OBJECTIVE:The purpose of the study was to determine clinical and laboratory predictors suggesting an unfavorable outcome of acute limb ischemia. PATIENTS AND METHODS:The work was based on retrospective assessment of treatment of 556 patients with confirmed acute limb ischemia, undergoing treatment in 2000-2018. All patients were operated on. The mean age amounted to 69.9±12.8 years. Women accounted for 51.3%. According to the classification of I.I. Zatevakhin, degree I ischemia was in 36.1% of patients, degree II in 59.2%, and degree III in 4.7%. In the majority of patients, acute ischemia was caused by arterial embolism. The patients were divided into two groups: Group 1 included those discharged with the saved limb after restoration of arterial blood flow and Group 2 comprised patients discharged after amputation. RESULTS:The time from the onset of the disease to the moment of surgical intervention in Group 2 was 10.3-fold longer (p=0.0001). Arterial thrombosis was 2.5 times more associated with the risk of major amputation (p=0.002). The chance of amputation in acute ischemia of upper extremities was 6.8 times less than in lesions of lower limbs (p=0.003). Distal lesions of lower-limb arteries increased 3.6-fold the risk of amputation (p=0.001). The chance of limb loss directly depended on the ischemia degree (p<0.024). In Group 2 patients, the neutrophil-to-lymphocyte ratio was 1.5-fold higher (p=0.001). CONCLUSION:The duration prior to revascularization, limb ischemia degree, etiology and the level of the arterial bed lesion remain the most significant predictors of an unfavorable outcome in acute limb ischemia. Elevated values of the neutrophil-to-lymphocyte ratio appeared to directly associated with the necessity to perform amputation.

Objective. To improve the results of treatment of comorbid patients with acute arterial ischemia by substantiating the optimal type of spinal anesthesia for surgical intervention on the affected limb.Materials and methods. The study involved 70 patients who were treated in the Department of Vascular Surgery of Clinical Hospital of ‘Russian Railways-Medicine Co.’ in Barnaul. The patients were divided into two groups: group 1 – patients operated under conditions of bilateral (bilateral) spinal anesthesia, group 2 – patients operated under conditions of monolateral (unilateral) spinal anesthesia. All patients underwent an assessment of the level of spinal block on the Bromage scale, monitoring of central hemodynamics using a MARG-10–01 rheograph, postoperative assessment of myocardial ischemia on the ECG, acute kidney damage to control diuresis.Results. In the 2nd group, there was a sufficient sensory and motor block to perform surgery. In the intraoperative period in the group of patients who underwent unilateral blockade, the mean arterial pressure decreased by 3 mm Hg. In this regard, there was no clinically significant increase in heart rate and a decrease in the stroke index and the index of total peripheral vascular resistance. In the 1st group, the decrease in mean arterial pressure reached 20% of the original, which led to an increase in heart rate by 12% and a decrease in stroke index by 11%.Conclusions. During the perioperative period, the indicators of central hemodynamics in the group 2 were more stable compared to the group 1, they did not need the use of vasopressor drugs and crystalloids. And in the early postoperative period, patients who underwent unilateral anesthesia did not show signs of acute kidney injury. Monolateral spinal anesthesia, compared with conventional spinal anesthesia, provides more stable hemodynamics in elderly patients with acute arterial ischemia.

A clinical case of arterial and venous thrombotic syndromes in

BACKGROUND:In the structure of surgical events, acute limb ischemia is a cause of death in 25-30% of patients. OBJECTIVE:The present study was aimed at examining the structure of patients with lower and upper limb acute ischemia in the Barnaul urban agglomeration. PATIENTS AND METHODS:We analyzed a total of 1,366 patients presenting with arterial embolism or limb thrombosis within 14 days after the onset of the acute event and hospitalized to the Department of Vascular Surgery during 2000-2018. The epidemiological index of acute limb ischemia amounted to 10.1 per 100 thousand people per year, being comparable with the data of the international statistics. Of these, 865 patients were hospitalized during 2000-2010, and 501 during 2011-2018. RESULTS:Comparing the groups demonstrated an increased number of hospitalizations of women (from 4.6 to 5.3 per 100 thousand/year) in the structure of all patients with acute ischemia, a statistically significant decrease in the number of patients with arterial thromboses, and an increase in the number of those admitted with arterial embolisms. We revealed a tendency to a decrease in the overall number of hospitalized patients and an increase in the number of patients with stage II-III arterial ischemia, with upper limb ischemia diagnosed significantly more often (from 1.4. to 3.2 per 100 thousand/year). CONCLUSION:Along with a trend towards a decrease in the total number of hospitalized patients with acute limb ischemia, we revealed an increase in the number of patients with acute limb ischemia in the presence of arterial embolism and a decreased number of patients with acute arterial thrombosis.

Introduction. For revascularization in the absence of autovenous material, epoxy-treated bioprostheses from the bovine internal mammary artery are widely used in the Russian Federation, which are subjected to certain structural deformations.Purpose and objectives. To compare the structural changes of the biological prosthesis and autovenes in the long-term period after surgery and to determine the influence of some clinical and laboratory parameters on this process.Materials and methods. The study included 45 patients with isolated occlusion of the superficial femoral artery (PBA), who underwent blood flow restoration using various types of prostheses. The patients were divided into 2 groups: group 1 (main) – 25 patients who underwent femoral-popliteal proximal bypass surgery with epoxy-treated bioprostheses from the bovine internal mammary artery; group 2 (control) – 20 patients who underwent femoral-popliteal proximal bypass surgery with a reversed autovena.Results and discussion. During the follow – up period from 1 year to 8 years, 28% of bioprostheses underwent expansion, and 20.0% of patients with autovena showed narrowing of the shunt. In the main group, males had better biological graft patency (RR = 0.76 CI (0.3 2; 1.77)), but in the control group, the male sex increased the risk of occlusion (RR = 1.25 CI (0.18; 8.77)). When followed up for 5 years, the relative risk of prosthetic expansion decreased. At the same time, in patients of the control group, which is not characterized by ectasia, we revealed a decrease in the relative risk of stenosis. The clinical factor affecting the expansion of the biological prosthesis was type 2 diabetes mellitus.Conclusions. The characteristic structural changes in the separated period (more than a year) for an autovenous conduit are narrowing, and for a biological prosthesis – expansion with the formation of aneurysms.

AIM To evaluate the efficacy of a micronized purified flavonoid fraction in patients with primary venous disease. The study enrolled 31 patients, with varicose veins observed in a total of 47 lower extremities which were divided into 3 groups depending on the CEAP clinical class. The group of class C2 included 19 limbs, with the groups of C3 and C4 comprising 14 limbs each. The patients received a micronized purified flavonoid fraction (Detralex) in a daily dose of 1000 mg for 1 month. The venous function of the lower extremities was examined using venous photoplethysmography before and after the course of pharmacotherapy. Venous refilling time and venous half-refilling time were measured as indicators of total venous reflux. In the overall sample of patients with clinical class C2-C4, a significant increase in venous photoplethysmography parameters was found after the course of administration of the micronized purified flavonoid fraction. Thus, the venous refilling time increased from 15.5 (11; 19) s to 19.3 (13; 25) s, the venous half-refilling time increased from 6.5 (5; 7) s to 7.5 (5; 9) s. At the same time, in the group of patients with clinical class C2 and C3, a significant increase in the venous refilling time was found, and in patients with C4, the increase was not significant. There was an inverse correlation between the increase in venous refilling time after drug exposure and the clinical class of venous insufficiency according to the CEAP, as well as the patient's age. Thus, the administration of the micronized purified flavonoid fraction for 1 month in primary venous disease led to a decrease in the total venous reflux. The effect of the micronized purified flavonoid fraction on the total venous reflux was higher in younger patients and in patients with a lower clinical class of the disease.

СРАВНИТЕЛЬНАЯ ОЦЕНКА РЕЗУЛЬТАТОВ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА НА РАБОТАЮЩЕМ СЕРДЦЕ1 Алтайский государственный медицинский университет, г

Цель исследования: изучить лабораторный фенотип редких мутаций Лейдена [FVL А(1961)A] и гена протромбина [FII А(20210)A] при их клинической реализации в виде тромбозов. Материалы и методы. Проведено многоцентровое проспективное наблюдательное исследование, включающее 80 носителей редких генетических форм тромбофилий: FVL А(1961)A (n = 31), FII А(20210)A (n = 10) и компаунд FII G(20210)A + FVL G(1691)A (n = 39). У всех пациентов исследована резистентность фактора Va к активированному протеину С (APC-R) по нормализованному отношению (НО) и уровень активности протромбина в плазме крови в состоянии физического здоровья и в случае эпизода тромботического события. Результаты. Определена ассоциативная связь развития тромботических событий со снижением НО при оценке APC-R как у гомозиготных носителей мутации Лейден (Ме = 0,35; 95% ДИ = 0,31–0,37 по НО), так и гетерозиготных компаундов (Ме = 0,43; 95% ДИ = 0,42–0,45 по НО). Заключение. Лабораторный мониторинг пациентов с редкими формами генетических тромбофилий позволяет выделить группу высокого тромбогенного риска, нуждающуюся в пролонгированной тромбопрофилактике. Objectives: to study the laboratory phenotype of rare Leiden mutation [FVL A(1961)A] and the prothrombin gene mutation [FII А(20210)A] implementating clinically as thrombosis. Patients / Methods. A multicenter prospective observational study included 80 carriers of rare genetic kinds of thrombophilia: FVL A(1961)A (n = 31), prothrombin FII А(20210)A (n = 10) and the compound FII G(20210)A + FVL G(1691)A (n = 39). All patients were tested for the factor Va resistance to activated protein C (APC-R), normalized ratio (NR), and the plasma prothrombin activity (%) in healthy conditions and in the case of thrombotic event. Results. An associative relation between the development of thrombotic events and a decrease in NR was determined when assessing APC-R, both in homozygous carriers of the Leiden mutation (Me = 0.35; 95% CI = 0.31–0.37 in NR) and heterozygous compounds (Me = 0.43; 95% СI = 0.42–0.45 in NR). Conclusions. Laboratory follow up for patients with rare kinds of genetic thrombophilias allows to identify a group at high thrombogenic risk requiring prolonged thromboprophylaxis.

Research objective. To study the structure of VTEC hospitalization and changes in this structure over the last 10 years.Materials and methods. The retrospective analysis of hospitalization of 2327 patients with VTEC for a 10-year period (2010–2019). Depending on the period of admission, patients were divided into 2 groups: the first group (1104 patients) included people hospitalized in the period of 2010–2014; the second group (1223 patients) – admitted to the hospital in the period of 2015–2019. The structure of hospitalization was analyzed. The dynamics of the number of hospitalizations of VTEC nosological forms was studied.Results and conclusions. No statistically significant difference was found in the frequency of VTEC hospitalization, but there is a tendency to an increase in the total number of VTEC. According to the data, the annual frequency of VTEC was 65.5 cases per 100 000 population. The significant increase in frequency of hospitalization of PATE patients was found. This fact may be related not only to the improvement of diagnosis, but also to the increase in the intensity of the thrombotic process. The study presented took into account VTEC requiring treatment in a specialized unit, without regard to VTEC recommended for the outpatient stage of treatment.