Pleiotropic therapy for the initial stages of chronic venous insufficiency in post-thrombotic disease
https://doi.org/10.21518/1995-1477-2020-3-4-20-26
Abstract
Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.
Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.
Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.
Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).
Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.
About the Authors
M. R. KuznetsovRussian Federation
Maxim R. Kuznetsov, Dr. of Sci. (Med.), Professor of RAS, Deputy Director for Clinical Affairs, Institute of Cluster Oncology named after L.L. Levshin
6, Bldg. 1, B. Pirogovskaya St., Moscow, 119991, Russia
V. Yu. Bogachev
Russian Federation
Vadim Yu. Bogachev, Dr. of Sci. (Med.), Professor, Department of Intermediate Level Surgery No. 2
1, Ostrovityanov St., Moscow, 117997, Russia
S. V. Sapelkin
Russian Federation
Sergey V. Sapelkin, Dr. of Sci. (Med.), Leading Research Associate, Department of Vascular Surgery
27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia
I. P. Marchenko
Russian Federation
Igor P. Marchenko, Cand. of Sci. (Med.), Surgeon, Deputy Chief Physician for Surgery
2, Gospitalnaya Square, Moscow, 111020, Russia
L. A. Neskhodimov
Russian Federation
Leonid A. Neskhodimov, Endoscopist, Head of Endoscopy Center, Consulting-Diagnostic Department
27, Lenin Ave., Moscow, 119071, Russia
A. A. Khotinskiy
Russian Federation
Andrey A. Khotinskiy, Postgraduate Student, Department of Intermediate Level Surgery No. 1, Faculty of General Medicine
1, Ostrovityanov St., Moscow, 117997, Russia
References
1. Bokeriya L.A., Zatevakhin I.I., Kirienko A.I. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Flebologiya = Flebologiya. Journal of Venous Disorders. 2015;4(2):3–52. (In Russ.) Available at: http://webmed.irkutsk.ru/doc/pdf/pe2015.pdf.
2. Kachroo S., Boyd D., Bookhart B.K., LaMori J., Schein J.R., Rosenberg D.J., Reynolds M.W. Quality of life and economic costs associated with postthrombotic syndrome. Am J Health Syst Pharm. 2012;69(7):567–572. doi: 10.2146/ajhp110241.
3. Savelev V.S. (ed.), Gologorskiy V.A., Kirienko A.I. Phlebology: guidelines for physicians. Moscow: Meditsina; 2001. 664 р. (In Russ.) Available at: https://booksmed.com/hirurgiya/1298-flebologiya-savelev-rukovodstvo-dlya-vrachej.html.
4. Yoo T., Aggarwal R., Wang T.F., Satiani B., Haurani M.J. Presence and degree of residual venous obstruction on serial duplex imaging is associated with increased risk of recurrence and progression of infrainguinal lower extremity deep venousthrombosis. J Vasc Surg Venous Lymphat Disord. 2018;6(5):575–583. doi: 10.1016/j.jvsv.2017.12.059.
5. Kuznetsov M.R., Sapelkin S.V., Boldin B.V., Leontiev S.G., Neskhodimov L.A. Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis. Angiologiya I Sosudistaya Khirurgiya = Angiology and Vascular Surgery. 2016;22(3):82–87. (In Russ). Available at: http://www.angiolsurgery.org/magazine/2016/3/11.htm.
6. Yablokov E.G., Kirienko A.I., Bogachev V.Yu. Chronic venous insufficiency. Мoscow: Bereg; 1997. 127 р. (In Russ.) 7. Shilov A.M., Knyazeva L.V. Pleiotropic Effects and Cardioprotective Action of Actovegin in Patients with Coronary Heart Disease. Lechebnoe delo = General Medicine. 2012;(4):64–73. (In Russ.) Available at: http://www.atmosphere-ph.ru/modules/Magazines/articles/delo/ld_4_2012_63.pdf.
7. Machicao F., Muresanu D.F., Hundsberger H., Pflüger M., Guekht A. Pleiotropic neuroprotective and metabolic effects of Actovegin’s mode of action. J Neurol Sci. 2012;322(1–2):222–227. doi: 10.1016/j.jns.2012.07.069.
8. Buchmayer F., Pleiner J., Elminger M.W., Lauer G., Nell G., Sitte H.H. Actovegin: a biological drug for more than 5 decades. Wien Med Wochenschr. 2011;161(3–4):80–88. doi: 10.1007/s10354-011-0865-y.
9. Elmlinger M.W., Kriebel M., Ziegler D. Neuroprotective and Anti- Oxidative Effects of the Hemodialysate Actovegin on Primary Rat Neurons in Vitro. Neuromolecular Med. 2011;13(4):266–274. doi: 10.1007/s12017-011-8157-7.
10. Fedorovich A.A. Non-invasive evaluation of vasomotor and metabolic functions of microvascular endothelium in human skin. Microvasc Res. 2012;84:86–93. doi: 10.1016/j.mvr.2012.03.011.
11. Biland L., Hürlimann F., Goor W., Körner W.F., Kündig A., Madar G. Treatment of venous ulcers. A multi-center randomized double-blind study. VASA. 1985;14:383–389. Available at: https://ncbi.nlm.nih.gov/pubmed/4072377.
12. Stein R., Seuser J. Local use of Actovegin ampoule solution in crural ulcer. Med Welt. 1986;37:173–176.
13. Uchkin I.G., Mosesov A.G., Tsyrulnikov A.A. Actovegin as a part of combination therapy for complicated forms of chronic venous insufficiency of the lower extremities. RMZH = RMJ. 2007;12(15):981–985. (In Russ.) Available at: https://rmj.ru/articles/khirurgiya/Aktovegin_kak_komponent_kompleksnoy_terapii_osloghnennyh_form_hronicheskoy_venoznoy_nedostatochnosti_nighnih_konechnostey/https://www.rmj.ru/articles/khirurgiya/Aktovegin_kak_komponent_kompleksnoy_terapii_osloghnennyh_form_hronicheskoy_venoznoy_nedostatochnosti_nighnih_konechnostey/.
14. Khismatov R.R., Trukhova V.V., Makarova N.N., Guseva S.L. Actovegin in the treatment of lower extremity trophic ulcers of venous etiology. RMZH = RMJ. 2008;30(16):2022–2024. (In Russ.) Available at: https://rmj.ru/articles/khirurgiya/Aktovegin_v_lechenii_troficheskih_yazv__nighnih_konechnostey_venoznoy_etiologii/.
15. Raposio E., Bertozzi N., Moretti R., Grignaffini E., Grieco M.P. Laser Doppler Flowmetry and Transcutaneous Oximetry in Chronic Skin Ulcers: A Comparative Evaluation. Wounds. 2017;29(7):190–195. Available at: https://ncbi.nlm.nih.gov/pubmed/28762949.
Review
For citations:
Kuznetsov M.R., Bogachev V.Yu., Sapelkin S.V., Marchenko I.P., Neskhodimov L.A., Khotinskiy A.A. Pleiotropic therapy for the initial stages of chronic venous insufficiency in post-thrombotic disease. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2020;(3-4):20-26. (In Russ.) https://doi.org/10.21518/1995-1477-2020-3-4-20-26

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International.