RESUMEN
The study comprised a total of 107 patients (all men) after endured femoropopliteal bypass grafting above the genicular fissure with a synthetic stent graft manufactured by the Gore Company for stage IIB and III chronic arterial insufficiency of the lower extremities according to the Fontain-Pokrovsky classification. Group One I (control group) was composed of fifty-four patients permanently taking in the postoperative period at the out-patient stage pentoxiphylline (trental 400 mg 1 tablet 3 times daily) and xantinol nicotinate at a dose of 150 mg one tablet thrice daily. Group Two (Study Group) consisted of fifty-three patients taking after reconstructive vascular surgery at the out-patient stage in addition to pentoxiphylline and xantinol nicotinate acetylsalicylic acid (cardiomagnil 75 mg 1 tablet once daily). The Control Group patients within 3 to 6 months of follow up were found to have a considerable progressing improvement of the functional abilities of the microcirculatory bed requiring in 44 (81.5%) cases hospitalization to the Surgical Department for intensive vascular therapy. Despite this fact four (7.4%) patients within the time frame from 6 to 9 months after surgery developed thrombosis of the vascular implant requiring a repeat surgical intervention. In the Study Group patients, the degree of functional capabilities of the microcirculatory bed in the postoperative period was less considerable, reaching the maximum after 10-12 months of follow up, with eighteen (34.0%) patients requiring hospitalization for additional vascular therapy to perform. There were no cases of implants' thrombosis in the Study Group patients. Pathological alterations in the functional state of the peripheral vascular bed correlated with viscosimetric indices and activity of blood platelet aggregation. The addition of antithrombocytic agents to conservative postoperative therapy considerably improved the outcomes of surgical treatment.
Asunto(s)
Aspirina , Arteria Femoral , Oclusión de Injerto Vascular/prevención & control , Enfermedad Arterial Periférica/cirugía , Arteria Poplítea , Injerto Vascular/efectos adversos , Aspirina/administración & dosificación , Aspirina/efectos adversos , Coagulación Sanguínea/efectos de los fármacos , Viscosidad Sanguínea/efectos de los fármacos , Arteria Femoral/patología , Arteria Femoral/trasplante , Oclusión de Injerto Vascular/sangre , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/patología , Humanos , Extremidad Inferior/irrigación sanguínea , Masculino , Pentoxifilina/administración & dosificación , Pentoxifilina/efectos adversos , Enfermedad Arterial Periférica/sangre , Enfermedad Arterial Periférica/patología , Agregación Plaquetaria/efectos de los fármacos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Arteria Poplítea/patología , Arteria Poplítea/trasplante , Periodo Posoperatorio , Reoperación , Resultado del Tratamiento , Injerto Vascular/métodos , Grado de Desobstrucción Vascular/efectos de los fármacos , Vasodilatadores/administración & dosificación , Vasodilatadores/efectos adversos , Niacinato de Xantinol/administración & dosificaciónRESUMEN
The article deals with present-day evidence concerning the role of blood-platelet activity in the development of a pathological process and acute ischemia in patients presenting with chronic arterial insufficiency of the lower extremities. Proved herein is the necessity of long-term administration of antiplatelet drugs in order to prevent vascular complications on the part of the heart, brain, and peripheral arteries, with a description of the drugs most commonly used for these purposes.
Asunto(s)
Arteriosclerosis Obliterante/tratamiento farmacológico , Aspirina/uso terapéutico , Fibrinolíticos/uso terapéutico , Pierna/irrigación sanguínea , Inhibidores de Agregación Plaquetaria/uso terapéutico , Arteriosclerosis Obliterante/cirugía , Aspirina/administración & dosificación , Aspirina/efectos adversos , Enfermedad Crónica , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Humanos , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Estómago/efectos de los fármacos , Factores de TiempoRESUMEN
The article deals with the main clinical and instrumental methods of determining severity of chronic arterial insufficiency of the lower extremities, showing possibilities of morphological studies for an accurate diagnosis of the ischaemia degree. Also determined are promising trends of studying the hypoxia-inducible factor (HIF) and vascular endothelial growth factor (VEGF) in assessment of ischaemic impairments of lower-extremities tissue.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico , Biomarcadores/sangre , Pierna/irrigación sanguínea , Arteriopatías Oclusivas/sangre , Enfermedad Crónica , Progresión de la Enfermedad , Prueba de Esfuerzo , Humanos , Factor 1 Inducible por Hipoxia/sangre , Pronóstico , Índice de Severidad de la Enfermedad , Factor A de Crecimiento Endotelial Vascular/sangreRESUMEN
The authors have hereby proposed a method to diagnose lower-limb muscular ischaemia by means of scintigraphy, used in 35 patients suffering from atherosclerosis obliterans with stage IIB and III A chronic arterial insufficiency of limbs. To do so, administration of the radioactive agent "Myoview" (99m)Tc-tetrophosmine) manufactured by the "Nycomed" Company into a patient's peripheral vein was followed by assessing its accumulation in lower-limb muscles at rest and after standard physical load. Alterations in the parameters studied relative to the norm made it possible to judge on the presence of lower-limb circulatory impairments. The method proved highly efficient, thus making it possible to use it for both therapeutic decision-making and probably in future for dynamic control after the treatment performed. Minimally invasive nature and simplicity in use of the methodology open wide possibilities for its use.
Asunto(s)
Arteriosclerosis Obliterante/diagnóstico por imagen , Imagen de Perfusión/métodos , Flujo Sanguíneo Regional/fisiología , Adulto , Arteriosclerosis Obliterante/fisiopatología , Diagnóstico Diferencial , Humanos , Inyecciones Intraarteriales , Masculino , Persona de Mediana Edad , Compuestos Organofosforados/administración & dosificación , Compuestos de Organotecnecio/administración & dosificación , Radiofármacos/administración & dosificación , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
Chair of Neurology of the Advanced Medical Training Department of the Federal Educational Facility of the Higher Vocational Education Russian State Medical University under the Russian Public Health Ministry, Moscow, Russia. The article deals with the findings obtained in examining and treating a total of eighty-seven patients suffering from atherosclerosis obliterans of the lower-limb arteries with stage IIB and III chronic arterial insufficiency. Studied were impairments of the theological properties of the blood and plasma, erythrocytic deformability and the concentration of malonic dialdehyde in blood at admission to the hospital, upon completion of the course of conservative treatment, and after the reconstructive vascular intervention performed. It was determined that the leading mechanism disturbing oxygen utilization by tissues is a decrease in erythrocytic deformability, which promotes shunting of the arterial blood flow and persists after the surgical vascular reconstruction preformed.
Asunto(s)
Arteriosclerosis Obliterante/cirugía , Hemorreología , Pierna/irrigación sanguínea , Arteriosclerosis Obliterante/diagnóstico , Arteriosclerosis Obliterante/fisiopatología , Enfermedad Crónica , Deformación Eritrocítica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Malondialdehído/sangre , Microcirculación , Persona de Mediana Edad , Modelos Biológicos , Procedimientos de Cirugía Plástica , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
The present literature review pays primary attention to the pathophysiblogical and immunological grounds of the process of restenoses of vascular anastomoses after reconstructive interventions in patients with atherosclerosis obliterans. On the molecular, cellular and tissue levels, analysed herein are alterations leading to restenosis, also presenting the data concerning currently available methods of diagnosis of this pathological condition. In addition, methods aimed at preventing and treating restenoses are discussed.