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Biomedical subjects

A V Pokrovskiĭ

Publications and source records attributed to A V Pokrovskiĭ.

At least 19 recordsLinked to original sources
PubMed2006

[The use of Alprostan for patients with intermittent claudication].

Total 50 patients with lower limb intermittent claudication (Fontain-Pokrovsky limb stage of chronic ischemia) due to femoropopliteal or ileofemoral atherosclerotic occlusion were treated with Alprostan (Prostaglandin El) in A.V. Vishnevsky Institute of Surgery, Moscow, from November 2003 to March 2005. The paper presents the analysis of drug's therapeutic effectiveness dependent on the level and severity of arterial lesion.

Aged↗
PubMed2005

[Alprostan for management of critical lower limb ischemia].

A clinical trial on Alprostan (prostaglandin E1) use for management of critical lower limb ischemia (Fontaine-Pokrovsky stages III and IV of chronic limb ischemia) was carried out in A. V. Vishnevsky Institute of Surgery from March, 2003 till April, 2004. The study aimed at appraisal of Alprostan effectiveness (administered alone or combined with reconstructive interventions) in coping with critical ischemia in patients with lower limb arterial occlusive lesions.

Alprostadil↗
PubMed2005

Comparative analysis of carotid endarterectomy late outcomes related to intervention modality.

The paper presents a comparative analysis of late outcomes after 105 carotid endarterectomies (CEA) performed in 89 patients from 1997 to 2003, including 95 patients (90.5%) operated for atherosclerotic stenosis of internal carotid artery (ICA) and 7 patients (6.6%)--for combined ICA stenosis and tortuosity. The severity distribution of cerebrovascular insufficiency (CVI) was the following: grade I--in 22.8%, grade II--in 12.4%, grade III--in 25.7% and grade IV--in 38.1% of patients. CEA methods included eversion endarterectomy in 50.4% cases and open (classic) surgical CEA with PTFE patch angioplasty in 49.6% cases. Mean follow-up period was 31.8 months for the eversion CEA group and 37 months--for the open CEA group (from 3 to 72 months). In 76.4% patients the duration of follow-up period exceeded 1 year. During the follow-up period all patients underwent clinical examination and color duplex scanning of reconstructed CA segment with assessment of diameter, vascular wall thickness and blood flow. TIA was registered in 1 patient from eversion CEA group and in 1 patient from open CEA group. Thus, in the long-term postoperative period 98% of patients were free from neurological complications. Hemodynamically significant restenoses developed in 8 cases (7.6%), including 4 patients from the eversion CEA group and 4 patients from the open CEA group. Myointimal hyperplasia (> 3 mm) accompanied by hemodynamical alterations occurred in 1 patient from the eversion CEA group and in 2 from the open CEA group. In the rest of cases restenoses were related to atherosclerotic plaque formation. In conclusion, the long-term outcomes indicate that CEA is effective in the prevention of cerebrovascular events regardless of carotid angioplasty strategy. The rate of late postoperative restenoses was similar for eversion and open CEAs. Both modalities can be promising for the surgical correction of CA stenoses.

Aged↗
PubMed2005

Carotid thromboses in the early postoperative period after carotid endarterectomy.

The paper analyzes 10 cases of internal carotid artery (ICA) thrombosis, which occurred after 635 carotid endarterectomies (CEA), carried out from January 1997 to July 2004. CEA procedures included 346 (54.5%) open CEAs with PTFE patch angioplasty and 289 (45.5%) eversion CEAs. Patients with thromboses in the reconstructed area (n=10) had the profiles of comorbidities and cerebrovascular insufficiency grade similar to the total CEA group (p>0.1). Differences concerned the higher rate of atrial fibrillation cases (10%), diabetes mellitus (30%) and contralateral ICA occlusions (20%) in the group of thromboses (p>0.1). Among these 10 patients, 5 underwent eversion CEA (1.44% of the total eversion CEA group) and 5 - open CEA with patch angioplasty (1.73%). In 8 patients thromboses manifested as local neurological symptoms in the area supplied by the operated carotid artery. One patient demonstrated the progression of general cerebral symptomatology, while in the tenth patient thrombosis was accompanied with cerebral coma. Urgent ultrasonography in 7 patients failed to detect a blood flow in ICA, that proved the diagnosis of ICA thrombosis; in 3 patients ultrasonography showed a mural thrombosis. Nine patients underwent reoperation in emergency, while for the tenth patient an intervention was contraindicated due to the thrombosis of middle cerebral artery, unstable clinical state (cerebral coma) and progression of neurological symptomatology. PTFE arterial graft was implantedin 7 reoperated patients with ICA thrombosis, thrombectomy from ICA was carried out in 1 patient and in another one patient a thrombectomy from reconstructed segment with PTFE patch angioplasty of the arteriotomy defect was fulfilled. In 3 reoperated patients a complete resolution of neurological symptoms was evident 24 hours after intervention, in 2 patients neurological symptomatology regressed over 2-4 weeks. In another 3 reoperated patients local neurological symptoms persisted; 1 patient demonstrated postoperative progression of neurological symptomatology and coma with fatal outcome. The last patient, for whom a reoperation was contraindicated, died due to aggravation of cerebral coma. Dynamic follow-up in early postoperative period after CEA, especially in the first 6 hours, as well as an urgent duplex scanning of the reconstructed area in case of neurological symptoms development, provides timely diagnosis of postoperative thrombosis and the success of reoperations. Adjustments to patient's cardiac status and appropriate intraoperative heparinization can decrease the risk of this complication. An urgent reoperation aimed at the restoration of carotid blood flow, immediately after the diagnosis of thrombosis (provided the absence of deep coma), promotes a complete or partial regression of neurological symptoms and helps to prevent a progression of cerebrovascular disturbances.

Aged↗
PubMed2005

[The assessment of medical therapy effectiveness of patients with lower limb chronic venous insufficiency: the results of prospective study with Ginkor Fort].

The results of prospective study on combined agent Ginkor Fort are presented. The study included 60 patients with variceal disease and clinical picture of chronic venous insufficiency (CVI), II-IV CEAP class. Besides the registration of common and well known subjective signs (lower limb pain, heaviness and discomfort feelings, night palsies and paresthesia, edema), the main outcome measures included the results of digital photo-plethysmography (PPG). Initial assessment demonstrated the decrease of both venous return time (To) and muscular-venous pump capacity (Vo) with the increase of CEAP class; the trend of To appeared to be statistically significant (p=0.0318). The treatment resulted in the regression of main clinical complaints according to the 6-score analog scale. PPG showed the rise of to from 19.5+/-4.9 s to 20.5+/-3.7 s, though this trend was statistically insignificant (p>0.05). Vo elevated significantly from 3.69+/-2.4% to 4.04+/-2.3% (p<0.05), demonstrating the grown functional capacities of leg pump. PPG with To and Vo analysis can be used in combination with ultrasonic examination for the quantitative assessment of venous outflow disturbances and accordingly, of the CVI severity. This method can serve as an indicator of conservative treatment effectiveness. Combined agent Ginkor Fort is feasible for adjunctive therapy in complex treatment of patients with lower limb CVI symptoms.

Adult↗
PubMed2005

[Derivatives of semi-synthetic diosmine in the treatment of patients with chronic venous insufficiency. The results of a prospective study--using phlebodia 600].

This paper describes the results of an open, prospective, non-comparable study of the efficacy and tolerance of the drug phlebodia 600 mg in patients with lower limb CVI. The study accrued 32 patients aged 21-70 years suffering from lower limb varicosity coupled with class I-IV CVI according to the CMP. Of the objective criteria, there were made measurements of the malleolar volume. The grade of subjective symptoms was recorded in terms of the clinical scale for evaluating the severity of the VCSS disease, which is a subdivision of the CEAP classification. The quality of the patients' life was examined before the patient was included into the study and after its completion using a standard CIVIQ questionnaire. The positive time course of changes was marked in all the constituents of the integral indicator of the patient's quality of life. The most significant change in the patients' quality of life was identified in patients in clinical class III according to the CEAP. The authors analyze the reports concerning the use of the above-indicated drug in European phlebological practice.

Adult↗
PubMed2004

[The long-term results and indications for use of Gore-Texgrafts in the femoropopliteal position in patients with atherosclerotic lesion of lower limb arteries].

Presented herein are the long-term results of femoropopliteal reconstructions above the knee joint fisure in patients with atherosclerotic lesion of the femoropopliteal segment using Gore-Tex grafts. The retrospective study accrued 108 patients. Of these, IIB degree lower limb ischemia (according to the A.V. Pokrovsky classification) was initially present in 64 (60.2%) and critical ischemia in 52 (40.8%) patients. Patients suffering from lower limb ischemia of varying degree did not significantly differ in the age or coexistent diseases. The mean value of the ankle/brachial index (ABI) accounted for 0.46+/-0.23 in patients with IIB degree ischemia and for 0.40+/-0.27 in patients with critical lower limb ischemia. All the patients were evaluated for the condition of the distal bed according to the scheme proposed by Rutherford et al. in 1997. The patients were distributed into three groups: patients with "good" runoff (from 1 to 4 points, n=65), patients with "satisfactory" runoff (from 5 to 7 points, n=36), and those with an "unsatisfactory" condition of the distal bed (runoff point over 7, n=7). The long-term results were assessed in 81 (75%) patients over the period as long as 105 months. The mean follow up accounted for 58,4 months. One year later the graft patency in the total patient group constituted 73.1%, after 3 years it was equal to 54.8%, and after 5 years to 49.9%. It is demonstrated that the initial runoff point exerted a significant effect on the graft patency. It is noteworthy that in patients with an initially "good" runoff point, 57.5% of the grafts were patent 5 years after operation whereas in patients with a "satisfactory" point only 35.3% turned out patent (p<0.05). Patients with an initially "unsatisfactory" runoff point developed thrombosis of all grafts over the period as long as 6 months following operation. The five-year limb salvage was observed in 77.6% of patients. It has been revealed over the 5-year period that the degree of initial limb ischemia did not produce any significant effect on the graft patency or limb salvage. The scheme for runoff assessment allows to define in a differentiated way the indications for use of Gore-Tex grafts in the femoropopliteal position. The runoff point had a significant effect on the long-term 5-year patency of the grafts.

Aged↗
PubMed2004

[Aspirin versus oral anticoagulants following lower limb arterial reconstructions: what to choose?].

Graft thrombosis in long-term postoperative period after lower extremity arterial reconstructions often results in limb loss. In some studies prolonged antithrombotic therapy was demonstrated to improve long-term patency of vascular grafts. Nevertheless little consensus exists on the optimal antithrombotic agents. The paper reviews publications on the problem. Oral anticoagulants seem to be feasible for reconstructions with poor outflow. In such cases strict laboratory monitoring of blood coagulation system is mandatory to prevent hemorrhagic complications.

Administration, Oral↗
PubMed2004

Roentgenoendovascular treatment of Conn's syndrome.

This paper describes the first in the world experience with the treatment provided in 1990 to a female patient suffering from hypereldosteronism associated with adenoma of the left adrenal. The treatment consisted in endovascular destruction of the adrenal, which was performed by means of acute occlusion of the adrenal venous bed using a sclerosing agent. The intervention resulted in a decrease of arterial pressure (AP) from 240/140 to 130/80 mm Hg. The patient has been followed up for 13 years. No recurrence of the disease has been recorded. AP is within normal.

Female↗
PubMed2004

A comparative study of the long-term results of open operations and endovascular interventions for atherosclerotic stenoses of the brachiocephalic trunk.

AIM: Our aim was to carry out a retrospective comparison of the long-term results of open and endovascular interventions for atherosclerotic stenoses of the brachiocephalic trunk (BCT). MATERIAL AND METHODS: Forty-five patients with BCT stenoses underwent 18 consecutive intrathoracic reconstructions and 27 balloon angioplasties. The long-term results of open interventions were followed up for a mean of 70+/-17 months (up to 169 months maximally). The long-term results of balloon angioplasties were followed up for a mean of 68+/-8 months (up to 117 months maximally). In a subgroup of patients who underwent intrathoracic operations, we studied the destiny of 12 (71%) of the 17 patients whereas in a subgroup provided dilatations, we examined the destiny of 18 (75%) of the 24 patients. RESULTS: Graft patency was preserved in 92% of patients, that of the dilated arteries in 94%. The clinical effect of surgery in the subgroups provided open reconstructions and endovascular interventions persisted in 83% and 89% of patients respectively, the incidence of strokes in the long-term period was 8% and 6%, the lethality reached 25% and 17%. CONCLUSION: Endovascular intervention is the method of choice in the treatment for atherosclerotic lesions of the BCT without injury to its bifurcation.

Angioplasty, Balloon, Coronary↗
PubMed2003

[Vascular surgery preventing ischemic stroke: is it possible?].

Experience with 1057 surgeries performed in patients with carotid stenosis is analyzed. It is demonstrated that for the last 10 years angiography has not been performed for diagnosis confirmation, indications for surgery are based on duplex scanning results. Thirty-five percent of operated patients had no clinical symptoms, but the majority of the patients (44%) were referred to surgeons late, after stroke. Techniques of classic and eversion endarterectomies are described in details. Postoperative lethality ranged from 0.9 to 1.2%, rate of postoperative stroke--from 1.1 to 1.4%. Long-term results were studied up to 196 months after surgery. High prophylactic efficacy of carotid endarterectomy was demonstrated. There were no progression of ipsilateral neurological symptoms in 94.3% patients.

Adult↗
PubMed2003

[Vasonit retard in the treatment of intermittent claudication in patients with obliterating diseases of the lower extremities].

This paper deals with an open no incomparable study of the efficacy of vasonit retard in the treatment of intermittent claudication in patients suffering from arterial pathology. The efficacy and tolerance of vasonit retard were investigated for two months at the A.V. Vishnevsky Institute of Surgery, RAMS, and at 20 vascular departments of Russia (Moscow, Sankt-Peterburg, Nizhny Novgorod, Perm, Yaroslavl, Volgograd, Omsk, Irkutsk, Chelyabinsk, Voronezh, Rostov-on-Don, Ekaterinburg). The study accrued 25 patients treated at the A.V. Vishnevsky Institute of Surgery, RAMS, and 348 patients treated on the basis of 20 vascular departments of Russia, The basic criterion for inclusion into the study was the presence in the patient of intermittent claudication, corresponding to extremity ischemia, degree IIA end, IIB, according to the A.V.Pokrovsky classification. The treatment by vasonit retard was conducted outpatiently. The drug was administered in a daily dose of 1200 mg for 2 months. After treatment the ankle/brachial index along the posterior tibial artery and dorsalis pedis artery rose by over 17% in the group treated pt the Institute of Surgery and by over 21.5% in the group which participated in the multicenter study. The minimal pain-free distance increased by 60% and 115% respectively. The maximal pain-free distance rose by 37.7% and 98.4% respectively. A 25% abatement of the pain intensity (according to the pain score) was recorded in the group seen at the Institute of Surgery and a 36.1% pain abatement in the group included into the multicenter study. No complications leading to drug discontinuation were marked. Thus, talking into account the clinical evidence and the data supplied by instrumental diagnostic techniques, it is necessary to admit that vasonit retard is an effective drug for the treatment of patients suffering from intermittent claudication.

Female↗
PubMed2003

Diagnosis of occlusive lesions of upper extremity arteries in patients with thromboangiitis obliterans.

The study accrued 84 patients suffering from thromboangiitis obliterans (TO) examined and treated at the A.V. Vishnevsky Institute of Surgery, RAMS, over the period 1988 to 2002. Based on the complaints on the part of the upper extremities the patients were distributed into four groups. Sixteen (19.1%) TO patients did not make any complaints on the part of the arms (degree I ischemia). Thirty-eight (45.2%) patients complained of numbness and paresthesia, chiefly of the tips of the fingers on both hands (degree II ischemia). Six (7.1%) persons complained of pains in the hands at physical exercise (decree III ischemia). Ulcers and necroses of the fingers were present in 24 (28.6%) patients (degree IV ischemia). The diagnostic procedures for arterial lesion of the upper extremities included laboratory investigations, duplex scanning of the great arteries, of the arteries of the hands, fingers and nail matrix, wide-field capillaroscopy, oxygen tension measurements, and angiography as well. Comparison of the clinical manifestations of arterial lesion of the upper extremities in TO patients to the data supplied by different research methods has revealed a direct correlation between the degree of ischemia and the pathomorphological as well as functional changes which increased as the ischemic syndrome was aggravated. As a result of the present work, there have been studied and systematized the criteria for the diagnosis of the degree of arterial lesion of the upper extremities in TO patients, based on the data, supplied by duplex scanning, capillaroscopy, measurements of transcutaneous oxygen tension and angiography. In addition, there has been studied the role of the humoral component of immunity in the delineation of inflammatory activity in patients with TO.

Adult↗
PubMed2003

[Lower limb chronic venous insufficiency: contemporary problems in diagnosis, classification and treatment].

The paper presents a brief analysis of contemporary problems in management of patients with lower limb chronic venous insufficiency (CVI). During the last decade occurrence of complicated CVI tended to diminish resulting from well-directed efforts in improvement of diagnostic and therapeutic methods, active participation of different specialists in management programs. The paper addresses the questions of assessment planning dependent on CVI manifestation and role of various diagnostic modalities (morphological and functional). The scope of therapeutic methods is enumerated, with special attention to their practical value and unresolved issues. Ultrasonography enabled to broaden indications for minimally invasive procedures in varices surgery. Accumulation of rich experience in sclerotherapy made possible to develop distinct indications for the procedure. The authors delineate promising directions for further research in CVI management.

Bandages↗