[Contrast-free MR phlebography as a method of screening of phlebothromboses and extravasal compression of the inferior vena cava and its basin]. / Beskontrastnaya MR-flebografiya kak metod skrininga flebotrombozov i ekstravazal'noi kompressii nizhnei poloi veny i ee basseina.

The study was aimed at assessing possibilities and determining diagnostic significance of the method of contrast-free magnetic resonance phlebography (MR phlebography) in diagnosis of diseases of the inferior vena cava (IVC) and its basin. Presented herein is experience with examining a total of 74 patients at two therapeutic-diagnostic facilities: the National Medical Surgical Centre named after N.I. Pirogov and the Medical Diagnostic Centre "Ramsey Diagnostics". The studies were carried out on magnetic resonance tomographs "Philips Intera Nova" and "GE Optima MR360", using a special protocol of contrast-free MR-phlebography in consequences at free breathing, followed by 3D reconstruction and processing of the obtained images as MIP and 3D. According to the obtained results our method makes it possible to visualize the anatomical passage of the vessels of the IVC basin, interrelationship with adjoining structures and osseous elements, to determine localization of the thrombus, its length, diameter of the vessel and degree of its narrowing at the level of the lesion, as well as to assess the collateral outflow without contrast enhancement. The sensitivity of the method in thromboses of the IVC basin veins amounted to 92%, with the specificity amounting to 90%. Hence, contrast-free MR phlebography is the most optimal screening method requiring no contrast medium, short in time and absolutely safe procedure in diagnosing the causes of extra- and intravasal pathology of the IVC and its basin as compared with ultrasonographic examination, contrast-enhanced phlebography, computed tomography (CT) and contrast-enhanced magnetic resonance tomography.

[Current aspects of endothelial protection in treatment of patients with chronic venous insufficiency at the stage of trophic disorders]. / Sovremennye aspekty endotelioprotektsii v lechenii bol'nykh s khronicheskoi venoznoi nedostatochnost'yu v stadii troficheskikh rasstroistv.

The authors analysed the results of comprehensive examination and treatment of a total of 40 patients presenting with lower limb chronic venous insufficiency at the stage of trophic disorders (class C6), including 28 (70%) patients with varicose disease of lower extremities and 12 (30%) patients with post-thrombotic disease. Studying the microcirculatory blood flow by means of laser Doppler flowmetry showed a statistically significant (p<0.05) baseline decrease in the index of microcirculation in patients (12.2±2.4 perf. units for varicose disease and 10.8±1.8 perf. units for post-thrombotic disease) as compared with the control group of apparently healthy volunteers (20.4±1.5 perf. units). All stages of treatment included the program of stimulation of reparative processes and normalization of microcirculation by means of sulodexide. Conservative measures were independent therapeutic procedures in 31 patients. Of these, trophic ulcers completely epithelialized in 9 patients and decreased by half of its initial surface in 22 patients. The study of the microcirculatory blood flow in dynamics suggested improvement of microcirculation during treatment. Hence, comprehensive therapy using sulodexide in patients with venous trophic ulcers is accompanied by an endothelium-protecting effect and leads to improvement of the indices of microcirculation of the skin of the crus.

[Effect of pharmacotherapy on course of postoperative period after endovenous thermal ablation].

The authors assessed the effect of a micronized purified flavonoid fraction (MPFF) on the course of the postoperative period after endovenous thermal ablation (EVTA). The patients of the Study Group matching by the main studied parameters to the Control Group patients were given the MPFF according to the suggested regimen for 7 days. The obtained results were analysed by means of questionnaires (CIVIQ, VCSS, VAS) and ultrasound angioscanning. The obtained findings were statistically processed by means of the program Statistica 6.0 and reliability of the results was assessed with the help of the Student t-test. Patients of the both groups showed complete stable obliteration of the target veins. No statistically significant differences of the items of the questionnaires CIVIQ and VCSS at the beginning of the study and at the last examination were revealed, differences were noted on days 2-14 after EVTA and were not statistically significant (p>0.05). Phlebotrophic therapy in the postoperative period after EVTA helps to decrease phlebitic alterations in the coagulated vein, to improve motor activity and mental psychoemotional state of the patients.

[Endovascular interventions in true and false aneurysms of hepatic, splenic and renal arteries].

A false aneurysm of visceral arteries is a life-threatening pathology sufficiently difficult to treat. Open operations are characterised by a large scope, considerable surgical injury and accompanied by a high rate of serious complications. The development of the technology of superselective catheterization of blood vessels, creation of specialized microcatheters, glue composites and various types of spirals made it possible to treat this severe pathology without resorting to open operations. The work deals with a brief literature review concerning epidemiology, methods of diagnosis and treatment of pseudoaneurysms of visceral arteries, followed by presenting three clinical case reports concerning successful treatment of posttraumatic false aneurysms of the right hepatic and splenic arteries, as well as an aneurysm of the renal artery. Both immediate and remote results of endovascular interventions in these patients are followed up, demonstrably showing possibilities of endovascular technologies in treatment of the pathology involved.