References

asurgery

Амбулаторная хирургия

Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)

2712-87412782-2591

ООО «ГРУППА РЕМЕДИУМ»

10.21518/1995-1477-2022-19-2-50-60

asurgery-309

Research Article

АНГИОЛОГИЯ

ANGIOLOGY

Современные возможности и перспективы консервативного лечения пациентов с заболеваниями периферических артерий

Modern possibilities and prospects of conservative treatment of patients with peripheral arterial diseases

https://orcid.org/0000-0001-7473-6692

Каторкин

С. Е.

Katorkin

S. E.

Каторкин Сергей Евгеньевич - доктор медицинских наук, профессор, заведующий кафедрой и клиникой госпитальной хирургии.

443099, Самара, ул. Чапаевская, 89

Sergey E. Katorkin - Dr. Sci. (Med.), Professor, Head of Department and Hospital Surgery Clinic.

89, Chapaevskaya St., Samara, 443089

s.e.katorkin@samsmu.ru

https://orcid.org/0000-0003-4530-7527

Кривощеков

Е. П.

Krivoshchekov

E. P.

Кривощеков Евгений Петрович - доктор медицинских наук, профессор, профессор кафедры хирургии Института последипломного образования.

443099, Самара, ул. Чапаевская, д. 89

Evgeny P. Krivoshchekov - Dr. Sci. (Med.), Professor, Professor of the Department of Surgery of the Institute of Postgraduate Education.

89, Chapaevskaya St., Samara, 443099

walker02@mail.ru

https://orcid.org/0000-0002-0717-9686

Ельшин

Е. Б.

Elshin

E. B.

Ельшин Евгений Борисович - заведующий приемным отделением стационара, врач-хирург отделения гнойной хирургии.

443035, Самара, ул. Мирная, д. 169

Evgeny B. Elshin - Head of the Reception Department of the Hospital, Surgeon of the Department of Purulent Surgery.

169, Mirnaya St., Samara, 443035

ebels@mail.ru

https://orcid.org/0000-0001-8764-2054

Кушнарчук

М. Ю.

Kushnarchuk

M. Y.

Кушнарчук Михаил Юрьевич - врач сердечно-сосудистый хирург отделения сосудистой хирургии клиники госпитальной хирургии, ассистент кафедры госпитальной хирургии.

443089, Самара, ул. Чапаевская, д. 89

Mikhail Yu. Kushnarchuk - Cardiovascular Surgeon, the Department of Vascular Surgery of the Department and Clinic of Hospital Surgery.

89, Chapaevskaya St., Samara, 443099

m.kushnarchuk@outlook.com

Самарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation

Самарская городская клиническая больница № 8РоссияSamara City Clinical Hospital No. 8Russian Federation

2022

19112022

1925060

2022

Каторкин С.Е., Кривощеков Е.П., Ельшин Е.Б., Кушнарчук М.Ю.

Katorkin S.E., Krivoshchekov E.P., Elshin E.B., Kushnarchuk M.Y.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.a-surgeon.ru/jour/article/view/309

Самым частым клиническим проявлением заболеваний периферических артерий является перемежающаяся хромота, возникающая вследствие недостаточного кровоснабжения пораженной конечности. В статье обобщены и систематизированы последние достижения в области консервативного лечения пациентов с перемежающейся хромотой. В соответствии с требованиями доказательной медицины приводится обзор современных перспективных тенденций консервативной терапии, представленных в последних российских и зарубежных согласительных документах. Основу комплексного лечения пациентов с заболеваниями периферических артерий составляют: немедикаментозное и лекарственное лечение для купирования симптомов хронической ишемии, фармакотерапия для вторичной профилактики сердечно-сосудистых осложнений, открытая или эндоваскулярная реваскуляризация для увеличения дистанции безболевой ходьбы. При развитии атеросклероза происходят нарушения состава комплекса регуляторных пептидов эндотелия, которые в норме осуществляют регуляцию гомеостаза и поддержание функции сосудов. При этом уменьшается способность сосудистой стенки противостоять воспалению и связанному с ним запуску патологических процессов атерогенеза. Экспериментально доказано, что использование в этой ситуации комплекса пептидов, полученных из сосудов здоровых и молодых животных, восстанавливает эндотелиальную функцию артерий, воздействуя на основные звенья патогенеза. Снижение оксидативного стресса, уменьшение атерогенного и липидемического действия, нормализация тонуса сосудов и показателей свертываемости крови, увеличение микрососудистого русла – это те механизмы, которые обосновывают применение у больных с облитерирующим атеросклерозом препарата на основе комплекса полипептидов, выделенных из сосудов. Ангиопротектор на основе комплекса полипептидов, выделенных из сосудов, может стать важной частью терапии пациентов с облитерирующими заболеваниями артерий нижних конечностей, оказывая комплексное патогенетическое действие. Необходимо дальнейшее изучение в мультицентровых клинических исследованиях продолжительности терапевтического действия препарата в более отдаленные сроки после курсового лечения, его влияния на отдаленные исходы заболевания, возможности применения повторных курсов при хронических облитерирующих заболеваниях артерий нижних конечностей III–IV стадии по классификации Фонтейна, а также применения препарата для лечения системного атеросклероза различных артериальных бассейнов.

The most common clinical manifestation of peripheral arterial disease is intermittent claudication due to insufficient blood supply to the affected limb. The article summarizes and systematizes the latest achievements in the field of conservative treatment of patients with intermittent claudication. In accordance with the requirements of evidence-based medicine, an overview of modern promising trends in conservative therapy presented in the latest Russian and foreign consensus documents, is given. The basis of the complex treatment of patients with peripheral arterial diseases is: non-drug and drug treatment to relieve the symptoms of chronic ischemia, pharmacotherapy for the secondary prevention of cardiovascular complications, open or endovascular revascularization to increase the distance of painfree walking. With the development of atherosclerosis, disturbances in the peptide composition of the endothelium occur, which reduce the ability of the vascular wall to resist inflammation and the associated triggering of pathological processes. It has been experimentally proven that the use of a complex of peptides obtained from the vessels of healthy and young animals in this situation restores the endothelial function of the arteries, affecting the main links of pathogenesis. Decrease in oxidative stress, decrease in atherogenic and lipidemic action, normalization of vascular tone and blood coagulation parameters, increase in the microvascular bed – these are the mechanisms that justify the indication of peptides to patients with atherosclerosis obliterans. Angioprotector based on a complex of polypeptides isolated from blood vessels can become an important part of the treatment of patients with obliterating diseases of the arteries of the lower extremities, providing a complex pathogenetic effect. It is necessary to further study in multicenter clinical trials the duration of the therapeutic effect of a drug in a longer period after a course of treatment, its effect on long-term outcomes of the disease, the possibility of using repeated courses, in chronic obliterating diseases of the arteries of the lower extremities III-IV stages according to the Fontaine classification, as well as the use drug for the treatment of systemic atherosclerosis of various arterial basins.

облитерирующий атеросклерозхроническая ишемия нижних конечностейперемежаю щаяся хромотаконсервативное лечениеэндотелийрегуляторные пептиды

obliterating atherosclerosischronic ischemia of the lower extremitiesintermittent claudicationconservative treatmentendotheliumregulatory peptides

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The authors declare that there are no conflicts of interest present.