Yakymchuk E. Prevention of systemic inflammatory and reperfusion complications of reconstruction of aorto-hip-popliteal segment in conditions of chronic critical ischemia

The dissertation deals the problem of prophylaxis of systemic inflammatory and reperfusion complications after operative approaches in patient with multistory occlusion of the main arteries. The work is based on examination and surgical treatment of 146 patients with atherosclerotic occlusion of the terminal part of abdominal aorta and main arteries of lower extremities (a 70 patients was diagnosed a chronic critical ischemia). It was established, that revascularization results in the increase of pro- and anti-inflammatory cytokines (IL-1 to 34,6-86,3%, IL-4 - 22,2-85,4%, IL-6 - 27,8-86,4%, TNF-a - 18,8-83,2%, dependent on the degree of chronic arterial ischemia, markers of systemic inflammatory response syndrome (C-reactive protein in the 30-70 time, lactate in 3,6-5,5 times, fibrinogen in 1,5-3,5 times), integral hematological data in the 3 times, activation of lipid peroxidation on the background of suppression of the antioxidant system, and impaired oxygen nutrition. To prevent the development of reperfusion and systemic inflammatory response syndrome in the condition chronic critical ischemia of lower extremities, were proposed the measures in the preoperative period, which include the application of Quercetin, Tiatriazolin, Peftoran, using the methods of efferent desintoxication, performance of prolongation epidural anesthesia. Including in the preoperative preparance of plasmoferesis reduces the manifestation of reperfusion syndrome in 2.5 times and the development of systemic complication (pneumonia) on 5.7 % .No complication were observed after the application of two leukapheresis sessions.