[The efficacy of peptide bioregulators of vessels in lower limbs chronic arterial insufficiency treatment in old and elderly people].

Atherosclerosis is a leading cause of obliterating diseases of the arteries in 80-90% of cases. The main pathogenetic mechanism is endothelial dysfunction, leading to hypertension, diabetes, congestive heart failure. The desire of modern society to improve the quality of life increases interest of human health in general and sexual health in particular, because the erectile function is an important factor in the quality of life, which makes us look for more effective methods of diagnosis, treatment and rehabilitation. The objective of the study was to assess the effectiveness of vasoactive tripeptide Vezugen in patients with vasculogenic erectile dysfunction as manifestation of atherosclerosis. Treatment results of erectile dysfunction in 41 patients were studied. A comparative analysis of clinical and instrumental parameters of blood flow in the main penile arteries before and after monotherapy was undertaken. The results show that the blood flow through the main artery of the penis after Vezugen treatment significantly improved both clinical and by objective indicators.

[Debitometry in outcome forecasting of lower limb artery reconstructions in elderly and senile patients].

We use perfusion roller debitometry as an original method of flowmetry. Roller pump enables to support perfusion pressure at constant level. This way, we can estimate the flow rate of distal vascular throughput at aorto-femoral and femoro-popliteal reconstruction for success of operation.

[Medico-diagnostic strategy in patients with postinfarction aneurysms of the left ventricle in combination with aneurysms of the abdominal part of the aorta].

The authors describe the algorithm of examination and methods of operation on 24 patients. It allowed shortening the time of compression of the aorta, of acute ischemia of the lower extremities, less operation blood loss, exclusion of postoperative lethality.

[Pathogenesis of chronic ischemia of the lower extremities in patients of advanced ages].

Peripheral artery disease can be most frequently observed at elderly and senile age. Aging, development of atherosclerosis and propensity to thrombosis are closely interconnected. The age of 50-70 years is the most critical to developing vascular insufficiency. The basic risk factors are smoking, arterial hypertension, male sex, genetic and alimentary infringements, diabetes and obesity. Chronic arterial insufficiency displays system character of atherosclerosis in elderly patients. The arterial diseases resulting in a chronic ischemia of legs are one of the widespread pathological processes considerably accelerating aging, reducing longevity and quality of a life in elderly and senile patients.

[Surgical treatment of patients with postinfarction aneurysm of the left ventricle in combination with atherosclerotic lesion of the lower extremity arteries].

Examinations and operations on 36 ischemic heart disease patients with postinfarction aneurysm of the left ventricle (PIALV) in combination with hemodynamically significant obliterating atherosclerosis of the lower extremity arteries were performed in the clinic during the period from 1995 through 2005. The first stage of the treatment included resection of PIALV and myocardium revascularization. Positive results were obtained in all 36 patients at the first stage of surgical treatment, without ischemia of the myocardium being observed in the postoperative period. The contractive function of the left ventricle as an ejection fraction due to resection of PIALV and its plasty was on average 17% greater, which created favorable conditions for the following stage of surgical treatment. At the second stage of surgery an individual approach was used for patients with generalized atherosclerotic lesions of the lower extremities with special reference to specific clinical picture, as well as non-standard surgical methods. Among the nonstandard surgical methods there were transprosthetic aortotomic shunts and the method of a reverse formation of anastomoses.

[The Troyanov-Trendelenburg operation in combination with sclerotherapy as an effective method of outpatient treatment of varicose disease].

The authors have analyzed the strategy and results of treatment of varicose disease of lower extremities in 452 patients on an outpatient basis. It was shown that the Troyanov-Trendelenburg operation should be used as the first stage of treatment, and sclerotherapy should be carried on after the 4th day.

[Surgical treatment of aneurysms of the abdominal aorta in patients with generalized atherosclerosis]. / Khirurgicheskoe lechenie anevrizm briushnoi aorty u bol'nykh s generalizovannym aterosklerozom.

The authors made operations on 131 patients with aneurysms of the abdominal aorta (AAA). Most severe patients were operated on using a modified resection or "exclusion" of the AAA and aorto-iliac bifurcation prosthesis with reverse formation of anastomoses. It was found that the proposed method increases safety of the operative treatment of AAA and is preferable for patients with a severe coexisting pathology.

[Transprosthetic aortotomy in reconstruction of the brachiocephalic zone arteries for multiple injury of the opening]. / Transproteznaia aortotomiia v rekonstruktsii arterii brakhiotsefal'noi zony pri ikh mnozhestvennom ust'evom porazhenii.

An experience with transprosthetic aortotomy in 8 patients is analyzed. There were no lethal outcomes. The technique of the operation is described.

[Continuous inhalation administration of surfactant-BL for control of adult respiratory distress syndrome after reconstruction of the abdominal aorta]. / Dlitel'noe ingaliatsionnoe vvedenie surfaktanta-BL dlia kupirovaniia respiratornogo distress-sindroma vzroslykh razvivshegosia posle rekonstruktivnogo vmeshatel'stva na briushnoiaorte.

A 62-year-old patient with Leriche's syndrome and critical ischemia of the low extremities has undergone the surgery of aortofemoral grafting. A patient has developed the severe ARDS on the second day of reperfusion (bilateral diffuse infiltrates, PO2/FiO2 < 100, lung injury score was 3). Different ways of administration of bovine surfactant (SURFACTANT BL, Russia) were used during the treatment. Total application time was 84 hours, total dose was 4000 mg (50 mg/kg). Considerable improvement of lung function occurred after start of the continuous inhalation of surfactant with a constant rate of 63 mg/h. Two hours after this step PO2/FiO2 reached 400 mm Hg and remained stable 12 hours more, up to the end of surfactant administration. The patient was soon successfully extubated and discharged on the 25th day after surgery. It is supposed that in spite of a small total dose of bovine surfactant the success was achieved due to an early start of the surfactant replacement, continuous inhalation and its definite rate.

[Intraoperative changes in the peripheral circulation with different methods for reconstructing the arteries of the extremities]. / Intraoperatsionnye izmeneniia perifericheskogo krovoobrashcheniia pri raznykh sposobakh rekonstruktsii arterii konechnostei.

An examination of 192 patients with obliterating atherosclerosis of lower extremities was made who had different reconstructive operation. Intraoperative measurements of oxygen strain in the foot skin and rheography of the shin have shown that temporary compression of large arteries when making vascular anastomoses cause ischemia of extremities, whose degree and duration is dependent on the technique of the technique of the intervention. Advantages of the method of transprosthetic aortotomy such as less duration and lower degree of ischemia were shown. The possibility was revealed to prognose nearest results of treatment for changing regional hemodynamics and oxygenation of tissues at the moment of termination of the operation.

[The physiological aspects of the efficacy of reconstructive operations in arteriosclerosis obliterans of the lower extremities]. / Fiziologicheskie aspekty éffektivnosti rekonstruktivnykh operatsii pri obliteriruiushchem ateroskleroze nizhnikh konechnostei.

Reconstructive operations in the aorto-iliac and femoro-popliteal segments were performed on 281 patients with obliterating atherosclerosis. An attentive examination of the patients in the nearest postoperative period and within the first 5 years has shown different efficiency of the operation in different patients. Favorable changes took place in regional hemodynamics, while disturbances retained in microcirculation and function of the extremity. Another cause of insufficient efficiency of the interventions was an initial stable suppression of tissue respiration and oxygen utilization in the extremity tissues. The dynamics was positive during a year followed after that by new symptoms of progressing disease.

[Clinical substantiation of the new type of mechanical suture in prosthesis of the aortofemoral segment]. / Klinicheskoe obosnovanie novogo vida mekhanicheskogo shva pri protezirovanii v aortobedrennom segmente.

An original apparatus and a new kind of mechanical suture were used in experiment and in clinic for the formation of telescopic anastomosis. The anastomosis has an ideal round form, it is hermetic, the line of anastomosis is overlapped by a newly formed neointima for a distance of 1 cm. The anastomosis is put during several minutes. This operation does not require special training of the surgeon.

[Hemodynamic changes in patients with arteriosclerosis obliterans of the lower extremities after restoration of the circulation]. / Izmenenie gemodinamiki u bo'lnykh obliteriruiushchim arterio- sklerozom nizhnikh konechnostei posle vosstanovleniia magistra'l- nogo krovotoka.

It was established that reconstructive operations allow to adequately reestablish regional hemodynamics, the linear and capacitance velocity of the blood flow along the explant in the group of prosthesis being close to the values of patients in the group of shunting. The data obtained allow to make a conclusion on high efficiency of shunting by the method of transprosthesis aortotomy in patients with obliterating arteriosclerosis of lower extremities.

[A shunting method in the aortoiliac segment]. / Sposob shuntirovaniia v aorto-podvzdoshnom segmente.

Results of various kinds of reconstructive interventions in 237 patients with atherosclerotic occlusions of the abdominal aorta and iliac arteries are described. Shunting operations and prostheses in the aortoiliac segment in 76% of the patients give prolonged and considerable improvement of blood circulation in lower extremities. The most favorable results were obtained in patients who had been subjected to reconstructive operations on the aortoiliac segment with transprosthesis aortotomy not requiring an exclusion of the aorta and iliac arteries from blood circulation. There were no severe complications and lethal outcomes in this group of patients. The amount of thromboses decreased markedly, intestinal pareses were less frequent, the volume of blood transfusions became less and operations shorter.

[Postoperative treatment of abdominal injury victims]. / Posleoperatsionnoe lechenie postradavshikh s travmoi zhivota.

Among other procedures of a complex intense therapy applied upon 265 abdominal trauma cases the authors have included an early peritoneal perfusion and longlasting peridural blockade. The results evidence a high prophylactic and therapeutic effectiveness of the suggested methods