Intravascular Laser Irradiation of Blood in Complex Therapy of Diffuse Atherosclerosis in Elderly and Senile Patients

The research is devoted to the problem of treating diffuse atherosclerosis in elderly and senile patients using the method of intravascular laser irradiation of blood as part of complex therapy. Atherosclerosis is the leading cause of disability and mortality among the elderly population, and in a significant proportion of patients the disease takes a diffuse form, simultaneously affecting the vessels of the heart, brain, and lower extremities. Modern treatment methods, including pharmacotherapy and surgical interventions, are not always applicable to this category of patients due to the severity of their condition and accompanying pathology. In this connection, the efficacy and safety of the minimally invasive method of intravascular laser irradiation of blood as a component of complex treatment is investigated, along with its impact on hemodynamics, hemorheology, coagulation potential, and lipid blood composition.

Cardiovascular diseases (CVD) remain the leading cause of disability and mortality among the population of most countries of the world (Chazov E.I., 2002; Ogанов R.G., 2003). Many CVD are based on atherosclerosis - a complex, multistage, progressive pathological process of vascular wall damage (Shlyakhto E.V., 2001; Karpov Yu.A., Sorokin E.V., 2002). It is precisely the primary cause of such severe complications as acute myocardial infarction, acute cerebral circulation disorder, thromboses, embolisms, and others (Laguta S.E., Panchenko E.P., 2002). The development of atherosclerosis is closely correlated with patient age. Among individuals over 65 years of age, atherosclerosis is found in almost 100% of cases, being the most characteristic pathology of elderly and senile age (Titov V.N., 1998; Sidorenko B.A., Preobrazhensky D.V., 1999). In a significant number of patients, atherosclerosis takes a diffuse form, simultaneously affecting to varying degrees the vessels of the heart, brain, and main arteries of the lower extremities, which significantly impairs the function of central and peripheral circulation (Lazebnik L.B., 2002; Khalfin R.A., 2003). Moreover, elderly and senile individuals have competing, concomitant diseases and possess low functional reserves of the organism, which additionally aggravates the course of atherosclerosis. Over the past decades, progressive population aging has been observed. An ever-increasing proportion consists of elderly and senile individuals with their inherent diseases (Khalfin R.A., 2003). This circumstance contributes to heightened interest in the problem of atherosclerosis and its treatment in elderly and senile patients.

The basis of modern atherosclerosis treatment lies in complex therapy aimed at correcting dyslipidemia and metabolic disorders, normalizing circulation. In cases of pronounced occlusion of large vessels or their aneurysmal dilation, as well as for prevention or elimination of consequences of circulation disorders in various vascular beds, reconstructive surgical interventions are used. However, in elderly and senile patients, due to the severity of their condition and accompanying pathology, as well as frequent medication intolerance, the use of the entire modern arsenal of conservative therapy is not always possible, and the application of surgical interventions is often limited. In this connection, the use of minimally invasive, safe, inexpensive, and effective methods of treatment for elderly and senile patients with diffuse atherosclerosis is highly relevant. One of them may be intravascular laser irradiation of blood (ILIB) (Gamaleya N.F., 1989; Babushkina G.V. et al., 1997; Borisova A.V., 1997; Kapustina G.M., 1997; Gavrishcheva I.A., 2000; Builin Y.A., 1997).

Conducted experimental and clinical studies have shown that ILIB positively affects blood rheology and possesses immunomodulating, anti-inflammatory, and analgesic effects (Korochkin I.M., 1991; Tuner J., Hode L., 1996). By now, practical experience has accumulated in the use of ILIB in the treatment of many diseases, including CVD (Atroshenko B.S. et al., 1994; Marcyash A.A., 1996; Kostenko V.A., 1997). With respect to patients with atherosclerosis, ILIB, given the features of the disease pathogenesis and the mechanism of therapeutic action of the method, is considered pathogenetic therapy. At the same time, the clinical efficacy of ILIB in complex therapy of patients with diffuse atherosclerosis of elderly and senile age has been insufficiently studied, indications for including ILIB in the therapy of these patients have not been determined, and data on its safety during long-term and repeated use are few and contradictory. The aforementioned circumstances make research in this direction relevant.

Goal and Objectives of the Study

The goal of the work is to improve the efficacy of complex therapy of diffuse atherosclerosis in elderly and senile patients through the use of intravascular laser irradiation of blood.

To achieve the stated goal, the following tasks are assumed:

1. To study the influence of complex treatment using ILIB on the quality of life of elderly and senile patients with diffuse atherosclerosis based on patient questionnaires and treating physicians' evaluations, retrospective and prospective analysis of medical histories.

2. To identify changes in central and regional hemodynamics parameters based on rheovasography, Dopplerography, rheoencephalography, integral body plethysmography, and ECG.

3. To register dynamics of clinical and biochemical blood indices, hemorheology, and hemostasis parameters after the use of ILIB in elderly and senile patients.

4. To determine the frequency and structure of complications during ILIB procedures in elderly and senile patients.

5. To study the duration of ILIB effect preservation in elderly and senile patients.

Scientific Novelty of the Work

For the first time, using clinical, laboratory, and instrumental research methods, the efficacy and safety of ILIB in complex therapy of diffuse atherosclerosis in elderly and senile patients has been proven. Indications and timing for including ILIB in complex therapy of diffuse atherosclerosis in elderly and senile patients have been determined. The possibility of long-term therapeutic use of ILIB in atherosclerotic damage of vessels of the lower extremities, brain, and heart has been studied. For the first time in this category of patients, data on changes in the morphofunctional state of formed blood elements under the influence of ILIB have been obtained.

Practical Value of the Work

Based on the obtained results, the advisability and safety of using intravascular laser irradiation of blood in complex therapy of diffuse atherosclerosis in elderly and senile patients have been identified. Recommendations on criteria for including ILIB in the treatment program have been developed. Methods for objective evaluation of the therapeutic effect have been proposed, and grounds for the timing of repeated ILIB courses have been substantiated.

Positions for Defense

1. Among elderly and senile patients with diffuse atherosclerosis of coronary, cerebral, and lower extremity arteries, the problem of treatment method selection is acute, as due to the severity of patients' condition, the possibility of pharmacotherapy and surgical interventions is limited; therefore, additional minimally invasive treatment methods are required to improve the quality of life of this category of patients, one of which may be ILIB.

2. Inclusion of ILIB in complex therapy in elderly and senile patients with atherosclerosis of coronary, cerebral, and lower extremity vessels contributes to improvement of rheological properties and lipid composition of blood, functional state of the endothelium, reduces the risk of thrombosis, favorably affects circulation, which allows improvement of complex treatment results.

3. Use of ILIB is indicated when medication therapy is insufficiently effective, is safe, is not accompanied by adverse effects on internal organ functions, and the achieved therapeutic effect is preserved for at least three months.

Presentation of the Work

The results of the investigations and the main provisions of the work were reported and discussed at medical, scientific-practical, and anniversary conferences of the Hospital for Veterans of Wars of St. Petersburg (1998, 2000, 2002, 2003, 2005), at the international conference "Therapeutic Plasmapheresis" (St. Petersburg, 1998), at the international symposium "Problems of Old Age" (Moscow, 1999), at the international conference "Laser and Information Technologies in Medicine of the 21st Century" (St. Petersburg, 2001), at the international conference "Improvement of Expertise of Temporary Disability. The Role of Restorative Treatment in Reducing Disability and Rehabilitation of the Disabled" (St. Petersburg, 2004), at the international symposium "Lasers for Medicine, Biology, and Ecology" (St. Petersburg, 2005), at a meeting of the international association of specialists in efferent and physico-chemical treatment methods in medicine (Society of Efferent Therapy) on May 17, 2005.

Implementation of the Work

The results obtained in the course of the work are used in the daily activities of the Department of Extracorporeal Blood Processing Methods of the Hospital for Veterans of Wars of St. Petersburg (Narodnaya St., 21), which made it possible to improve treatment results and objectify control over the efficacy of ILIB, and have also been introduced into the practice of Clinic No. 109 of St. Petersburg (Olekho Dundicha St., 8, bldg. 2).

Volume and Structure of the Dissertation

The dissertation is presented in 138 pages of typed text. The work consists of an introduction, three chapters, a conclusion, conclusions, practical recommendations, a bibliography, and an appendix.