Possibilities and Prospects of Therapeutic Stimulation of Angiogenesis in Injuries of the Great Arteries of the Extremities (Systematic Review)

The structure of combat surgical pathology due to modern defeat factors of modern weapons used in armed conflicts of recent times is characterized by a high frequency of injuries of blood vessels of the lower extremities, which is often accompanied by massive bleeding and/or acute limb ischemia (ALI). A review of scientific literature devoted to the types of surgical methods for the treatment of acute limb ischemia is presented. The issues of neoangiogenesis regulation in tissues are considered, the possibilities of application of genetically engineered technologies of angiogenesis stimulation in patients with chronic lower limb ischemia are presented. The results of experimental and clinical studies in this direction are presented. A promising concept of the possibility of application of genetically engineered complexes of VEGF-dependent angiogenesis stimulation based on cyclic plasmid DNA of this growth factor is substantiated. The review included data from relevant articles describing methods of angiogenesis stimulation in ischemia, as well as the structure and nature of limb arterial injuries published in the period of January 2013 and January 2023 and presented in PubMed, ScienceDirect, and eLibrary databases. Currently, surgical treatment of the wounded with the injuries of the main arteries of the extremities does not always allow to achieve the optimal result. The key to accelerated restoration of the injured limb arteries may be the understanding of the processes of angiogenesis stimulation and development of new techniques of adjuvant therapeutic stimulation of angiogenesis in this category of patients. In the long term, this will lead to a decrease in disability and improved outcomes of treatment of modern surgical trauma. Taking into account numerous literature sources, publications of our colleagues, we can conclude that the techniques of therapeutic stimulation of angiogenesis in patients with the injury of the main arteries of the limb are promising and effective. However, further study of angiogenesis mechanisms in this type of injuries is required, as well as expansion of indications for its application.

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