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As the population ages, the prevalence of chronic diseases increases and, accordingly, the probability of simultaneous occurrence of many chronic diseases among the elderly population increases, which affects the dynamics and prognoses of the underlying disease. Prevention of complications of concomitant semantics for the underlying disease seems to be a complex medical problem, the solution to which is aimed at improving the quality of life of patients. Based on the data obtained, the effect of polymorbidity on the course of acute lower limb ischemia (ALLI) was studied in the elderly urban population. The purpose of the study is to analyze the effect of multimorbidity on the life quality of the elderly urban population, exemplified by patients with acute lower limb ischemia., Material and Methods: 91 patients with ALLI (n=91) were examined, the mean age equaled to 70±1.2 years, with thromboembolism against the background of arterial occlusion., Results: The age of patients is one of the highest risks and must be taken into account when deciding on surgical intervention and further therapy for ALLI., Research Limitations: The study had no administrative restrictions., Conclusion: It was found that the value of the comorbidity index in patients with acute lower limb ischemia is associated with the severity of the underlying disease and characterizes the predicted decrease in the probability of a 10-year survival and the risk of death.

Objective: To study the incidence of peptic ulcers accompanied by gastrointestinal bleeding after surgery for critical lower limb ischemia and their relationship with the factors predisposing to mucous membrane damage., Material and Methods: The study involved 94 patients with critical lower limb ischemia who were eligible for open bypass surgery. All patients underwent preoperative gastro- and duodenoscopy. The patients were followed up for 1 year, while the relationship between the nature of the lesion of the proximal gastrointestinal tract mucosa and the duration of pain syndrome against the background of ischemia, painkiller consumption and redo surgery., Results: All study participants had lesions of the mucous membrane of the stomach and duodenum: inflammatory changes were identified in 92.6% of patients, ulcerative defects in 7.4%. When conducting a correlation analysis, we obtained a weak and moderate strength of the relationship between the duration of rest pain and severity of mucous membrane lesion and strong correlation between painkiller consumption and endoscopic data. Postoperative gastrointestinal bleeding was more common after redo reconstructive surgery or amputation compared to one intervention (7.7% and 1.8%, respectively)., Conclusion: Various lesions of gastrointestinal mucous membrane are diagnosed in all patients with critical lower limb ischemia. It is associated with the underlying disease and painkiller consumption. Risk of bleeding is higher after redo surgery and amputations. Prevention of lesions requires comprehensive examination of patients and individual approach.

Background: Currently there is no data on peripheral arterial disease prevalence in Russia., Aim: To estimate prevalence of patients with symptomatic low limb ischemia (LLI) in Russian Federation on 2014., Patients and Methods: «League for patient' protection» had sent questionnaires for all regional health departments asking to name prevalence of ICD-10 codes I70.2 (atherosclerosis of arteries of extremities) and I73.1 (thromboangiitis obliterans (Buerger)) on 2014. The figures were listed separately for ischemia I-IIa and III-IV (critical limb ischemia, CLI) (Pokrovsky, 1976). Also were mentioned major amputations and mortality., Results: Total number of received questionnaires was 44, we've got information from all RF' federal regions with a population of appr. 71 million people. There were 174 125 cases of symptomatic LLI. Prevalence of symptomatic LLI among Russian population aged more than 40 years was 0.51%. Prevalence of intermittent claudication was 0.36% and of critical limb ischemia - 0.13%. Rate of major amputations was 6.9%., Conclusion: World PAD prevalence among people older than 25 years is 8.3%. The same figure in our study was only 0.5%. This is due to the fact that we considered only symptomatic LLI and only with codes I70.2 and I73.1. Prevalence of symptomatic patients among all PAD patients is 10-35%. So the real number of PAD patients in Russian might be 1.5-5%. We can conclude that PAD is still unrevealed in Russia. Another conclusion could be that the treatment results are less than satisfactory. Finally there is urgent necessity for special PAD register in RF.

Objective: to perform a complex ophthalmological and general examination of patients with retinal vein occlusion (RVO) and to derive classification criteria for retinal ischemia., Materials and Methods: A total of 44 patients with RVO and macular edema and 20 controls were enrolled. All patients underwent a thorough ophthalmological and general examination and clinical laboratory testing., Results: Cardinal risk factors of RVO development were derived from among somatic illnesses and laboratory results. Regional hemodynamics assessment helped identify the most significant systolic and diastolic blood flow disturbances in the central retinal vein and central retinal artery circulation systems. Profound changes in electrophysiological parameters were found. Statistical analysis of the collected data allowed to identify 3 stages of retinal ischemia., Conclusion: The established risk factors of RVO development, regional blood flow impairment and original classification criteria for retinal ischemia make it possible to predict the course of the disease and treatment effect.

Peripheral artery diseases amount to more than 20% of all types of cardiovascular diseases, which corresponds to 2-3% of the total population. 15 to 30% of the population of Russian Federation over 65 years have signs of obliterating arteriopathy. Advance of arterial insufficiency in some cases leads to development of special state - chronic critical limb ischemia (CLI). This article presents a review of statistical data from different sources, showing high prevalence of this severe issue, as well as data of amputations rate, performed in different countries due to CLI, reflecting the extreme relevance of the search for new methods of CLI treatment.

Critical limb ischemia is a syndrome that combines several peripheral artery diseases with different ethiology and pathogenesis but with similar prognosis, high morbidity and mortality. Possibility of surgical and conservative treatment of critical limb ischemia almost completely exhausted. Some hopes have arisen due to progress in cell technology. The article provides a critical analysis of pathogenic prerequisites of stem/progenitor cells for the treatment of patients with a critical limb ischemia in detail the basic results of preclinical and clinical studies on the safety and efficacy of cell technology. Unsolved problems and prospects of practical application are also discussed.

The article is dedicated to management of diabetic patients suffering from chronic critical ischaemia of the lower limbs treated with vasaprostan. The authors analysed herein therapeutic outcomes in a total of 156 patients with vasaprostan administered both as monotherapy and in a combination with surgical management. Good results were also obtained concerning prevention of ischaemic and pyo-necrotic complications in this cohort of patients and respectively a decrease of the number of high amputations.

This paper analyzes the long-term results of venous blood flow arterializations of the leg and foot, performed in 67 patients with critical lower limb ischemia at the Department of Vascular Surgery, Russian Scientific Center of Surgery, over the period from 1996. Indications for surgery were occlusions of the arteries of the femoropopliteotibial segment, which excluded the possibility of performing reconstructive bypass graftings. Analysis of the long-term results of venous blood flow arterialization of the leg and foot evidences its high efficacy. The use of such operation in patients with initial critical lower limb ischemia enables amputation of the involved limb to be avoided in 64% of cases and ensures the high level of physical and social adaptation of the patient for the nearest 2-3 years.

The lesion of distal arteries in patients with thrombangiitis obliterans happened to looking for nondirect methods of blood supply improvement of the involved limb - transplantation of omental pedicle, arterialization of veins, thoracic sympathectomy, etc. From 1986 in the Department of vascular surgery of A. V. Vishnevsky Institute of Surgery we use method of arterialization of the venous system in patients with critical lower limb ischemia of differ etiology. Practically at the same time we applied this operation for patients with critical upper limb ischemia and thrombangiitis obliterans. In this paper we present our successful experience of 5 operations - arterialization of the hand venous system in 4 patients with thrombangiitis obliterans and critical upper limb ischemia. We reviewed in details the technique of performance of arterialization of the hand venous system and studied the long-term results of the treatment.

Effect of 96% ethanol para-neural injection on sympathetic trunk has been studied experimentally on 18 rabbits. It is demonstrated that ethanol injection leads to dystrophic alteration of sympathetic ganglia and acute aseptic inflammation of para-neural tissues. Clinical study has been carried out on 40 elderly and old patients with critical lower limb ischemia and diffuse arterial occlusive disease. All the patients were divided into 2 equal groups. At the patients of 1st group the revascularizing osteo-trepanation of femur and crus was performed, at 2nd group this operation was completed with ultrasonic-assisted lumbar chemical desympathetization on affected side. At 20% of 1st group patients the symptoms of critical ischemia have not be eliminated; there were no negative dynamics of ischemia at the patients of 2nd group.

Management of critical and subcritical lower limb ischemia poses a challenge due to poor effectiveness and high costs of therapy. Problem solving supposes not only the development of effective surgical and medical management of severe arterial insufficiency, but also preventive efforts on early outpatient stage. The paper reviews 611 patients with lower limb arterial obliterative lesions and correlates age, sex, concomitant diseases, stage of arterial insufficiency and risk factors. Consideration of these parameters can be useful in choosing the most effective management strategy. Authors mention that in community outpatient facilities treatment effectiveness of chronic lower limb arterial obliterative lesions does not exceed 40%, white the success of conservative treatment according to the protocol developed in their clinics reaches 90%. It means that there is a real perspective of lowering the incidence of severe lower limb arterial insufficiency managed in hospital environment by improving preventive and therapeutic strategies at outpatient care level.

Twenty men with atherosclerotic lesion of lower extremity arteries verified by contrast angiography and ultrasound Doppler were examined. The patients' age varied from 36 to 69 years (mean 57 years). Six patients had IIB ischemia, 13 presented with degree III and one patient had degree IV ischemia according to the R. Fontaine classification modified by A. V. Pokrovsky. The MOS SF = 36 questionnaire was used to estimate the quality of life of all the patients. The individual typological properties of the personality were defined using the psychodiagnostic test (PDT). A significant decrease of the patients' quality of life was revealed according to the scales: physical function, physical role, physical pain, general health condition. A correlation was recorded between the patient's age and the parameters of the "physical function scale" (r=-0.63; p<0.005). The individual typological properties of the personality exert an effect on five of the eight SF = 36 scales. A feedback was discovered between neurotism and mental health (r=-0.455; P<0.05), conscientiousness and the physical role (r=-0,487; p<0.05); a direct relationship was found between disinhibition and physical pain (r=0.451; p<0.05), general activity and physical pain (r=0.535; p<0.05). An indistinctly pronounced feed back manifested itself between the "neurotism" and "physical pain" scales (r=-0.409), "psychotism" end the "physical role", (r=-0.437), "introversion" and "vitality" (r=-0.408), "femininity" and the "emotional role" (r=-0.404), and a direct relationship was established between the scales "esthetic impressionability" and "vitality" (r=0.406).

At the department of vascular surgery of the Novgorod regional hospital 455 reconstructive operations for atherosclerotic occlusions in the aorto-femoral segment were performed at the period from 1984 to 1991. Specific complications requiring reconstructive reoperations took place in 92 patients (20.2%), 21 patients (4.6%) having earlier specific complications and 71 patients (15.6%)--late ones. Causes of the appearance of the specific complications are analyzed, the methods of treatment of such patients are recommended. Lethality after reoperations for late complications made up 9.8%, amputation of the extremity was performed in 14.1% of the patients. The positive result of the reoperations with a regress of ischemia and the preserved function of the extremity was noted in 76.1% of the patients.

The authors show the significance of radionuclide angiography in evaluating the efficacy of surgical treatment of lower limb critical ischemia by formation of an arteriovenous anastomosis on the side of the affection. An operation for formation of an arteriovenous anastomosis on the lower third of the leg or the foot was found to be most effective. Increased perfusion of the ischemic limb on the level of balanced mixing of the blood flow was revealed in most patients, which the authors believe to be caused by venous stasis in the lower limb due to reduced difference in pressure in the arterial and venous bed. The highest percentage of favorable late--term results of the operation was revealed among this contingent of patients.

Reconstructive operations in the aorto-iliac and femoro-popliteal segments were performed on 281 patients with obliterating atherosclerosis. An attentive examination of the patients in the nearest postoperative period and within the first 5 years has shown different efficiency of the operation in different patients. Favorable changes took place in regional hemodynamics, while disturbances retained in microcirculation and function of the extremity. Another cause of insufficient efficiency of the interventions was an initial stable suppression of tissue respiration and oxygen utilization in the extremity tissues. The dynamics was positive during a year followed after that by new symptoms of progressing disease.

It was found that clinical symptoms of the III degree ischemia were not reliable criteria of reversibility of ischemic disorders which requires additional information. The express-histochemical method of examination of bioptates of the ischemic extremity muscles is thought to be highly informative under such conditions as well as studying indices of the prekallikrein-kallikrein system of blood. The leading importance may be attached to the factor of time of severe ischemia when no additional information can be obtained. In patients with the III degree ischemia and its duration over 12 hours primary amputation of the extremity is indicated without an attempt being made to reestablish the blood flow.

The data on 292 patients treated in the clinic for acute thrombosis and embolism of the peripheral vessels from 1969 to 1978 are analysed. The dynamics of the frequency of the development of these vascular complications with consideration for the heliogeomagnetic situation were studied. It is established that the condition is more serious and the mortality rate higher in patients who became ill on magnetoactive days than in individuals in whom the disease developed in a magnetotranquil period.