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Vol. 12, Art. 32 (pp. 374-385)    |    2011       

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Choice of postoperative treatment of patients with obliterating atherosclerosis of arteries of lower extremities, depending on the predicted risk of thrombotic occlusion

A.A. Poliantsev*, P.V. Mozgovoy**, D.V. Frolov*, A.M. Spelchuk*

* Volgograd State Medical University, Department of General Surgery.
** Clinic № 1 Volgograd State Medical University, Department of Cardiovascular Surgery

Brief summary

The control group included 35 patients, who received Aspirin 125-150 mg per day and Simvastatin 10 mg per day. The main group of 31 people undergoing surgery in 2005, the appointment of therapy has been used predictive model based on morphometric data. I.e. patients with low predicted level of thrombotic reocclusion in the late postoperative period prescribed basic therapy – aspirin 125 - 150 mg per day and Simvastatin 20 mg per day (the value of total cholesterol was pursued at 2.6 mmol/l). For patients at high risk of thrombosis (17 - 54,8%) – initial dosage of Simvastatin was 40 mg per day. At follow-up of the patient, if the level of liver enzymes increased 2-fold or higher than normal levels, the dosage of Simvastatin was reduced to 20 mg per day and Neonatsin was added to treatment at a dosage of 1,5 - 3 g per day (the value of total cholesterol was pursued at 1.8 mmol/l). Before discharge, that is, before the start of the study and yearly, that is, during the late postoperative period, patients were evaluated change in all systems of hemostasis, blood rheology indicators, changes in lipid composition of blood, as well as changes in regional hemodynamics. Thus, there were significant difference between groups on indices of lipid profile, the rest of the aggressive treatment of atherosclerosis has a positive effect on vascular-platelet hemostasis, blood rheology, however, no significant differences in performance were noted. There was no significant difference in the groups with respect to parameters of regional hemodynamics, but the number of thrombotic reocclusions in the late postoperative period was significantly lower. Conclusion: In summary, we can conclude that by appointing postoperative patients with antiplatelet doses of Aspirin, antihyperlipidemic drug Simvastatin and Neonatsin at a dosage of pathogenic testimony, we can prolong the positive result of the operation, affecting the activity of the atherosclerotic process in the area of reconstruction and the distal channel.


Key words

Atherosclerosis of arteries of lower extremities; morphometry; long-term results; Simvastatin, prevention of late thrombotic reocclusions.

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