PROSPECTS FOR FORECASTING THE COURSE OF OBLITERATING ATHEROSCLEROSIS OF LOWER LIMB ARTERIES

Obliterating atherosclerosis of lower limb arteries is a common cause of disability including that of individuals of the working age. Most vascular reconstructions are performed as early as at the stage of critical ischemia which is associated with the known risks of these operations. In some cases these interventions appear non-effective. The main reason for non-effectiveness of reconstructive surgery is incompetence of the outflow vessels. Despite the development of diagnostic measures, the timely implementation of reconstructive interventions still remains an open question. The concept of treatment of the given disease at the modern stage of development of vascular surgery does not suggest a personalized approach to patients with different rate of development and severity of symptoms, besides, no classification of the disease by the course exists. In our opinion, two kinds of course of obliterating atherosclerosis of lower limb arteries should be distinguished depending on progression of clinical manifestations: stable and non-stable courses. Differences in the course of the disease help develop an individual treatment strategy for a particular patient, compare risks of reconstructive interventions at early stages of the disease and risks of development of critical ischemia of lower limbs. Objective assessment of the prognosis of the disease is impossible due to absence of any information concerning predictors of different courses of the disease. Bearing in mind the fact that in recent decades the main precursor of unfavorable vascular events is assumed to be endothelial dysfunction, we rest our concept on the assessment of markers of damage and dysfunction of the endothelium at different stages of the disease taking into account the genetic status of the patient. A study and a long-term observation of patients with different localization of obliteration could probably make a certain contribution to elaboration of the concept of prognosis of the course of the disease.