Surgeries on the paravertebral sympathetic ganglia still keep their meaning. They become surgeries of choice in cases of peripheral arterial damage. Sympathectomy ensures maximum arterial bed dilation, increases blood flow to the ischemic zone, accelerates the angiogenesis. Minimally invasive chemical destruction of the lumbar sympathetic ganglia under the control of a spiral computed tomograph is an alternative to surgical lumbar sympathectomy. It has comparable effectiveness in comparison with open intervention treatment both in the immediate and long-term periods. The study reflects the results of the influence of computed tomographically controlled puncture paravertebral sympathectomy on the symptoms of obliterating diseases of the arteries of lower extremities.
Objective. To evaluate the informativeness of ultrasound scanning of the lower limb arteries and angiography in patients with critical ischemia for choosing the optimal level of extremity amputation. Methods. Treatment of 289 patients with obliterative diseases of the arteries of the lower extremities of various genesis with the indications for amputation of the damaged lower extremity was analyzed. Results. Ultrasound scanning of arteries could not always characterize the severity of collateral circulation, but indicated only the level of occlusion. However, the severity of chronic ischemia of the lower limb is determined not only by the level of occlusion, but also by the severity of collateral blood flow at the same level of damage. That is why, in our opinion, the results of an ultrasound examination of the lower limb arteries cannot be decisive when choosing the level of amputation. Angiography made it possible to characterize not only the level of occlusion or stenosis, but also the state of collateral circulation, which had a decisive influence on the choice of the method of limb amputation. Conclusion. Ultrasound examination of the lower extremity vessels allows to establish the level of occlusion, but is uninformative for the assessment of collateral anastomoses, which is an important factor in choosing the level of non-traumatic amputation of the lower extremity. In patients with critical ischemia, transtibial amputations should be avoided, as they show worse results. The operation of choice should be a transfemoral amputation or non-traumatic through-knee amputation.
The aim — to investigate features of venous system alteration in lower extremities during pregnancy and puerperal period using ultrasound Doppler angiography.Materials and methods. The results were analyzed of ultrasound angiography of the venous system of the lower extremities in 54 pregnant women (group I) with varicose veins of the lower extremities and 14 women (group II) after delivery and the end of the lactation period before surgery for varicose disease.Results and discussion. Venous walls are getting thinner and wider in diameter during pregnancy, ostial valve regurgitation with reflux up to 2 — 3 seconds is developing, numerous capillary veins in inguinal region and vulvar lips are appearing along with aneurysmal dilatation of the stem and accessory veins and vein branches that were especially often revealed in case of inherited predisposition to varicose decease. The regression of varicose disease was revealed after the childbirth in comparison with the period of pregnancy.Conclusions. Pregnancy accelerates the development of varicose disease, especially with inherited predisposition. During pregnancy walls of veins are getting thinner, vertical and horizontal refluxes and aneurysmal dilatation are progressing in the areas of venous anastomosis and along the venous trunk. After the childbirth there was a regression of varicose decease, remission of refluxes, veins’ walls recovery. Varicose involution is mainly manifested in proximal segment of thighbone (31.9 %), saphenofemoral junction (24.6 %) and less — in proximal segment of shin‑bone (9.7 %).
РефератМета. Розробити методику профілактики специфічних ускладнень ендовенозної лазерної коагуляції. Матеріали і методи. Запропоновано спосіб профілактики розвитку специфічних ускладнень ендовенозної лазерної коагуляції шляхом активного видалення продуктів коагуляції з просвіту вени. Проведено спостереження за двома групами хворих, яким виконували лазерне втручання класичним методом (1-ша група) та з використанням розробленої методики (2-га група). Результати. Запропоновані спосіб і пристрій для вакуумної евакуації продуктів коагуляції із зони операції унеможливлюють потрапляння їх у венозну систему і запобігають розвитку ранніх специфічних післяопераційних ускладнень («металевого» присмаку в роті, головного болю, запаморочення, загального нездужання, «важкості» дихання), що покращує перебіг післяопераційного періоду. Висновки. Вакуумна евакуація продуктів коагуляції з просвіту вени запобігає їх потраплянню у загальну венозну систему, мінімізує частоту розвитку специфічних ускладнень і покращує перебіг раннього післяопераційного періоду. Використання методики профілактики ускладнень ендовенозної лазерної коагуляції в лікуванні варикозної хвороби і пристрою для його реалізації не ускладнює виконання операції і не збільшує її вартість. Ключові слова: варикозна хвороба; ендовенозна лазерна коагуляція; профілактика ускладнень. AbstractObjective. To elaborate a procedure for prevention of specific morbidity of endovenous laser coagulation. Маterials and methods. A procedure for prophylaxis of specific morbidity of endovenous laser coagulation, using active elimination of the coagulation products from venous lumen was proposed. The investigation was performed for two groups of patients, to whom the laser intervention was done in accordance to classic method (1-st Group) and using a procedure elaborated (2-nd Group). Results. The method and the apparatus proposed for the vacuum evacuation of the coagulation products from the operation zone makes impossible their entry into venous system and prevents the development of early specific postoperative complications («metallic» taste in the mouth, a headache, dizziness, general ailment, a respiration «difficulty»), what improves the postoperative period course. Conclusion. Vacuum evacuation of the coagulation products from the vein lumen prevents their entry into common venous system, minimizes the rate of the specific complications development and improves the early postoperative period course. Prophylaxis of specific morbidity of endovenous laser coagulation in the treatment of varicose disease as well as apparatus for its realization do not complicate the operation performance nor enhances its cost. Кeywords: varicose disease; еndovenous laser coagulation; prophylaxis of morbidity.
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