Purpose:to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE).Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning.   Examination also included echocardiography.Results.In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 – 13.70±2.05 days, group 2– 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable – shin veins, popliteal, and common femoral veins, unfavorable – superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post­infarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

Objective. To study the effectiveness of endovascular laser coagulation in patients with recurrent varicose veins in their lower extremities.Material and methods. Outcomes after the treatment of 54 patients with varicose vein relapses in the lower extremities were analyzed. Under the tumescent anesthesia, endovascular laser coagulation was made: in 5 patients – stump of the great saphenous vein; in 22 patients – recanalized, residual and preserved subcutaneous venous trunks; in 27 patients – insufficient communicating veins of the thigh and lower leg.Results and discussion. In average, surgery lasted for 31 ± 0.6 minutes; intensity of the postoperative pain syndrome was 3.4 ± 0.4 points. Early postoperative complications were registered in 1 (1.8 %) patient, side effects in the form of hyperpigmentation and paraesthesia – in 4 (7.4 %). In 12 months, all operated patients demonstrated an improvement in all parameters of their quality of life by 29.2– 40 %; cosmetic outcome after surgery was 7.8 points out of a ten-point scale. The long-term observation revealed the relapse in varicose veins only in 1 (1.8 %) patient.Conclusion. The justified use of endovasal laser coagulation in patients with relapses of varicose veins in the lower extremities allows to avoid manipulations in the area of scar-altered tissues, to reduce tissue damage and duration of surgery, to improve patients’ quality of life, to avoid additional incisions as well as to improve cosmetic outcomes after surgery.

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.

СОВРЕМЕННЫЕ БИОМАРКЕРЫ ОСТРОЙ ИНТЕСТИНАЛЬНОЙ ИШЕМИИПервыйОстрая интестинальная ишемия является одной из наиболее сложных проблем в ургентной хирургии в силу высокой летальности, одной из причин которой является поздняя диагностика. Оперативное лече-ние часто проводится в фазу разлитого перитонита.С целью выделения наиболее доступных и точных способов ранней диагностики острой интести-нальной ишемии выполнен данный обзор литературы.В настоящее время для диагностики острой интестинальной ишемии используют немногочислен-ный ряд биомаркеров, таких как α-глутамат-S-трансфераза, D-димеры, прокальцитонин, D-лактат, кишеч-ный белок, связывающий жирные кислоты (I-FABP), ишемия-модифицированный альбумин. По данным литературы, наиболее высокие показатели чувствительности и специфичности выявлены у I-FABP (75-85% и 70-80% соответственно), α-глутамат-S-трансферазы (67,8% и 84,2%), ишемия-модифицированного альбумина (94,7% и 86,4%). Кроме этого, для ранней диагностики в настоящее время используются до-рогостоящие и инвазивные методы, такие как КТ-ангиография, МРТ с контрастированием, селективная ангиография, однако данные технологии доступны не всем лечебным учреждениям.Для решения проблемы улучшения ранней диагностики острой интестинальной ишемии следует про-водить дальнейший поиск различных биомаркеров и их более широкое внедрение в клиническую практику. Ключевые слова: острая интестинальная ишемия, биомаркеры, диагностика, мезентериальный тромбоз, кишечный белок, связывающий жирные кислоты (I-FABP)The acute mesenteric ischemia is one of the most complex problems in the urgent surgery because of the high mortality, the cause of which is late diagnosis. The operation treatment is often provided in the phase of diffuse peritonitis.This literature review is done in order to identify the most accessible and accurate methods of early diagnosis of the acute mesenteric ischemia.At present time rather a small number of biomarkers for diagnosing the acute mesenteric ischemia are used, such as α-glutamate-S-transferase, D-dimers, procalcitonin, D-lactate, intestinal fatty acid binding protein (I-FABP), ischemia-modified albumin. According to the literature the highest sensitivity and specificity were found in I-FABP (75-85% and 70-80% respectively), α-glutamate-S-transferase (67.8% and 84.2%), ischemia-modified albumin (94.7% and 86.4%). In addition, expensive and invasive methods are currently used for early diagnosis, such as CT angiography, contrast-enhanced MRI, selective angiography. However, these technologies are not available to all medical institutions.We should continue further search of various biomarkers and their more widespread introduction to clinical practice in order to solve the problem of early acute mesenteric ischemia diagnostics.

В последнее время периферический атеросклероз приобретает масштаб глобальной проблемы ввиду широкой распространенности. В работе представлены современные проблемы, связанные с лечением поражений периферических артерий как проявлений системного атеросклероза. Подробно обсуждаются вопросы возникновения тромботических осложнений как в магистральных, так и в периферических артериях. Доказывается особая роль антиагрегантов в профилактике сосудистых событий. Выделяются две основные группы антиагрегантов-ацетилсалициловая кислота (АСК) и блокаторы АДФ-рецепторов. Показана важность длительного, часто пожизненного применения антиагрегантов, при этом АСК, согласно международным и российским клиническим рекомендациям, представляет собой базовый препарат, используемый для этих целей. Обсуждаются вопросы осложнений при длительном приеме АСК, в частности гастропатии, доказывается более безопасное применение АСК в лекарственной форме «таблетки, покрытые кишечнорастворимой пленочной оболочкой». Именно АСК, по международным и российским клиническим рекомендациям, является базовым препаратом для длительной или постоянной антитромботической терапии со степенью доказательности IA. В то же время двойная антиагрегантная терапия применяется только в исключительных случаях, в частности после эндоваскулярной дилатации и стентирования артерий голеней, и то на срок до 1 мес.