[Preventive surgery after vascular reconstruction for chronic lower limb ischemia]. / Preventivnye khirurgicheskie vmeshatel'stva posle sosudistykh rekonstruktsii po povodu khronicheskoi ishemii nizhnikh konechnostei.

OBJECTIVE: To analyze the results of redo reconstructions of lower limb arteries in patients with obliterating atherosclerosis, immediate and long-term results in patients who underwent reconstructive interventions with occlusion of previous reconstruction and preventive interventions. MATERIAL AND METHODS: The study included 43 patients. The main group (group 1) consisted of 18 patients who underwent preventive vascular reconstructions. The control group enrolled 25 patients who underwent redo interventions for occlusion of previous reconstructions. The control group was divided into 2 parts; 15 patients had chronic limb ischemia (group 2), 10 patients had acute limb ischemia (group 3). Mean age of patients was 56.8±8.2 years; there were 37 (86%) men and 6 (14%) women. Multifocal vascular atherosclerosis was noted in 41 (95.3%) patients, carotid artery lesion - 29 (70.7%), coronary artery disease - 34 (79%). Patients with type II diabetes mellitus were excluded. RESULTS: We chose each surgical intervention considering preoperative diagnostic data. Open, endovascular and hybrid interventions were performed. There were no deaths and limb amputations in the 1st group. Two (13.3%) amputations were registered in the 2nd group, 3 (30%) amputations and 1 (10%) death were registered in the 3rd group. The follow-up period was 24 months. An 18-month freedom from amputations was 71.5%, 78% and 38%, respectively (p<0.05 compared to the 1st and 2nd groups). CONCLUSION: Preventive surgical interventions prevent ischemia and amputation, as well as improves the results of redo surgery.

[Methods of decreasing the risk of repeat interventions in patients after arterial revascularization]. / Sposoby snizheniia riska povtornogo vmeshatel'stva u patsientov posle arterial'noi revaskuliarizatsii.

Discussed in the article are the main problems related to surgical treatment of patients with peripheral artery disease, particularly taking into consideration that in the world there are from 160 to 202 million people suffering from this disease, with two thirds of such patients having signs of lesions of coronary or cerebral arteries. Vascular reconstructive interventions cannot completely eliminate the problem, since in the postoperative period there may develop cardiovascular complications related to both the limb involved as either acute or progressing chronic ischaemia and arteries of other localization (coronary, cerebral). The risk of serious cardiovascular complications in patients with a history of endured adverse ischaemic events on the part of limbs is severalfold higher. To solve these problems and decrease complications, salicylic acid is used as basic therapy. Attempts at replacing it by another drug or combined therapy with an alternative antiaggregant showed no advantages in increased risk of massive haemorrhage. On the other hand, a combination of salicylic acid with an anticoagulant at a low dose, i. e., rivaroxaban 2.5 mg twice daily as compared with acetylsalicylic acid monotherapy made it possible to significantly decrease the incidence of various cardiovascular complications in the form of myocardial infarction, stroke, adverse ischaemic events on the part of the extremity, limb amputation.

[Hybrid interventions for acute thrombosis after reconstructive operations on lower-limb arteries]. / Gibridnye operatsii pri ostrykh trombozakh posle rekonstruktivnykh operatsii na arteriiakh.

BACKGROUND: A steadily growing number of primary lower extremity arterial reconstructions is inevitably followed by the need to perform repeat interventions. Shunt reocclusion may become a cause of return of ischaemia to the initial level, may significantly increase the degree of limb-threatening chronic ischaemia, as well as lead to the development of an acute condition requiring urgent corrective measures to be taken. A reoperation currently continues to remain the standard of treatment. Despite advances in modern resuscitation, the postoperative mortality rate in such patients reaches 20%. AIM: This study was aimed at assessing feasibility of hybrid technologies in acute thrombosis after reconstructive operations on lower-limb arteries. PATIENTS AND METHODS: We retrospectively analysed the results of treatment of 66 consecutive patients urgently admitted to the City Clinical Hospital named after S.S. Yudin from 2015 to 2020 with acute lower limb ischaemia caused by acute occlusion of the zone of primary vascular reconstructions previously performed at other medical facilities. Depending on the method of surgical treatment, the patients were divided into two groups. The Study group included 20 patients subjected to open surgical interventions followed by angiographic control and using one or other type of X-ray-endovascular treatment. Endovascular interventions were performed for more than 70% stenoses in the major arteries and zone of the previously performed operation. The Comparison group comprised 46 patients treated without endovascular technologies. They were subjected to thrombectomy from the vascular construction with/without reconstructive-restorative operations. RESULTS: Seventeen (85%) of the 20 Study group patients were operated on in a stagewise manner, with the first stage consisting of an open intervention - thrombectomy and reconstruction followed by angiographic control and roentgenendovascular treatment. The remaining three (15%) patients underwent simultaneous interventions. In the postoperative period, limb amputations were performed in ten (22%) Comparison group patients and in one (5%) Study group patient (p=0.049). There were three (7%) lethal outcomes in the Comparison group, with none in the Study group. CONCLUSION: A combination of open and endovascular interventions in patients with shunt occlusion after vascular reconstructions makes it possible to reveal the cause of shunt occlusion, as well as to remove multilevel lesions, minimizing surgical wound and contributing to reducing the amputation rate.

[Reperfusion syndrome: state of the art]. / Reperfuzionnyi sindrom. Sovremennoe sostoianie problemy.

Reperfusion syndrome is a complex series of clinical manifestations resulting from restoration of blood flow to previously ischaemic tissues. It is accompanied by damage to cells, tissues and organs at various levels, followed by the development of multiple organ failure. This review deals with the main pathophysiological mechanisms of the development of reperfusion syndrome in lesions of cardiac, cerebral and lower-limb vessels. Oxidative stress is considered to be the most important marker of ischaemia-reperfusion injury irrespective of the type of tissues affected. Presented herein are the data on contemporary possibilities of influencing various stages and components of the development of reperfusion injury by means of drug therapy, demonstrating that due to the importance of oxidative stress as a key link of reperfusion injury, antioxidant therapy should be the main component of prevention and treatment of reperfusion injury.

[Current concepts of anticoagulant and antiplatelet therapy in patients with vascular pathology]. / Osnovnye pozitsii po antikoaguliantnoi i antiagregantnoi terapii u patsientov s patologiei sosudov na sovremennom étape.

The routine practice of a vascular surgeon is invariably associated with decreasing the risk of adverse cardiovascular events in patients presenting with either arterial or venous pathology. Antithrombotic therapy is one of the key approaches used to achieve this purpose. However, a wide variety of modern drugs inhibiting platelet aggregation and agents blocking the coagulation cascade, as well as their combinations makes the selection of the most appropriate treatment for a particular patient quite a difficult task. The choice should carefully be made taking into consideration the nosology, aetiology, accompanying diseases and therapy thereof, as well as the balance of the risk of ischaemic and haemorrhagic complications. Therefore, availability of modern antithrombotic drugs favourably contributing to a more personified approach to treatment is of utmost importance. Thus, for example, rivaroxaban, an anticoagulant belonging to the class of direct-acting oral factor Xa inhibitors, provides a possibility to select an optimal dosage and regimen for a particular patient with arterial or vascular pathology in practice of a cardiovascular surgeon.

[Endovascular revascularisation in patients with necrotic wounds and extended infrainguinal arterial disease]. / Endovaskulyarnaya revaskulyarizatsiya u patsientov s gnoino-nekroticheskimi ranami nizhnikh konechnostei s infraingvinal'nym protyazhennym porazheniem arterial'nogo rusla.

OBJECTIVE: To report own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. MATERIAL AND METHODS: We have analyzed literature data and own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. RESULTS: Endovascular strategy is preferable in a certain subgroup of patients with extended infrainguinal lesions. CONCLUSION: Considering own data, we assumed the need for routine correction of outflow pathways (simultaneous angioplasty of at least 2 tibial arteries). Primary results are encouraging, but further research is required.

[Additional possibilities in conservative treatment of patients with post-thrombotic disease of lower limbs]. / Dopolnitel'nye vozmozhnosti v konservativnom lechenii patsientov s posttromboticheskoi bolezn'iu nizhnikh konechnostei.

AIM: This study was undertaken to evaluate efficacy of Actovegin in the composition of comprehensive therapy in patients presenting with post-thrombotic disease of lower extremities free from trophic disorders. PATIENTS AND METHODS: The study included a total of 60 patients (28 men and 32 women) diagnosed as having post-thrombotic disease of lower limbs without trophic disorders (C1-C3 according to the CEAP classification), induced by previously endured iliofemoral phlebothrombosis. The duration of the disease varied from 1 year to 10 years. All patients for 10 days received Actovegin intravenously in drips at a dose of 1200 mg (30 ml of the drug reconstituted in 400 ml of normal saline) followed by continuing taking the drug orally in a daily dose of 1200 mg for 30 days. During the whole follow up period the patients wore class 2 compression stockings (RAL standard). The results of the carried out treatment in relation to the subjective complaints (pain, feeling of heaviness, convulsions, pruritus and paresthesias) were assessed by the visual analogue scale and based on the CIVIQ-20 questionnaire, with additionally measuring the malleolar circumference. RESULTS: On the background of the carried out therapy the patients demonstrated a significant decrease in the oedematous syndrome in the area of the ankles. This parameter decreased form 26.88±0.39 cm to 25.02±0.35 cm (p<0.05). The patients' complaints of tingling decreased form 5.73±0.79 to 2.32±0.68 points (p<0.05), the incidence and intensity of convulsions fell from 6.51±1.39 to 3.2±0.98 points (p<0.05). The intensity of the oedematous syndrome (swelling) decreased significantly from 8.11±1.75 to 4.33±1.20 points (p<0.05), the pain syndrome fell from 7.92±1.88 to 3.12±1.45 points (p<0.05), the feeling of heaviness in the lower limbs decreased from 8.52±1.73 to 3.91±1.48 points (p<0.05). Also, improvement of the general quality of life of patients was observed (the integral parameter decreased from 63.27±1.8 to 44.33±1.19 points, p<0.05).

[Revascularisation in patients with failed previous arterial reconstructions]. / Metody revaskuliarizatsii u patsientov s narusheniem prokhodimosti ranee vypolnennykh arterial'nykh rekonstruktsii.

Redo arterial reconstructions are followed by advanced surgical risk or impossible in some cases. Active introduction of endovascular surgery complements the capabilities of conventional surgical approach. It is presented case report of restoration of patency of synthetic femoral-popliteal shunt with previous occlusion for a long time. The technique of recanalization and stenting of allograft is described. Immediate results are favorable but further research is needed.

[Conservative treatment of chronic lower limb ischemia in ambulatory practice (in Russian only)]. / Konservativnoe lechenie khronicheskoi ishemii nizhnikh konechnostei v praktike ambulatornogo khirurga.

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.

[Endovascular surgery in treatment of patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia]. / Éndovaskuliarnaia khirurgiia pri lechenii bol'nykh s ostrym narusheniem mezenterial'nogo krovoobrashcheniia v stadii ishemii kishki.

Analysed herein are the results of endovascular revascularization of the superior mesenteric artery (SMA). The study included a total of 18 patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia. The patients underwent multispiral computed tomography (MSCT) and once impairments of blood flow in the SMA were revealed, we performed endovascular revascularization of the artery. Patency of the SMA was assessed by repeat contrast-enhanced MSCT. Thirteen (72.2%) patients were found to have occlusion in the system of the SMA and five (27.8%) were diagnosed as having significant stenoses of the SMA. All 13 patients with occlusion of the SMA underwent vacuum thrombextraction followed by transluminal balloon angioplasty (TBA). Of these, thrombotic masses were obtained in 11 (84.6%) patients. Stents were implanted in 3 cases wherein TBA turned out inefficient. The patients with haemodynamically significant stenoses of the SMA were subjected to TBA followed by stent implantation. Good roentgenoendovascular results of restoration of blood flow through the SMA and its branches were obtained in 83.4% of cases. Assessing blood parameters and patients' condition severity revealed positive dynamics or a tendency towards improvement. The mortality rate amounted to 16.6%. A conclusion drawn is that this technique is efficient and appropriate for SMA lesions of any localization.

[Objective assessment of the degree of ischaemia and efficacy of treatment in chronic arterial insufficiency of lower limbs]. / Ob''ektivnaia otsenka stepeni ishemii i éffektivnosti lecheniia pri khronicheskoi arterial'noi nedostatochnosti nizhnikh konechnostei.

Presented in the review is the data concerning contemporary criteria for assessing the degree of chronic lower limb ischaemia and quality of the treatment performed. Problems regarding objectivization of the degree of an ischaemic lesion of an extremity and assessment of quality of conservative treatment still remain unresolved. Currently, in the world practice along with instrumental methods (assessment of the ankle-brachial index) subjective criteria are mainly employed: assessment of pain-free walking distance or maximum distance walked. In order to work out appropriate regiments of conservative treatment and compare efficacy of various drugs for treatment of chronic lower limb ischaemia and, in particular, intermittent claudication, it is necessary to use objective criteria. Detailed consideration is hence given to the possibilities of using morphological, biochemical and histological criteria such as determination of vascular endothelial growth factor A (VEGF-A) in peripheral blood and determination of apoptosis markers (BNIP3) and hypoxia-inducible factor (HIF-1) in a biopsy sample of the gastrocnemius muscle of the ischaemized extremity.

[Cryocompression sclerotherapy of reticular veins and teleangiectasias]. / Kriokompressionnaia skleroterapiia retikuliarnykh ven i teleangioéktazov.

Compression serves as an important component for carrying out successful and safe phlebosclerosing treatment. At the same time, the necessity of wearing compression hosiery or bandages is associated with known limitations and objections of patients, especially in a hot season. We comparatively assessed efficacy of usual compression stockings and a short-term pneumatic bandage with cryoelements while carrying out sclerosing treatment of dilated intradermal veins. Our open prospective observational study included a total of fifty 18-to-35-year-old women. After performing standardized sclerotherapy of reticular veins and telangiectasias on the symmetrical portions of the lower limbs, a pneumatic cryocompression bandage with a pressure of 50 mmHg was applied onto one of the limbs for 15 minutes, with a class 2 compression (RAL standard) medical stocking put on the other limb to be worn by the patients at daytime for 10 days. We assessed completeness of obliteration of the target veins, frequency of the development of typical undesirable events (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as the composite discomfort score according to an 11-point visual analogue scale. It was determined that using the pneumatic bandage with cryoelements as compared with the traditional compression stockings significantly decreased the frequency of the development of typical undesirable events after phlebosclerosing treatment, such as formation of ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis. Significance of differences was revealed as early as 7 days after sclerotherapy, to be increasing during further dynamic follow up. By convenience for the patients, the use of the short-term pneumatic cryobandage was four times better than wearing the compression stockings. A conclusion was drawn that while carrying out sclerotherapy of reticular veins and telangiectasias short-term pneumatic cryocompression by efficacy and safety was not inferior to the traditional medical stockings (RAL standard) and made it possible to significantly decrease the incidence of the known undesirable events after phlebosclerosing treatment.

[Embryology, anatomy and rare pathologies of the popliteal artery: Peculiarities of surgical treatment]. / Émbriologiia, anatomiia i redkie patologii podkolennoi arterii: osobennosti khirurgicheskogo lecheniia.

Knowledge of anatomical variations of the division of the popliteal artery and specific lesions of the arterial segment involved is necessary for the surgeon, traumatologist-orthopaedist, vascular surgeon. The article contains a review of recent literature data on the prevalence of different variants of branching patterns of the arteries of the crus, also providing a detailed discussion of embryological development of the arterial system of the lower extremities, in many ways explaining the appearance of rare pathologies of the popliteal artery, such as for example popliteal artery entrapment syndrome. Particular attention is paid to cystic damage of the popliteal artery, describing currently known theories of the development of this rare pathology, this is accompanied by sharing own experience in surgical treatment of the patients involved. Awareness of anatomical variants and peculiarities of embryonic development contributes to decreasing the possibility of iatrogenic damage of the popliteal artery during orthopaedic operations and to appropriate decision-making as to the method of revascularization.

Predictors of Chronic Thromboembolic Pulmonary Hypertension.

PURPOSE: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). MATERIAL AND METHODS: We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning.   Examination also included echocardiography. RESULTS: In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post-infarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

[Conservative treatment of patients with peripheral artery diseases: possibilities and existing problems]. / Konservativnoe lechenie bol'nykh s zabolevaniyami perifericheskikh arterii: vozmozhnosti i sushchestvuyushchie problemy.

With due regard to the requirements of evidence-based medicine, the article contains a review of present-day positions concerning conservative therapy in patients with peripheral artery diseases and chronic arterial ischaemia, represented in the latest Russian and foreign consensus documents, showing importance of bringing the basic provisions of the consensus documents to the notice of practical health-care providers with the aim of working out more effective therapeutic regimens. Some sections of the guidelines regarding the duration of treatment, among the number, require definite specification with the wording of more clear-cut practical conclusions.

[Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis]. / Rekanalizatsiia glubokikh ven nizhnikh konechnostei kak pokazatel' éffektivnosti lecheniia ostrogo venoznogo tromboza.

The authors analysed the results of examination and treatment of a total of 102 patients presenting with iliofemoral venous thrombosis. During treatment, ultrasonographic duplex scanning was used to determine the localization of the proximal margin of thrombotic masses, the time of appearing of the first signs of recanalization, its degree at various levels of the deep venous system, as well as alteration in velocity of the venous blood flow in the deep veins of the lower limbs. The dynamics of clinical symptoms was assessed by the visual analogue scale. Clinical and instrumental examination was performed on day 10, and then 1, 3, 6 and 12 months after the beginning of treatment. The patients were subdivided into three groups. Group One comprised 38 patients receiving therapy with low-molecular-weight heparin (enoxaprin) followed by switching to indirect anticoagulants (warfarin) combined with venotonics (original highly-purified diosmin 600 mg once daily). Group Two was composed of 33 patients receiving rivaroxaban at a dose of 15 mg twice daily for 3 weeks, followed by 20 mg once daily. Group Tree patients (n=31) were also given rivaroxaban according to the above-described standard regimen but in combination with venotonics (original highly-purified diosmin 600 mg once daily). The obtained findings showed that prescribing rivaroxaban to patients from the first day of the disease made it possible to considerably improve and accelerate the processes of restoration of patency of deep veins of lower extremities as compared with the patients taking vitamin K antagonists (warfarin). In patients receiving rivaroxaban, there were no cases of residual thrombotic occlusions of the major veins, and recanalization in three fourths of patients was assessed as good and in the remaining third as moderate. In the warfarin group, occlusion in the iliac veins was noted to persist persisted in 13% of patients, with good recanalization observed only in half of the patients. Addition of venotonics (original highly-purified diosmin) to anticoagulants from the first day demonstrated safety of this therapeutic regimen (with no cases of clinically significant haemorrhagic complications revealed) and its high efficacy as compared with monotherapy with rivaroxaban. A combination of diosmin with rivaroxaban turned out more efficient than a combination of diosmin with warfarin.

[Duration of anticoagulant therapy in venous thromboembolic complications].

Adequate anticoagulant therapy is a general approach to treatment of deep vein thrombosis. However, the duration of anticoagulant therapy is not strictly specified in everyday clinical practice. The present article deals with various approaches to selecting the duration of therapy with anticoagulants based on the findings of studies, national and foreign clinical guidelines. The minimal duration of therapy for deep vein thrombosis and pulmonary thromboembolism amounts to 3 months in accordance with the national and American recommendations. For some cohorts of patients, continuation of therapy above 3 months is considered: patients with idiopathic thrombosis (the recommended duration of therapy of not less than 6 months), patients having persisting risk factor for relapse of thrombosis on termination of the main therapeutic course, oncological patients (6 month therapy followed by assessing the risk and benefit of continuing therapy with anticoagulants). Prolonged therapy of venous thromboembolism using unfractionated heparin or low-molecular-weight heparin followed by changing over to vitamin K antagonists is associated with decreased risk for thrombosis relapse approximately by 90%, however increasing the risk of haemorrhage. Currently, as an alternative, it is possible to consider administration of novel oral anticoagulants (rivaroxaban, dabigatran, apixaban) which beside high efficacy are associated with less risk of bleeding. The route of administration, no necessity to control the INR, and the minimal number of drug and food interactions make administration of new oral anticoagulants an attractive alternative to therapy with heparins and vitamin K antagonists.

[Pharmacological preconditioning in carotid endarterectomy].

The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months. It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain. A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions.

[Sulodexide in conservative treatment of peripheral arterial diseases].

Presented in the article is a review of the literature, analysing principles of conservative therapy of patients with obliterating diseases of lower limb arteries and most commonly used drugs to treat them, followed by discussing the mechanisms of action and efficacy of such pharmacological agents as pentoxyphyllin, cilostazol, naphthidrofuryl, aktovegin, sulodexide. Described in details are subtle mechanisms of action of sulodexide as an endothelioprotector, its clinical efficacy in intermittent claudication.

[Use of naftidrofuryl in angiology].

The review analyses the role of serotonin in the development of pathological processes in angiological patients, showing its negative role in aggravating chronic and acute ischaemia of various organs (brain, myocardium, extremities) both at the expense of vasoconstriction and due to an increase in blood platelet aggregation of blood platelets and erythrocytes, followed by analysis of clinical efficacy of naftidrofuryl) - serotonin 5-HT2 receptor antagonist. Results of numerous randomized trials confirmed its efficacy and safety in treatment of angiological patients, being superior to other vasotropic drugs (cilostazol, pentoxyphyllin, nicotinic acid).