Effectiveness of step-by-step treatment of neurovascular syndrome

   Introduction. The progression of neurovascular syndrome leads not only to temporary disability, but also often to disability of the patient.
   The purpose of the study: to evaluate the effectiveness of various options for stage-by-stage treatment of neurovascular syndrome.
   Materials and methods. The present study is based on the analysis of the examination results of 155 patients with neurovascular syndrome. At the first stage, all patients underwent conservative therapy, and later, if necessary, surgical treatment was performed. 136 (87.7 %) patients received inpatient treatment and 108 (69.7 %) were operated on. All of them were observed in the vascular surgery department of the Republican Clinical Hospital of the Ministry of Health of the CBD in the period 2000-2018. Against the background of conservative treatment for 5 years, an aggravation of clinical manifestations occurred in 67.7 % of patients. We performed surgical intervention on these patients. Distal periarterial sympathectomy allowed to obtain a 10-year positive result (without relapse) in 34.2 % of patients. Subsequently, 59.4 % of patients underwent proximal periarterial sympathectomy.
   Results. During 68.3 ± 8.2 months after distal sympathectomy, 40.6% of patients had no manifestations of chronic upper limb ischemia.
   Discussion. Most authors tend to believe that secondary neurovascular syndrome prevails in FR. However, according to some epidemiological studies of a healthy population, up to 89% of people with FR have primary FR, while in the study of clinic patients secondary FR is more often detected (50-70 %).
   Conclusion. Thus, our study demonstrated that staged minimally invasive surgical treatment can delay the onset of severe upper limb ischemia.

1. Алекперов Р. Т. Синдром Рейно как мультидисциплинарная проблема / Р. Т. Алеклеров // Альманах клинической медицины. – 2014. – № 35. – С. 94–100.

2. Багаутдинова З. Р. Оценка клинической эффективности терапии простаноидами феномена Рейно при ревматических заболеваниях / З. Р. Багаутдинова [и др.] // Казанский медицинский журнал. – 2018. – Т. 99. – № 6. – С. 911–918. doi: 10.17816/KMJ2018-911

3. Воробьёва Н. А. Антитела изотопов Ig G и Ig Е к основному белку миелина при демиелинизирующих заболеваниях : Дисс... к. м. н. / Н. А. Воробьева. – 2008. – 192 с.

4. Герасимова М. М. Патология нервной системы при аллергических васкулитах / М. М. Герасимова. – Н. Новгород: Издательство НМИ, 2012. – 174 с.

5. Дрюк Н. Ф. Иммунокорригирующая терапия в комплексном лечении болезни и синдрома Рейно / Н. Ф. Дрюк, О. И. Орап // Клиническая хирургия. – 2009. – № 7. – С. 50–54.

6. Пономаренко, Г. Н. Физиотерапия пациентов с болезнью Рейно / Г. Н. Пономаренко, Ю. С. Кутьин // Физиотерапевт. – 2010. – № 1. – С. 49–50.

7. Рахматуллаев Р. К вопросу о десимпатизации верхней конечности при феномене Рейно / Р. Раъхматуллаев [и др.] // Вестник Авиценны. – 2018. – Т. 20. – № 1. – С. 113–119. doi: 10.25005/2074-0581-2018-20-1-113-119

8. Aloe L., Tuveri M. A. Nerve growth factor and autoimmune rheumatic diseases. Clin Exp Rheumatol., 1997, № 15 (4), рр. 433–438.

9. Anderson M. E., Moore T. L., Lunt M., Herrick A. L. Digital iontophoresis of vasoactive substances as measured by laser Doppler imaging – a non-invasive technique by which to measure microvascular dysfunction in Raynaud's phenomenon. Rheumatology (Oxford), 2004, № 43 (8), рр. 986–991. doi: 10.1093/rheumatology/keh244

10. Curtiss P., Schwager Z., Cobos G., Lo Sicco K., Franks A. G. Jr. A systematic review and meta-analysis of the effects of topical nitrates in the treatment of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol., 2018, № 78 (6), рр. 1110–1118. doi: 10.1016/j.jaad.2018.01.043

11. Fitzgerald O., Hess E. V., O'Connor G. T., Spencer-Green G. Prospective study of the evolution of Raynaud's phenomenon. Am J Med., 1988, № 84 (4), рр. 718–726. doi: 10.1016/0002-9343(88)90109-x

12. Fraenkel L., Zhang Y., Chaisson C. E., Evans S. R., Wilson P. W., Felson D. T. The association of estrogen replacement therapy and the Raynaud phenomenon in postmenopausal women. Ann Intern Med., 1998, № 129 (3), рр. 208–211. https://doi.org/10.7326/0003-4819-129-3-199808010-00009

13. Wigley F. M. Clinical practice. Raynaud's Phenomenon. N Engl J Med., 2002, № 347 (13), рр. 1001–1008. doi: 10.1056/NEJMcp013013

14. García-Carrasco M., Sisó A., Ramos-Casals M. et al. Raynaud's phenomenon in primary Sjögren's syndrome. Prevalence and clinical characteristics in a series of 320 patients. J Rheumatol., 2002, № 29 (4), рр. 726–730.

15. Koné-Paut I., Olivar E., Elbhar C., Garnier J. M., Berbis P. Syndrome de Raynaud chez l'enfant. Etude de 23 cas [Raynaud's syndrome in children. Study of 23 cases]. Arch Pediatr., 2002, № 9 (4), рр. 365–370. doi: 10.1016/s0929-693x(01)00794-1

16. Pizzorni C., Sulli A., Craviotto C., Tuccio M., Seriolo B., Cutolo M. Prospettive diagnostiche nelle vasculopatie reumatologiche: l'impiego della videocapillaroscopia [Diagnostic perspectives in the rheumatologic vasculitis: the role of video-capillaroscopy]. Reumatismo, 2002, № 54 (2), рр. 99–104.

17. Zhang W., Wei Y., Jiang H., Xu J., Yu D. T3 versus T4 thoracoscopic sympathectomy for palmar hyperhidrosis: a meta-analysis and systematic review. J Surg Res., 2017, № 218, рр. 124–131. doi: 10.1016/j.jss.2017.05.063

18. Zufferey P., Depairon M., Chamot A. M., Monti M. Prognostic significance of nailfold capillary microscopy in patients with Raynaud's phenomenon and scleroderma-pattern abnormalities. A six-year follow-up study. Clin Rheumatol., 1992, № 11 (4), рр. 536–541. doi: 10.1007/BF02283115

19. Асланов А. Д. Современный подход к комплексному подходу к лечению и реабилитации больных с феноменом Рейно / А. Д. Асланов [и др.] // Вестник Всероссийского общества специалистов по медико-социальной экспертизе, реабилитации и реабилитационной индустрии. – 2019. – № 4. – С. 43–51. doi: 10.17238/issn1999-2351.2019.4.43-51

20. Асланов А. Д. Использование природных факторов Кабардино-Балкарской Республики в лечении и реабилитации больных с нейроваскулярными заболеваниями верхних конечностей / А. Д. Асланов [и др.] // Вестник Всероссийского общества специалистов по медико-социальной экспертизе, реабилитации и реабилитационной индустрии. – 2019. – № 4. – С. 93–102. doi: 10.17238/issn1999-2351.2019.4.93-102

21. Асланов А. Д. Лечение феномена Рейно на Северном Кавказе / А. Д. Асланов, А. В. Жириков, А. Г. Куготов // Современные проблемы науки и образования. – 2015. – № 3. – С. 226.

22. Перенести в английский вариант

23. Alekperov R. T. Raynaud’s syndrome as a multidisciplinary problem. Almanac of Clinical Medicine, 2014, № 35, рр. 94–100. (In Russ.)

24. Bagautdinova Z. R., Gaisin I. R., Glavatskikh M. M., Bragina T. A. Evaluation of the clinical effectiveness of prostanoid therapy for Raynaud’s phenomenon in rheumatic diseases. Kazan Medical Journal, 2018, vol. 99, № 6, pp. 911–918. doi: 10.17816/KMJ2018-911 (in Russ.)

25. Vorobyeva N. A. Antibodies of Ig G and Ig E isotopes to the main myelin protein in demyelinating diseases. Diss ... Ph. D. 2008. p. 192. (In Russ.)

26. Gerasimova M. M. Pathology of the nervous system in allergic vasculitis. NMI Publishing House: Nizhny Novgorod, 2012. 174 p. (In Russ.)

27. Druk N. F. Orap O. I. Immunocorrective therapy in the complex treatment of Raynaud’s disease and syndrome. Clinical surgery, 2009, № 7, рp. 50–54. (In Russ.)

28. Ponomarenko G. N., Kutyin Yu. S. Physiotherapy of patients with Raynaud’s disease. Physiotherapist., 2010, № 1, pp. 49–50. (In Russ.)

29. Rakhmatullaev R., Abduvakhidov B. U., Pulatov O. N. On the issue of desympathization of the upper limb in Raynaud’s phenomenon, 2018, vol. 20. № 1, pp. 113–119. doi: 10.25005/2074-0581-2018-20-1-113-119 (in Russ.)

30. Aloe L., Tuveri M. A. Nerve growth factor and autoimmune rheumatic diseases. Clin Exp Rheumatol., 1997, № 15 (4), рр. 433–438.

31. Anderson M. E., Moore T. L., Lunt M., Herrick A. L. Digital iontophoresis of vasoactive substances as measured by laser Doppler imaging – a non-invasive technique by which to measure microvascular dysfunction in Raynaud's phenomenon. Rheumatology (Oxford), 2004, № 43 (8), рр. 986–991. doi: 10.1093/rheumatology/keh244

32. Curtiss P., Schwager Z., Cobos G., Lo Sicco K., Franks A. G. Jr. A systematic review and meta-analysis of the effects of topical nitrates in the treatment of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol., 2018, № 78 (6), рр. 1110–1118. doi: 10.1016/j.jaad.2018.01.043

33. Fitzgerald O., Hess E. V., O'Connor G. T., Spencer-Green G. Prospective study of the evolution of Raynaud's phenomenon. Am J Med., 1988, № 84 (4), рр. 718–726. doi: 10.1016/0002-9343(88)90109-x

34. Fraenkel L., Zhang Y., Chaisson C. E., Evans S. R., Wilson P. W., Felson D. T. The association of estrogen replacement therapy and the Raynaud phenomenon in postmenopausal women. Ann Intern Med., 1998, № 129 (3), рр. 208–211. https://doi.org/10.7326/0003-4819-129-3-199808010-00009

35. Wigley F. M. Clinical practice. Raynaud's Phenomenon. N Engl J Med., 2002, № 347 (13), рр. 1001–1008. doi: 10.1056/NEJMcp013013

36. García-Carrasco M., Sisó A., Ramos-Casals M. et al. Raynaud's phenomenon in primary Sjögren's syndrome. Prevalence and clinical characteristics in a series of 320 patients. J Rheumatol., 2002, № 29 (4), рр. 726–730.

37. Koné-Paut I., Olivar E., Elbhar C., Garnier J. M., Berbis P. Syndrome de Raynaud chez l'enfant. Etude de 23 cas [Raynaud's syndrome in children. Study of 23 cases]. Arch Pediatr., 2002, № 9 (4), рр. 365–370. doi: 10.1016/s0929-693x(01)00794-1

38. Pizzorni C., Sulli A., Craviotto C., Tuccio M., Seriolo B., Cutolo M. Prospettive diagnostiche nelle vasculopatie reumatologiche: l'impiego della videocapillaroscopia [Diagnostic perspectives in the rheumatologic vasculitis: the role of video-capillaroscopy]. Reumatismo, 2002, № 54 (2), рр. 99–104.

39. Zhang W., Wei Y., Jiang H., Xu J., Yu D. T3 versus T4 thoracoscopic sympathectomy for palmar hyperhidrosis: a meta-analysis and systematic review. J Surg Res., 2017, № 218, рр. 124–131. doi: 10.1016/j.jss.2017.05.063

40. Zufferey P., Depairon M., Chamot A. M., Monti M. Prognostic significance of nailfold capillary microscopy in patients with Raynaud's phenomenon and scleroderma-pattern abnormalities. A six-year follow-up study. Clin Rheumatol., 1992, № 11 (4), рр. 536–541. doi: 10.1007/BF02283115

41. Aslanov A. D., Achkasov E. E., Kugotov A. G. Modern approach to the integrated approach and treatment and rehabilitation of patients with Raynaud’s phenomenon. Vestnik Vserossiiskogo obshchestva spetsialistov po mediko-sotsialnoi ekspertize, rehabilitation and Rehabilitation industry, 2019, № 4, pp. 43–51. doi: 10.17238/issn1999-2351. 2019. 4. 43-51 (in Russ.)

42. Aslanov A. D., Achkasov E. E., Kugotov A. G. et al. The use of natural factors Kabardino-Balkar Republic in the treatment and rehabilitation of patients with neurovascular diseases of the upper limbs. Bulletin of the Russian society of specialists in the medical-social expertise and rehabilitation and rehabilitation industry, 2019, № 4, рр. 93–102. doi: 10.17238/issn1999-2351.2019.4.93-102 (in Russ.)

43. Aslanov A. D., Zhirikov A. V., Kugotov A. G. Treatment of the Rayn- aud phenomenon in the North Caucasus, 2015, № 3, рр. 226. (In Russ.)