[Endovascular treatment of deep vein thrombosis of the upper extremities]. / Endovaskulyarnoe lechenie trombozov glubokikh ven verkhnikh konechnostei.

OBJECTIVE: To improve the results of treatment of deep vein thrombosis of the upper extremities sing endovascular technologies. MATERIAL AND METHODS: We analyzed safety and effectiveness of treatment in 24 patients with deep vein thrombosis of the upper extremities. All ones were divided into 2 homogeneous groups by 12 people each. In the first group, conventional anticoagulation was performed. In the second group, we used additional regional catheter thrombolysis with alteplase and, if necessary, venous stenting or balloon angioplasty for residual stenosis. Patients received apixaban at baseline and throughout 6 postoperative months. After 12 months, we performed ultrasound and clinical examination to identify deep vein patency and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. The quality of life of patients was studied using the SF-36 questionnaire. RESULTS: In the first group, we observed complete vein recanalization in 25% of cases, partial - in 33%, minimal - in 41% of cases; in the second group - 83.3% and 16.7% of patients, respectively. In the first group, clinical manifestations of venous outflow disorders were absent in 25% of patients, mild disorders - 25%, moderate - 8.3%, severe - 41.7% of patients. In the second group, venous outflow was not impaired in 83.7% of patients, mild violations occurred in 16.7% of patients. In the first group, physical health was equal to 44.2±1.7 scores, psychological health - 49.3±2.3 scores; in the second group - 69.3±5.7 and 71.3±5.4 scores, respectively. CONCLUSION: Endovascular treatment improved postoperative outcomes.

[Pharmacomechanical thrombectomy for total-subtotal deep vein thrombosis]. / Farmakomekhanicheskaya trombektomiya v lechenii total'no-subtotal'nogo tromboza glubokikh ven.

OBJECTIVE: To improve treatment outcomes in patients with late stages of total-subtotal deep vein thrombosis using pharmacomechanical thrombectomy. MATERIAL AND METHODS: We compared treatment outcomes in 2 homogeneous groups of patients with deep vein thrombosis and severe acute venous insufficiency. Standard anticoagulation (apixaban) was performed in the first group (n=20), endovascular treatment was applied in the second group (n=20). Regional catheter thrombolysis was performed at the first stage, and percutaneous mechanical thrombectomy was performed at the second stage. Incidence of hemorrhagic syndrome was assessed. The results were evaluated after one year considering patency of deep veins and severity of venous outflow disorders. RESULTS: Hemorrhagic complications occurred in 15% and 25% of patients, respectively. This required discontinuation of anticoagulation throughout the treatment and subsequent appointment of minimum doses of apixaban. Complete restoration of vein patency was observed in 20% and 55%, partial recanalization - 45% and 25%, minimal recovery - in 35% and 20% of patients, respectively. In the first group, venous outflow disorders were absent in 20% of patients, mild disorders were registered in 45%, moderate - 20%, severe - 15% of patients. In the second group, these values were 55%, 25%, 20% and 0% of patients, respectively. CONCLUSION: Pharmacomechanical thromboectomy can improve treatment outcomes.

[Endovascular surgery for deep vein thrombosis]. / Endovaskulyarnaya khirurgiya tromboza glubokikh ven.

The authors reviewed national and world literature data on endovascular technologies for the treatment of deep vein thrombosis. Indications, technologies, complications and results of systemic and regional thrombolysis are described in detail. The authors consider percutaneous mechanical thrombectomy, pharmacomechanical thrombectomy, venous stenting and catheter thrombectomy. The role of combined endovascular approaches in delayed stages of disease is emphasized. The indications for implantation of cava filter are presented.

[Regional catheter thrombolysis for late proximal deep vein thrombosis]. / Rezul'taty lecheniya pozdnego proksimal'nogo tromboza glubokikh ven regionarnym kateternym trombolizisom.

OBJECTIVE: To compare the efficacy of regional catheter thrombolysis with urokinase and alteplase for late proximal deep vein thrombosis. MATERIAL AND METHODS: We analyzed safety and effectiveness of treatment of 38 patients with late proximal deep vein thrombosis divided into 2 statistically homogeneous groups by 19 people. In the first group, regional thrombolysis with urokinase was performed with injection of the drug into thrombosed popliteal, femoral and iliac veins. Alteplase was used in the second group. Patients received rivaroxaban in pre-, perioperative period and throughout 6 months after surgery. Complications of endovascular therapy were recorded. After 12 months, ultrasound and clinical examination were carried out to assess vein recanalization and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. RESULTS: Minor hemorrhagic complications of endovascular treatment developed in 31.7 and 21% of patients, respectively. In the first group, complete vein recanalization occurred in 31.6%, partial - in 21%, minimal - in 47.4% of patients. In the second group, these values were 47.4%, 36.8% and 15.8%, respectively. In the first group, no signs of venous outflow disorders were observed in 31.6% of patients, mild disorders - in 15.8%, moderate disorders - in 31.6%, severe - in 21% of patients. In the second group, these values were 47.4%, 31.6%, 10.5% and 10.5%, respectively. CONCLUSION: Thrombolysis with alteplase is safer and more effective compared to urokinase.

[Venous stenting in acute period of total and subtotal deep vein thrombosis]. / Effektivnost' venoznogo stentirovaniya v ostrom periode total'no-subtotal'nykh trombozov glubokikh ven.

OBJECTIVE: To study the efficacy and safety of venous stenting and long-term anticoagulation with inhibitors of blood clotting factor XA in the treatment of total and subtotal deep vein thrombosis. MATERIAL AND METHODS: We analyzed 60 patients with total and subtotal deep vein thrombosis divided into 2 comparable groups by 30 people. Patients of the first group underwent regional catheter thrombolysis and percutaneous mechanical thrombectomy. The same endovascular treatment supplemented by venous stenting was performed in the second group. In the first group, rivaroxaban was prescribed before, during and for 6 months after surgery; apixaban was used in the second group. Complications of endovascular and anticoagulant therapy were recorded. After 12 months, control ultrasound and clinical examination of patients was performed to analyze recanalization of deep veins and severity of venous outflow disorders. Recanalization of veins was evaluated as follows: less than 50% - minimal, 50-99% - partial, 100% - complete. RESULTS: In the first group, complete and partial recanalization of veins was found in 63.3 and 36.7% of patients, respectively. In the second group, these values were 93.3 and 6.7%, respectively. In the first group, venous outflow disorders were absent in 56.7%, mild violations presented in 36.6%, moderate violations - in 6.7% of patients. In the second group, venous outflow was normal in 93.3% of patients, and mild disorders presented in 6.7% of patients. Hemorrhagic complications developed in 8 (13.3%) patients, equally in both groups.

[Local management of purulent wounds with wound dressings]. / Mestnaya terapiya gnoinykh ran ranevymi pokrytiyami.

Purulent-inflammatory lesions of skin and soft tissues account for 30-35% of causes of admission to surgical hospitals. In outpatient system, this value reaches 35-60%. Moreover, suppuration of wounds after elective surgery occurs in 2-5% of cases. Adequately selected drugs for local wound therapy can achieve localization of purulent process and avoid spread of infection. This review summarizes data on development, experimental and clinical testing of wound dressings over the past 10 years, presents classification options and analyzes their advantages and disadvantages. The authors emphasize higher efficacy of hydrophilic coatings, and coatings based on chitosan, collagen, methylcellulose and its derivatives are preferred. It is advisable to introduce a component with antimicrobial, anesthetic and hemostatic activity stimulating tissue regeneration into the matrix of wound dressing. The priority is introduction of antiseptic substances causing fewer side effects compared to antibiotics. Further research and development of new wound dressings is a priority in surgery considering changing landscape and development of resistance of microorganisms.

[Efficacy of percutaneous mechanical thrombectomy for proximal deep vein thrombosis]. / Effektivnost' chreskozhnoi mekhanicheskoi trombektomii pri lechenii proksimal'nogo tromboza glubokikh ven nizhnikh konechnostei.

OBJECTIVE: To study the efficacy and safety of percutaneous mechanical thrombectomy and long-term anticoagulation with rivaroxaban for proximal deep vein thrombosis. MATERIAL AND METHODS: We analyzed the effectiveness of treatment in 60 patients with proximal deep vein thrombosis divided into 2 homogeneous groups by 30 people. Standard therapy was performed in the first group, therapy with percutaneous mechanical thrombectomy was applied in the second group. Patients received rivaroxaban in preoperative, perioperative and 6-month postoperative period. We considered complications of endovascular treatment and anticoagulation. Ultrasound and clinical examination were carried out after 12 months to analyze restoration of deep vein patency and venous outflow disorders. Recovery of vein lumen was assessed as follows: <50% - minimal, 50-99% - partial, 100% - complete. RESULTS: Recurrent deep vein thrombosis was found in 2 (6.7%) patients of the second group. Hemorrhagic complications following rivaroxaban therapy occurred in 8 (13.3%) patients (equally in both groups). In the first group, complete restoration of vein lumen was found in 16.7% of patients, partial recovery - in 40%, minimal recovery - in 43.3% of patients. In the second group, these values were 16.7%, 60% and 23.3%, respectively. Severe venous outflow impairment developed in 43.3% of patients in the first group and 23.3% of patients in the second group. Moderate impairment occurred in 30% and 20% of patients, mild disorders - in 10% and 40% of patients, respectively. CONCLUSION: Percutaneous mechanical thrombectomy on the background of long-term anticoagulation with rivoroxaban improves treatment outcomes in patients with proximal deep vein thrombosis.

[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.

[Cardiac ruptures in acute myocardial infarction]. / Razryvy serdtsa pri ostrom infarkte miokarda.

Presented in the article are the generalized data of the Russian and foreign literature addressing the currently important problem of myocardial ruptures as one of the most dangerous complications of infarction, also analysing the results of clinical studies on interconnection of heart ruptures with systemic thrombolytic therapy and with a percutaneous coronary intervention. This is followed by describing the mechanisms that may lead to myocardial rupture during thrombolytic therapy and surgical endovascular treatment, underlying the necessity of pharmacological pre- and post-conditioning for prevention of reperfusion myocardial lesions. The article also touches upon the clinical and instrumental diagnosis of myocardial ruptures, as well as approaches to surgical treatment depending on the type of rupture and necessity of myocardial revascularization.

[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.

[One-year results of conservative and endovascular treatment of deep venous thrombosis followed by severe acute venous insufficiency]. / Odnoletnie rezul'taty konservativnogo i endovaskulyarnogo lecheniya tromboza glubokikh ven s razvitiem tyazheloi ostroi venoznoi nedostatochnosti.

OBJECTIVE: To compare the results of conservative and endovascular treatment of deep vein thrombosis followed by acute severe venous insufficiency. MATERIAL AND METHODS: Two statistically valid groups of patients with deep vein thrombosis and acute severe venous insufficiency were compared. Warfarin was administered in the first group, endovascular methods - in the second group (n=30). At the first step, we performed catheter-guided thrombolysis, then transcutaneous mechanical thrombectomy and venous stent deployment. Anticoagulation was achieved with Apixaban. Hemorrhagic complications were monitored during the treatment. One-year results were assessed considering lumen patency restoration and severity of venous congestion with Villalty score. RESULTS: In the first group, each third patient had hemorrhagic complications that required cessation of anticoagulant therapy in 1.3% of patients. In the second group, hemorrhagic events occurred in 10% of patients and were managed by lowering Apixaban dosage. Complete restoration of lumen patency was detected in 23.3% in the first group and 93.3% in the second group. Partial restoration developed in 63.3% and 6.7%, occlusion in 13.3% and 0%, respectively. Only 23.3% of patients in the first group had no clinical evidence of venous congestion. Mild congestion was found in 20%, severe - in 56.7% of cases. In the second group, 6.7% of patients had minimal venous congestion.

[Acute cerebral circulation impairment associated with percutaneous coronary intervention]. / Ostroe narushenie mozgovogo krovoobrashcheniia, assotsiirovannoe s chreskozhnym koronarnym vmeshatel'stvom.

The article deals with generalized literature data on the current importance of the problem concerning acute cerebral ischemia occurring during percutaneous coronary interventions. Pathophysiological mechanisms of the development of acute cerebral circulation impairment are described, with their classification. Also considered are various risk factors which may cause this formidable complication, followed by describing modern methods of its surgical treatment. It is noted that the main risk factors for neurological complications appearing after revascularization of coronary arteries include age, accompanying diseases (instability of arterial pressure, diabetes mellitus, atrial fibrillation, atherorosclerotic lesions of the aorta and brachiocephalic arteries, previous stroke), as well as systolic dysfunction, leukocytosis, and a low level of cognitive function prior to operation. The development of acute cerebral circulation impairment during and after percutaneous coronary intervention is an indication for using methods of endovascular treatment. It is most appropriate to use a combination of direct percutaneous thrombectomy and a stent retriever. It is underlined in the article that removal of the thrombus form the cerebral artery is not an independent surgical procedure but rather a methodology envisaging an operation to be performed from the simplest technique to the most complicated one. As the first procedure, it is necessary to perform thrombaspiration and then, if ineffective, a second stage consisting in thrombextraction with the help of a stent retriever. Besides, in order to increase efficacy of thrombaspiration there have been worked out several techniques combining the use of direct thrombextraction and a stent retriever. Described in detail are 4 most commonly used techniques.

[Effect of the type of a coronary stent on dynamics of quality of life in patients with ischaemic heart disease]. / Vliianie vida koronarnogo stenta na dinamiku kachestva zhizni u patsientov s ishemicheskoi bolezn'iu serdtsa.

The purpose of the present study was to investigate the dynamics of quality of life in patients with ischaemic heart disease before and after implantation of a coronary stent depending on the stent's type and patient's gender. The authors analysed the dynamics of quality of life in a total of 120 patients with ischaemic heart disease. The patients were subdivided into two equal groups of 60 each. Group One patients were subjected to implantation of bare-metal stents, whereas Group Two patients received stents coated with zotarolimus as an antiproliferative agent. The control group was composed of 60 people who did not suffer from ischaemic heart disease and were comparable by the age and gender. Quality of life was investigated prior to stent implantation and 6, 12 and 24 months thereafter with the use of the SF-36 questionnaire. It was determined that the indices of quality of life before stenting of coronary arteries was higher in men than in women. However, no gender-related differences were revealed after stent implantation. The dynamics of the parameters of quality of life of patients following implantation of uncoated metal stents within 6 months turned out to have a positive and then rapidly progressing negative course, whereas implantation of stents coated with antiproliferative drug zotarolimus was within 12 months followed and accompanied by a positive and then slowly progressing negative course.

[Efficacy of treatment of lower-limb critical ischaemia by methods of indirect revascularization]. / Éffektivnost' lecheniia kriticheskoi ishemii nizhnikh konechnostei metodami nepriamoi revaskuliarizatsii.

AIM: The study was aimed at comparing the efficacy of implantation of autologous bone marrow cells with that of revascularizing osteotrephination in treatment of lower limb chronic critical ischaemia in patients with a poor distal vascular bed. PATIENTS AND METHOD: We analysed the results of comprehensive examination and treatment of a total of 60 patients presenting with lower limb chronic critical ischaemia due to atherosclerotic lesions of the femoropopliteal-tibial segment. According to the technology of treatment, the patients were divided into two statistically homogenous groups of 30 people each. Group One patients underwent standard revascularizing osteotrephination and Group Two patients in accordance with the original technique received intramuscular implantation of 40 ml of autologous bone marrow cells, with this volume distributed in 2-ml injections to 20 points of the muscles of the crus and femur along the internal and external surface. RESULTS: The use of the original technique of treatment made it possible to achieve the clinical status in the form of moderate or minimal improvement 6 months after bone marrow cells implantation in 29 (96.7%) patients and after 12 months in 28 (93.3%) patients, whereas after revascularizing osteotrephination in 25 (83.3%) and 20 (66.7%) patients, respectively. In the remote period after 12 months, the limb was saved in 28 (93.3%) and 26 (86.7%) patients in Group Two and Group One, respectively. The patients of the second group as compared with those of the first group after 12 months demonstrated a statistically significant increase in the physical health component by 19.8% and the mental health component by 9.8%. CONCLUSION: Implantation of autologous bone-marrow cells in chronic critical limb ischaemia is pathogenetically substantiated and makes it possible to optimize the results of treatment of patients.

[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 reconstructive operation in lesions of femoropopliteotibial segment and dubious outflow pathways]. / Vybor rekonstruktivnoi operatsii pri porazheniiakh arterii bedrenno-podkolenno-bertsovogo segmenta i somnitel'nykh putiakh ottoka.

We analysed the results of surgical treatment of 40 patients with lower limb critical ischaemia induced by atherosclerotic lesion of arteries of the femoropopliteotibial segment with dubious outflow pathways. The patients were divided into two groups of 20 each. Group One patients underwent autovenous femoropopliteal or tibial bypass grafting below the fissure of the knee joint and Group Two patients were subjected to profundoplasty with closure of the arteriotomic opening with an autovenous patch. The outflow pathway index in Group One amounted to 7.5±0.09 and in Group Two to 7.45±0.08. Our findings suggest that the use of profundoplasty as reconstructive operation in patients with dubious outflow pathways is pathogenetically substantiated, because it makes it possible to decrease the rate of early postoperative complications by 20% and that of late bypass thromboses by 25%, as well as to increase the level of the physical component of health by 12.1% and that of mental health by 3.2%. A conclusion drawn is that performing profundoplasty in this cohort of patients is appropriate and effective.

[Reaction of connective tissue of arterial and venous walls to implantation of synthetic and biological grafts]. / Reaktsiia soedinitel'noi tkani arterial'noi i venoznoi stenok na implantatsiiu sinteticheskogo i biologicheskogo protezov.

BACKGROUND: 30% of patients in the remote period appear to develop restenosis of the anastomoses formed during reconstructive-restorative operations on vessels. Two major causes of restenosis have been determined: intimal hyperplasia and smooth muscle cell proliferation. The reaction of connective-tissue elements of vascular walls in response to implantation of grafts remains unstudied. OBJECTIVE: The study was undertaken to examine the reaction of connective tissue of the arterial and venous walls to implantation of synthetic and biological grafts. MATERIAL AND METHODS: We analysed the results of an experimental study performed on a total of 60 rabbits divided into 4 groups each consisting of 15 animals: in the first 2 groups we examined tissue reaction to implantation of synthetic and biological grafts on the wall of an artery and in the remaining 2 groups - on the wall of a vein. The synthetic grafts were made of polytetrafluoroethylene, with the biological ones made of bovine internal thoracic arteries. The portions of the vessels along with the implanted grafts were subjected to histological examination on postoperative days 14, 21 and 30. The specimens were studied by means of light microscopy after haematoxylin-eosin staining. We also carried out a morphometric study consisting in determining the quantitative ratio of the cellular composition of connective tissue. RESULTS: After implantation on the arterial wall, the connective-tissue capsule under the synthetic prosthesis was 1.8 times thicker than under the biological one, with predominance of the cellular component over fibrous one, which deformed the zone of implantation. Under the biological prosthesis, the capsule on the arterial wall was presented by fibrous structures with no deformation of the zone of implantation. The reparative reaction of the venous wall to implantation of the synthetic prosthesis was represented by a thin fibrous connective-tissue capsule. The reaction of the venous wall to the biological transplant was at all terms of the experiment characterised by significant inflammatory alterations with granulomatosis and immunomorphological shifts with formation of lymphoid follicles on the border with the transplant. CONCLUSION: Implantation of the synthetic polytetrafluoroethylene prosthesis on the arterial wall induced a hyperplastic reaction of the elements of connective tissue, and a normoplasic one on the venous wall. Implantation of the biological prosthesis on the arterial wall did not induce proliferation of connective-tissue elements, and on the venous wall - granulomatous inflammation.

[Role of TGFß1 and VEGF-А gene polymorphisms in development of chronic obliterating diseases of lower-limb arteries]. / Rol' polimorfizmov genov TGFß1 i VEGF-A v razvitii khronicheskikh obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei.

The study was aimed at investigating the interrelationship of gene polymorphisms of transforming growth factor (TGFß1) and endothelial vascular growth factor (VEGF-A) with the risk for the development of chronic obliterating diseases of lower-limb arteries (CODLLA) in the Russian population of Central Russia. We studied polymorphism C-509T of the TGFß1 gene and polymorphism +936C>T of the VEGF-A gene in 202 patients with CODLLA and in 148 apparently healthy individuals. Genomic DNA was isolated by the standard method of phenol-chloroform extraction. These polymorphisms were genotyped by means of polymerase chain reaction followed by analysing restriction fragments length polymorphism. Patients with CODLLA were found to have a decrease of frequency of homozygous genotypes of transforming growth factor ß1 for the wild-type alleles: -509CC (p=0.02) and an increase of frequency of homozygotes for the variant allele: -509TT (p=0.00004), which was indicative of an abrupt increase in secretion of transforming growth factor. We revealed no deviation of associations of the examined polymorphisms by the significant homozygous carrier state for the normal allele +936CC of endothelial growth factor gene as compared with the healthy cohort. A conclusion was made that a proatherogenic risk factor for CODLLA is an increase of TGFß1 secretion, with no genetically-determined prerequisites of the effect of VEGF-A gene polymorphism on the development of the disease revealed.

[Effectiveness of biological prosthesis for femoro-femoral bypass in high risk patients]. / Éffektivnost' biologicheskogo proteza pri bedrenno-bedrennom shuntirovanii u lits s vysokim operatsionnym riskom.

AIM: To compare synthetic and biological prostheses for femoral bypass surgery. MATERIAL AND METHODS: There were 40 patients with critical ischemia of lower extremities due to atherosclerotic lesion of aorto-iliac segment and severe comorbidities. They were divided into 2 groups by 20 patients. C-shaped femoro-femoral bypass with synthetic polytetrafluoroethylene and lavsan prostheses was performed in the first group and S-shaped bypass procedure with biological prosthesis from the internal thoracic arteries of the bull - in the second group. RESULTS: Biological prosthesis is associated with reduced early postoperative morbidity by 10%, late graft thrombosis incidence by 20% and increased physical and psychological health by 7.1%. CONCLUSION: S-shaped femoro-femoral bypass with a biological prosthesis from the internal thoracic arteries of the bull is pathogenetically substantiated and effective.

[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.