Цель Оценка различных параметров ходьбы с помощью опросника Walking Impairment Questionnaire (WIQ) у больных критической ишемией нижних конечностей до и через 1 год после спинальной нейростимуляции. Методы У 46 больных критической ишемией нижних конечностей 64,5 (54,9–72,6) года с помощью опросника WIQ до и через 1 год после спинальной нейростимуляции оценивались параметры: «боль», «расстояние», «скорость», «лестница», где 100% — отсутствие ограничений при ходьбе. С помощью многомерного линейного регрессионного анализа определялись факторы, влияющие на параметры ходьбы до и после спинальной нейростимуляции. Результаты У больных критической ишемией нижних конечностей исходно выявлены низкие значения опросника WIQ: менее 10% по шкалам «расстояние», «скорость» и «лестница» и около 30% по шкале «боль». Через 1 год после спинальной нейростимуляции значения шкал «боль», «расстояние» и «скорость» повысились до 83,3 (68,4–100,0), 39,5 (17,9–55,2) и 24,4 (17,3–35,8) % соответственно (p<0,001, p = 0,004, p = 0,005). Наи­более низкие показатели были по шкале «лестница» — 6,2 (3,4–7,3) %, p = 0,06. До спинальной нейростимуляции фактором, неблагоприятно влияющим на показатели шкалы «расстояние», являлся сахарный диабет 2-го типа (β = –0,417; p = 0,002), на «скорость» — возрастной фактор (β = –0,544; p = 0,005). Через 1 год после спинальной нейростимуляции на скорость передвижения также отрицательно влиял возраст (β = –0,497; p = 0,002), на показатели шкалы «лестница» — ишемическая болезнь сердца (β = –0,421; p = 0,001) или сахарный диабет 2-го типа (β = –0,325; p = 0,032). Заключение Спинальная нейростимуляция у больных критической ишемией нижних конечностей улучшает параметры ходьбы в отдаленные сроки после лечения за исключением способности подниматься по лестнице. Сахарный диабет 2-го типа, ишемическая болезнь сердца, а также возраст являются неблагоприятными факторами, влияющими на параметры ходьбы как до, так и в отдаленные сроки после спинальной нейростимуляции. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Финансирование Исследование не имело спонсорской поддержки.

Today, there are insufficient data on the dynamics of quality of life (QoL) in patients with critical lower limb ischemia after spinal cord stimulation.OBJECTIVE:To study the dynamics of QoL in patients with critical lower limb ischemia one year after spinal cord stimulation.MATERIAL AND METHODS:QoL analysis was performed in 43 patients with critical lower limb ischemia using the SF-36 questionnaire before and one year after spinal cord stimulation.RESULTS:At baseline, we detected reduced QoL parameters corresponding to the physical function (≤30 points). The parameters of mental health corresponded to the moderate level (the score ranged between 42 and 59 points). The total score of physical well-being was reduced: 22.8 (20.2-29.3); the mean score of mental well-being was 41 (32.8-49.2) (p<0.001). One year after spinal cord stimulation, the level of all QoL parameters was increased but the total score of physical well-being remained low 33.2 (24-44.1). The mean score of mental well-being corresponded to the moderate level of QoL 56.5 (49-60.4) (p<0.001). Multivariate regression analysis showed that the physical parameters of QoL after spinal cord stimulation are adversely affected by such factors as age, the history of stroke, the ankle-brachial index (ABI), the presence of type 2 diabetes mellitus (DM), and ischemic heart disease (IHD) in combination with stenosis of brachiocephalic arteries (BCA). The mental health is affected by age and the presence of stenosis of brachiocephalic arteries.CONCLUSION:When selecting patients with critical lower limb ischemia for spinal cord stimulation, such factors as the baseline clinical status (comorbidities), age, history of stroke, and the severity of peripheral artery ischemia need to be taken into account to improve treatment effectiveness and QoL.

Aim. To evaluate various parameters of walking using the Walking Impairment Questionnaire (WIQ) in patients with critical lower limb ischemia (CLLI) before and one year after spinal cord stimulation (SCS). Methods. In 46 patients with CLLI aged 64.5 (54.9–72.6) years, the following parameters were assessed before and one year after SCS using the WIQ questionnaire: pain, distance, speed, stairs, where 100% no restrictions when walking. Results. In patients with CLLI, low WIQ values were initially identified for the scales of distance, speed, and stairs, less than 10%, and about 30% for the pain scale. One year after SCS, the values of pain, distance, and speed increased to 83.3% (68.4%–100%), 39.5% (17.9%–55.2%), and 24.4% (17.3%–35.8%), respectively, with significance at p < 0.001, p = 0.004, and p = 0.005, respectively. The lowest rates were on the scale of stairs: 6.2% (3.4%–7.3%), p = 0.06. Before the SCS, the factor adversely affecting the indicators of the distance scale was diabetes mellitus (β = –0.417; p = 0.002), and the age factor adversely affected the walking speed (β = –0.544; p = 0.005). After SCS, age exerted a negative effect on the walking speed (β = –0.497; p = 0.002). The scale for stairs was negatively affected by the presence of coronary heart disease (β = –0.421; p = 0.001) or diabetes mellitus (β = –0.325; p = 0.032). Conclusion. The use of SCS in patients with CLLI improves the parameters of walking in the long-term follow up after treatment, except for the ability to climb stairs. Age and the presence of diabetes mellitus or coronary heart disease are adverse factors that affect the walking parameters, both before and in the long-term period after SCS. Received 14 March 2019. Accepted 25 July 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

AIM To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. MATERIAL AND METHODS The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Microcirculatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcutaneous oximetry (TcpO2, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. RESULTS In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and TcpO2, the authors observed an increase in MBF and tissue metabolism - from 1.3 (0.7-2.8) to 6.2 (3.8-8.7) PU and from 14.5 (7.5-22.1) to 41.1 (26.4-57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO2 <10 mmHg and the duration of pain. CONCLUSION SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO2 <10 mmHg and the duration of pain.

Background. Several previous studies have demonstrated that spinal cord stimulation (SCS) can reduce the amputation rate in patients with critical lower limb ischemia (CLLI) and improve blood circulation parameters of the lower limbs. However, there is a lack of studies on the long-term effects of SCS on the quality of life (QoL) of patients with CLLI. Aim. The present study aimed to assess QoL changes in patients with CLLI after SCS system implantation in the long run (i.e., 30–60 months).Methods. This study included 38 patients with CLLI (10 females, 28 males; age range: 39–83 years) who underwent surgery in 2012–2016. QoL was analyzed using the SF-36 questionnaire before and 30–60 months after SCS. The mortality and amputation rates and amputation levels of the patients were also analyzed. The SF-36 questionnaire scores were normalized according to the data of the respective sex and age groups in the general Russian population. The obtained scores were analyzed in their dynamics and compared with the scores of the general population.Results. The preoperative scores of three of four physical well-being QoL parameters of the patients significantly reduced compared with the scores of the general population (p < 0.001). However, the scores of mental well-being QoL parameters were close to those of the general population. The total physical well-being score reduced (37.9 ± 9.2 points), whereas the total mental well-being score was within the medium range (48.1 ± 8.3 points). At 30–60 months after SCS system implantation, 5 patients or their representatives were unavailable, 12 died, 3 underwent amputation at the tibial level, and 16 showed preserved support function of the legs (2 of these patients underwent toe amputation). SCS system failure was noted in 3 patients. Patients with preserved support function of the legs completed the SF-36 questionnaire at 30–60 months after SCS system implantation. All QoL parameter scores showed increases, and the total postoperative physical well-being score of these patients was close to that of the general population (46.3 ± 10.6 points, p = 0.050 compared with the preoperative score). However, the total mental well-being score of the patients was higher than that of the general population (57.9 ± 3.8 points, p = 0.041). Conclusion. SCS does not reduce the mortality rate in patients with CLLI compared with conservative therapy. However, it reduces the amputation rate in patients who survive. Significant positive changes in QoL persist for a long time after SCS system implantation in most patients.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

AIM:To evaluate long-term outcomes of spinal neurostimulation (SNS) in patients with critical lower limb ischemia (CLI).MATERIAL AND METHODS:Long-term outcomes of SNS were assessed in 52 CLI patients. Changes of clinical status were considered by using of Rutherford R.B. et al. scale. Before and in 12 months after SNS percutaneous oxygen partial pressure (TO2, mm Hg) was measured at the affected lower limb at rest and in orthostatic test. Ankle-brachial index (ABI) was also determined.RESULTS:SNS improved clinical status in most cases through following effects: 1) reduced pain syndrome and increased motor activity; 2) skin ulcers healing due to increased TO2 and improved functional state of microcirculation. No augmentation of TO2 during orthostatic test at TO2 <10 mm Hg was associated with negative clinical dynamics after SNS (OR 3.2, CI 2.2-54.1, p=0.002). Coronary artery disease with supra-aortic vessels lesion was associated with reduced ABI after SNS (OR 2.1, CI 1.4-3.8, p=0.001).

The aim - to assess the state of peripheral perfusion in patients with critical lower limb ischemia (CLLI) before and during the longterm period after spinal cord stimulation (SCS). Material and methods. Microcirculatory blood flow (MBF) of the lower limbs (LL) was studied in 42 patients with CLLI by transcutaneous oximetry (ТсрО 2 , mmHg) and laser doppler flowmehy (Perfusion Units (PU)). Results. Prior to SCS we observed a reduction in peripheral perfusion and a disturbance the function of MBF in the form of a paradoxical reaction of blood flow during the orthostatic test (OT). After SCS, we observed an increase in tissue metabolism and MBF from 10.5 (6.4-16.0) mmHg and 1.0 (0.5-1.9) PU to 39.5 (15.0-57.0) mmHg and 5.7 (2.3-9.6) PU respectively, with an improvement in MBF function as an adequate response in OT. Conclusions. With CLLI, we detected a decrease in peripheral perfusion and breaking mechanisms of adaptation of MBF during OT. After SCS there is an increase the level of peripheral perfusion and improvement in the function of MBF.

Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

Представлен клинический случай установки вентрикулоатриального шунта у 10-месячного пациента с тяжелой сопутствующей патологией – спаечной болезнью после многократных оперативных вмешательств по поводу неспецифического язвенного колита. При установке вентрикулоатриального шунта выявлены анатомические особенности строения внутренней югулярной вены. В послеоперационном периоде, по данным клинико-неврологического и инструментального исследования, отмечалась положительная динамика пациента.

The paper analyzes the outcomes of treatment of 538 patients with arterial aneurysms. The patients were divided into two groups according to time intervals. The first group included 275 people, of whom 207 patients (75.3%) were exposed to microsurgical clipping and 68 (24.7%) underwent endovascular treatment. The second group comprised 263 patients. Mortality in the endovascular subgroup of the second group was 1.6%. Preconditioning technology in microsurgery of large and giant aneurysms proved to be a useful procedure for the protection of ischemic brain lesions. The strategy of using endovascular treatment demonstrates a decline in surgical mortality.