[State of the brain blood flow autoregulation].

The brain blood flow autoregulation (BFA) has been studied in normalcy and different variants of atherosclerosis in 97 subjects. Group 1 included 32 patients with obliterating atherosclerosis of the arteries of the low extremities with different stages of chronic artery insufficiency without hemodynamic lesions of brachiocephalic arteries; group 2 consisted of 30 patients wit different forms of chronic brain ischemia with hemodynamically significant unilateral atherosclerotic stenosis of the inner carotid artery (from 70 to 95%). The control group included 35 healthy volunteers aged 20-25 years. BFA parameters were assessed using the original technique worked out by the authors. In the normalcy, the BFA mechanism is able to maintain the constancy of perfusion pressure in the brain due to two major components. In the first stage, it is the aggravation of arterial blood inflow lasting for 1,5 min after the removal of pneumatic cuffs with the following surpassing increase of the venous blood outflow from the scull that decreases the tissue pressure. The most distinct BFA changes were seen in patients with hemodynamically significant stenosis of the inner carotid artery while patients with peripheral atherosclerosis had less marked BFA disturbances.

[Antiplatelet therapy in patients with chronic obliterating diseases of lower-limb arteries].

The article deals with present-day evidence concerning the role of blood-platelet activity in the development of a pathological process and acute ischemia in patients presenting with chronic arterial insufficiency of the lower extremities. Proved herein is the necessity of long-term administration of antiplatelet drugs in order to prevent vascular complications on the part of the heart, brain, and peripheral arteries, with a description of the drugs most commonly used for these purposes.

[Clinical and morphological parallels of various degrees of chronic arterial insufficiency of lower limbs (review of the literature)].

The article deals with the main clinical and instrumental methods of determining severity of chronic arterial insufficiency of the lower extremities, showing possibilities of morphological studies for an accurate diagnosis of the ischaemia degree. Also determined are promising trends of studying the hypoxia-inducible factor (HIF) and vascular endothelial growth factor (VEGF) in assessment of ischaemic impairments of lower-extremities tissue.

[Possibilities of radionuclide study of lower-limb muscles perfusion in diagnosis of chronic arterial insufficiency].

The authors have hereby proposed a method to diagnose lower-limb muscular ischaemia by means of scintigraphy, used in 35 patients suffering from atherosclerosis obliterans with stage IIB and III A chronic arterial insufficiency of limbs. To do so, administration of the radioactive agent "Myoview" (99m)Tc-tetrophosmine) manufactured by the "Nycomed" Company into a patient's peripheral vein was followed by assessing its accumulation in lower-limb muscles at rest and after standard physical load. Alterations in the parameters studied relative to the norm made it possible to judge on the presence of lower-limb circulatory impairments. The method proved highly efficient, thus making it possible to use it for both therapeutic decision-making and probably in future for dynamic control after the treatment performed. Minimally invasive nature and simplicity in use of the methodology open wide possibilities for its use.

[Correction of disordered cerebral blood flow autoregulation in atherosclerosis].

The work deals with studying the parameters of autoregulation of the cerebral blood flow in a total of 127 patients subdivided into four groups. Clinical Group I consisted of thirty 45-to-70-year-old male patients (mean age 55.13 +/- 6.44 years) presenting with no signs of systemic atherosclerosis (CAD, chronic arterial insufficiency of the lower extremities, cerebrovascular insufficiency) or any other chronic diseases (chronic cardiac, pulmonary or renal insufficiency, chronic hepatitis, etc.). Clinical Group II comprised 32 patients diagnosed as having varying-degree chronic arterial insufficiency on the background of atherosclerosis obliterans of the lower-limb arteries (average age 57.46 +/- 5.15 years). Clinical Group III was composed of 30 patients presenting with different degrees of chronic cerebral ischaemia and having haemodynamically significant unilateral atherosclerotic lesions of the internal carotid artery (mean age 55.39 +/- 6.25 years), with the Control Group enrolling thirty-five 20-to-25-year-old volunteers. The findings of the work showed that the patients with atherosclerosis had significant impairments of the cerebral blood flow autoregulation, whose type and degree appeared to depend upon localization of the lesion. In the patients with peripheral atherosclerosis, a 10-day therapeutic course of intravenous administration of alpha-lipoic acid (Berlithion) at a dose of 600 mg daily could be used to correct disordered autoregulation of the cerebral vessels and may be considered from the position of preoperative preparation of such patients for reconstructive vascular interventions on the aorta and lower-limb arteries. Efficacy of alpha-lipoic acid (Berlithion) on the alterations in the cerebral blood flow autoregulation in patients presenting with haemodynamic stenosis of the internal carotid artery is insignificant, in connection with which such patients require surgical restoration of the patency of the major cerebral arteries.

[Current problems status of restenosis after reconstructive interventions on the pelvic and lower-limb arteries in patients with atherosclerosis obliterans].

The present literature review pays primary attention to the pathophysiblogical and immunological grounds of the process of restenoses of vascular anastomoses after reconstructive interventions in patients with atherosclerosis obliterans. On the molecular, cellular and tissue levels, analysed herein are alterations leading to restenosis, also presenting the data concerning currently available methods of diagnosis of this pathological condition. In addition, methods aimed at preventing and treating restenoses are discussed.