A method for the treatment of patients with acute phlebothrombosis

 

(57) Abstract:

The invention relates to medicine, in particular to the pathology of the veins. Along with the ongoing conventional therapy additionally perform percutaneous laser irradiation section thrombosed vein daily for 10 minutes within 10 days of low-intensity laser radiation with a wavelength of 0.83 μm, 20 mW. The result is the acceleration of the time of the organization of the clot, restoring endothelial affected vein and recanalization of the thrombosed vein. table 1.

The invention relates to medicine, namely to the pathology of the veins, and can be used for the treatment of patients with acute phlebothrombosis.

The annual incidence of acute deep vein thrombosis in different countries varies from a few to tens of millions of cases. Treatment of patients with venous thrombosis is a difficult task. Currently, there are different ways conservative (anticoagulants, fibrinolytic tools, plasmapheresis, intravenous laser irradiation of blood) and operational (thrombectomy and plicate vein) treatment of patients suffering from phlebothrombosis. Conservative therapy is usually aimed at the improvement of microcirculation, re is e have a direct on thrombus, the venous wall and parabasal fabric. Search for new, more effective ways to treat patients with acute phlebothrombosis is an important medical and social problem (Genic C. N., Emelianov, S. Y., Surgery, 1996; N 2; 138-140).

Closest to the claimed is a method in which after performing plicatio Vienna (flashing with U-joints) or the establishment of cava filter above the level thrombosis is a medical therapy aimed at improving the rheological properties and the decline in the hypercoagulability of blood /Gervaziev Century B. , Karpenko, A. A., Surgery, 1995; N 2; 31-37/. The disadvantage of the used method is the low impact on the processes of the organization and recanalization of the thrombus in the lumen of the affected vein, causing the high incidence of complications, including postthrombotic syndrome that develops in most patients undergoing phlebothrombosis. After thrombectomy does not create conditions for the early recovery of the endothelium of the vein. The characteristics of the organization of the blood clot and commit to venous thrombus wall appear to the 9th day of phlebothrombosis.

The closest analogue in the treatment of acute phlebothrombosis includes plicatio vein above the level of the thrombosis and the ohms are achieved local fibrinolytic effect and system hypocoagulation (Losev R. H., L. C. L., "the Use of helium-neon laser in the treatment of acute embalagens of deep vein thrombosis" in Proc. "Application of low-intensity lasers and radiation of millimeter range in experiment and clinic", Saratov, 1994, S. 132-135). However, the invasiveness of the method, repeated sessions of laser therapy require silicone tube in parabasal fiber for numerous institutions fiber, increases the possibility of a festering wound. Requires disposable fiber optic cables, as the process of disinfection and sterilization is quite complicated and time-consuming.

We first proposed a method for the treatment of patients with phlebothrombosis, which includes conventional conservative therapy /anticoagulants and thrombolytic tools/ and prompt intervention /thrombectomy and peoplecare/, intravenous laser irradiation of blood, which is conducted additionally transcutaneous laser irradiation section thrombosed vein. Use of low-intensity laser radiation with a wavelength of 0.83 μm, 20 mW. Daily treatment for 10 days last 10 minutes

Method for the treatment of patients with acute iliofemoral deep vein thrombosis of the lower extremities is the following transcutaneous laser irradiation (TLO) daily for 10 days semiconductor pulse laser device with a wavelength of 0.83 μm. Output power 20 mW, exposure time 10 minutes Simultaneously performed through the catheter intravenous total impact energy helium-neon laser (GNL) = 0,632 μm, the radiated output power of 2 mW, exposure time 30 min, perform 5 sessions after 48 h from the second day after surgery. Along with this conduct therapy with medication, improves microcirculation in the tissues, rheological and antiplatelet properties of blood.

Proof positive of laser arsenide-gallium radiation with a wavelength of 0.83 μm, 20 mW are the results of experimental studies on 24 dogs. Acute thrombosis of the femoral vein of the hind legs was modeled in two groups of animals. In the first (primary) group experiences through 2-4-6 days after modeling thrombosis spent outside (in the projection of the affected veins) irradiation of gallium-Galiev laser according to the above method, while the second affected limb irradiation energy of the laser is subjected. Thus, the condition of the walls of the affected veins unirradiated limb served as control in each experiment. Studied morphological changes in infected and irradiated with low-intensity laser Vienna amounted to 1 (onezero, was 1 control group experiments. As NEELY has not only local, but also has a General effect on the blood and overall body, it is carried out 2 control group experiments (5 animals) who have thrombosis of the femoral vein was modeled by the same procedure, but without the use of LLLT.

In the main group on the 5th, 8th and 14th days were fence sections thrombosed veins of animals with histological and histochemical study of the status of the thrombus and vessel wall. Tissue was fixed in 10% solution of neutral formalin for 14 days, followed by the standard technique to fill in paraffin were preparing histological specimens with a thickness of 5-7 microns.

Review the preparations were stained with hematoxylin and eosin, as well spudded (pH 3.5 to 5.0) solution of toluidine blue.

In the main group aiming irradiated Vienna characteristics of the organization of the thrombus appeared on the 5th day. Here begin the process of recanalization, on the 8th day in this group of experiments appears endothelial lining recanalizing areas of Vienna. On the 14th day the process of organizing thrombus under the influence of LLLT over.

In contrast to the described processes in contralateral organization of the thrombus appeared only on the 8th day in the form of foci of organizing thrombus in the area of attachment to the vessel wall.

When laser therapy in the group of the experiment was observed Express organization of the blood clot was no evidence of progressive growth. So, even in a double effect of LLLT marked seal the junction of the thrombus to the vascular wall ("sole"), and also observed activation in this area and in the vessel wall lymphohistiocytosis and macrophage reaction. Vessels in the perivascular region was observed normal axial flow and a calm state of endothelial lining. In the study of glycosaminoglycans (GAGS) were detected moderate gamma metachromasia.

In the 2nd control group experiments, where NEELY was not applied, the first signs of organization of the thrombus appeared only on the 14th day after the thrombotic lesion of Vienna. It should be noted the progression here "growth" of a blood clot. On the surface of the thrombus was constantly observed the process of aggregation of formed elements and their subsequent adhesion to the vascular wall or on the surface of an existing thrombus.

Thus, experimental studies with certainty prove that the application of low-intensity laser radiation in the projection of the affected veins greatly accelerates the processes of rivers is P> Proposed method in the clinic were treated 5 patients with acute iliofemoral phlebothrombosis that showed its high efficiency (see table).

All patients noted a marked clinical effect, it showed a rapid decrease of swelling of the affected limb. Reduced dose and the amount of heparin that were controlled by the data of the coagulation time of blood coagulation.

Clinical improvement was confirmed by duplex studies (see table) and venography. The number of sessions NEELY was determined by the clinical effectiveness. To achieve the effect required a from 6 to 10 sessions of exposure NEELY once a day. There were no complications.

Clinical improvement and recanalization confirmed duplex and phlebographic research in the group of patients receiving conventional treatment, occurred on 25-26 days.

Example: a Patient Century , 40 years, history N 16778. Was admitted to our Department with complaints of swelling of the left lower extremity after trauma to the patella (07.07.1996 g), and therefore was made osteosynthesis. In the postoperative period developed thrombophlebitis of subcutaneous and deep veins of the left tibia, the elk hemoptysis. On radiographs of the chest - picture infarction pneumonia. Conducted under the conditions of the district hospital anticoagulation, antiplatelet agents. September 22, 1996, the newly developed acute deep vein thrombosis of the left lower extremity, and the process took iliofemoral segment. At clinical examination: marked swelling of the thigh (circumference 8 cm longer than the contralateral), swelling extends to the lower leg, foot. Appeared pain to palpation in the projection of the affected veins and other signs of acute phlebothrombosis.

Performed retrograde ricavare, in which is mounted a floating thrombus in the lumen of the left iliac vein.

31.09.96 were operation: access by Rob left exposed diseased iliac vein and made her plicate. A day after the operation applied daily for 10 days exposure to gallium-Galiev laser "Blaster-4P", power at the end of the emitter 20 mW, exposure time 10 minutes Spent intravenous laser irradiation of blood (ILIB) performed 5 sessions with a break in one day. On the 7th day noted that the volume of the lower limbs are the same. Heparin was administered 2.5 thousand units twice a day, and 7 days cancelled due to persistent, reliable the femoral and iliac veins to the left, Set the blood flow in the affected veins. 19 days from receipt in a satisfactory condition, the patient was discharged to outpatient treatment.

Thus, the percutaneous application of low-intensity laser radiation with a wavelength of 0.83 μm, 20 mW for 10 min in the treatment of acute iliofemoral of phlebothrombosis provides reduction of terms of organization and recanalization of a blood clot, which reduces the effects of postthrombotic syndrome. The shortening of the recovery of the endothelium of the vein reduces the chance of developing rethrombosis.

A method for the treatment of patients with acute phlebothrombosis, including plicatio vein above the level of thrombosis and intravenous effects of helium-neon laser, characterized in that it further conduct percutaneous irradiation area thrombosed vein of low-intensity laser radiation wavelength of 0.83 μm, 20 mW, daily for 10 minutes for 10 days.

 

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FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

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4 cl

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1 ex

FIELD: medicine.

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FIELD: medicine.

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