Correction of hemostasis and hemorheology with intravenous laser blood irradiation and cytokinotherapy in indirect revascularization at the perioperative period in patients with critical ischemia of their lower extremities

Abstract

Purpose . To study potentials for correcting hemostasis and hemorheology with intravenous laser blood irradiation (ILBI) and cytokine therapy (CT) in indirect revascularization at the perioperative period in patients with critical ischemia of lower extremities. Material and methods . A prospective controlled clinical trial included 162 patients with critical lower limb ischemia (CLLI) having distal arterial steno-occlusion who had indirect revascularization surgery. CLLI etiological factors were: obliterating atherosclerosis in 108 (66.7%) patients and obliterating thromboangiitis in 54 (33.3%) patients. 56 patients had chronic ischemia of degree III; 106 patients – chronic ischemia of degree IV. All patients were divided into 5 groups who had various curative modalities at their perioperative period: Group I (n = 34) –standard treatment; Group II (n = 32) – standard treatment + ILBI; Group III (n = 32) – standard treatment + CT with Roncoleukin; Group IV (n = 33) – standard treatment + ILBI + CT; patients from Group V (n = 31) in revascularizing osteotrepanation had intraosseous marrow laser irradiation (IOLI) – standard treatment + ILBI + CT. The researchers also studied dynamics of hemostatic parameters (fibrinogen – F, fibrinolytic activity – FA, fibrin degradation products – PDF, activity of antithrombin-III, plasminogen – P) and hemorheology (erythrocyte deformability – DE, von Willebrand factor – WF, ADP induced platelet aggregation). The obtained hemostasis and hemorheology findings were compared with identical parameters of 48 practically healthy subjects («reference group»). Results . On admission, patients with CLLI in distal steno-occlusion had a sharp change in their hemostasis formula shifting towards hypercoagulation and deterioration of hemorheology. ILBI and CT techniques applied either separately or in combination with other therapeutic measures in the perioperative period of indirect revascularization normalized parameters of blood coagulation system (for all parameters – p < 0.05; r = 0.4) and of hemorheology (for DE – p < 0.05; r = 0.4; for WF and ADP-induced platelet aggregation – p < 0.05; r = 0.3). The best results were obtained under the combination of ILBI and CT at the perioperative period of indirect revascularization, especially in revascularizing osteotrepanation with IOLI. Conclusion . ILBI and CT applied in combination with standard treatment at the perioperative period in indirect revascularization reliably correct hemostasis and hemorheology in patients with CLLI and distal arterial steno-occlusion.