[Efficacy of Detragel in treatment of varicothrombophlebitis in elderly and aged patients]. / Éffektivnost' detragelia pri lechenii varikotromboflebita u lits pozhilogo i starcheskogo vozrasta.

AIM: The present study was aimed at improving the results of treatment in elderly and aged people by means of local therapy with 'Detragel'. PATIENTS AND METHODS: The authors analysed the results of comprehensive examination and treatment of 60 elderly and aged patients presenting with acute varicothrombophlebitis and severe somatic diseases. Depending on the method of treatment, the patients were subdivided into 2 statistically homogeneous groups consisting of 30 patients each. The patients of both the first and the second group were subjected to crossectomy followed by application of either the 'Lioton' gel or 'Detragel' onto the thrombosed veins for 30 days in Group One and Group Two patients, respectively. Ultrasonographic angioscanning was used to determine dissemination of the thrombotic process in the superficial veins. Before and after the operation we examined the dynamics of the temperature-related and leukocytic reaction, as well as the degree of severity of the oedematous and pain syndromes. Six months after the operation we studied the patients' quality of life using the SF-36 questionnaire. RESULTS: A disseminated form of varicothrombophlebitis was revealed in 35 (58.3%) patients, a local form in 11 (18.3%), and a subtotal one in 9 (15%) patients. The total form with the involvement of the anastomoses of the superficial veins with the deep ones, requiring thrombectomy was detected only in 5 (8.3%) patients and thrombosis of the perforant veins in 3 (5%) patients. Crossectomy made it possible to disrupt the spread of the thrombotic process to the deep veins, with no venous thromboembolic complications registered. Local therapy with Detragel made it possible by POD 7 to normalize both the temperature-related and leukocytic reactions, to relieve the oedematous and pain syndromes, as well as in the remote period to increase the physical health component by 6.42% and the mental health component by 10.21%. CONCLUSION: Local therapy of acute varicothrombophlebitis with Detragel in elderly and aged patients makes it possible to increase the patients' quality of life.

[CHOICE OF PROSTHESIS IN AXILLOFEMORAL BYPASS IN PATIENTS WITH HIGH RISK AND MULTILEVEL LESIONS OF LOWER LIMB ARTERIES].

An analysis of results of experimental research was made in 60 patients with critical ischemia of lower extremities due to bilaterally atherosclerotic lesions of aorto-iliac segment, which had a high operationally anaesthetic risk. Synthetic polytetrafluoethylene prosthesis or biological shunt from internal pectoral bull arteries were used as a shunt. Revasculization was performed through the system of arteria profunda femoris considering multilevel lesions of lower limb arteries. An application of biological prosthesis allowed decreasing the rate of early postoperative complications on 13,3% , late thromboses--on 30%, extending the medium term of shunt functioning in 1.8%, improving physical component of health on 12.8% and mental--on 9.1% during the immediate postoperative period. The experiments on rabbits were carried out. It was shown, that biological prosthesis had the greatest biological compatibility.

[Use of a biological graft for subclavian-femoral bypassing in patients at operational-anaesthesiological risk].

UNLABELLED: Analysed herein are the results of an experimental study performed on 30 rabbits and a clinical study of treating a total of 60 patients presenting with critical ischaemia of lower limbs on the background of bilateral atherosclerotic lesions of the aortoiliac segment and running high operational-anaesthesiological risk. The animals were subdivided into three groups: an intact group consisting of 6 animals and two study groups comprising 12 rabbits each. In the first study group onto the wall of the abdominal aorta we implanted a synthetic polytetrafluoroethylene prosthesis, the second study group animals received biological graft "Kemangioprotez" from bovine internal thoracic arteries. The biological prosthesis on day three after implantation onto the arterial wall induced 3.2 times and on day seven 1.2 times more pronounced inflammatory reaction than the polytetrafluoroethylene prosthesis. 30 days after implantation of the synthetic graft the degree of repair connective-tissue processes in the arterial wall was 1.8-fold and 70 days after was 3.3-fold more pronounced than after implantation of the biological prosthesis at the same terms. In the connective-tissue capsule around the synthetic prosthesis predominated cellular elements while around the biological prosthesis - fibrous structures predominated. The patients were subdivided into 2 groups consisting of 30 patients each. In Group One patients the shunt used was a synthetic polytetrafluoroethylene prosthesis, in Group Two being a biological graft from bovine internal thoracic arteries. All patients suffered from severe concomitant diseases in the decompensation stage and a multi-level lesion of lower-limb arteries. Revascularization of the ischaemized extremity was carried out through the system of the deep femoral artery system. The use of a biological prosthesis made it possible in the immediate postoperative period to decrease the frequency of early postoperative complications by 13.3%, that of late graft thromboses by 30%, to prolong the average term of grafts functioning 1.8-fold, to increase the physical component of health by 12.8% and the mental one by 9.1%. CONCLUSION: For femorosubclavian shunting in high-risk patients it is appropriate to use a biological graft while establishing a distal anastomosis with the deep femoral artery.

[Efficiency of bioprosthesis in case of axillary-femoral bypass in patients with high operative risk].

It was analyzed the treatment results of 60 male patients with critical limb ischemia in case of atherosclerotic lesions of the aorta-iliac segment and severe somatic diseases. All patients were divided into 2 groups. Every group consisted 30 patients. The first group included axillary-femoral bypass by using of synthetic polytetrafluoroethylene prosthesis. The second group - by using of bioprosthesis of bull's internal thoracic arteries. Using of bioprosthesis allows to reduce early postoperative complications in intermediate postoperative period on 13.3%, late bypass thrombosis on 30%. Also there was elongation of average time of bypasses functioning in 1.8 times. Physical health was increased on 12.8%, mental - on 9.1%.

[Choice of the method of minimally invasive treatment of high venovenous blood reflux in patients with varicose disease of the lower extremity veins].

An analysis of complex examination and the following treatment of 337 patients with varicose disease was made. According to the results of the examination three groups of patients were established: the first group--of low intensive, the second group--of mean intensive, the third group--of highly intensive blood reflux. The patients of the first group were treated by the method of injection-sclerosing therapy. In the second group the sclero-surgical technology was used: after crossectomy into the lumen of the varicosity altered part of the great subcutaneous vein the sclerosing substance was administered through a catheter. In the third group ablation of the great subcutaneous vein of the femur was performed and obturation of the varicosity altered veins of the crus with the autovein ablated from the femur. In the first group recurrent diseases were noted in 9.1%, in the second group--in 9.4%, in the third--in 3% of the patients.

[Diagnosis and treatment of atypical forms of varicose disease of pelvic veins].

Results of sclerotherapy of 59 patients with atypical forms of varicose disease of pelvic veins were analyzed. Four atypical forms of the disease were revealed: suprapubic (30.5%), vulvar (20.3%), perineal (25.5%) and gluteal (23.7%). Clinical, ultrasonic and phlebographic investigations have found that a pathological caval reflux of blood involving the internal ileac vein and its inflows underlie the development of atypical forms. An original technology of sclerotherapy of atypical forms of varicose disease by means of multiple repeated administration of sclerosant in minimal doses has been developed capable to cause but proliferative processes in the varicose vein walls. Elastic compression was not used. Varicose disease of the lower extremity veins was revealed in 36 (61%) patients with atypical forms of varicose disease of the pelvic veins. The volume of treatment of such patients was supplemented with operation of crossectomy, catheter sclerotherapy of the main trunk of the large subcutaneous vein and injectional sclerotherapy of its inflows. Results of treatment were assessed by clinical examination of the patients, duplex scanning and investigation of quality of life on the basis of self-appraisal of the patients according to recommendations of the international association of phlebologists. Excellent results were obtained in 32.6%, good - in 46.1%, satisfactory - in 19.1%, unsatisfactory - in 2.2% of the patients.

[Noninvasive diagnostics and treatment of pelvic organs blood repletion syndrome].

Analysis of complex clinical and ultrasound research in 78 women with chronic pelvic venous insufficiency was carried out. Left-side regional renal venous hypertension leading to valve insufficiency of left ovarian vein with extension of reno-ovarian blood reflux on racemose, uterovaginal, presacral, vesical and rectal venous plexuses was discovered in 100% of patients. Right-side cava-ovarian blood reflux was discovered only in 26.9% of patients and in combination with reno-ovarian lead to complete decompensation of venous outflow from pelvis. Three degrees of blood repletion of small pelvis organs were marked out. At first degree (61.5% of patients) complex drug treatment was carried out, at second degree (18%) - sclerotherapy, at third degree (20.5%) - operative excision of ovarian veins. Perfect results were seen in 35.9% of patients, good results - in 44.9% of patients, satisfactory - in 19.2% of patients. On basis of self-appraisal 80.8% of patients consider their life quality as completely recovered, 15.7% of patients - as improved, 3.5% of patients - without any changes.

[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%.

[Sclerotherapy of high venovenous blood reflux in patients with early varicose disease of the lower extremities].

Results of diagnosis and treatment of 270 patients with varicose disease were analyzed. Based on duplex scanning two groups of patients were divided: group 1 consisted of 164 patients with low-intensity reflux, group 2 consisted of 106 patients with high-intensity reflux. Patients of group 1 were treated with ultrasound-assisted puncture sclerotherapy. In group 2 sclerosurgical procedures were used: sclerosant was injected into great saphenous vein trough catheter after crossectomy. For obliteration of varicose subcutaneous veins and perforants of shank the Irish technique was used. In group 1 recurrence of the disease was revealed in 9.1% patients, in group 2 -- in 9.4% patients.

[The mechanisms of the natural history of small pelvis varicosis]. / Mekhanizmy razvitiia varikoznoi bolezni ven malogo taza.

An analysis was made of the results of an all-round clinical, ultrasound, phlebotonometric and phlebographic examination of 89 patients with the clinical evidence of chronic venous insufficiency (CVI) of the pelvis. It is established that small pelvis varicosis develops because of hemodynamic disorders in the system of the inferior vena cava, iliac and left renal veins. In men, blood reflux from the iliac vein to the parietal tributaries leads to the development of the atypical forms of varicosis. In women, the left- sided regional renal venous hypertension induces valvular insufficiency of the left ovarian vein with the extent of the renoovarian blood reflux to the pampiniform, uterovaginal, presacral, vesical and rectal venous plexus. The concomitant action of the caval and renoovarian blood refluxes causes the origination of the syndrome of the blood overfilling of the pelvic organs and varicosis of the pubis, perineum, vulva, and buttocks. The clinical, ultrasound and phlebographic appearance of small pelvis varicosis is described in detail.

[Sclerotherapy of small pelvis varicosis]. / Skleroterapiia varikoznoi bolezni ven malogo taza.

This paper analyses the results of sclerotherapy provided to 89 patients with small pelvis varicosis. Selection of the treatment technology depended on the clinical variant of disease. In patients with damage to the parietal venous system of the pelvis, the treatment was realized by multiple repeat injections of a sclerosing agent to the pelvic veins in a minimal dose which may induce only proliferative processes in varicose vein walls. Elastic compression was not applied. Women with the syndrome of blood overfilling of the pelvic organs (visceral pattern of lesion) were provided sclerotherapy of the left ovarian vein followed by its pharmacological spasm. The treatment results were evaluated by clinical examination of patients, duplex scanning end estimation of the quality of life based on the patients' self-estimation according to the recommendations of the International Association of Phlebologists. Excellent results were obtained in 32.6%, good in 46.1%, satisfactory in 19.1% and unsatisfactory results in 2.2% of patients.

[The diagnosis and treatment of chronic venous insufficiency of the pelvis of non-occlusive genesis]. / Diagnostika i lechenie khronicheskoi venoznoi nedostatochnosti taza neokkliuzionnogo geneza.

The clinical, ultrasonic duplex scanning and phlebographic (retrograde pelvis renoovaricography) examinations of 89 patients with chronic venous insufficiency of the pelvis were analyzed. Two forms of the clinical course of the disease were established: parietal and visceral. A detailed clinical, ultrasonic and phlebographic characteristics of these forms are described. The authors have developed two original methods of sclerotherapy: 1. varicose dilated superficial veins in the zones of atypical localization without using the elastic compression; 2. left ovarian vein with its following pharmacological spasm. The effectiveness of the sclerozing treatment was 86.6% with the first method and 100%--with the second method.

[Technology for sclerosurgical treatment of upper veno-venous reflux of the large subcutaneous vein in varicose vein patients]. / Tekhnologiia sklerokhirurgicheskogo lecheniia vysokogo veno-venoznogo refliuksa po bol'shoi podkozhnoi vene u bol'nykh varikoznoi bolezn'iu.

Under analysis were results of a complex ultrasound examination and the following treatment of 101 patients with varicose disease which had developed due to a high veno-venous ejection. The decision on the method of treatment depended on the variant of reflux spread and the degree of dilatation of the large subcutaneous vein. Four variants of spreading the reflux were established: in the inguinal area only (3.8%), along the femur to the level of the knee articulation (13.6%), femur and the upper third of the shin (66.8%), from the groin to the malleolus (15.8%). Selective interventions consisting in scleroobliteration or removal of the large subcutaneous vein within the limits of the femur or upper third of the shin were fulfilled in 84.2% of the patients. Sclerotherapy was used in veins having the diameter from 5 to 7 mm, sclerosurgery--with the diameter from 8 to 10 mm, surgical treatment in veins with the diameter more than 10 mm. The effectiveness of liquidation of the reflux was 95.2%.

[Mechanisms of the development of venous hypertension in patients with varicose disease]. / Mekhanismy razvitiia venoznoi gipertenzii u bol'nykh varikoznoi bolezn'iu.

The examination of 539 patients with varicose disease was fulfilled with the help of ultrasonic (dopplerography, angioscanning), rentgenological (phlebography, lymphography), functional (rheovasography, photoplethysmography) methods. Two forms of venous hypertension were established: superficial and deep. Hemodynamic disorders in patients with the superficial form result from the formation of isolated blood refluxes in the superficial, perforant and profound veins. In patients with this form the muscular-venous pump has mild disturbance and is clinically manifested as a slowly progressing course of the disease. The basis for the development of the deep form is a severe valve incompetence of the profound veins with the formation of associated blood refluxes in all the elements of the muscular-venous pump. The latter completely looses its function which leads to a rapid lympho-venous decompensation.

[The mechanisms of the development of decompensated forms of varicose veins]. / Mekhanizmy razvitiia dekompensirovannykh form varikoznoi bolezni.

The functional (rheovasography, photoplethysmography), ultrasonic (dopplerography) and roentgenological (distal ascending and retrograde popliteal and talocrural phlebography) methods of investigation were used for studying the state of the musculo-venous pump of the crus in 50 patients with the varicose disease in the stage of trophic disorders. It was established that the formation of pathological capacities in the crural muscular veins and leakage of blood from the posterior tibial into deep plantar veins was responsible for the development of the decompensated course of this disease.

[The pathogenetic validation of the volume and the technology for the surgical correction of disorders in the musculo-venous pump of the lower extremities in patients with decompensated forms of varicose veins]. / Patogeneticheskoe obosnovanie ob''ema i tekhnologiia khirurgicheskoi korrektsii narushenii myshechno-venoznoi pompy nizhnikh konechnostei u bol'nykh s dekompensirovannymi formami varikoznoi bolezni.

The state of the venous, capillary blood circulation and lymph flow was studied in 70 patients with varicose disease at the stage of trophic disorders with the help of photoplethysmography, rheovasography, dopplerography, distal ascending and retrograde femoral, popliteal, talocrural phlebography, lymphography. It was established that a sharp disturbance of the musculo-venous pump function caused decompensation of not only the venous blood circulation but also the lymph flow, while the removal of the subcutaneous veins of the crus is not possible without deterioration of the lymphatic drainage. The authors propose not to ablate the main trunks of the subcutaneous veins on the crus but to perform occlusion of the autovein ablated from the femur. A technology of resection of the pathologically altered vein of the soleus and gastrocnemius muscles and retrograde occlusion of the posterior tibial veins is developed for improving the work of the musculo-venous pump of the leg. Good results of treatment were obtained in 84.3% of the patients.

[Surgical correction of vertical reflux of blood in musculo-venous pump of the lower limbs and pelvis in patients with varicose veins]. / Khirurgicheskaia korrektsiia vertikal'nogo refliuksa krovi v myshechno-venoznoi pompe nizhnikh konechnostei i taza u bol'nykh varikoznoi bolezn'iu.

The authors have made an analysis of results of treatment of 469 patients with the varicose disease. During operations on them surgical correction of vertical reflux of blood was performed by means of extravasal correction of incompetent valves of the femoral, popliteal and tibial veins, resection or obturation of the posterior tibial veins. Traditional methods (frame spiral and fascioplication) and original ones (three ligatures and tension of the valve cusps through the frame spiral coil) were used. Elimination of the vertical reflux of blood in each of the four pumps (abdomino-caval and femoral ones, those of the leg and foot) forming the musculo-venous pump, results in getting 7% greater amount of excellent and good results, bad results were obtained in 3.4% less number of cases. The period of temporary loss of working ability becomes shorter.

[Hemodynamic characteristics of the state of musculo-venous pump of the lower limbs and pelvis in patients with varicose veins]. / Gemodinamicheskaia kharakteristika sostoianiia myshechno-venoznoi pompy nizhnikh konechnostei i taza u bol'nykh s varikoznoi bolezn'iu.

The method of phlebotonometry developed by the authors was used in an analysis of results of the state of musculo-venous pump of lower extremities and pelvis in 106 patients with varicose disease. The dynamics of phlebotonogram indices was studied during isolated functional exercises of the muscles of prelum abdominale, femur, leg and foot. In the first and second stages of the disease the function of both the single pumps and the whole pump system is disturbed but mildly and has no stage distinctions. Their pronounced impairment appears but in cases of a complicated course of the disease. In valvular incompetence of deep veins the musculo-venous pump looses its function: the greater the degree of valvular incompetence, the worse the functioning of this structure.

[Noninvasive diagnosis of pathological reflux of blood in the musculo-venous pump of the lower limbs and pelvis in varicose disease]. / Neinvazivnaia diagnostika patologicheskikh refliuksov krovi v myshechno-venoznoi pompe nizhnikh konechnostei i taza pri varikoznoi bolezni.

An examination and following treatment of 469 patients with varicose disease were carried out on the basis of a three-steps noninvasive diagnostic complex developed by the authors of the article. The first step is intended for examining the patients in order to detect injuries of each of the four pumps (the abdomino-caval pump, femur, shin and foot) involved in the venous return. The functional tests developed by the authors were used. The second step included the determination of the degree of injury of the pumps under study with the help of functional rheovasography of the femur, shin and foot. Methods of ultrasonic dopplerography were used at the third step for detecting the causes of the developing blood refluxes.