile blood flow after intracavernous papaverine hydrochloride assumed the features of great blood flow, whereas it remained reduced in patients with arterial erectile impotence. In Doppler sonography, basic parameters were determined, viz assessment of the form of a Doppler wave, initial blood flow velocity, maximum blood flow velocity and their difference.

[The "steal" syndrome in patients with occlusive diseases of the aorta and iliac arteries]. / Sindrom "obkradyvaniia" u bol'nykh s obliteriruiushchimi porazheniiami aorty i podvzdoshnykh arterii.

In the work, the findings of clinical, functional and angiographic investigations in patients with the "steal" syndrome are systematized. In 39 of the 152 patients with atherosclerosis of the vessels of the aortoiliofemoral segment, the two forms of the "steal" syndrome (external iliac and pelvic "steal") causing the arterial erectile impotence were revealed. For objectivization of the syndrome, a test of "coitus loading" on the muscles of the lower extremities was used.

[Possibilities of ultrasonic dopplerography and multi-level manometry in the evaluation of lesions of the arteries of the lower limbs]. / Vozmozhnosti ul'trazvukovoi doplerografii i mnogourovnevoi manometrii v otsenke porazhenii arterii nizhnikh konechnostei.

Dopplerographic and manometric examination was conducted in 429 patients with obliterating lesions of the lower limb arteries in order to find optimal diagnostic combinations. The data of noninvasive diagnosis were verified in 119 cases. The data obtained bore evidence that coincidence of the findings of ultrasonic dopplerography and multilayer manometry is indicative, with a high degree of probability, of the presence or absence of lesions of the lower limbs. The findings of ultrasonic dopplerography are the main criteria in appraising affections of the aortoiliac segment and those of multilayer manometry--in appraising affections of the femoropopliteal segment. The findings of both methods are of equal significance in appraising the tibial segment. Multilayer manometry allows indirect appraisal of the condition of arteries in the channel of the deep femoral artery.