The aim of the work was to study the composition of the alcohol extract, antioxidant activity and pharmacological properties of peppermint leaves of three forms - menthol, linalool and carvone. Materials and methods: Chromatography-mass-spectrometric analysis was performed on an Agilent Technologies device. For the model evaluation of antioxidant activity, the aerometric method for measuring the total antioxidant activity was used, implemented in the TsvetYauza-01-AA device. Tonic activity was studied in terms of the duration of swimming of laboratory animal (male mice) with a load of 7% of the animal's body weight until complete fatigue - "The mouse forced swim test". The discussion of the results. When studying the chemical composition of medicinal plant raw materials of peppermint leaves of menthol, linalool, carvone types, more than 50 compounds were identified. A comparative analysis showed that the content of menthol in peppermint leaves of the menthol type can exceed the content of menthol in other chemotypes by ten or more times. At the same time, the tonic effect of an aqueous extract from peppermint leaves is mostly associated with the menthol. It should be taken into account when using this type of raw material in the manufacturing. Findings. The raw material of peppermint leaves may have a different degree of pharmacological activity depending on the chemotype, which should be taken into consideration when using this type of raw material.

Acute mesenteric ischemia (AMI) represents a severe and potentially life-threatening condition caused by an abrupt reduction in intestinal blood flow. This ischemic event, if not promptly addressed, leads to intestinal necrosis. The clinical presentation of AMI is commonly nonspecific and variable, complicating early diagnosis. Without timely detection and intervention, AMI can progress to devastating complications including intestinal necrosis, sepsis, multiple organ dysfunction syndrome (MODS), or short bowel syndrome secondary to extensive bowel resection. Early identification is therefore paramount to optimizing treatment and reducing both morbidity and mortality associated with this condition. This review explores the pivotal role of computed tomography (CT) in the diagnosis of AMI, evaluates the diagnostic accuracy of CT in comparison with alternative imaging modalities, and discusses future advancements aimed at enhancing CT-based diagnostic capabilities. A comprehensive review of the existing literature was conducted, focusing on studies investigating the utility of CT and other imaging techniques in the evaluation of AMI. Relevant diagnostic parameters were analyzed, including bowel wall thickening, pneumatosis intestinalis, and damage within the superior mesenteric artery (SMA) and its branches. The role of CT angiography was also assessed in diagnosing abnormalities of the mesenteric arterial and venous systems. The findings underscore that CT is a highly effective diagnostic tool for AMI, offering superior sensitivity and specificity compared to other imaging technologies such as X-ray, ultrasound, and magnetic resonance imaging (MRI). However, certain limitations — such as suboptimal image quality in specific patient populations, the risks associated with ionizing radiation, and adverse reactions to contrast agents — must be acknowledged and addressed. Despite these challenges, CT has emerged as a cornerstone in the early detection and management of AMI, facilitating rapid and accurate assessments that are critical to improving patient outcomes. Advances in CT technology and integration of artificial intelligence and machine learning algorithms into CT imaging workflows could refine diagnostic accuracy and reduce time-to-diagnosis. A multidisciplinary approach that combines CT imaging with other diagnostic modalities may further optimize the patient management of with AMI. Keywords: acute mesenteric ischemia, mesenteric circulation disorder, computed tomography, CT angiography, early diagnosis, intestinal ischemia, superior mesenteric artery, artificial intelligence, machine learning, multidisciplinary approach. For citation: Kuznetsov M.R., Chernookov A.I., Atayan A.A., Belykh E.N., Kanadashvili O.V., Ramazanov A.A., Ivanova M.I., Tsedinov S.O. Computed tomography in acute mesenteric ischemia: diagnostic possibilities, limitations and the future. RMJ. 2024;10:23–26. DOI: 10.32364/2225-2282-2024-10-4

Violation of mesenteric circulation and intestinal damage are life-threatening conditions that require early diagnosis and, if necessary, prompt surgical intervention. Currently, the diagnosis of these conditions remains a difficult task due to the nonspecific nature of clinical symptoms andlimitations of existing diagnostic tools. The aim of the study is to study the potential of intestinal fatty acid binding protein (I-FABP) as a biomarker of mesenteric circulatory disorders and intestinal damage. The article discusses the structure and function of I-FABP, its expression and distribution in the small intestine, the mechanisms of release of I-FABP. Clinical studies of I-FABP levels in patients with these conditions are analyzed, assessing the accuracy of diagnosis and potential thresholds. The results of this study show that I-FABP has significant potential as a biomarker of OMI, intestinal ischemia and intestinal damage. Elevated levels of I-FABP have been observed in patients, and the diagnostic accuracy of I-FABP appears to be superior to other currently used biomarkers. However, further research is needed to determine optimal thresholds and establish standardized I-FABP measurement protocols. Thus, the introduction of I-FABP as a biomarker into clinical practice may lead to earlier diagnosis and improved outcomes in patients with intestinal ischemia.

Introduction . The wide prevalence of varicose veins of the lower extremities and relapses of this disease causes a frequent combination of this pathology with other surgical and traumatological diseases. The expediency of using simultaneous operations is manifested in their obvious economic advantages. Objective . To substantiate the expediency and effectiveness of simultaneous laser thermal obliteration of recurrent veins of the lower extremities and Baker’s cyst. Materials and methods . 9 patients with recurrent varicose veins and Baker’s cyst were operated on. Of these, there were 7 (77.8%) women and 2 (22.2%) men, the average age was 52.8 ± 0.2 years. The average duration of the incidence of varicose veins was 14.1 ± 0.3 years, Baker’s cyst – 3.5 ± 0.1 years. As planned, patients underwent simultaneous laser endovenous coagulation of recurrent veins and intracavitary thermal obliteration of Baker’s cyst. Results . There were no complications, the duration of operations was 40.3 ± 0.4 minutes. The intensity of the pain syndrome in 6–8 hours after surgery was 4.1 ± 0.2 points. On the 10th day, no pain was observed in any patient. The duration of pain was 7.8 ± 0.4 days. Long-term results were studied 12–16 months after completion of treatment in 9 (100%) patients. Recurrent varicose veins were not detected. In 8 (88.9%) patients, complete obliteration of Baker’s cyst was established. Conclusions . Reliable obliteration of Baker’s cyst and recurrent varicose veins, 100% technical success, disappearance of clinical symptoms of this pathology, absence of relapses of both diseases in 8 (88.9%) patients after 12-16 months indicates high efficiency and indisputable prospects of such an approach to the treatment of this category of patients. However, the study is based on a small number of observations, so further accumulation of experience is required to generalize the results of the study.

Introduction. Sclerobliteration of varicose veins of the lower extremities is one of the most common methods of treating patients with varicose veins. However, the main disadvantage of echosclerobedation of the trunks of the great and small saphenous veins is the possibility of recanalization of sclerosed veins. In this regard, it is of interest to compare the results of using radiofrequency vein obliteration and endovenous laser coagulation in these patients. Aim. To study the effectiveness, advantages and disadvantages of the use of radiofrequency vein obliteration and endovenous laser photocoagulation of recanalized varicose veins in patients undergoing sclerobliteration. Materials and methods. 44 patients aged 18 to 62 years underwent radiofrequency obliteration and endovenous laser coagulation of varicose veins after previous sclerobliteration. A comparative assessment of the duration of the operation, technical success, intensity of the pain syndrome, the level of postoperative complications and relapses of the disease after the use of these methods of recanalized saphenous veins after previous sclerotherapy was made. Results and discussion. The technical success of endovenous laser coagulation of reknalizirovanny varicose veins was 100%, radiofrequency obliteration of veins – 90.9%. The intensity of postoperative pain on the 7th day from the moment of radio wave exposure was 12.1% lower than after the use of endovenous laser coagulation, the average duration of laser thermolysis was 32 ± 0.6 minutes, radio wave – 39 ± 0.7 minutes. Conclusion. Laser coagulation compared to radiofrequency is a more reliable and feasible operation, but is accompanied by a higher level of postoperative pain and side effects.

Aim: to justify the choice of the most optimal treatment method depending on the cause, and clinical and anatomical patterns of the varicose veins relapse. Patients and Methods: treatment results of 157 patients with varicose vein relapses were analyzed. The mean age of patients was 39,8±0,3 years. 3 years after surgery, relapse occurred in 23 (14.7%) patients, in terms of 3 to 5 years — in 95 (60.5%), after 5 years or more — in 39 (24.8%). Different treatment methods were used depending on the individual clinical and anatomical relapse form of varicose veins. Anesthesia choice depended on the type and extent of surgical intervention. Of the open access, 94 (59.9%) surgical interventions were performed, minimally invasive methods of treatment were used in 63 (40.1%) cases. The life quality was assessed at the patient's admission to the clinic and 1–2 years after the end of treatment using the CIVIQ-2 questionnaire. Results and Discussion: after the use of minimally invasive techniques, the average pain intensity on the VAS was 3.1±0.2, in patients who underwent open resurgeries — 5.4±0.3. Early postoperative complications were noted in 3 (1,9%) patients. Long-term treatment results were examined in 129 (82.2%) patients out of 157 included in the study within 12 to 24 months after discharge from the clinic. After performing open surgeries, the average value of the cosmesis index on a ten-point scale was 6.1±0.3 points, after minimally invasive interventions — 7.9±0.5. In the long-term period, the disease repeatedly recurred in 2 (1.6%) patients. It was also found that the use of the developed treatment tactics for patients with relapses of varicose veins leads to an improvement in the life quality parameters by 1,2–1,5 times. Conclusion: eliminating the causes of varicose disease relapse, minimizing the invasiveness of interventions improves immediate and long- term treatment results and the life quality of patients. The use of preoperative duplex angioscanning and modern high-tech treatment methods helps to reduce the relapse number of varicose veins associated with technical and tactical errors of surgeons. KEYWORDS: varicose vein relapses, minimally invasive interventions, open surgeries, life quality. FOR CITATION: Zubritskiy V.F., Chernookov A.I., Kuznetsov M.R. et al. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins. Russian Medical Inquiry. 2023;7(4):225–231 (in Russ.). DOI: 10.32364/2587-6821-2023-7-4-225-231.

Due to the increase in allergic reactions to synthetic drugs, there has been a demand to expand the range of medications based on medicinal plant-based raw materials. Tanacetum vulgare is a medicinal plant that contains large amount of biologically active substances and is widely used in traditional and modern medicine. The aim of the study was to elaborate the chemical composition and pharmacological activity of extracts (the essential oil, the tincture and the petroleum extract) derived from medicinal plant-based raw materials of Tanacetum vulgare. The object of the study was essential oil obtained from fresh Tanacetum vulgare grass, petroleum extraction of Tanacetum vulgare and tincture obtained from Tanacetum vulgare using the maceration method. The qualitative composition of essential oil, tincture and petroleum extraction was determined by chromatography-mass spectrometry. In essential oil, regardless of the preparation method, the maximal antioxidant activity is shown by the petroleum extraction from the grass of Tanacetum vulgare. Hydrodistillation was performed using a Ginsberg method or hydrodistillation using a Cleveger method. More than 80 compounds have been identified; more than 100 compounds have been identified in tincture, and more than 150 compounds have been identified in petroleum extraction,such as camphor, borneol, ascaridiol, isoaromadendrene, cubenol, limonene, carvacrol, pinene, cineol, terpineol and chrysanthenon. Tincture and essential oil exhibit antioxidant activity slightly lower than petroleum extraction.

Introduction . There is a growing number of people over 60 years old and consequently a growing number of elderly and senile patients with varicose veins globally. These patients have involutive changes that occur in the body, and therefore they need a special and personalized approach to examination and treatment. Aim . Study and evaluate age-related and varicose disease-related structural changes in the inner lining of the large subcutaneous vein. Materials and methods . 135 fragments of the large subcutaneous vein were examined, 55 of which belonged to deceased people who had no venous disease, 80 operated patients with varicose veins. There are 4 age groups: young, middle, elderly and senile. Histological, morphometric and electron microscopic examination was performed. Results and discussions . The study showed that involutive changes are characterized by a decrease in the number of endothelial cells along the inner perimeter and their flattening, loosening and edema of the subendothelial stroma in persons over 75 years of age. In varicose veins, morphological changes progress with increasing patient age and disease duration. In young and middle-aged people with varicose veins, endotheliocytes flatten, protrude into the lumen of the vessel, collapse, areas of endothelial atrophy appear along the perimeter, signs of myoelastofibrosis appear, as indicated by an increase in the volume fraction of intima due to connective-woven structures. In patients over 60 years of age, endothelial desquamation is more evident in intimacy, the preserved cells are destructively changed, the volume fraction of intima significantly decreases, which corresponds to the signs of intima sclerosis. Conclusions . Under normal conditions in senile age, the volume fraction is significantly reduced compared to the middle age group (p < 0.005). In case of varicose veins, structural changes, both qualitative and quantitative, progress against the background of involutive changes and disease duration, which aggravates endothelial dysfunction.

OBJECTIVE:To analyze the results of redo reconstructions of lower limb arteries in patients with obliterating atherosclerosis, immediate and long-term results in patients who underwent reconstructive interventions with occlusion of previous reconstruction and preventive interventions.MATERIAL AND METHODS:The study included 43 patients. The main group (group 1) consisted of 18 patients who underwent preventive vascular reconstructions. The control group enrolled 25 patients who underwent redo interventions for occlusion of previous reconstructions. The control group was divided into 2 parts; 15 patients had chronic limb ischemia (group 2), 10 patients had acute limb ischemia (group 3). Mean age of patients was 56.8±8.2 years; there were 37 (86%) men and 6 (14%) women. Multifocal vascular atherosclerosis was noted in 41 (95.3%) patients, carotid artery lesion - 29 (70.7%), coronary artery disease - 34 (79%). Patients with type II diabetes mellitus were excluded.RESULTS:We chose each surgical intervention considering preoperative diagnostic data. Open, endovascular and hybrid interventions were performed. There were no deaths and limb amputations in the 1st group. Two (13.3%) amputations were registered in the 2nd group, 3 (30%) amputations and 1 (10%) death were registered in the 3rd group. The follow-up period was 24 months. An 18-month freedom from amputations was 71.5%, 78% and 38%, respectively (p<0.05 compared to the 1st and 2nd groups).CONCLUSION:Preventive surgical interventions prevent ischemia and amputation, as well as improves the results of redo surgery.

Aim: to substantiate the feasibility of concurrent surgeries in patients with varicose vein disease and anterior abdominal wall hernias (ventral hernias). Patients and Methods: the paper presents the treatment results of 82 patients with ventrial hernias and lower limb varicose vein disease. The method choice and the scope of surgical intervention were determined on the basis of clinical and instrumental examination data. Commonly, Lichtenstein tension-free hernia repair in combination with crossectomy, endovasal laser coagulation (EVLC), varicose veins radiofrequency ablation (VVRFA) were performed. The long-term results were analyzed 1–2 years after the use of concurrent surgeries. The life quality before surgery and a year after was determined by the SF-36 questionnaire. Results: the patients consisted of 45 (54.9%) men and 37 (45.1%) women aged 19 to 69 years. In 20 (24.4%) of the admitted patients, work was associated with physical activity, and 56 (68.3%) patients were at the most capable age: 19 to 50 years. Upon admission to the clinic, 78 patients had complaints. Commonly, they had a combination of varicose vein disease with inguinal or umbilical hernias. After the use of concurrent surgeries, no specific complications were observed in this patient cohort, as well as complications associated with both diseases concomitantly. In the long-term period, patients noted an improvement in their general health by 23.2%. In the preoperative period, the indicator of physical functioning was 41.27 points; after the operation, there was an increase in this indicator according to patients’ estimates by 1.6 times — to 67.32 points. After surgery, the greatest positive trend of vital activity (42.8%) and role limitations due to emotional state (57.3%) were observed. There was an increase in all indicators of life quality by 18.2–53.9% in patients who underwent concurrent surgeries. Conclusion: the obtained results demonstrated the safety and high efficacy of concurrent surgeries in patients with varicose vein disease and ventral hernias. Thus, the use of concurrent surgeries is considered to be an alternative to the staged treatment of patients with varicose vein disease and ventral hernias KEYWORDS: concurrent surgeries, varicose vein disease, ventral hernias, life quality, postoperative complications. FOR CITATION: Chernookov A.I., Kuznetsov M.R., Kandyba S.I. et al. Concurrent surgeries in patients with varicose vein disease and ventral hernias. Russian Medical Inquiry. 2022;6(4):164–170 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-164-1.

Introduction. True doubling of great saphenous vein is observed in 1.6–2.1% of patients with varicose veins and may be one of the reasons for the development of postoperative relapse of the disease. Performing endovasal laser coagulation (EVLC) of both great saphenous vein trunks makes it possible to increase the radicality of the intervention and reduce the likelihood of a recurrence of varicose veins. Aim. Based on the study of immediate and long-term results, to substantiate the expediency of using EVLC of the main and true additional stem of great saphenous vein in patients with varicose veins. Materials and methods . From 2014 to 2020, 24 patients with a true doubling of great saphenous vein were treated. Among the applicants there were 12 women and 12 men aged 23 to 62 years with clinical class C2–C4 according to the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification. All patients under tumescent anesthesia underwent simultaneous EVLC of the main and accessory trunk of the BPV, followed by miniflebectomy or sclerobliteration of varicose tributaries. Results and discussion . The use of simultaneous coagulation of both trunks was performed by all patients, thus the technical success of the operation was observed in 100% of cases. There were no intraoperative complications. The use of such a volume of intervention is accompanied by an increase in the duration of the operation by 29.3%. Hyperpigmentation in the projection of the coagulated trunk was observed in 2 (8.3%) patients, neurological disorders – in 1 (4.2%) patient. During the examination of patients 1–2 years after the operation, no relapses of the disease were detected, and the cosmetic result of the intervention on a ten-point scale, patients on average estimated at 7.6 points. Conclusions . True doubling of the great saphenous vein is rare and may increase the likelihood of relapses of the disease. EVLC of the main and additional BPV trunks is accompanied by an increase in the duration of surgery by an average of 29.3%, and the number of patients with hyperpigmentation by 1.5 times. Simultaneous EVLC of both tables with true duplication of BPV makes it possible to reliably block a potential source of varicose disease recurrence and reduce the likelihood of recurrent veins.

Despite the improvement of blood circulation restoration methods in acute ischemia of various localizations and the use of anticoagulant and antiplatelet therapy to maintain the reperfused artery patency, there is still no effective prevention of reperfusion tissue injury, which determined the aim and objectives of the present study. Objective of the study. The article presents our own data on the effect of intravenously injected liposomal antioxidant complex «Flamena» on the degree of myocardial damage in rats in the ischemia-reperfusion model. Material and Methods. The study was performed on 53 mature male white outbred rats. Results. The efficacy of the agent has been shown, expressed by a decrease in the size of irreversibly damaged tissues, a decrease in the percentage of large infarctions. The optimal dose of the substance in experimental myocardial infarction was found to be 2.9 ml/kg. Conclusion. The efficacy of liposomal-antioxidant complex «Flamena», especially demonstrated on the traumatic experimental IR model in small laboratory animals with prolonged ischemia, suggests the potential of this method of reperfusion injury prevention in acute ischemic events and dictates the need for further research. Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study На фоне совершенствования методов восстановления кровообращения при острых ишемических пораже- ниях различных локализаций и применения антикоагулянтной и антиагрегантной терапии для поддержания проходимости реканализованной артерии до настоящего времени не имеется эффективной терапии для профилактики реперфузионного повреждения тканей, что и определило цель и задачи настоящего иссле- дования. Цель исследования. В статье представлены собственные данные по изучению влияния липосомально- антиоксидантный комплекса «Фламена», вводимого внутривенно, на степень повреждения миокарда у крыс в модели ишемии-реперфузии. Материал и методы. Исследование было выполнено на 53 половозрелых самцах белых беспородных крыс. Результаты. Показана эффективность применения препарата, проявившаяся снижением размеров нео- братимо поврежденных тканей, снижением процента крупных инфарктов. Установлено, что оптимальной дозой препарата при экспериментальном инфаркте миокарда является 2,9 мл/кг. Заключение. Эффективность липосомально-антиоксидантного комплекс «Фламена», особенно показанная на травматичной экспериментальной модели ИР у малых лабораторных животных и при длительной ише- мии, говорит о перспективности такого способа профилактики реперфузионного повреждения при острых ишемических событиях и диктует необходимость дальнейших исследований.

Discussed in the article are the main problems related to surgical treatment of patients with peripheral artery disease, particularly taking into consideration that in the world there are from 160 to 202 million people suffering from this disease, with two thirds of such patients having signs of lesions of coronary or cerebral arteries. Vascular reconstructive interventions cannot completely eliminate the problem, since in the postoperative period there may develop cardiovascular complications related to both the limb involved as either acute or progressing chronic ischaemia and arteries of other localization (coronary, cerebral). The risk of serious cardiovascular complications in patients with a history of endured adverse ischaemic events on the part of limbs is severalfold higher. To solve these problems and decrease complications, salicylic acid is used as basic therapy. Attempts at replacing it by another drug or combined therapy with an alternative antiaggregant showed no advantages in increased risk of massive haemorrhage. On the other hand, a combination of salicylic acid with an anticoagulant at a low dose, i. e., rivaroxaban 2.5 mg twice daily as compared with acetylsalicylic acid monotherapy made it possible to significantly decrease the incidence of various cardiovascular complications in the form of myocardial infarction, stroke, adverse ischaemic events on the part of the extremity, limb amputation.

This paper discusses the issues emerging during the treatment of lower-limb arterial diseases and intermittent claudication. According to the international and Russian guidelines, the common management strategy for intermittent claudication is as follows: conservative treatment is recommended in patients without limiting intermittent claudication who can walk 30 m or more without pain. Drugs that are prescribed is these patients are addressed. No large well-designed studies on most of these drugs were conducted, therefore, it is challenging to assess their efficacy in patients with intermittent claudication. The authors focus on cilostazol that has the largest evidence base. This drug is included in the Russian and international clinical guidelines. Several students demonstrate that cilostazol provides antithrombotic effect, stabilizes atherosclerotic plaques, prevents hyperplasia of neointima and restenosis after vascular procedures, improves lipid metabolism, and significantly increases pain-free walking distance (intermittent claudication distance). Recent studies show that cilostazol can be used in the complex treatment for COVID-19 due to pleiotropic mechanism of action. KEYWORDS: lower-limb arterial diseases, intermittent claudication, conservative treatment, cilostazol, COVID-19, restenosis, antiplatelet therapy. FOR CITATION: Kuznetsov M.R., Reshetov I.V., Sapelkin S.V., Yasnopol’skaya N.V. Conservative treatment for intermittent claudication. Russian Medical Inquiry. 2021;5(4):212–217 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-212-217.

Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.

BACKGROUND A steadily growing number of primary lower extremity arterial reconstructions is inevitably followed by the need to perform repeat interventions. Shunt reocclusion may become a cause of return of ischaemia to the initial level, may significantly increase the degree of limb-threatening chronic ischaemia, as well as lead to the development of an acute condition requiring urgent corrective measures to be taken. A reoperation currently continues to remain the standard of treatment. Despite advances in modern resuscitation, the postoperative mortality rate in such patients reaches 20%. AIM This study was aimed at assessing feasibility of hybrid technologies in acute thrombosis after reconstructive operations on lower-limb arteries. PATIENTS AND METHODS We retrospectively analysed the results of treatment of 66 consecutive patients urgently admitted to the City Clinical Hospital named after S.S. Yudin from 2015 to 2020 with acute lower limb ischaemia caused by acute occlusion of the zone of primary vascular reconstructions previously performed at other medical facilities. Depending on the method of surgical treatment, the patients were divided into two groups. The Study group included 20 patients subjected to open surgical interventions followed by angiographic control and using one or other type of X-ray-endovascular treatment. Endovascular interventions were performed for more than 70% stenoses in the major arteries and zone of the previously performed operation. The Comparison group comprised 46 patients treated without endovascular technologies. They were subjected to thrombectomy from the vascular construction with/without reconstructive-restorative operations. RESULTS Seventeen (85%) of the 20 Study group patients were operated on in a stagewise manner, with the first stage consisting of an open intervention - thrombectomy and reconstruction followed by angiographic control and roentgenendovascular treatment. The remaining three (15%) patients underwent simultaneous interventions. In the postoperative period, limb amputations were performed in ten (22%) Comparison group patients and in one (5%) Study group patient (p=0.049). There were three (7%) lethal outcomes in the Comparison group, with none in the Study group. CONCLUSION A combination of open and endovascular interventions in patients with shunt occlusion after vascular reconstructions makes it possible to reveal the cause of shunt occlusion, as well as to remove multilevel lesions, minimizing surgical wound and contributing to reducing the amputation rate.

Папышева Ольга Виуленовна -к. м. н., главный врач ГБУЗ «ГКБ им

ХирургияАнтитромбоцитарная терапия при периферическом атеросклерозе М.Р.Кузнецов 1, 2

The routine practice of a vascular surgeon is invariably associated with decreasing the risk of adverse cardiovascular events in patients presenting with either arterial or venous pathology. Antithrombotic therapy is one of the key approaches used to achieve this purpose. However, a wide variety of modern drugs inhibiting platelet aggregation and agents blocking the coagulation cascade, as well as their combinations makes the selection of the most appropriate treatment for a particular patient quite a difficult task. The choice should carefully be made taking into consideration the nosology, aetiology, accompanying diseases and therapy thereof, as well as the balance of the risk of ischaemic and haemorrhagic complications. Therefore, availability of modern antithrombotic drugs favourably contributing to a more personified approach to treatment is of utmost importance. Thus, for example, rivaroxaban, an anticoagulant belonging to the class of direct-acting oral factor Xa inhibitors, provides a possibility to select an optimal dosage and regimen for a particular patient with arterial or vascular pathology in practice of a cardiovascular surgeon.