Metabolic actions

Surgical tactics and the determination of the degree of operational risk

The principal recognized position in the choice of treatment method in accordance with this classification is the need to restore blood flow to the main brand viagra application of reconstructive operations, starting with stage 2B.

In deciding on the surgical treatment should be considered multifocal nature of atherosclerotic lesions and the presence of comorbidity, complicating the condition of patients. According to our data, about 70% of patients with coronary heart disease, every 4-th detect myocardial infarction and chronic cerebrovascular insufficiency, half the patients have hypertension in combination with chronic lung disease. A 35% - disease of the gastrointestinal tract and every 7-th - diabetes.

Proceeding from the above, treatment of patients with atherosclerosis should be comprehensive, aimed both at restoring blood flow in the aorta and main arteries, and the correction of associated pathology. The main objective of restoring kroobrascheniya should be achieved with minimal trauma to the patient.

Principles of conservative treatment

One of the main conservative treatment is to improve blood rheology. It is not surprising, since patients have expressed rejection of the rheological characteristics: increased plasma fibrinogen, increased time of platelet aggregation, blood viscosity and plasma, the decrease in blood fibrinolytic activity and the change of thromboelastogram towards hypercoagulability.

Among the medicines that are used for conservative treatment, allocated a number of groups.

1. Antispasmodics: peripheral miolitiki (papaverine, drotaverine, bentsiklan) drugs block a-adrenoceptors or preganglionic momentum transfer (caffeine, prazosin), the central holinomiolitiki (tolperizon, baclofen), a substance with a versatile action (Abana).

2. Disaggregants: pentoxifylline, acetylsalicylic acid, ksantinola nicotinate, ticlopidine, reopoliglyukin.

3. Antiatherosclerotic means: drugs that block the absorption of cholesterol from the gut (cholestyramine), which inhibit the biosynthesis and transport of cholesterol and triglycerides (fibroevoy acid derivatives clofibrate, ciprofibrate) and statins (lovastatin, simvastatin) and other drugs (nicotinic acid).

4. Preparations of the metabolic actions: solkoseril, Actovegin, etc.

5. Angioprotectors: pirikarbat etc.

Particularly want to emphasize that an important place in the overall arsenal of therapeutic interventions in patients with obliterating diseases of the aorta and lower extremity arteries is dosed walking path, which contributes to the development of collateral circulation.

Purely conservative treatment is indicated for patients with chronic arterial insufficiency of stage 1 and 2A, in patients with stage 2B and critical ischemia with the development of ulcerative-necrotic lesions question arises about the restoration of trunk circulation. With the view of normal men power of modern technologies in recent years, many papers on the use of balloon angioplasty in patients with different localization of occlusive-stenotic lesions of the arteries of the pelvis and lower extremities.

However, not all cases, we can apply the plastic balloon occlusion of the aorta or due to widespread arterial occlusions. Attempts to recanalization in these cases, dangerous thrombosis of the great arteries (often with thrombosis of peripheral channel), which inevitably leads to amputation in 60% of cases, and often fatal.

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