A special place is occupied by the drug alprostadil, which is the most effective pharmacological treatment for critical ischemia.
Its active principle is prostaglandin E1. Alprostadil - a powerful blocker of platelet activity, which reduces their aggregation and adhesion to the endothelium and inhibits the increased cytokine hyperproduction blood cells. This reduces tissue damage and parietal thrombus. Activated thrombolysis, improves microcirculation by improving erythrocyte deformability, decreases platelet aggregation and decreases blood viscosity.
The drug also affects atherogenesis by inhibiting the mitotic activity and reducing the proliferation of smooth muscle cells in the vascular wall. Also noted a favorable effect on lipid metabolism (decreased level of low density lipoprotein). In addition, increased levels of proteins in muscle and slowed down the process of splitting, increased insulin sensitivity, improves metabolism of amino acids, more actively oxidize glucose. An important advantage of the drug is its prolonged effect, persisting for 6-9 months.
Actively used by many others, as is widely known and have brand viagra appeared relatively recently, vasoactive drugs in the group of integrated action: ksantinola nicotinate, dipyridamole, buflomedil, naftidrofuril, preparations of the pancreas, dobesilat calcium, nicergoline, Detralex.
In addition, when used HOZANK: solkoseril or Actovegin, fosfaden, ATP. Of the metabolic action of drugs - a variety of vitamins (C, B1, B6, etc.), antioxidants (vitamin E, probucol), various противоатеросклеротические funds, which include inhibitors of cholesterol synthesis, bile acid sequestrants, HMG CoA reductase inhibitors, fibrates, calcium antagonists , piridinolkarbamat, preparations containing unsubstituted fatty acids, garlic preparations, as well as immune modulators, etc.
Along with pharmacotherapy is currently being actively used a number of physical methods of action that can be attributed to the section of methods of intensive therapy. These include fotogemoterapiya (ultraviolet irradiation of blood or intravenous laser therapy), hemosorbtion and plasmapheresis. There are a large number of publications to prove their efficacy in treating patients HOZANK, although not all of their mechanisms of action yet understood.
In other words, there is a very wide range of different drugs and therapeutic interventions that have therapeutic efficacy in the treatment of patients HOZANK, and only a doctor should determine the specific scheme of their use in general health care program, a sequence of appointments, the duration of individual treatments and receive individual drug most rational combinations thereof, and informed choice of drugs based on their mechanisms of action in each specific clinical situation. Unfortunately, it is necessary to note that work on this issue, no, even though the ability to respond adequately to the doctor these questions, particularly in outpatient practice, to the greatest extent by the success of the treatment and prognosis. We are confident that with proper use of all therapeutic possibilities, especially pharmacotherapy, and timely treatment of early and properly organized dispensary control may improve the prognosis of these diseases.
This, of course, is directly related to improving the long-term results of surgical interventions.
The most realistic and effective solution to improve the treatment of patients HOZANK is training doctors Angiology, primarily working in clinics, ie, organization of post-graduate specialization in therapeutic Angiology.
An integral part of the problem of treating patients HOZANK a differentiated approach that takes into account the severity of arterial insufficiency.
He, of course, is related to the pathogenetic features of different stages of chronic arterial ischemia, a comparative study of which is possible only when there is a clear clinical classification. If the stage of intermittent claudication, this classification was developed enough and is based on the distance that can pass a patient, in the case of "pain of rest", ie at the third stage of Fontaine, the evaluation criteria are different.
It is important to share the stage 3a and critical ischemia, ie, stage 3b, which was noted in the consensus documents of the leading angiologs several European countries (Berlin, 1989). In our opinion, the main distinguishing clinical feature of these stages is the presence or absence of ischemic edema of the legs, the emergence and strengthening of which pay attention correlates with the frequency lowering of the affected limb out of bed. Analysis of our observations showed that for stage 3a is characterized by lowering the frequency of the affected limb 3 - 4 times a night for critical ischemia - more. Proposed by many authors separation of these stages of the value of regional arterial blood pressure (ie greater than or less than 50 mmHg. Cent.) Seems to us wrong in connection with a large number of inaccuracies related to the influence of various factors.
The clinical manifestations are the same as if integral, uniting many of the most different pathogenetic mechanisms and the surrounding circumstances.
Our studies [6] showed that acute ischemia is characterized by: 1) a sharp decrease in the tone of arterial and venous vessels, 2) a sharp deterioration in the rheological properties of blood, 3) arteriovenous shunting, leading to "steal" of the distal vascular bed, 4) ischemic edema tibia, and 5) an imbalance of humoral regulatory systems, 6) hyperproduction of biologically active substances (cytokines) by blood cells in the background of their increased adhesion to the vascular wall. In this case, were found qualitative differences between critical ischemia of the stage 3a, which is pathogenetically be closer to the stage 2b.
Therapeutic tactics in critical ischemia is reduced first to attempt to address the issue of the possibility of surgical intervention (different reconstructive surgery, autotransplantation of the greater omentum, arterialization of the venous bed of the foot, osteotrepanation, kompaktotomiya, etc.). In the case of the impossibility of surgical treatment is limited only by conservative measures.
In conclusion, it should be noted that a more active implementation of the latest achievements of science angiologicheskuyu coagulation would solve many important primarily for clinical practice issues.
These include: 1) determine the causes of a qualitatively more severe disturbances in blood rheology of critical ischemia, 2) identifying and summarizing changes in hemostasis and blood rheology as risk factors in the development and progression HOZANK 3) identification of the pathogenetic differences between autoimmune and atherosclerotic vascular lesions walls, 4) determine the causes of venous thrombosis, particularly in patients with no anatomical prerequisites for its development, and 5) develop the concept of lifelong treatment HOZANK, in particular the combination of the reception of rheologically active drugs with different physical and balneo effects.
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