Background. Reperfusion syndrome is an inevitable event in recovery of the blood flow after a longstanding ischemia. The article is dedicated to the study of the expressiveness of this condition. Aim – to compare the depth of morphological alterations of the arterial endothelium in ischemic and reperfusion injury in experiment. Materials and Мethods. The work was conducted on 90 laboratory animals – rats of Wistar line. Models of ischemia and reperfusion were obtained by compression of the abdominal part of the aorta (1st group) with further conditioning (2nd group). The animals were withdrawn from the experiment and the vessel wall was taken on the 1st, 3d, 5th, 7th day. Preparations were studied in a transmission electron microscope «Libra 120» with automatic scanning of images. Results. Comparison of pathomorphological data obtained in examination of the aortas and iliac arteries of the two groups of animals («ischemia» and «reperfusion») showed that the cascade of pathomorphological changes includes several main stages. Transient ischemia leads to injury (alteration) of the main components of the vessel wall. Under action of this factor endotheliocytes exhibit a nonspecific response changing their synthetic activity that was manifested by a complex of morphological signs in the nucleus, karyolemma, cytoplasm and plasmalemma. In some cells the changes took an irreversible character and were accompanied by rupture of mitochondrial membranes, of general purpose organelles and of plasmalemma. Such endotheliocytes died and were desquamated. Because of short duration of ischemia these changes were insignificant. Subendothelial structures underwent edema which is logical in view of derangement of the barrier function of the epithelium and presence of a mild inflammatory component (in response to death of a part of endotheliocytes and cells of the vascular wall stroma). Examination of the ultrastructure of the vessel wall in the ischemiareperfusion group revealed adaptive and pathological changes in the endothelial cells. Data were obtained that evidence a significant disorder in microhemodynamics in tissues in reperfusion. Conclusion. No significant structural and ultrastructural differences in injuries and reactive changes in «ischemia» and «reperfusion» groups were found. In view of this, for subtle differentiation of pathomorphogenesis of these two conditions it is reasonable to use examination methods with higher resolution.

ГБОУ ВПО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения и социального развития РФ, г. Рязань 2 ГУЗ Рязанский областной клинический кардиологический диспансер, г. Рязань В работе проанализированы уровень эндотелина-1, молекул адгезии и Среактивного белка в плазме крови у больных облитерирующим атеросклерозом артерий нижних конечностей в различные сроки после реконструктивных операций. Обследовано 25 пациентов мужского пола страдающих ОААНК IIб-IV стадии заболевания по классификации Фонтена-Покровского, которым выполнялись реконструктивные операции с использование аллопротеза.

The combination of peripheral atherosclerosis and diabetes mellitus is a severe pathology, characterized by a high rate, mortality and social significance. The results of limb salvage and distant survival in this pathology in a remote period are unsatisfactory in spite of all existing treatment methods. Clinical trials in previous years have shown efficacy and safety of the medication, which is a plasmid construct with the gene encoding vascular endothelial growth factor - kambiogenplasmid, in patients with disease stage IIa-III according to the A.V. Pokrovsky and Fontaine classification, who were not indicated for surgical treatment. The article presents the clinical cases of successful use of this drug for therapeutic angiogenesis in patients with critical limb ischemia and severe type 2 diabetes mellitus. The inclusion of therapeutic angiogenesis in the conservative treatment algorithms is promising for the treatment of this group of patients. There is a need for further research on the efficacy and safety of the medication in patients with peripheral atherosclerosis and diabetes mellitus in a remote period.

The article presents a case of a hybrid intervention using an arterial allograft on the great arteries of the lower extremities in a patient with chronic limb threatening ischemia and prosthetic infection. The patient has a history of repeated operations using synthetic polytetrafluoroethylene and dacron prostheses. In the early postoperative period, a clinical presentation of the prosthesis bed suppuration developed. The article shows the main phases of patient treatment: removal of synthetic prostheses, transplantation of the donor femoral artery, and balloon angioplasty of the popliteal and anterolateral arteries. In the postoperative period, blood circulation in the lower limb is fully compensated, and the dorsal pedis artery pulse is determined. Wounds were healed by primary intention. At the control visit after 6 months, no adverse events were revealed; according to the data of duplex scanning, the main blood flow in the arteries of the leg was recorded, the blood circulation was fully compensated. Thus, hybrid intervention using arterial allograft and balloon angioplasty of the popliteal and anterolateral tibial arteries proved to be an effective method of treatment in the current clinical situation.