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Introduction: Changes in autonomic nervous system (ANS) balance associated with endovascular interventions may potentially cause haemodynamic abnormalities that lead to periprocedural cardiovascular complications. This study aimed to determine the relationships between changes in ANS balance and impedance cardiography (ICG) parameters after endovascular leg revascularization. Material and methods: Before the procedure, and 1, 3 and 5h after the intervention, 5-min examinations of both ANS balance and ICG parameters were performed using a Task Force Monitor in 42 patients undergoing endovascular leg revascularization. Results: When compared to patients with intermittent claudication, individuals with chronic limb-threatening ischaemia had a significantly shorter R-R interval and lower stroke volume (SV) and left ventricle ejection time (LVET) at the beginning of the study. During the 5h after endovascular leg revascularization, significant fluctuations were noted in the following: heart rate, frequency-domain parameters of heart rate variability, baroreflex effectiveness indices, and ICG parameters, such as total peripheral resistance, SV, LVET, and ejection rate. The deltas of ANS parameters correlated with the deltas of ICG parameters in the respective periods of measurement. Conclusions: Dynamic fluctuations in ICG and ANS parameters that occurred in patients who had undergone endovascular leg revascularization might potentially affect the risk of the occurrence of a cardiovascular event in the periprocedural period. The correlations between the ANS and ICG parameters suggest that haemodynamic oscillations after endovascular leg revascularization are mediated by changes in ANS activity, most probably through a sympathoexcitatory effect of the procedure related to changes in skeletal muscle perfusion. [ABSTRACT FROM AUTHOR]

Introduction. Statins effect on the outcome of endovascular intervention due to chronic lower limb ischaemia (CLLI) is still uncertain. The aim of this study was to determine the effect of statin type on the late outcome of superficial femoral artery (SFA) stenting in patients with CLLI. Material and methods. Retrospective analysis of the medical documentation of 275 consecutive patients treated with SFA stenting due to CLLI, including 125 (45%) patients with critical limb ischaemia (CLI). Measured outcomes were: target lesion revascularization (TLR), target extremity revascularization (TER), and target limb amputation (TLA). Results. Statins were used by 267 (97%) of the patients, respectively: atorvastatin (n = 191, 70%), simvastatin (n = 31, 11%) and rosuvastatin (n = 45, 16%). During the 675.0 ± 569.7 days of follow-up, TLR was required by 79 (29%) patients, TER by 109 (39%), and TLA by 27 (10%). Patients treated with rosuvastatin in comparison with those treated with atorvastatin, in spite of greater initial LDL and triglyceride levels, required TER (p = 0.01) and TLR (p = 0.03) less frequently. The risk of TER in patients treated with rosuvastatin was significantly (p = 0.016) lower than in individuals treated with atorvastatin and simvastatin, as shown in the Kaplan-Meier analysis. Cox's proportional hazards regression showed that therapy with rosuvastatin was the strongest factor (HR 0.40 ± 95% CI; 0.2-0.81) decreasing the likelihood of TER. Conclusions. Rosuvastatin after SFA stenting seems to have the strongest effect on reduction in reintervention risk but without influence on limb salvage. [ABSTRACT FROM AUTHOR]

Background. Although the description of arteriosclerosis obliterans dates back to the middle of the nineteenth century, no efficient pharmacological agent reducing symptoms of lower limb ischaemia has yet been discovered. As well as pentoxyphylline, which has been used for many years, sulodexide -- a glycosaminogly- can with heparin-like activity -- is also being employed. Material and methods. In a multidirectional ongoing trial, the effectiveness of both agents was preliminarily assessed following 8 weeks of treatment, including 7 days of intravenous injections, 42 days of oral administration, and subsequent 7-day re-administration of intravenous drips. Both drugs were dosed in accordance with the manufacturer's indications: intravenous pentoxyphylline 2 x 300 mg in 250 ml 0.9% NaCl, and orally: 2 x 600 mg in retard form: intravenous sulodexide 1 x 1 amp. (600 LSU) in 250 ml 0.9% NaCl, and orally 2 x 1 caps (250 LSU). Forty patients with the early stage of the disease (IIB according to the Fontaine classification) were evaluated (mean age 54.3 years old -- 17 study subjects in the pentoxyphylline group and 23 in the sulodexide group). Lower limb arterial sufficiency was assessed by means of treadmill test, with ankle-brachial index evaluation and plethysmography conducted before and after the treadmill test. Results and conclusions. In the conducted project, the non-significant influence of pentoxyphylline over both pain-free and total claudication distance was determined. In the case of sulodexide, significant lengthening of pain-free (by 20.13 m) and total claudication distance (by 25.71 m) were established, and statistical significance was reached for claudication distance increase by sulodexide in comparison with pentoxyphylline (16%; p < 0.05). No significant influence of the two agents over plethysmographic parameters of arterial sufficiency both pre- and post-treadmill tests was demonstrated, although comparative analysis showed a clinically irrelevant difference in the affection of lower-limb pressure values before and after treatment. A 5-year evaluation period of both drugs' effectiveness has been planned, with the intention of enlarging the study population. [ABSTRACT FROM AUTHOR]

Aim: This study was aimed at assessing tolerability, safety and therapeutic efficacy of Pletax® (cilostazol) compared with Trental® (pentoxifylline) in patients with moderate-to-severe intermittent claudication., Patients and Methods: The study included a total of one hundred 40-to-65-year-old patients presenting with confirmed diagnosis of moderate-to-severe intermittent claudication. Depending on the therapeutic regimen, the patients were divided into two groups. Group 1: 50 patients orally took Pletax® (cilostazol) at a dose of 100 mg twice daily 30 minutes before meals or 2 hours after meals together with conventional therapy. Group 2: 50 patients took oral Trental® (pentoxifylline) in a dose of 400 mg 3 times daily 30 minutes before meals or 2 hours after meals along with conventional therapy. The duration of the follow up period amounted to 24 weeks for both groups. The treadmill test was carried out at room temperature, with the running track tilt angle of 0° at a speed of 3 km/h. The primary parameters of efficacy were as follows: the dynamics of the minimal walking distance (a distance walked by the patient until the appearance of pain in the extremity) and dynamics of the maximal walking distance (a distance walked by the patients until full stop due to pain in the extremity)., Results: Analysing efficacy demonstrated higher results of Pletax® compared with Trental®. The obtained findings suggested that Pletax® showed a significant clinical effect as soon as at 2 weeks, followed by advantage during the whole period of follow up. Analysing the parameters of the minimal and maximal walking distances in the group of patients taking Pletax® demonstrated clear superiority over the Trental® group as soon as by week 2 of administration, which preserved during the whole follow-up period. The minimal pain-free walking distance in the Pletax group at baseline amounted to 92.9±83.4 m (Trental group - 92.3±78.4; p=0.3), followed by an increase at week 8 to 126±115 m (Trental group - 116±96.3; p=0.51), at week 16 to 136±116 m (Trental group - 118±95.5; p=0.04), at week 24 to 149±126 b (Trental group - 127±98.9; p=0.01). At the same time, the effect of Pletax® and Trental® on the secondary parameter of efficacy, i.e., the ankle-brachial index was comparable: at baseline - 0.472 and 0.482 (p=0.28), at 2 weeks - 0.48 and 0.483 (p=031), at 8 weeks - 0.49 and 0.485 (p=0.74), at 16 weeks - 0.494 and 0.492 (p=0.2), at 24 weeks - 0.501 and 0.496 (p=0.45)., Conclusion: The obtained findings demonstrated advantages of Pletax® over Trental®, manifesting themselves in the achievement of the highest parameters by such criteria as the minimal and maximal walking distance. High safety and efficacy of Pletax® were confirmed by low frequency of unfavourable events during therapy.

The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.

Endovascular intervention is one of the main methods of treatment in atherosclerotic lesions of the infrainguinal segment in patients with chronic lower limb ischaemia. Recent years have witnessed active use of drug-eluting techniques, significantly improving the long-term outcomes of peripheral reconstructions. This article is a review of publications on the results of using modern drug-eluting balloon catheters and stents in the femoropopliteoltibial position. The accumulated data will help solve the main problems of the classic balloon angioplasty, reducing the incidence of restenosis, improving primary patency, and decreasing the need for repeat interventions in the remote period of follow-up.

Reperfusion syndrome is a complex series of clinical manifestations resulting from restoration of blood flow to previously ischaemic tissues. It is accompanied by damage to cells, tissues and organs at various levels, followed by the development of multiple organ failure. This review deals with the main pathophysiological mechanisms of the development of reperfusion syndrome in lesions of cardiac, cerebral and lower-limb vessels. Oxidative stress is considered to be the most important marker of ischaemia-reperfusion injury irrespective of the type of tissues affected. Presented herein are the data on contemporary possibilities of influencing various stages and components of the development of reperfusion injury by means of drug therapy, demonstrating that due to the importance of oxidative stress as a key link of reperfusion injury, antioxidant therapy should be the main component of prevention and treatment of reperfusion injury.

Occlusion of the superficial femoral artery is a frequently encountered pathology in peripheral vascular disease. In patients with chronic lower limb ischaemia in a lesion of crural arteries the results of femoropopliteal bypass grafting are unsatisfactory, therefore, the deep femoral artery becomes the decisive collateral pathway for perfusion of the lower extremity., Patients and Methods: The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 - 95 patients with stage II B, Group 2 - 56 patients with stage III, and Group 3 - 15 patients with stage IV., Results: Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 - in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years., Conclusion: Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.