[Case of effective endovascular treatment of venous gangrene]. / Sluchai éffektivnogo éndovaskuliarnogo lecheniia venoznoi gangreny.

Presented in this article is a clinical case report regarding treatment of a patient with deep vein thrombosis complicated by venous gangrene having developed 10 days after the onset of the disease. Conservative therapy (infusion of colloids and crystalloids, anticoagulants, agents improving microcirculation, venotonics, nonsteroidal anti-inflammatory drugs, elevated position of the limb) made it possible to stabilize the patient's condition, but not improving haemodynamics of the affected limb. A decision was made to use endovascular techniques. Treatment was carried out in three stages. The first stage during 48 hours consisted in regional catheter thrombolysis with urokinase, exerting a minimal clinical effect. The second stage was percutaneous mechanical thrombectomy after which the diameter of thrombosed veins became free by half, with the beginning of disease regression. The third stage consisted in venous stenting of residual stenosis of the iliac vein, resulting in normalization of the venous outflow from the affected limb. A conclusion was drawn on feasibility of combined use of regional thrombolysis, percutaneous mechanical thrombectomy, and venous stenting in treatment of venous gangrene.

[Efficacy of apixaban in prevention of haemorrhagic complications in treatment of deep vein thromboses with endovascular techniques]. / Éffektivnost' apiksabana v profilaktike gemorragicheskikh oslozhnenii pri lechenii trombozov glubokikh ven éndovaskuliarnymi tekhnologiiami.

PURPOSE: This study was undertaken to investigate efficacy of apixaban in prevention of haemorrhagic complications during treatment of proximal thromboses of deep veins of the lower extremities using endovascular techniques. PATIENTS AND METHODS: We retrospectively studied the results of treating a total of 50 patients presenting with deep vein thromboses at late stages of the pathological process. The patients were subdivided into 2 statistically homogeneous groups. Group One was composed of 30 patients undergoing treatment consisting in a combination of catheter-guided thrombolysis with urokinase and percutaneous mechanical thrombectomy, with rivaroxaban used for prolonged anticoagulation therapy. Group Two comprised 20 patients subjected to similar endovascular treatment with additional venous stenting. Prolonged 6-month anticoagulation therapy was carried out with apixaban. The results of treatment were assessed after 12 months by means of control ultrasonographic and clinical examination in order to determine the degree of restoration of the lumen of deep veins and severity of venous outflow impairments. RESULTS: After 1 year, in Group One patients there was no evidence of impaired venous outflow in 40% of patients, with a mild degree revealed in 40%, moderate degree in 13.3%, and severe degree in 6.7% of patients. In Group Two patients, there were no symptoms of venous insufficiency in 83.4%, with a mild degree revealed in 16.6%. Neither moderate nor severe impairments of venous outflow were observed. In Group One, manifestations of haemorrhagic syndrome on the background of taking rivaroxaban were noted to occur in 10% of patients and in Group Two on the background of taking apixaban also in 10% of patients. CONCLUSION: The use of apixaban in patients with proximal thromboses of deep veins of lower limbs on the background of treatment by endovascular techniques proved effective and safe.

[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.

[Results of administering oral anticoagulants for treatment of patients with venous thromboembolic complications]. / Rezul'taty primeneniia peroral'nykh antikoaguliantov pri lechenii bol'nykh s venoznymi tromboémbolicheskimi oslozhneniiami.

The objective of the study was to compare safety and efficacy of rivaroxaban and dabigatran with warfarin in treatment of patients with acute venous thromboembolic complications (VTEC). The authors analysed the results of examining and treating a total of 95 patients presenting with VTEC and randomly divided into three groups. In all groups the initial anticoagulant therapy consisted in unfractionated heparin administered for 5 days, after which the patients followed by switching were switched to a 6-month course of treatment with oral anticoagulants. Patients from Group One received warfarin, Group Two patients were treated with dabigatran etexilate, and Group Three patients were treated with rivaroxaban. Relapses of the disease were diagnosed in 2 (5.7%) patients from Group One. Haemorrhagic complications were noted in 8 (22.9%) Group One patients, in 3 (10%) Group Two patients and in 2 (6.7%) Group Three patients. After the end of treatment, complete recanalization of the thrombosed veins was revealed 13 (37.1%) patients from Group One, in 15 (50%) patients from Group Two and in 14 (46.7%) patients from Group Three. One year after the end of treatment, freedom from chronic venous insufficiency was observed in 8 (23.3%) patients of Group One, in 12 (40%) patients of Group Two and in 11 (36.6%) patients of Group Three. The composite quality of life indices after the treatment course were (appeared to be) higher in Group Two and Three patients compared with those of Group One. Hence, a conclusion was drawn that dabigatran and rivaroxaban turned out to be superior by efficacy and safety to warfarin in treatment of this patient cohort. No statistically significant differences were observed while comparing dabigatran and rivaroxaban.

[Mechanisms of development and sclerosurgical treatment methods of acute surface varicothrombophlebitis].

An analysis of complex laboratory, ultrasonic investigations and following treatment of 120 patients with acute surface varicothrombophlebitis was made. The patients were divided into two groups, each being 60 people. In the first control group the treatment was conducted in one step: standard venectomy was performed at high point of inflammatory process. In the main group, the development of thrombotic process was prevented by sclerosurgical technology at the first stage. Radical treatment was carried out at the second stage after 4-6 weeks. The number of complications in near-term postoperative period decreased in 5% and in long-term in 13.3%, the quality of life increased in 13.3% in second group patients.

[Effects of garlic allicor tablets on lipid metabolism and risk of fatal cardiovascular complications in patients with atherogenic dyslipoproteinemia].

The aim of investigation was to assess an effect of allicor at a lipid metabolism and a free radical oxidation of blood lipids, anthropometic values, and arterial blood pressure at patients with atherogenic dislipoproteidemy. 112 patients (47 men and 65 women) 40 to 60 years of age were examined. 56 patients had ischemic heart disease and/or equal disorders. Another 56 patients were free of any signs of atherosclerosis, but had one or more risk factor of cardiovascular pathology. Six month therapy using allicor results in moderate hypolipidemic and antioxidative effect. A dosage of 600 mg per day decreases individual ten-year chance of fatal cardiovascular complications at patients with clinical signs of atherosclerosis, whereas at patients who have no signs of atherosclerosis the complications are decreased with dosage of 300 mg per day.

[Minimally invasive surgery of acute superficial varicothrombophlebitis in patients having somatic contraindication to venectomy].

An analysis was made of complex examination and the following treatment of 21 patients with acute superficial varicothrombophlebitis who had some pronounced pathology of internal organs preventing radical treatment. An original technology of treatment of varicothrombophlebitis developed by the authors includes crossectomy, truncal catheter sclerotherapy up to the place of thrombosis of the subcutaneous veins, stage-wise phlebocentesis of the thrombosed veins followed by injectional sclerotherapy with the ultrasonic control. The thrombophlebitis phenomena were arrested in all patients. In addition, the clinical manifestations of chronic venous insufficiency were regressed in the postoperative period.

[Optimization of surgical treatment of acute superficial varicose thrombophlebitis]. / Optimizatsiia khirurgicheskogo lecheniia ostrogo poverkhnostnogo varikotromboflebita.

Complex examination and the following treatment of 142 patients with acute superficial varicothrombophlebitis were analyzed. The patients were divided into 2 groups. The first group consisted of 41 patients who were subjected to venectomy in the acute period of the disease, the second group--of 101 patients with two stages of treatment. At the first stage sclerosurgical technologies were used to arrest the inflammatory process. At the second stage the thrombosed varicose veins were surgically ablated. In the first group patients complications at the early postoperative period developed in 17% of cases, at the late period--in 14.6%. In the second group complications were noted in 3 and 2% of cases respectively.