[The place of arterial allograft in reconstructive surgery of the main arteries of the lower extremities]. / Mesto arterial'nykh allograftov v rekonstruktivnoi khirurgii magistral'nykh arterii nizhnikh konechnostei.

Critical limb ischemia, especially in the absence of autologous vein, prosthetic and native vascular infections are isolated diseases for which there currently doesn't have best surgical treatment. Vascular allografts may be the treatment of choice for these patients. In this analysis, we tried to reflect the directions of development of vascular allotransplantation, global trends related to indications for their use, methods of conservation, degradation and endothelial dysfunction. At the present time there doesn't have meta-analyzes on the efficiency of using arterial allografts or other options for implantation (synthetic graft, xenografts) for critical limb ischemia and graft and native infections. Now it is wrong to recommend using them always. Further studies of their performance are necessary. In addition, development of graft control techniques is also needed when rejection develops. Currently, there are no special diagnostic markers, the assessment of which could save patients with immune-mediated dilatation and dysfunction of allografts.

[Treatment strategy for non-combat mine - explosive injury of the lower limbs]. / Sluchai minno-vzryvnoi travmy nizhnikh konechnostei mirnogo vremeni.

Mine-explosive trauma is one of the most serious types of combat lesion and injuries in peacetime. We report a patient with mine-explosive trauma of the lower limbs followed by injury of the vascular bundle. Well-coordinated work of a multidisciplinary team of specialists at all stages of treatment is presented. The management was effective to save patient's life, avoid amputation and restore lower limb function.

[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[Current aspects of performing treadmill test in patients with peripheral artery disease]. / Sovremennye aspekty provedeniia tredmil testa u patsientov s zabolevaniiami perifericheskikh arterii.

The protocols of performing treadmill tests (TMT) in patients presenting with peripheral artery disease have over the last decades undergone significant changes, with the alterations concerning not only the speed and time values of the load, but also the parameters measured. Currently, there is no unified generally accepted method of TMT, hence the need for an optimal protocol for carrying out this type of examination, which would help obtain reliable results in assessment of everyday life functional activity of patients and efficacy of various methods of treatment for peripheral atherosclerosis. The choice of an optimal methodology of performing a TMT in patients with intermittent claudication is extremely important because studying the haemodynamic parameters alone not always clearly reflect functional peculiarities of the course of the disease, since they depend not only on the presence of arterial stenoses or occlusions, but also on the activity of oxidative enzymes, endothelial and mitochondrial dysfunction, taking therapeutic agents, concomitant pathology and a series of other factors. The article is a review of the related literature contained in such databases as the Medline, PubMed, Russian Science Citation Index (RSCI) and Scopus and concerning TMT in patients with peripheral artery disease. The authors summarized the information from a total of 63 literature sources over the period from the 1970s to 2018.

[Oxidative carbonylation of proteins in experimental hind-limb ischaemia-reperfusion injury]. / Okislitel'noe karbonilirovanie belkov pri éksperimental'noi ishemii i reperfuzii nizhnikh konechnostei.

Formation of carbonylated protein derivatives is one of the key signalling pathways in cellular damage and may be regarded as a reliable marker in cellular injury. It allows evaluating both direct effects of reactive oxygen species and indirect interrelations with the secondary by-products of oxidation. The present study was undertaken to investigate the activity of lysosomal cysteine proteinases (cathepsins B and L) in blood serum and the arterial wall in an experimental model of ischaemia and ischaemia-reperfusion injury. To this was added comprehensive assessment of oxidative modification of proteins derived from blood serum and the arterial wall, namely, calculating the area under the curve of the absorption spectrum of the products of protein carbonylation, the proportion of the primary and secondary markers of oxidative stress, as well as the reserve and adaptation potential. The obtained findings were indicative of the development of oxidative stress in the model of ischaemia-reperfusion injury from day 1 to day 7, and in the ischaemia model on day 3 and day 5 in both the vascular wall and blood serum, which was accompanied by activation of cathepsins B and L. Reversible oxidation of proteins was observed on days 3 and 5 in the experimental ischaemia model and on days 1 and 7 in the ischaemia-reperfusion injury model, which was confirmed by the predominance of the primary markers of oxidative stress. Irreversible oxidation of proteins, i. e., the predominance of the secondary markers, was suggestive of the enhancement of oxidative stress, its transition to the late stage, leading to the loss of biological properties of proteins and eventually followed by their aggregation and degradation as seen in the ischaemia-reperfusion injury model on days 3 and 5. Analysing the obtained findings revealed direct correlation between the total area under the curve of oxidative modification of proteins and overall activity of cathepsin L in the ischaemia model: in blood serum on days 3 and 5, in the vascular wall for cathepsins B and L on day 5; in the ischaemia-reperfusion injury model: the activity of cathepsin L in blood serum on day 3, in the vascular wall on day 5 for cathepsins B and L.

[Concentration of matrix metalloproteinases and magnesium ions in patients with varicose veins of lower limbs]. / Kontsentratsiya matriksnykh metalloproteinaz i ionov magniya pri varikoznoi bolezni ven nizhnikh konechnostei.

The study was aimed at investigating alterations in the concentration of matrix metalloproteinases (MMP-1, MMP-9) and the tissue inhibitor of metalloproteinase-1 (TIMP-1), as well as the level of magnesium ions (Mg2+) as an indicator of connective tissue dysplasia (CTD) in patients presenting with lower limb varicose veins. The study included a total of 110 people. Of these, the Study Group comprised 90 patients with lower limb varicose veins of clinical class C2-C6 (according to the CEAP classification) and the Control Group was composed of 20 apparently healthy volunteers. Samples of peripheral blood were examined. The content of MMP-9, MMP-1 and TIMP-1 in blood serum was determined by means of the quantitative solid-phase immunoenzymatic assay. The concentration of Mg2+ was determined by the colorimetric method. We revealed a statistically significant interrelationship between the concentrations of matrix metalloproteinases and severity of varicose transformation of lower-limb veins, with the highest level of matrix metalloproteinases being observed in patients with cutaneous alterations and trophic ulcers. Determination of the level of matrix metalloproteinases and magnesium ions, characterizing connective tissue dysplasia, makes it possible to predict the development of lower limb chronic venous insufficiency and to evaluate the degree of its severity.

[Quality of life of patients with venous thromboses in different variants of anticoagulant therapy].

The CIVIQ questionnaire was used to evaluate quality of life of patients presenting with deep vein thrombosis of lower limbs in different variants of anticoagulant therapy. The study included a total of 170 patients who were depending on the variant of anticoagulant therapy subdivided into 3 groups: Group One (comprising 48 patients) taking rivaroxaban as monotherapy; Group Two (consisting of 73 subjects) receiving low molecular weight heparin (enoxaparin sodium) followed by adjusting the warfarin dose, and Group Three (including 49 patients) receiving low molecular weight heparin (enoxaparin sodium) followed by rivaroxaban. The total value of the level of quality of life in all groups showed a tendency towards restoration. However, patients taking warfarin during the follow-up period were found to have negative dynamics by the 6th month of treatment. It was revealed that quality of life on all parameters was higher in patients taking rivaroxaban and lower in those taking warfarin. The parameters of the physical component of health turned out to depend upon the degree of recanalization of the thrombus. After 6 months of anticoagulant therapy patients taking rivaroxaban (Groups One and Three) were found to have good recanalization in 87.5 and 87.7% of cases, respectively, while in Group Two being observed in 54.8% of patients only. Taking an anticoagulant at a fixed dose not requiring laboratory control (rivaroxaban) increases patient compliance, thus leading to improvement of both mental and social wellbeing.

[Ultrasound dynamics lysis apex thrombus as an objective criterion of effectiveness of anticoagulation therapy in venous thrombosis].

OBJECTIVE OF THE STUDY: To assess the effectiveness of anticoagulant therapy (ACT) for the treatment of patients with deep venous thrombosis (DVT) of the lower extremities. MATERIAL AND METHODS: The study considered ultrasonic characteristics of lysis of the proximal part of thrombus: localization and nature of venous thrombosis, the length and diameter of the proximal floating part of the thrombus, and duration of the venous thrombosis. Depending on the ACT options patients were divided into 3 groups: Group 1 (18 patients) received rivaroxaban, group 2 (19 patients) received enoxaparin sodium with subsequent transition to warfarin, and 3 group (19 patietns) received enoxaparin sodium, followed by administration of rivaroxaban. RESULTS: Treatment with rivaroxaban was preferable over standard ACT with enoxaparin/warfarin with regards to the lysis of thrombus when duration of thrombosis did not exceed 10 days. In 10.5% of patients who received warfarin flotation of thrombi remained for 14 days; the length of the floating part of the thrombi did not exceed 3 cm. Such circumstances and inability to reach a therapeutic INR value required cava filter placement. Treatment with enoxaparin sodium followed by the administration of rivaroxaban was found to be the most efficient ACT regimen as there was no negative dynamics of ultrasound characteristics of lysis of thrombi at any duration of the disease.

[Possibilities of pharmacotherapy for chronic venous insufficiency with diosmin preparations from the position of the endothelial functional state].

Despite a high level of the development of modern angiology and vascular surgery, the problem of chronic venous insufficiency (CVI) complicating the course of various venous diseases seems to have no tendency towards being solved, thus calling forth permanent search for optimization of methods of treatment and rehabilitation of patients presenting with the above-mentioned syndrome. The article presents a review of contemporary studies dedicated to the problem of correcting CVI. Special attention is paid to the endothelial state in CVI and possibilities of correcting endothelial dysfunction with the use of bioflavonoids, in particular, diosmin. Also presented herein are the results of an original experimental study dedicated to peculiarities of the endothelial functional state, endothelial dysfunction, and correction thereof on the background of the existing CVI.

[Correction of endothelial dysfunction as a component in treatment for atherosclerosis obliterans of lower-limb arteries]. / Korrektsiia éndotelial'noi disfunktsii kak komponent v lechenii obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei

The authors analysed the effect of various therapeutic agents on the level of biochemical markers of endothelial dysfunction. The obtained findings confirmed efficacy of the studied agents in prevention of restenosis of the zone of reconstruction due to neointimal hyperplasia, thus leading to improved results of reconstructive operations on major arteries of the lower extremities.

[Biochemical and morphological assessment of the functional state of the endothelium in reconstructive operations on the abdominal aorta in animal experiments].

The article deals with the analysis of biochemical and morphological alterations in the functional state of the endothelium of laboratory animals after a reconstructive surgical intervention on the abdominal aorta. These alterations were assessed at various terms following operative treatment in the comparison group and intact control group. The authors carried out of computer-assisted morphometry of the reconstruction zone on histological preparations for correct interpretation of the biochemical alterations and assessment of the correlation between the studied biochemical indices in blood and the arterial wall.