[Chemichal desympathization in the treatment of throphic ulcer in patients with varicose veins of the lower limbs].

The in vivo study on 25 rabbits and clinical study, involving 60 patients with lower limbs' varicose disease and trophic ulcers was carried out. The in-vivo study was based on the chemical distruction of the sympathic trunk by injecting 95% ethanol and 6% phenol paraneurally along the vascular bundle in the ear. The regeneration of the sympathic neural trunk was registered within 2-3 months after the injury. In human patients the US-guided chemical desympathization led to the increase of the capillary circulation (1.9 times at rest and 0.3 times under the load) during 2 months. The fact favoured the faster regress of inflammatory process in the ulcer.

[Diagnostic and therapeutic possibilities of lumbar chemical sympathectomy in patients with chronic obliterating diseases of lower-limb arteries].

The authors have analysed the findings obtained in a comprehensive examination followed by surgical management of eighty-five patients presenting with chronic obliterating diseases of lower limbs arteries (CODLLA). Studying the macrohaemodynamics and microcirculation of the ischaemic extremity was carried out according to the diagnostic programme for the disease concerned: i.e., rheovasography, photoplethysmography, transcutaneous oximetry, ultrasonographic duplex scanning of the lower-limb arteries, and angiography. All the patients were found to have signs of critical ischaemia of the lower extremities on the background of a concomitant lesion of the vessels of the femoropopliteal and crural segments. However, no reconstructive operations were performed owing to occlusion of the arteries of the feet and crura, and the patients were therefore subjected to surgical procedures aimed at indirect revascularization of the extremity involved. The patients were divided into two groups (Group One and Group Two, comprising 45 and 40 patients, respectively). The forty-five Group One patients were subjected to revascularizing osteotrephination (ROT) of the femur and cms in the sites with sufficient blood supply, as determined by duplex scanning. We managed to relieve the symptoms of critical ischaemia in 82.2% of the patients from this group. The manifestations of ischaemia were noted to be gradually increasing in seven (15.6%) patients during the postoperative period, and they all had to be subjected to a high amputation of the affected extremity. Whereas, the forty Group Two patients underwent ROT supplemented by ultrasonography-controlled lumbar chemical sympathectomy (LCS). A combination of LCS and revascularizing osteotrephination made it possible to stop ischaemia in 90% of the patients suffering from critical ischaemia of the lower limbs, and to reduce the rate of amputations by 5.6%.

[Role of blood refluxes in the genesis of venous trophic disorders in patients with chronic venous insufficiency].

The authors analyzed the results of a comprehensive examination of 120 patients with class C6 chronic venous insufficiency according to the CEAP classification, and open trophic ulcers. The patients were subdivided into 2 groups. Group One comprised a total of 75 patients with varicosity, and Group Two consisted of 45 patients with post-thrombotic disease. The localization, intensity and length of the refluxes of blood in the venous system of the affected extremity were determined by means of ultrasonographic angioscanning. Examining the patients with varicosity revealed that in 81.4% the main haemodynamic factor leading to development of the ulcer was a high-intensity, total-subtotal blood reflux along the superficial veins, and in 9.3% - high-intensity superficial and deep refluxes of blood. We failed to determine the blood reflux priority in 9.3% of patients. The trophic ulcers had developed under the effect of low-intensity refluxes of blood in the superficial, deep and perforating veins in elderly patients on the background of heart failure. The most damaging influence on the microcirculatory bed in patients with post-thrombotic disease with recanalization of deep veins is exerted by a high-intensity total reflux of blood in the popliteal and talocrural segments of the venous system of the lower extremities, which was revealed in 68.9% of patients. The developing pathological flow of blood from the muscular-venous pump of the cms into the deep veins of the foot induces perforating insufficiency on the foot and crus, thus creating two zones of venous hypertension above and beneath the ankle. The major factor of trophic ulcers development in patients with segmental obliteration (17.8%) and insufficient recanalization of deep veins (13.3%) was venous hypertension in the distal portions of the affected extremity. Blood refluxes in deep veins of the ankle were of a low-intensity pattern, and played an auxiliary role in development of trophic disorders.

[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.

[Hemodynamic characteristics and priority of blood refluxes in genesis of trophic ulcers in patients with varicose disease of lower extremities].

An analysis of results of complex examination of 75 patients with varicose disease and trophic ulcers has shown that in 81.4% of the patients the main hemodynamic factor resulting in the development of ulcers was highly intensive total-subtotal reflux of blood along the superficial veins, and in 9.3% it was the highly intensive profound reflux along the posterior tibial veins. In 9.3% of the patients the priority of blood reflux was not established. Trophic ulcers were developing under the influence of low intensity refluxes of blood in the superficial, profound veins and perforators in elderly patients against the background of heart failure.

[Lumbar chemical sympathectomy in complex treatment of critical impairments of microcirculation in patients with decompensated forms of chronic venous insufficiency].

The authors describe a method of chemical lumbar sympathectomy under USI control in 40 patients. No complications were noted. Positive effect was observed for 2 months.

[Effects of blood refluxes on formation of trophic ulcers in patients with postthrombotic disease].

The results of complex examination of 45 patients with chronic venous insufficiency having class C6 open trophic ulcers by CEAP classification due to postthrombotic disease were analyzed. The localization, intensity and duration of blood refluxes in the venous system of the injured extremity were determined using ultrasonic angioscanning. Highly intensive total reflux of blood in the popliteal and talocrural segments of the lower extremity venous system found in 68.9% of patients has most injuring effects on the microcirculatory bed of patients having postthrombotic disease with recanalization of the profound veins. The developing pathological cross-flow of blood from the musculo-venous pump of the shank into the foot profound veins gives rise to perforator vein incompetence on the foot and shank forming two zones of venous hypertension under and over the ankle-bone. The main factor of the developing trophic ulcers in patients with segmental obliteration (17.8%) and insufficient recanalization of the profound veins (13.3%) was venous hypertension in the distal parts of the injured extremity. Blood refluxes in the shank profound veins were weakly intensive and played a subsidiary role in the development of trophic disorders.

[Hemodynamic characteristics and surgical treatment of varicose disease with primary involvement of deep vein valves].

Results of clinical examinations and ultrasonic duplex scanning of the venous system of the lower extremities performed in 31 patients with the varicose disease were analyzed. The disease developed due to the primary valve insufficiency of the profound veins. This form is characterized by total-subtotal refluxes of blood along the subcutaneous veins, multiple lesions of the perforant veins, the presence of the hemodynamically valuable blood refluxes in the profound and muscle veins. The hemodynamic parameters of blood flow and the technology of surgical treatment of the deep, superficial, perforant and muscle blood refluxes are shown allowing to restore the quality of life in 76.7% of the patients and considerately improve it in 23.3%.