TRAINING of COLLATERALS
(Latin collateralis side) — a complex of the preventive measures directed to preparation of this or that department of vascular system for performance of function of blood circulation in the conditions of switching off of the main vessels of this department. Since it is carried out by gradual redistribution of load with main of collateral vessels.
In separate bodies (e.g., nek-ry departments went. - kish. a path) the termination of a blood flow on the main vessels quickly, without prejudice to function is compensated for the account of existence of well developed collaterals (see the Call, a terala vascular). Therefore during the bandaging of the main vessels (see Bandaging of blood vessels) such bodies there is no need in preliminary Since. In other bodies and areas of a body (a brain, extremities) collateral vessels can not always compensate the sudden termination of a blood flow on the main vessel. In this regard before bandaging of a vessel hold a training of collaterals for the purpose of stimulation of their functionality.
Since to a thicket it is shown before the operations connected with bandaging of the main vessels (removal of tumors, infiltriruyushchy a wall of blood vessels, operation for the pulsing hematoma, traumatic arterpovenozny fistulas stratifying aneurisms of arrozivny bleedings in the conditions of an infection, etc.) when single-step recovery of the struck vessel by its prosthetics or shunting is impracticable. Means of modern reconstructive angiosurgery allow to avoid even more often bandaging of the main vessels therefore need in Since in practice arises seldom.
Contraindications to Since the same, as for recovery operations on vessels (extensive injuries, inf. complications, serious condition of the patient, etc.).
As criterion of efficiency Since the condition of metabolic balance shall serve in fabrics; only one morfol. the development of collateral ways found, e.g., at an angiography cannot testify to their functional competence. As specified V. A. Oppel, the main sense of a training of collaterals comes down to elimination fiziol. insufficiency of collaterals.
Training of arterial collaterals. The need for a training of arterial collaterals is defined by the following tests characterizing functional sufficiency of a collateral arterial bed.
Moshkovich's test is that on the extremity raised up impose a plait, tightening it before disappearance of pulse on an extremity. At the same time skin of an extremity distalny a plait sharply turns pale. In 5 min. the plait is removed and watched emergence of a reactive hyperemia, quickly or slowly extending to the periphery. About a condition of collaterals judge by intensity, rate of propagation and by level, on Krom distribution of a hyperemia stopped.
At insufficiency of a collateral arterial bed the reactive hyperemia on the affected extremity appears later, than normal, and differs in smaller intensity the Border of its distribution indicates level, with to-rogo insufficiency of distal collateral network of an extremity begins. More precisely the condition of collaterals can be defined if at an applying a tourniquet to block the main artery manual pressing, and then to dismiss a plait, continuing to squeeze an artery to exclude influence on manifestations of a reactive hyperemia of a blood-groove on the main artery. In this case the pallor of skin lasting more than 5 min. (at norm of 1 — 2 min.), or emergence of its marble coloring (a focal hyperemia) testifies to insufficiency of collaterals.
For conducting test of Korotkov the extremity is hardly bandaged elastic bandage. Above bandage impose a cuff of a tonometer, lift pressure in it above systolic then bandage is removed. In addition press the main artery a finger. Gradually, lowering pressure in a cuff, fix the indication of the manometer at the time of emergence porozovennya skin distalny cuffs, a cut reflects pressure in collateral vessels. If it is lower than 35 mm of mercury., that collateral circulation in an extremity is considered defective.
From other tests p methods of a research matter: Rusanov's test (see Rusanov test) and the thermometry before and after loading allowing to reveal functional insufficiency of collateral circulation even in the absence of its external signs; a reovazografiya (see Reografiya), a sfigmografiya (see), reflecting total krovenapolneniye of this or that body part depending hl. obr. from collateral vessels; the angiography (see), edges allows to study precisely a structure and to establish degree of passability of a vascular bed, however does not give an idea of a functional condition of arteries that it is extremely important for assessment of a hemodynamics in fabrics. Objective indicators receive also by means of an ultrasonic flyuorimetriya, at a cut define the ABP in distal departments of an extremity after pressing of the main artery. If arterial pressure is higher than 50 mm of mercury., it demonstrates
sufficient development of collaterals. More rare than others use Genle's test, edges consists in a puncture of a bottom surface of distal phalanxes of symmetric fingers of both feet and comparative assessment of intensity of bleeding (on an ischemic extremity bleeding is less expressed).
The specified methods in a complex with careful a wedge, inspection of the patient allow to give an assessment of a condition of collateral circulation and to choose an appropriate method Since.
Methods Since divide on conservative and operational. From conservative most often apply a method mechanical (manual or by means of special compressors) pressing of the main artery is higher than the place of alleged bandaging. Duration of each compression and duration of all course of a training depend, first of all, on features of krovosnabzhayemy body and a condition of the patient. So, even short-term crossclamping of the general carotid artery at patients of advanced and senile age with atherosclerosis of brain vessels is fraught with grave consequences whereas full obturation of a femoral artery can not be followed by essential disturbances. The general rule for this method is gradual increase in term of each pressing with shortening of intervals between them. It is carried out Since before obtaining satisfactory results of functional trials in the conditions of the long termination of the main blood-groove. For a training of collaterals the means applied at conservative treatment of obliterating defeats of vessels of extremities (see) can be used. Treat them: the pharmaceuticals allocated for mobilization of collaterals (introduction of spasmolysants intramusculary and in the affected artery, acetylcholine, vitamins, ATP, blood, blood substitutes, etc.); the pharmaceuticals improving rheological properties of blood (reo-Polyglucinum, trental, etc.); LFK promoting Since by creation of the dosed increase in function of an extremity; to lay down. massage; electrostimulation of muscles of extremities; physiotherapeutic procedures — the oxygen, radonic and hydrosulphuric bathtubs (see) which are improving a peripheral blood stream and removing the spastic phenomena; mud applications (see Mud cure), UVCh (see UVCh-therapy), ultrasound (see. Ultrasonic therapy), a diathermy (see), impulse currents (see), magnetotherapy (see) etc. which influence is based mainly on thermal influence.
Operational ways Since, applied earlier, were based on the principle of gradual reduction of a blood-groove on the main vessel by means of its partial sewing up, use of a special tourniquet, a ligature, a fascial strip, a metal corbel, etc. Also operations of consecutive more and more proximal bandagings of a vessel were made. In practice of modern surgery these ways do not apply. For stimulation of collateral circulation during the main operative measure resort to various ways of a desimpatization of a vascular bed, beginning from a segmented resection of the affected main artery or removal of its outside cover and finishing a resection of a sympathetic trunk (see the Sympathectomy). For the purpose of creation in ischemic body of additional collateral blood supply hem richly vaskulyarizirovanny body (shouting-ganopeksiya) to this body or make the operations aimed at the development of collaterals in the adjacent pool, napr, Fieschi's operation (see Arterialization of a myocardium).
The training of venous collaterals gives usually more bystry and full effect than Since arteries. The large role is played here by an exercise stress, edges are increased by a blood stream, involving in a venous drainage all existing outflow tracts and promoting formation of new. In the beginning skin, fascial and muscular veins of an extremity extend, then from thin-walled wide muscular veins steady main collateral outflow tracts form and skin and fascial (unstable) collaterals are at the same time reduced. Artificial to the stenozprova-ena of the main vein, carried out before its bandaging, is the reliable way of a training of venous collaterals providing their functional sufficiency at full bandaging of the main vein. One of methods Since veins nizhnnkh extremities about insufficient passability of the main veins is constant use of elastic bandage or a stocking. Development of venous collaterals is promoted by use of the pharmaceuticals improving rheological properties of blood, and also massage, physiotherapeutic methods, etc.
Training of l and m f and t of and-chesky collaterals. Data concerning an opportunity Since limf, systems are extremely poor. It is known that the factors inducing education collateral limf, bonds, stagnation of a lymph, accumulation of metabolites, a fabric hypoxia are. Recovery of the blocked lymph drainage happens according to the following scheme: disclosure as a result limf, hypertensia of iredsushchestvovavshy collaterals, their new growth, formation from capillaries of collateral collectors, a reduction of unstable vessels after recovery of a lymph drainage. Actions for mobilization limf, collaterals carry out at treatment of a lymphostasis (see).
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