scholarly journals Correction of hemostasis and hemorheology with intravenous laser blood irradiation and cytokinotherapy in indirect revascularization at the perioperative period in patients with critical ischemia of their lower extremities

2021 ◽  
Vol 24 (2-3) ◽  
pp. 45-53
Author(s):  
J. V. Kosayev ◽  
I. A. Hasanov ◽  
N. S. Abushov ◽  
G. T. Taghi-zada
Keyword(s):  
Lower Extremities ◽  
Perioperative Period ◽  
Critical Ischemia ◽  
Indirect Revascularization ◽  
Blood Irradiation ◽  
Laser Blood Irradiation

scholarly journals Possibilities of the cellular immunity correction using intravenous laser irradiation of the blood and cytokinotherapy with roncoleukin in perioperative period while indirect revascularization done in patients with critical ischemia of the lower extremiti

2020 ◽  
Vol 87 (3-4) ◽  
pp. 59-64
Author(s):  
J. V. Kosayev ◽  
I. A. Hasanov ◽  
N. S. Abushov ◽  
G. T. Tagizade ◽  
I. L. Namazov
Keyword(s):  
Laser Irradiation ◽  
Cellular Immunity ◽  
Standard Treatment ◽  
Lower Extremities ◽  
Perioperative Period ◽  
Arterial Stenosis ◽  
Critical Ischemia ◽  
Joint Application ◽  
Group I ◽  
Indirect Revascularization

Objective. To study up the possibilities of the cellular immunity correction using intravenous laser irradiation of the blood and cytokinotherapy with roncoleukin in perioperative period while indirect revascularization done in patients with critical ischemia of the lower extremities. Materials and methods. Prospective controlled clinic-laboratory investigation was performed in 162 patients, suffering critical ischemia of the lower extremities on background of distal arterial stenosis (occlusion) and to whom indirect revascularization operations were done. Etiology of the lower extremities critical ischemia were the obliterating atherosclerosis - in 108 (66.7%) patients and obliterating thrombangiitis - in 54 (33.3%) patients. In 56 patients a Degree III was diagnosed, and in 106 patients - IV Degree of chronic ischemia. In perioperative period in 34 patients a standard treatment was performed (Group I), in 32 patients - standard treatment and intravenous laser irradiation of the blood (Group II), in 32 patients - standard treatment and cytokinotherapy with roncolekin (Group III), in 33 patients - standard treatment, intravenous laser irradiation of the blood and cytokinotherapy (Group IV), in 31 patients in a revascularized osteotrepanation with intramedullary laser irradiation - standard treatment, intravenous laser irradiation of the blood and cytokinotherapy (Group V). Parameters of cellular immunity (CD3+, CD4+, CD8+lymphocytes; ratio CD4+/CD8+) and of phagocytosis were studied in dynamics. The cellular immunity indices were compared with identical indices in 48 practically healthy persons (a reference group). Results. While admittance to hospital in patients with critical ischemia of the lower extremities in a distal stenosis (occlusion) the abrupt change of cellular immunity was revealed towards the immune insufficiency. Inclusion of intravenous laser irradiation of the blood and of cytokinotherapy, separately or in combination, into the treatment measures complex of perioperative period in indirect revascularization have leaded towards trustworthy (p < 0.05) elimination of the cellular immunity indices. Correction of cellular immunity trustworthily depended on (p < 0.01-0.001) the treatment factor with moderate (r =0.5- 0.6) correlation. Best results were obtained while joint application of intravenous laser irradiation of the blood and cytokinotherapy in perioperative period in indirect revascularizaation, peculiarly while operation of revascularized osteotrepanation with intramedullary laser irradiation. Conclusion. Application of intravenous laser irradiation of the blood and cytokinotherapy together with standard treatment in perioperative period while doing indirect revascularization corrects the cellular immunity trustworthily in patients, suffering critical arterial ischemia of the lower extremities, and the dynamics of these indices may be used as an objective criterion of the efficacy estimation for the therapy conducted.

scholarly journals The state of lipid exchange, hemostasis, inflammatory reaction and potentials for their correction in indirect revascularization in patients with critical ischemia of lower extremities (a correlation statistical analysis)

2021 ◽  
Vol 25 (1) ◽  
pp. 27-35
Author(s):  
J. V. Kosayev ◽  
I. A. Khasanov ◽  
N. S. Abushov ◽  
G. T. Taghi-zade
Keyword(s):  
Lipid Metabolism ◽  
Inflammatory Reaction ◽  
Standard Therapy ◽  
Therapy Group ◽  
Cytokine Therapy ◽  
Standard Therapy Group ◽  
Critical Ischemia ◽  
Indirect Revascularization ◽  
Blood Irradiation ◽  
Laser Blood Irradiation

Aim: to study the state of lipid metabolism, hemostasis, inflammatory reaction and the potential for their correction after indirect revascularization in patients with distal steno-occlusion of arteries and critical ischemia of lower extremities (critical ILE).Material and methods. Changes in hemostasis and dynamics of its parameters during the complex surgical treatment in 131 patients with critical ILE and distal arterial stenoocclusion were analyzed. To achieve the targeted goals, patients were divided into the following groups: 34 patients had traditional care (control group); 32 patients had intravenous laser blood irradiation in combination with standard therapy (Group I); 32 patients had cytokine therapy with roncoleukin in combination with standard therapy (Group II); 33 patients had intravenous laser blood irradiation combined with cytokine therapy and standard therapy (Group III). Parameters of lipid metabolism were studied in dynamics (total cholesterol, very low density lipoproteins, high density lipoproteins, triglycerides); products of lipid peroxidation (malondialdehydes, conjugates, superoxide dismutase); inflammatory mediators (C-reactive protein, sialic acids, seromucoids, fibrinogen A, circulating immune complexes); hemostatic parameters (fibrinogen, fibrinolytic activity, fibrin degradation products, antithrombin III activity). Hemostatic indices were compared with identical parameters of 48 apparently healthy individuals (reference group).Results. On admission, patients with critical ILE and distal wall occlusion had sharp changes in their lipid metabolism, inflammatory reaction, and hemostasis. Conclusion. The inclusion of intravenous laser blood irradiation and cytokine therapy separately and in combination in a set of therapeutic measures led to the leveling of the studied homeostasis indicators. The best results were obtained in the group where patients had combined perioperative intravenous laser blood irradiation with cytokine therapy in indirect revascularization.

scholarly journals Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus

2021 ◽  
Vol 88 (3-4) ◽  
pp. 21-27
Author(s):  
Yu. V. Ivanova ◽  
I. A. Kryvoruchko ◽  
V. A. Prasol ◽  
K. V. Miasoiedov ◽  
S. A. Andreieshchev
Keyword(s):  
Diabetes Mellitus ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Ankle Brachial Index ◽  
Lower Extremities ◽  
Critical Ischemia ◽  
Diabetes Mellitus Type Ii ◽  
Indirect Revascularization ◽  
Autologous Mesenchymal Stem Cells

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus. Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix. Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted. Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

scholarly journals Influence of intravenous laser blood irradiation on lymphovenous outflow and the state of humoral and cellular immunity in patients with postthrombophlebitic disease of the lower extremities

2021 ◽  
Vol 25 (1) ◽  
pp. 21-26
Author(s):  
G. V. Yarovenko ◽  
S. E. Katorkin ◽  
A. V. Yashkov
Keyword(s):  
T Lymphocytes ◽  
Lymph Nodes ◽  
Cellular Immunity ◽  
B Lymphocyte ◽  
Lower Extremities ◽  
Humoral And Cellular Immunity ◽  
Blood Irradiation ◽  
Group 2 ◽  
Laser Blood Irradiation ◽  
Group 1

Post-thrombophlebitis of lower extremities occurs in 14–29 % of cases and develops within the fi rst two years after the episode of deep vein thrombosis of lower extremities in 20–50 % of patients. Objective: to apply intravenous laser blood irradiation (ILBI) for optimizing outcomes in patients with post-thrombophlebitic disease of their lower extremities. Materials and methods. 52 patients were treated with ILBI. They were randomized into two groups by the following clinical criteria: stage of occlusion – 18 patients (Group 1) and stage of recanalization – 34 patients (Group 2). ILBI course included 7 sessions: irradiation power – 3–15 mW, pulse frequency – 80–3000 Hz, exposure time – 5–15 minutes. Parameters of venous outfl ow and inguinal lymph nodes were monitored by ultrasound examination. Radial immunodiffusion was used to determine levels of IgG, IgM and IgA in blood plasma and serum; turbidimetry – to determine immune complexes; T-lymphocytes – by the receptors to erythrocytes. B-lymphocyte level was monitored with luminescence-serological and complementary rosette formation techniques. Results and discussion. A statistically signifi cant increase in linear and volumetric blood fl ow in great vessels was revealed in both groups. In Group 1, linear blood fl ow in the great saphenous vein increased by 5.2 %; volumetric blood fl ow increased up to 113.0 ± 2.14 mL/min (p < 0.01). In Group 2, volumetric blood fl ow slowed down by 4.1 %. Lymph nodes contracted statistically signifi cantly; the medullary layer narrowed up to 0.32 ± 0.05 cm (p < 0.05), level of IgG, IgM and CIC decreased; number of T-lymphocytes increased up to 60.2 ± 1.7 % (p < 0.05). Conclusion. The revealed effects of intravenous laser blood irradiation at the venous outfl ow, lymph nodes and humoral and cellular immunity in patients with post-thrombophlebitic disease of lower extremities give a reason to recommend the implementation of the discussed technique into a wide clinical practice.

scholarly journals REMOTE 3-YEAR RESULTS OF APPLICATION OF «INDIRECT» WAYS OF REVASCULARIZATION IN PATIENTS WITH CHRONIC ISCHEMIA OF LOWER EXTREMITIES

2015 ◽  
Vol 174 (2) ◽  
pp. 84-88 ◽  
Author(s):  
Yu. V. Chervyakov ◽  
I. N. Staroverov ◽  
A. V. Borisov ◽  
E. G. Nersesyan ◽  
O. N. Vlasenko ◽  
...  
Keyword(s):  
Conservative Therapy ◽  
Lower Extremities ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Lumbar Sympathectomy ◽  
Indirect Revascularization ◽  
The Difference ◽  
Positive Results ◽  
Efficacy Of Treatment

There are several ways of «indirect» revascularization such as revascularizated osteotrepanation of shinbone and lumbar sympathectomy (LS) for treatment of patients with chronic ischemia of lower extremities. They appeared to be sufficiently effective for the patients with II stage of the disease. Patients with critical ischemia (III stage) had persistent positive results after lumbar sympathectomy during 3-year period only in 33% of cases and using revacularized osteotrepnation - 46%. The difference in efficacy of treatment using LS and standard conservative therapy is statistically low significant, so that isn’t allowed recommending the sympathectomy for treatment of III stage ischemia. The method of revascularizated osteotrepanation of shinbone showed a reliably better result, therefore this way is reasonable to apply in surgery in case of III stage ischemia.

scholarly journals Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

2021 ◽  
Vol 88 (3-4) ◽  
pp. 28-34
Author(s):  
M. M. Lopit ◽  
V. І. Rusyn ◽  
P. A. Boldizhar ◽  
F. V. Gorlenko ◽  
O. M. Kochmar
Keyword(s):  
Surgical Treatment ◽  
Lower Extremities ◽  
Late Results ◽  
Anterior Tibial Artery ◽  
Critical Ischemia ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Tibial Arteries ◽  
Anterior Tibial ◽  
Indirect Revascularization

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice. Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment. Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients. Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients. Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

scholarly journals NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

2020 ◽  
Vol 18 (6) ◽  
pp. 710-715
Author(s):  
N. N. Ioskevich ◽  
◽  
L. F. Vasilchuk ◽  
P. E. Vankovich ◽  
S. P. Antonenko ◽  
...  
Keyword(s):  
Lower Limb ◽  
Type I Diabetes ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Type I ◽  
Critical Ischemia ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

scholarly journals The analysis of database of registered diseases of peripheral arteries in Yekaterinburg

2019 ◽  
Vol 60 (6) ◽  
pp. 288-292 ◽  
Author(s):  
Elena P. Burleva ◽  
Yu. V. Babushkina ◽  
D. A. Lobanova ◽  
T. A. Barkan
Keyword(s):  
Medical Records ◽  
Statistical Processing ◽  
Lower Extremities ◽  
Management Decision ◽  
Peripheral Arteries ◽  
Critical Ischemia ◽  
Number Of Patients ◽  
Target Values ◽  
Management Decision Making ◽  
Quality Of Medical Care

The study was carried out to analyze database of registered diseases of peripheral arteries in patients of Yekaterinburg during 2009-2013. The database of the territorial foundation of mandatory medical insurance of the Sverdlovsk region in 2009-2013 was used as study material. The number of registered cases of treatment of diseases of peripheral arteries was analyzed. The sampling of patients with diseases of peripheral arteries taking treatment in twenty-four-hours and day-time hospitals. The statistical processing was applied to all cases ranged by years: patients with compensated blood circulation, critical ischemia of extremities and mortification. The audit was applied to randomly selected 40 medical records of patients with diseases of peripheral arteries, receiving treatment in twenty-four-hours and day-time hospitals during 2014 and 50 medical records ofpatients with diseases ofperipheral arteries against the background of diabetes mellitus from register of the oblast podiatry consulting room. The total number of treated patients with diseases ofperipheral arteries in Yekaterinburg during five years made up to 31,309, including 19% ofpatients with diabetic affection of lower extremities. In twenty-four-hours hospital 12,716 (40.6%) patients were treated and 18,593 (59.4%) were treated in day-time hospital. The study established increasing in day-time hospitals number of patients with arteriosclerosis obliterans up to 1.8 times, with diabetic angiopathy up to 3.6 times. At increasing of number of treated patients number ofpatients with critical ischemia of lower extremities during 5 years decreased insignificantly and number of large amputations have a certain trend to decreasing (up to 2.5%). The study established deviations under application of medicinal therapy in patients with diseases of peripheral arteries at pre-specialized stage and absence of achievement of target values of main laboratory parameters. The database of registered diseases of peripheral arteries can be used as a tool for data analysis and further management decision making with purpose of enhancing quality of medical care of patients residing in municipality.

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