[Treatment of critical lower limb ischemia at elderly and old patients with severe concomitant diseases].

Effect of 96% ethanol para-neural injection on sympathetic trunk has been studied experimentally on 18 rabbits. It is demonstrated that ethanol injection leads to dystrophic alteration of sympathetic ganglia and acute aseptic inflammation of para-neural tissues. Clinical study has been carried out on 40 elderly and old patients with critical lower limb ischemia and diffuse arterial occlusive disease. All the patients were divided into 2 equal groups. At the patients of 1st group the revascularizing osteo-trepanation of femur and crus was performed, at 2nd group this operation was completed with ultrasonic-assisted lumbar chemical desympathetization on affected side. At 20% of 1st group patients the symptoms of critical ischemia have not be eliminated; there were no negative dynamics of ischemia at the patients of 2nd group.

[Experimental and clinical grounds of revascularizing osteomyoplasty for treatment of critical ischemia of the lower extremities].

In an experimental work it was found that under conditions of muscle ischemia the revascularizing osteomyoplasty was better than revascularizing osteotrepanation: it resulted in 1.4 times greater diameter of muscle fibers and 1.3 times larger size of the capillary network. An analysis of treatment of 30 patients was made who had critical ischemia of the extremities against the background of a diffuse lesion of the arteries below the inguinal ligament. In the first group consisting of 15 patients standard revascularizing osteotrepanation of the femur and shin was performed, in the second group (15 patients) revascularizing osteomyoplasty on the shin was added to the revascularizing osteotrepanation on the femur. In the second group the percentage of "mild improvement" of the clinical status of the patients was 10 times greater, and the number of patients with "minimal improvement" was 3.7 times less.

[Sclerotherapy of high venovenous blood reflux in patients with early varicose disease of the lower extremities].

Results of diagnosis and treatment of 270 patients with varicose disease were analyzed. Based on duplex scanning two groups of patients were divided: group 1 consisted of 164 patients with low-intensity reflux, group 2 consisted of 106 patients with high-intensity reflux. Patients of group 1 were treated with ultrasound-assisted puncture sclerotherapy. In group 2 sclerosurgical procedures were used: sclerosant was injected into great saphenous vein trough catheter after crossectomy. For obliteration of varicose subcutaneous veins and perforants of shank the Irish technique was used. In group 1 recurrence of the disease was revealed in 9.1% patients, in group 2 -- in 9.4% patients.

[Minimally invasive surgery of acute superficial varicothrombophlebitis in patients having somatic contraindication to venectomy].

An analysis was made of complex examination and the following treatment of 21 patients with acute superficial varicothrombophlebitis who had some pronounced pathology of internal organs preventing radical treatment. An original technology of treatment of varicothrombophlebitis developed by the authors includes crossectomy, truncal catheter sclerotherapy up to the place of thrombosis of the subcutaneous veins, stage-wise phlebocentesis of the thrombosed veins followed by injectional sclerotherapy with the ultrasonic control. The thrombophlebitis phenomena were arrested in all patients. In addition, the clinical manifestations of chronic venous insufficiency were regressed in the postoperative period.

[Optimization of the injection-sclerosing therapy of varicose disease of the lower extremities]. / Optimizatsiia in"ektsionno-skelroziruiushchei terapii varikoznoi bolezni ven nizhnikh konechnostei.

Results of treatment of two groups of patients were analyzed. The first (investigation) group included 106 patients with varicose disease who were given injection-sclerosing therapy by two original methods of elimination of high and low veno-venous refluxes under ultrasound control. The second group consisted of 82 patients treated by traditional methods of sclerotherapy without a purposeful elimination of veno-venous refluxes. The method developed by the authors allowed to make the effectiveness of treatment of refluxes better: that of saphenous-femoral by 41.6%, saphenous-popliteal and perforant by 7.9% that resulted in 35.9% lower recurrence of the disease.

[Optimization of surgical treatment of acute superficial varicose thrombophlebitis]. / Optimizatsiia khirurgicheskogo lecheniia ostrogo poverkhnostnogo varikotromboflebita.

Complex examination and the following treatment of 142 patients with acute superficial varicothrombophlebitis were analyzed. The patients were divided into 2 groups. The first group consisted of 41 patients who were subjected to venectomy in the acute period of the disease, the second group--of 101 patients with two stages of treatment. At the first stage sclerosurgical technologies were used to arrest the inflammatory process. At the second stage the thrombosed varicose veins were surgically ablated. In the first group patients complications at the early postoperative period developed in 17% of cases, at the late period--in 14.6%. In the second group complications were noted in 3 and 2% of cases respectively.

[Technology for sclerosurgical treatment of upper veno-venous reflux of the large subcutaneous vein in varicose vein patients]. / Tekhnologiia sklerokhirurgicheskogo lecheniia vysokogo veno-venoznogo refliuksa po bol'shoi podkozhnoi vene u bol'nykh varikoznoi bolezn'iu.

Under analysis were results of a complex ultrasound examination and the following treatment of 101 patients with varicose disease which had developed due to a high veno-venous ejection. The decision on the method of treatment depended on the variant of reflux spread and the degree of dilatation of the large subcutaneous vein. Four variants of spreading the reflux were established: in the inguinal area only (3.8%), along the femur to the level of the knee articulation (13.6%), femur and the upper third of the shin (66.8%), from the groin to the malleolus (15.8%). Selective interventions consisting in scleroobliteration or removal of the large subcutaneous vein within the limits of the femur or upper third of the shin were fulfilled in 84.2% of the patients. Sclerotherapy was used in veins having the diameter from 5 to 7 mm, sclerosurgery--with the diameter from 8 to 10 mm, surgical treatment in veins with the diameter more than 10 mm. The effectiveness of liquidation of the reflux was 95.2%.