[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.

[The influence of different methods of revascularization on quality of life of patients with critical ischemia of lower extremities].

Quality of life was estimated in 160 patients with critical ischemia of lower extremities within 6 months after operation using questionnaire SF-36. It was established that the most positive influence on quality of life of the patients was observed after revascularizing osteotrepanation supplemented with traditional lumbar sympathectomy in patients without high operative-anesthesiological risk or lumbar chemical desympathization in patients with severe coexisting somatic pathology.

[Prediction of critical lower limb ischemia at the patients with lower limb arteries atherosclerosis].

Arterial inflow, venous outflow and microcirculation were studied with ultrasound Doppler, photopletismography and oxygen partial pressure detection at 115 patients with lower limb arteries atherosclerosis and different stages of limb ischemia. Four-level algorithm of critical limb ischemia prediction has been created. First level is the study of arterial inflow. Gradient of regional systolic blood pressure >or=2.0 is the critical parameter. Second level is the study of venous outflow. Critical parameter - gradient of postocclusive venous pressure >or=3.0. Third level is the ratio of arterial and venous blood flow. Venous-arterial index >or=40% demonstrates critical disturbances of macrohemodynamics. Fourth level is the study of microcirculation. If the capillary gradient

[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%.

[Non-invasive diagnosis and treatment tactics in management of disordered regional haemodynamics in patients with chronic obliterating diseases of lower-limb arteries].

By means of ultrasonographic angioscanning, Doppler ultrasonography, photoplethysmography, and determination of oxygen partial tension, the authors have analysed the relationship between the arterial inflow, venous return, and the state of microcirculation in a total of 120 patients presenting with various-degree chronic ischaemia of the lower extremities, having developed on the background of obliterating arterial diseases. he authors worked out a complex of methods of non-invasive diagnosis, making it possible to determine the beginning of and to take control over the course of chronic ischaemia of the extremity involved. Also determined herein were the threshold levels of critical disorders of macro-and micro-haemodynamics (the regional systolic pressure gradient of more than 2, the postocclusion venous pressure gradient of more than 3, and the venous-arterial index of more than 40%), which makes it possible to consider that the patient concerned is running a high risk of the development of critical ischaemia in the near future. Such being the case, it is necessary to perform a reconstructive vascular operation, and if impossible - to carry out intensive therapy of both systemic and local risk factors.

[The mechanisms of critical impairments of microcirculation in patients with chronic ischemia of lower extremities].

The interrelationships of the arterial inflow, venous return and state of microcirculation were studied in 115 patients with different degrees of chronic ischemia of the lower extremities due to obliterating diseases of the arteries using ultrasonic dopplerography, photoplethysmography, percutaneous determination of the partial oxygen pressure. It was found that the main adaptive mechanism of compensation of the deficient arterial inflow was compensatory angiotrophoneurosis, slowing down of blood flow in the microcirculation bed due to a spasm of the venule precapillary sphincter. The threshold levels of critical impairments of the macro- and microdynamics were established which allowed prognosis of the development of critical ischemia of lower extremities.

[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.