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Khirurgii

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Year 2021 Vol. 29 No 4

REVIEWS

S.N. YAROSHKIN, S.A. SUSHKOU, L.A. FRALOU

POTENTIAL AND PERSPECTIVES OF INDIRECT REVASCULARIZATION IN TREATMENT OF LOWER LIMBS CRITICAL ISCHEMIA

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

This review was undertaken by a literature search of the International scientific database PubMed and Cochrane library. The review highlights the issues and perspectives of indirect revascularization in the patients with lower limbs critical ischemia. The study revealed that lower limbs critical ischemia remains the actual problem of angiosurgery, despite of the widespread introduction of angioplasty and open vascular reconstruction. However, angioplasty and bypass surgery revascularization cannot be performed in some category of patients, so that the further improvement of indirect revascularization techniques has been of great interest to researchers. The severity of the ischemic process is determined not only by the mechanical blood flow restriction but also by the angiogenic potential of the surrounding soft tissues, foremost muscular one. Therefore, in the case of technical irreparability of the main blood flow it remains possible to preserve the limb by creating new vascular networks in the muscular tissue. Revascularizing osteotrepanation of the lower limb bones is considered to be the optimal variant to achieve this result. The discontent of clinical outcomes occurred due to the slow development of the angiogenic effect, which in critical ischemia is fraught with loss of a limb until the maximal angiogenesis is reached. In recent years, cell therapy has become a very promising and advanced scientific research topic. So that its methods have been actively introduced into practice; they are easily combined with revascularizing osteotrepanation and are able significantly accelerate angiogenesis induced by surgical bone injury. In this regard, there is reason to believe that curative effect increases when revascularising osteotrepanation is combined with cell therapy, including the use of bone marrow aspirates.

Keywords: angiogenesis, arteriogenesis, cell therapy, critical limb ischemia, peripheral arteries diseases, revascularization
p. 490-503 of the original issue
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Address for correspondence:
210027, Republic of Belarus,
Vitebsk, Frunze Avenue, 27,
Vitebsk State Medical University,
the Department of General Surgery,
e-mail: sergionik@gmail.com,
Yaroshkin Siarhei N.
Information about the authors:
Yaroshkin Siarhei N., PhD, Associate Professor of the Department of General Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-2764-1812
Sushkou Siarhei A., PhD, Associate Professor, Vice-Rector for Research Work, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7524-6182
Fralou Leanid A., PhD, Associate Professor, Head of the Department of General Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-3357-4409
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