[Radiofrequency ablation in comprehensive surgical treatment of patients with varicose veins of lower limbs]. / Radiochastotnaia obliteratsiia v kompleksnom khirurgicheskom lechenii bol'nykh s varikoznoi bolezn'iu nizhnikh konechnostei.

Analysed herein are the results of using radiofrequency ablation (RFA) in comprehensive surgical treatment of patients presenting with varicose veins of the lower extremities. The study included a series of ninety-eight 28-to-60-year-old patients (with a total of 105 operations performed) suffering from varicose veins of the lower limbs. Of these, there were 10 men (10.3%) and 88 women (89.7%). Venous disease of clinical class C2 according to the CEAP classification was diagnosed in 80 patients, that of class C3 in 17, and that of class C4a in 1 patient. The procedure of RFA was performed by means of the VNUS device model RF62. The impact was exerted in an automatic mode, maintaining the catheter's temperature at 120° C during a 20-second treatment cycle for each 7 cm of the vein's length. In all cases, each 7-cm-long venous segment to be treated was acted upon 4 times. Forty-five patients after RFA underwent ultrasonographic monitoring performed first on POD 7 and then at 3, 6, 12 and 24 months. Recanalization of the trunk of the great saphenous vein (GSV) was registered in 3 (2.8%) cases at terms up to 3 months after the operation. In 2 cases recanalization turned out to be provoked by an incompetent perforant vein in the lower third of the femur. Seven (6.6%) patients with a large diameter of the great saphenous vein were found to develop post-closure hyperpigmentation which resolved spontaneously 8 months later. The remaining patients, with strict adherence to the indications for RFA, demonstrated complete obliteration of the vessel treated, with no recanalization observed ultrasonographically 10-12 months after the procedure. An additional experimental study with a morphological analysis confirmed appropriateness of carrying out four 20-second treatment cycles of RFA in each segment of the vein. A conclusion was made that RFA used in comprehensive surgical treatment for varicose veins of the lower limbs makes it possible to attain good therapeutic and cosmetic results that persist over time, if conducted in compliance with the mentioned fundamentally essential peculiarities of performing the procedure.

[Stimulation of tissue lymphatic drainage in the treatment of patients with arterial diseases]. / Stimuliatsiia limfaticheskogo drenazha tkanei v lechenii bol'nykh s zabolevaniiami arterii.

The results of treatment of 17 patients with endarteritis obliteran and 44 patients with atherosclerosis obliteran of the lower limbs were analysed. The complex of therapeutic measures included direct and indirect stimulation of lymphatic drainage in the tissues. The effect of lymphostimulation on regional hemodynamics, microcirculation, and metabolism in the tissues of the ischemic lower limb are appraised. Changes in the lymphatic system resorption capacity, in microcirculation, in the composition and properties of the peripheral lymph in the limb in stimulation of lymphatic drainage of tissues are analysed. Indirect lymphostimulation contributed to the improvement of the indices under study in patients with IIb and IIIa stages of ischemia. Direct stimulation of lymphatic drainage caused a more pronounced effect in cases of stage IIIa ischemia of the limb and may be applied in preoperative and postoperative management of patients with stage IIIb ischemia.

[The lymphatic system of the lower extremities in patients with obliterating diseases of the terminal portion of the aorta and its branches]. / Limfaticheskaia sistema nizhnikh konechnostei u bol'nykh s obliteriruiushchimi zabolevaniiami terminal'nogo otdela aorty i ee vetvei.

The paper deals with the results of X-ray lymphographic and morphological studies of the peripheral lymphatic system in 82 patients with various stages of chronic lower extremity arterial insufficiency. Destructive and sclerotic changes in lymphatic vessels, inguinal lymph nodes, and impairments in lymph flow whose severity was in proportion to the stage of chronic ischemia were detected. The associated immune, barrier-filtration and transport dysfunctions called for their adequate correction. In patients with Stages II and III ischemia, direct controlled endolymphatic therapy promotes the improvement of tissue lymphatic drainage and hemocirculation in the diseased extremity and recovery of immune homeostasis in the region.

[Status of lymphatic vessels, lymph flow and lymph toxicity in patients with obliterating arterial diseases of the lower extremities]. / Sostoianie limfaticheskikh sosudov,limfotoka i toksichnost' limfy u bol'nykh s obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei.

The condition of the lymph vessels, the lymph flow, and the toxicity of peripheral lymph were studied in 46 patients with obliterating diseases of the arteries of the lower limbs. The results of the study showed the severity of the destructive changes in the peripheral lymphatic system to be directly dependent on the severity of the arterial ischemia of the limb. Block of the lymphatic system, deceleration of the lymph flow, and changes in the lymph vessels themselves lead to deterioration of the tissue drainage function and intensification of regional endotoxicosis. In view of which correction of the peripheral lymphatic system should be included in the complex of measures for the treatment of patients with obliterating diseases of the lower limb arteries.