РОЛЬ РЕНТГЕНЭНДОВАСКУЛЯРНОЙ ХИРУРГИИ В ЛЕЧЕНИИ ОБЛИТЕРИРУЮЩЕГО АТЕРОСКЛЕРОЗА АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ У ПАЦИЕНТОВ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА

Varicose vein disease of the lower extremities in patients with the vascular type of Ehlers–Danlos syndrome (EDS) is associated with a high risk of vascular rupture and postoperative complications. Therefore, an individualized approach to diagnosis, treatment, and postoperative management is essential for patients with varicose veins and vascular-type EDS. An analysis of two clinical cases of patients with confirmed vascular-type EDS was conducted. Diagnosis included clinical examination, genetic testing, duplex vein scanning, CT angiography, and coagulation tests. Minimally invasive treatment methods were applied. A 46-year-old female patient underwent miniphlebectomy without complications, with restored venous outflow. The surgery was successful, with a decrease in the symptoms of chronic venous insufficiency. The second case concerned a 21-year-old patient with a history of recurrent episodes of deep vein thrombosis, as well as nosebleeds and hematomas with minimal trauma. Given the high risk of complications during invasive intervention, as well as the results of genetic analysis confirming the vascular type of EDS, it was decided to refuse surgical treatment. The patient received complex conservative therapy. Surgical treatment for vascular-type EDS should be as minimally invasive as possible. Genetic testing is necessary in cases of early varicose vein development. Individualized anesthesia selection and continuous monitoring are crucial due to the high risk of vascular complications.

Clinical questionWhat is the impact of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on survival and on cardiovascular and kidneyoutcomes for adults living with chronic kidney disease (CKD)?Current practiceFew therapies slow kidney disease...

Background. In recent years the deterioration of the demographic situation has been noted in most countries of the world that is due to the steady increase in population of arterial hypertension and the aging of the population. According to the statistical forecast of the UN by 2025, the number of people over 60 will exceed 1 billion which is 15% of the entire global population. In Ukraine, according to epidemiological studies, the prevalence of hypertension among circulatory system diseases in adults (18 years and older) is 46.8% and almost half of patients with circulatory system diseases have elevated blood pressure. In patients aged 65 years and older, the prevalence of hypertension varies in the range of 53-72%. It has long been proven that the risk of cardiovascular and cerebrovascular complications in hypertensive patients depends not only on the absolute blood pressure level but also on fluctuations in blood pressure over different periods that is blood pressure variability. Blood pressure is not a static parameter but rather undergoes continuous fluctuations over time due to the interaction between environmental factors and behaviour on the one hand and the internal regulatory mechanisms of the cardiovascular system on the other hand. Elevated blood pressure may indicate cardiovascular dysregulation and itself may be a cardiovascular risk factor associated with increased all-cause mortality and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease and incidence of dementia. Aim. The study aimed to improve the system of prevention and diagnosis of elderly and senior hypertensive patients at the ambulatory-polyclinic stage due to the study of the contribution of blood pressure variability. Materials and methods. The group of examinees was formed taking into account 27 elderly and senile hypertensive patients including those combined with coronary artery disease. For this purpose, ambulatory blood pressure monitoring was used. Results. Systolic blood pressure variability (SD) in hypertensive patients was higher than in the control group (p<0.001). So, during the study, SD was 17.9±7.1 mm Hg. while in the control group 12.1±2.6 mm Hg. The frequency of high blood pressure variability detection in elderly and senile hypertensive patients was 51.9% (n=14). High blood pressure variability compared to low blood pressure variability and control was associated with a more pronounced systolic blood pressure variability (during the active monitoring period), and it was equalled 23.7±5.2 mm Hg compared to 14.8±6.5 mm Hg (p<0.001) and 12.1±2.6 mm Hg. (p<0.001). In elderly and senile hypertensive patients with high and low blood pressure variability, the non-dipper group prevailed over the dipper group in the structure of daily blood pressure rhythm (71.4% vs. 28.6% and 84.6% vs. 15.4% respectively). According to the ambulatory blood pressure monitoring data high blood pressure variability group compared to low blood pressure variability and controls was characterised by higher average values of the number of blood pressure indicators. In the group of high blood pressure variability patients, the average daily systolic blood pressure exceeded the control value by 10% (р<0.05). The daily index of systolic blood pressure in the group of high blood pressure variability patients was 111% higher than in patients with low blood pressure variability (p<0.05). The daily index of diastolic blood pressure in the group of high blood pressure variability patients was 140% higher than in patients with low blood pressure variability (p<0.05). The daily index of average blood pressure in the group of high blood pressure variability patients was 191% higher than in patients with low blood pressure variability (p<0.01). Conclusions. 1. High blood pressure variability has occurred in 16 out of 27 (51.9%) hypertensive elderly and senile patients. 2. The non-dipper group has predominated in the structure of blood pressure diurnal rhythm in elderly and senile hypertensive patients with high and low blood pressure variability patients. _________________________________________________________________________________________ Keywords: arterial hypertension; essential hypertension; blood pressure variability; high blood pressure variability; low blood pressure variability; elderly and senile hypertensive patients

IntroductionThe impact of obesity on the incidence of blunt pelvic fractures in adults is unclear, and adolescents may have an increased risk of fracture due to variable bone mineral density and leptin levels. Increased subcutaneous adipose tissue may provide protection, though the association between obesity and pelvic fractures in adolescents has not been studied. This study hypothesized that obese adolescents (OAs) presenting after motor vehicle collision (MVC) have a higher rate of pelvic fractures, and OAs with such fractures have a higher associated risk of complications and mortality compared to non-OAs. MethodsThe 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-16 y old) presenting after MVC. The primary outcome was a pelvic fracture. Adolescents with a body mass index ≥30 (OA) were compared to adolescents with a body mass index <30 (non-OA). Subgroup analyses for high-risk and low-risk MVCs were performed. Multivariable logistic regression analyses were also performed adjusting for age and sex. ResultsFrom 22,610 MVCs, 3325 (14.7%) included OAs. The observed rate of pelvic fracture was similar between all OA and non-OA MVCs (10.2% versus 9.4%, P = 0.16), as well as subanalyses of minor or high-risk MVC (both P > 0.05). OAs presenting with a pelvic fracture after high-risk MVC had a similar risk of complications, pelvic surgery, and mortality compared to non-OAs (all P > 0.05). However, OAs with a pelvic fracture after minor MVC had a higher associated risk of complications (OR 2.27, CI 1.10-4.69, P = 0.03), but a similar risk of requiring pelvic surgery, and mortality (all P > 0.05). ConclusionsThis national analysis found a similar observed incidence of pelvic fractures for OAs versus non-OAs involved in an MVC, including subanalyses of minor and high-risk MVC. Furthermore, there was no difference in the associated risk of morbidity and mortality except for OAs involved in a minor MVC had a higher risk of complication.

Aim of the study: to determine the prevalence of the main risk factors and analyze the risk of developing cardiovascular complications in the adult population in the Vladimir region of the Russian Federation. Material and methods:The cross-sectional population-based study included 1,350 men and women aged 30-69 years from 5 cities of the Vladimir region (Vladimir, Kovrov, Murom, Yuryev-Polsky and Vyazniki).The response to the study was 87%.The study was completed by 1174 people (424 men -36.1% and 750 women -63.9%).Using a survey, instrumental and biochemical studies, the following risk factors were determined taking into account gender indicators: smoking, hypertension, hypercholesterolemia, hyperglycemia and obesity.The risk of developing fatal cardiovascular complications was assessed using the classic European score scale.Depending on the total score, the risk was assessed as follows: low risk <1%, moderate risk -from 1% to 5%, high risk -from 5% to 9% and very high risk -10-14%.Results: In the surveyed unorganized population, every third man is obese, while among women this figure was significantly high (33.7%versus 42.1%, p<0.001).The incidence of hypertension among men and women was comparable (41.5% and 39.9%, respectively).The frequency of tobacco smoking among men was 38.4%, which is 4 times higher than in women (p <0.0001).Every second person had a total cholesterol level > 5 mmol/l.Its frequency was comparable among men and women (53.2% and 51.5%, respectively).In 23.1% of women and in 18.5% of the unorganized population from 5 cities of the Vladimir region, fasting blood glucose above 6.1 mmol/l was detected.The high and very high risk of cardiovascular complications among men was 32%, among women the risk was 2 times lower (15.5%).Low and moderate risk predominated among women (66.3%), which is 1.5 times more common than men (43.6%).With comparable rates of hypertension and hypercholesterolemia, male gender and smoking status contributed to the total cardiovascular risk.The frequency of very high risk of cardiovascular complications among men in certain cities of the Vladimir region was 2.5-4 times higher compared to women.

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Abstract. The prevalence of pain syndrome increases with age, reaching maximum values among elderly people, which is associated with the presence of comorbidities in this cohort of patients. The intensity of pain syndrome and the effect of treatment are assessed using simple tools, such as: self-as-sessment, visual analogue scale (VAS), analogue pain relief scale, etc. In elderly and senile patients, the Numerical Rating Scale (NRS), the Analogue Pain Relief Scale, the Facial Pain Scale (FPS), and the Verbal Descriptor Scale (VDS) are also used. In recent years, the Defense and Veterans Pain Rating Scale (DVPRS) has been proven to be easy to use and informative.Conclusions. Elderly and senile patients represent a vulnerable group of patients with a high risk of complications. The pain management plan should include a comprehensive assessment of the pain syndrome using modern clinical scales and a course of treatment with adequate pain relief.Keywords: pain syndrome, elderly and senile patients, pain assessment scales.

Critical lower limb ischemia (CLI) is the final stage of peripheral arterial disease and occurs with chronic pain at rest, loss of tissue and limb. Despite the active development of new technologies, including endovascular and open surgical methods of treatment, and the development of various guidelines, CLI still remains an unresolved burden of vascular surgery around the world. The second part of the review describes large randomized trials, open and endovascular methods of lower limb revascularization in CLI. Also, the use of deep vein arterialization technology in No-option cases for conventional methods of revascularization.

Overweight (body mass index (BMI)>25) and obesity (BMI>30) are associated with adverse outcomes in the general population. In older people, an increased risk of adverse events was observed in leaner and overweight older subjects. We evaluated the association between BMI and cardiac surgery complications in subjects aged 75 and older. Retrospective review of complication rates compiled as part of the New York State Department of Health Adult Cardiac Surgery Report. Academic tertiary care medical center. One thousand four hundred forty-eight subjects aged 75 and older who underwent cardiac surgery in an academic hospital between 1991 and 1999. Subjects were divided into tertiles based on their BMI. Logistic regression was used in multivariate analyses examining the association between tertiles of BMI (<23, 23-26,>26) and complications from cardiac surgery, adjusting for age and gender or using a full model adjusting for history of diabetes mellitus, hypertension, myocardial infarction (MI), congestive heart failure, smoking, chronic obstructive pulmonary disease, peripheral vascular disease, renal disease, surgical priority, age, and gender. Mean age was 79 (range 75-94); 58% of the subjects were male. The incidence of any postoperative complication, respiratory failure, or death was U-shaped, with higher incidence in the first tertile of BMI, followed by the last tertile and then the middle tertile. Subjects in the lowest tertile of BMI in the full model had a higher adjusted risk of stroke (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 0.96-2.59), bleeding (OR = 1.71, 95% CI = 0.79-3.67), respiratory failure (OR = 1.65, 95%CI = 0.95-2.87), cardiovascular complications (stroke, MI, arrhythmia) (OR = 1.59, 95% CI = 0.93-2.73), and all complications (OR = 1.45, 95% CI = 1.05-2.00) than subjects in the middle tertile. The risk of most complications in subjects in the highest tertile of BMI was similar to that of subjects in the middle tertile except for wound infections (OR = 3.51, 95% CI = 0.92-13.33). The risk of death was higher in subjects in the lower tertile of BMI (OR = 1.97, 95% CI = 1.12-3.44) than in subjects in the middle tertile. The association between BMI and adverse cardiac surgical outcomes was stronger in men than women and decreased with advancing age. In the geriatric population, subjects with lower BMI have a higher risk of complications and death from cardiovascular surgery than subjects with higher BMI. An increased BMI does not increase the risk of complications from cardiovascular surgery, with the exception of wound infections.

Цель представленного обзора — демонстрация важности комплексного гериатрического обследования в кардиологии, включая гериатрические аспекты ведения данного контингента больных. До настоящего времени в РФ полностью отсутствует гериатрический подход к ведению пациентов кардиологического профиля, что предусматривает рассмотрение международного опыта по данному вопросу. Курация пациентов пожилого и старческого возраста осложняется наличием гериатрических синдромов и возраст-ассоциированных заболеваний, ведущих к ухудшению качества жизни, повторным госпитализациям, инвалидизации и риску смерти. Ведущим гериатрическим синдромом для врача-гериатра является старческая астения и множественная сопутствующая полиморбидная патология. Пациента, попадающего в стационар по неотложному состоянию, имеющего в анамнезе сердечно-сосудистую коморбидную патологию, в первую очередь рассматривают как пациента с высоким риском сердечно-сосудистых осложнений, опуская значение риска неблагоприятных исходов, включающее потерю независимости и нарушение функционального статуса. Данный обзор показывает важность определения старческой астении вне кабинета гериатра, обосновывая необходимость повышения квалификации врачей-кардиологов по гериатрии. The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician’s office, justifying the need for advanced training for cardiologists in geriatrics.

Aim To study prognostic significance of the degree of stenosis of carotid and lower-extremity arteries (LEA) in patients at high and very high risk of cardiovascular complications (CVC).Material and methods The study included men and women aged 40-67 years at high and very high risk of CVC. Duplex ultrasound scanning of carotid arteries and LEA was performed for all patients. Laboratory tests included measurements of glucose, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, uric acid, creatinine with estimation of glomerular filtration rate (GFR) using the CKD-EPI Creatinine Equation formula, and high-sensitivity C-reactive protein (hsCRP). Composite endpoint was death from CVC, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results The study included 214 patients from groups of high and very high risk of CVC. Median age of patients was 59.0 [53.2; 64.0] years. A very high risk was identified in 141 (65.8 %) patients and a high risk of CVC in 73 (34.1 %). Atherosclerotic plaques in at least one vascular bed were found in 191 (89.3 %) patients. Duration of the follow-up period was 32.0 [13.7; 49.1] months. Outcomes comprising the composite endpoint were observed in 36 (16.8 %) patients. Presence of carotid stenosis ≥35 % was not statistically significantly associated with the occurrence of outcomes comprising the composite endpoint (relative risk, RR: 1.22; 95 % confidence interval, CI: 0.56-2.66; p=0.607). In contrast, the presence of LEA stenosis ≥35 % was associated with a 2.51 times increased RR of CVC (95 % CI: 1.02-6.23; p=0.044).Conclusion In patients from the groups of high risk and very high risk of CVC, the presence of LEA stenosis ≥35 % predicted the development of severe CVC with a 69.4% sensitivity and a 61.8% specificity. The presence of LEA stenosis ≥35 %, but not of carotid arteries, was an independent predictor of severe CVC (RR, 2.51; 95 % CI: 1.02-6.23; p=0.044) after adjustments for sex, age, presence of arterial hypertension, diabetes mellitus, ischemic heart disease, obesity, smoking, LDL-C, GFR, and drug therapy.

Association Between Nonsurgical Weight Loss From Body Mass Index >40 to Body Mass Index <40 and Complications and Readmissions Following Total Hip Arthroplasty.

MP11-05 FACTORS ASSOCIATED WITH PERIOPERATIVE COMPLICATIONS FOLLOWING AUGMENTATION CYSTOPLASTY: A CONTEMPORARY POPULATION-BASED ANALYSIS

Time-varying risk of microvascular complications in latent autoimmune diabetes of adulthood compared with type 2 diabetes in adults: a post-hoc analysis of the UK Prospective Diabetes Study 30-year follow-up data (UKPDS 86)

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review