Above the surface

Chronic obliterative diseases of the aorta and arteries of the lower extremities (due in most cases, atherosclerosis) account for more than 20% of all cardiovascular disease, which corresponds to 2-3% of the total population [1]. Thus, in the Edinburgh study (1990) [2], patients with intermittent claudication was 4.5% in the age group 55 to 74 years, asymptomatic lesions noted in 8% of cases. It is significant that the treating physicians only 30-50% of patients were aware of the presence of intermittent claudication in the past [3].

The main feature of this disease is steadily progressive course, characterized by the increase in severity of intermittent claudication and its conversion into a permanent pain or gangrene, which occurs in 1520% of patients [4]. Perioperative mortality in amputation below the knee is 510% above the knee in 1520%. Mortality in the first two years after amputation in the range 2530%, and after 5 years of 5075%. In this case, after the amputation of lower leg prosthesis for 2 years go to only 69.4% of patients, and thigh of 30,3%.

Mortality after reconstructive surgery earlier is 213% [5], currently brand viagra in the leading clinics of Russia does not exceed 1.2% [6]. Estimating the required number of operations in patients with obliterating diseases of the aorta and lower extremity arteries, can lead the U.S. as an example, where in 1995, holds 400,000 hospitalizations for peripheral arterial disease. Was carried out 50 000 balloon angioplasties, 110,000 bypasses, 69000 amputations. The costs for primary amputation in the developed countries like the UK is over twice the cost for successful revascularization [7].

According to the LA Boqueria, et al. [8], in 1998 the need for reconstructive operations on the arterial system in Russia is 930 per 1 million population annually holds no more than 22% of the required amount.

Pathology and pathogenesis

The term atherosclerosis is derived from the Greek words athtre wheat gruel and hard sclerosis. Although the morbid anatomy of atherosclerosis studied more than 140 years since the first papers R. Virchow (1856), the nature and characteristics of the processes occurring in the vessel wall in this disease, remain caution against nitrates poorly understood. Even observed during microscopic examination of cellular and extracellular changes in the vessel wall in the formation of atherosclerotic plaques are treated differently. During the formation of atherosclerosis, the major changes occurring in the endothelium and smooth muscle cells of the subendothelial intima.

There are 4 different types of Arteriosclerosis:

1. Fatty spots or stripes, which represent parts of a pale-yellow, containing lipids, not rising above the surface of the intima. This is the earliest manifestation of atherosclerosis.

2. Fibrous plaques are oval or rounded education that contain lipids, towering above the surface of the intima, often coalescing into continuous hilly field.

3. Fibrous plaques with various complications: ulceration, hemorrhage, the imposition of thrombotic masses.

4. Calcification deposition in fibrous plaques of calcium salts.

The most significant atherosclerotic changes mostly localized in areas of maximum hemodynamic or mechanical action on the vessel wall: a bifurcation zones, areas of divergence of the great arteries from the aorta and in the convoluted parts of the artery.

According J.S.A. Fuchs [9], the leading risk factors for atherosclerosis include hypertension, high cholesterol and smoking. To a lesser extent influenced by obesity, diabetes, hypertriglyceridemia, sedentary lifestyle, stress and heredity.

Screening
diabetes risk
Desirable properties