Vol 8, No 4 (2015)

The purpose of the study To evaluate the results of gene therapy in patients with HODLLA stage II and III within the period up to 3 years. Materials and methods We have experience of using the first registered domestic genetic drug based on gene vegf 165 in treatment of patients with chronic obliterating diseases of lower limb arteries (HODLLA) for stages II and III of A.V. Pokrovsky - Fontaine in the amount of 65 observations. Of these, traced long-term outcomes in terms of over 3 years, 45 people (II stage - 27 patients, III st. N = 18). The average age of patients was 63,3 ± 5,8. Evaluation results performed depending on the initial stage of the disease. The efficacy of treatment was evaluated by the following methods: 1. Determination of the quality of life (physical and psychological components of health) was made in using Russian version of the standard questionnaire SF 36; 2. pain-free walking distance was determined during the treadmill-test (walking speed of 1 km/h, the angle of 0°); 3. save the leg; 4. the survival rate of patients. Results and their discussion Significantly improved quality of life at 1 year follow-up, and then save a positive result for 3 years for all patients with stage II disease. The average value of the physical health component for inclusion in the clinical trial was 29,0 ± 6 points. During the first year PH had increased to 42,2 ± 8. In the future, marked by a further increase to the level of 47,6 ± 9 to the end of the observation period. The mental component of health initially 34,2 ± 4,0 points, in the first year of observation MH increased to 52,9 ± 5, and 2 and 3 years was stabilized and reached 54,8 ± 6. The average value of pain-free walking distance was 159 ± 123 m, to the end of 1 year - 676 ± 542 m, to the end of 2 year it was 704 ± 475 m, 3 years - 654 ± 415m. A safety limb throughout the observation period was 100%, survival rate - 88.9%. Patients with stage III HODLLA original value PH was 22,3 ± 1,3 points. During the first year had increased to 31,4 ± 9,3 and further noted its gradual increase to 37,5 ± 9,0 at the end of 3 years. MH changes were more significant. When included in the CI it was 25,2 ± 4,3 points, for the first year of follow-up increase in 36,2 ± 11. For 2 and 3 years, he continued to grow and reached 51,1 ± 8,3 points. Initially, the average value of pain-free walking distance was 31,5 ± 25m, to the end of 1 year - 200 ± 107m, after 2 years - 274 ± 72m, after 3 years - 271 ± 63m. Save the limb for the entire observation period - 78%. Three observations in the first year and one in the second year of lower limb amputations performed at the level of the thigh on the progression of chronic ischemia. The survival rate in this group was 100%. Conclusion The use of a single course of treatment based on gene vegf 165 in patients with stage II and III of HODLLA A.V. Pokrovsky-Fontaine classification leads to a stable positive effect in the large majority of patients in long-term period of three years and does not require repeated courses of gene therapy. In 82% of patients showed improvement, both physical and, to a greater extent, the psychological component of quality of life; It showed a significant increase in pain-free walking distance, increased their daily activity. All patients showed good tolerability and lack of side effects; fixed stabilization of the results. The survival rate was 93.3%. Keywords. Atherosclerosis, chronic lower limb ischemia, gene treatment, quality of life

 

Endovascular techniques are an important part of modern surgery , proven to be effective in the diagnosis and treatment of neoplastic
processes , diseases of the heart and blood vessels , surgical infections and bleeding. Research continues to develop equipment
manipulations , optimal drug prevention schemes , various methods of vascular imaging , devices for closing defects arteries and
others. The article reflects the relevance of the use of endovascular interventions , and historical aspects of local complications of
this technology . Particular attention was paid to the authors of hemorrhagic complications arising in the artery catheterization
with a frequency of 1.5 to 9 %. The article indicated predisposing local factors of complications , such as advanced age , presence
of anatomical features of the structure , blood diseases , heart, diabetes , obesity, renal failure , atherosclerosis, polimorbitnoy
pathology; In particular , only the risk of bleeding complications in patients age may reach 9 % or more. The article lists the
triggers of hemorrhagic complications after arterial puncture: the use of anticoagulant, thrombolytic and antiplatelet therapy,
repeated surgeries, prolonged exposure introdyussera in the artery, the use of instruments larger than 7 Fr, insufficient experience
of the operator and thoroughness puncture and subsequent hemostasis and others. Authors reduce the number slozhneny allows
professional staff , ultrasonic testing , which should be used in patients with hip circumference of 60 cm, in cases when impossibility
of determining the pulsation of the artery. The article presents the classification of devices for local hemostasis , according to which
the isolated compression , ligation , and klipiruyuschie occlusive device summarizes characteristics specific devices , presented
how they work , given the positive and negative aspects of their application. The results of the use of devices for hemostasis in the
literature are very contradictory and insufficient , which requires further study the effectiveness of their use in different groups of
patients.