[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.

[Specific strategic decisions and surgical treatment in patients with ischemic heart disease and postinfarction aneurysms of the left ventricle and atherosclerotic lesions of brachiocephalic arteries].

Under observation there were 14 male patients. Since 1995 a method of transprosthetic aortotomy has been used in patients with impaired carotid arteries, later this method was used in patients with postinfarction aneurysms of the left ventricle. In addition, in 3 critical patients we used minimally invasive techniques of surgery in stage-wise treatment. Single-stage operations in ischemic heart disease patients with postinfarction aneurysms of the left ventricle and a lesion of the brachiocephalic arteries (BCA) are indicated in the following cases: 1. In intrathoracal lesion of BCA; 2. In atherosclerotic lesion of the left coronary artery trunk; 3. In patients with postinfarction aneurysms of the left ventricle and with output fraction less than 35%; 4. When instable angina is not amendable to medicinal stabilization.

[Specific features, problems, and prospects of myocardial revascularization in elderly and aged patients].

Last years the progress in development and improvement of coronary surgery and angioplasty, with shunting with patients of elderly and senile age, has been observed in the Russian Federation. This is connected, in the first place, with the progress in timely diagnostics of coronary artery disease, development of surgical equipment, anaesthesiology and resuscitation, introduction of new methods of intra-operative protection of myocardium, development and active use of modern methods of treatment of patients before and after the operation. However despite the versatility of existing scientific schools and literary sources covering this problem, the discussions on indications and contraindications to active surgical treatment of coronary artery disease with the patients of the given age group still continue. A great number of specialists in the field of cardiology and cardiosurgery do not tackle the solution of these problems as based on age-specific morphological and functional changes of the cardiovascular system.

[A topographic anatomical validation of the choice of the approach in reconstructive operations on the extracranial portion of the internal carotid artery]. / Topografoanatomicheskoe obosnovanie vybora dostupa pri rekonstruktivnykh operatsiiakh na ékstrakranial'nom otdele vnutrennei sonnoi arterii.

The purpose of the research was to give a topographical substantiation of the choice of an approach to the extracranial internal carotid artery (ICA) in view of individual anatomical variability of ICA and various localizations of stenosis or occlusion. In 38 human corpses ICA was uncovered using operative methods proposed by Cooper. DePalma, Pauliukas and Nelson. A comparative estimation of the approaches was given with calculation of standard parameters of the operative wound. It was established that the approach to the subcranial ICA was dependent on the type of constitution, features of the anatomical shape of the mandible, distance between the mandibular angle and mastoid process. The statistical processing of the findings has shown that all the factors in question made up 91.5% which is enough for the mathematical description of the position of ICA. Regression models of accessibility of the ICA segment for each of the four investigated approaches were made. The PC program for Windows 95/NT which allows the estimation of accessibility of ICA in each patient before operation was created. These mathematical models were used in the clinic for surgical treatment of the ICA pathology in 24 patients. The difference between the calculated data of ICA accessibility and intraoperative measurements was +/- 3 mm. It demonstrates reliability of the estimation of the approach parameters before operation.