The use of fluorescence imaging in surgery has significantly expanded in recent years. Fluorescence angiography is a method of assessing tissue perfusion, which used in various fields of medicine. Fluorescence angiography uses the fluorescence signal emitted by injected substances (fluorophores) after irradiation with special laser sources, providing the doctor with real-time tissue visualization. This review examines the most common aspects of the clinical application of fluorescence. The everincreasing use of fluorescence angiography, the high specificity and sensitivity of the method, will turn it into a standard of medical care in the near future.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by damage to joints and internal organs. The introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) into clinical practice has significantly improved the quality of life of patients with RA, reduced the incidence of disabling changes in the joints, and provided good control over disease activity. At the same time, the problem of accelerated atherosclerosis and increased cardiovascular risk in RA remains relevant. Endothelial dysfunction (ED) and systemic inflammation make a significant contribution to the progression of atherosclerosis in patients with RA. This review analyzes the role of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-a) in the pathogenesis of atherosclerosis and ED, presents current scientific data on the effect of bDMARDs on endothelial function in patients with RA, and also considers laboratory markers and instrumental methods for studying ED. Programmed cell death protein 1 (PD-1), IL-18, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), and fractalin are promising therapeutic targets in the treatment of RA and atherosclerosis. When planning and organizing clinical trials of new drugs intended for the treatment of RA, it is justified to include additional endpoints devoted to assessing the development and progression of atherosclerosis and ED. According to experimental and clinical studies, therapy with bDMARDs helps to reduce the severity of ED, which has a positive effect on the condition of the vascular wall, slows the progression of atherosclerotic lesions of the arteries and reduces cardiovascular mortality in patients with RA. In this regard, it is appropriate to consider the possible inclusion of atherosclerosis in the indications for initiating therapy with bDMARDs in patients with RA.

Introduction. Multilevel atherosclerotic lesions of peripheral arteries are the main cause of decompensation of blood circulation with the development of critical ischemia of the lower extremities. Currently, there is an ongoing discussion about the expediency of supplementing the intervention on the aorto-femoral segment with a single-stage femoral-popliteal reconstruction. However, to clearly define the tactics of revascularization of multilevel lesions, it is necessary to conduct a comparative analysis of the long-term results of various types of revascularization operations, depending on the level of peripheral vascular resistance and the condition of the deep femoral artery.
Aim. To evaluate the results of various revascularization operations and develop differentiated tactics for surgical correction of blood flow in patients with multilevel atherosclerotic lesions of the lower extremity arteries, depending on the level of peripheral vascular resistance and the presence or absence of hemodynamically significant lesions of the deep femoral artery.
Material and Methods. A retrospective study conducted on the basis of the Vascular Surgery Department of the St Petersburg City Multidisciplinary Hospital № 2 included 379 patients observed between 2013 and 2025. 217 patients were re-hospitalized. A combined lesion of the aorto-femoral and femoral-popliteal segments (FPS) was found in all patients. The level of peripheral vascular resistance was assessed according to the method proposed by R. B. Rutherford, with changes by A. V. Pokrovsky in the modification of L. A. Maslov.
Results. In the analysis of the results of various methods of revascularization of multilevel atherosclerotic lesions of lower extremity arteries over 144 months with isolated reconstruction of the aorto-femoral segment and simultaneous revascularization of the aorto-femoral and femoro-popliteal segments, the best results of primary and secondary patency were noted in the groups of open and hybrid interventions compared with endovascular surgeries (p<0.05). At the same time, the primary patency of the reconstructed FPS was significantly worse in the group with high peripheral vascular resistance (PVR) (p<0.05), and did not significantly depend on the fact of performing femoro-profundoplasty (p >0.05). The rates of freedom from reinterventions and the number of preserved limbs in the group of simultaneous interventions were significantly lower than in isolated reconstruction and directly depended on the level of peripheral vascular resistance (p<0.05).
Conclusions. In most cases, isolated reconstruction of the aorto-femoral segment is the tactic of choice to achieve optimal revascularization in patients with multilevel vascular lesion. Additional reconstruction of the femoral-popliteal segment may be recommended if the clinical manifestations of significant ischemia in the distal parts of the lower extremities persist. Assessment of the value of peripheral vascular resistance allows predicting the immediate and long-term results of revascularization, regardless of the type of surgical intervention.

Introduction. Changes in the parameters of the microvascular bed (MVB) are the most sensitive predictors that are the first to respond to pathogenic factors before the appearance of clinical symptoms. When comparing linear and volumetric blood flow indices in the MVB, obtained by high-frequency Doppler ultrasound (HFUS), in 25 healthy individuals at rest using the principal component method, the indicators of the subjects were divided into 3 groups.
The purpose of the work was on the basis of discriminant analysis (DA) to determine the most significant indicators of blood flow in the microcirculatory system that affect the division of practically healthy individuals.
Materials and methods. Based on the selected discriminant functions, three classification functions were formed, which included only those characteristics that influenced the division of the subjects. These include: maximum systolic velocity (Vs), maximum average velocity (Vm), average volume systolic velocity (Qas), maximum diastolic velocity (Vd).
As a result, according to the blood flow indices in the MVB, the subjects were divided into following groups: in group 1, the following blood flow indices were below the confidence interval (CI) (Vs=1.12 cm/s, Vm=0.77 cm/s, Vd=0.39 cm/s), while Qas=0.55 ml/min was above the CI. Group 2 is characterized by high Vm and Vd values (above 1.26 cm/s and 0.9 cm/s, respectively) with a Qas value below 0.229 ml/ min, while Vs was within the CI. Group 3 is characterized by the following values: Vs=1.89 cm/s (above the CI), Vd=0.42 cm/s (below the CI), Vm and Qas within the CI (1.17 cm/s and 0.28 ml/min, respectively).

Introduction. Type 2 diabetes mellitus occupies a leading position in the structure of non-infectious diseases in the world. The development of severe vascular complications of the disease, including diabetic foot syndrome, requires complex treatment and is an economically costly process accompanied by high disability and mortality of patients.
Objective. To evaluate the association of polymorphic markers A1298C of the MTHFR gene with changes in the microcirculatory bed during the development of diabetic foot.
Materials and methods. At the 1st stage of the study, the distribution of genotypes of the A1298C polymorphism of the MTHFR gene was studied in 198 patients with uncomplicated type 2 diabetes mellitus and 199 patients with diabetic foot. At the 2nd stage of the study, 30 patients with a comparable percentage distribution of the frequencies of the studied polymorphism as at the 1st stage were selected from the general groups of patients, and their microcirculation was examined using laser Doppler flowmetry. At the 3rd stage of the study, microcirculation parameters were analyzed depending on the carriage of the genotype of the A1298C polymorphism of the MTHFR gene. Results. In patients with diabetic foot syndrome, who are carriers of the A/A and A/C genotypes, a decrease in the temporal variability of perfusion by 2 and 1.2 times was revealed at a remote point. Locally, in patients with the studied complication of type 2 diabetes mellitus and genotypes C/C, A/C, a deterioration in the general condition of the microcirculatory bed by 2 and 2.2 times was noted. A decrease in the variability of microcirculation at a point on the 1st toe in diabetic foot syndrome with carriage of the A/A and A/C genotypes by 2 and 1.8 times was recorded.
Conclusion. Carriage of different genotype variants of the A1298C polymorphism of the MTHFR gene is associated with different pathways for the implementation of mechanisms of microcirculatory bed impairment.

Introduction. Researches in recent decades have proved the importance of the endothelium role in regulating vascular tone in various pathologies and have significantly changed the perception of it, having shown its key role in the pathogenesis of a number of systemic pathologies such as diabetes mellitus, atherosclerosis, hypertension and many others. Aim. To compare the diagnostic significance of ultrasound dopplerography of microcirculatory vessels (MCV) using 2 stress tests: iontophoresis and occlusion test in patients with type 2 diabetes mellitus and a control group.
Materials and methods. Patients with type 2 diabetes and control groups were performed functional tests: occlusion test and ionophoresis of acetylcholine solution, with assessment of microcirculatory vascular response by ultrasound dopplerography.
Results. Patients in the type 2 diabetes group had altered response dynamics to vascular occlusion, with significant differences in the degree of increase in blood flow indicators in the MCV in response to the occlusion test were observed as early as 2 minutes after cuff deflation (p<0.001), and in the group with acetylcholine iontophoresis, 4 minutes after iontophoresis (p<0.001).
Conclusion. Both techniques proved to be accurate in diagnosing endothelial dysfunction in patients with type 2 diabetes mellitus, and demonstrated high reproducibility.

Introduction. One of the important systems that requires close attention in patients with traumatic spinal cord disease (TSCD) is the gastrointestinal tract. The development of spinal shock leads to a sharp drop in blood pressure, to disruption of splanchnic blood circulation and, as a consequence, to ischemic damage to the intestine, its paresis, disruption of nutrient absorption, and cachexia. Active intraintestinal therapy can improve the treatment results of such patients.
Objective. In the experiment, to determine changes in the intramural blood supply to the small intestinal wall in the acute period of traumatic damage to the spinal cord and the e ffect of increased intraintestinal pressure on it.
Materials and methods. The experimental study was performed on male rats weighing 215–315 g (n=20), with spinal cord injury modeled. The intramural vascular bed of the small intestine was monitored using optical coherence angiography (OCA): at the first stage of the experiment — before modeling the injury, after 3 hours and after 24 hours; at the second stage of the experiment, 24 hours after the injury and then with the injection of physiological solution (0.9% NaCl) into the intestinal lumen at different pressures.
Results. Spinal cord injury results in a decrease in the overall density of the vascular network within 3 hours after injury compared to the intact intestine and statistically significantly progresses by the end of 24 hours. The introduction of a physiological solution into the lumen of the small intestine 24 hours after spinal injury modeling, at a pressure of 7 cm, results in the reappearance of some of the small-diameter blood vessels that had previously disappeared.
Conclusion. According to the OCA data, intramural microcirculation of the small intestine in the acute period of spinal injury is characterized by a decrease in the overall density of the vascular network. Dosed injection of physiological solution into the lumen of the small intestine at 7 cm of H2O leads to an increase in the density of the vascular network, bringing the indicators closer to the original ones.

Introduction. In the modern armed conflict, limb injuries have a high proportion in the structure of combat surgical pathology. In this case, injuries to the arteries of the limbs are often accompanied by massive external bleeding and/or acute ischemia, which is one of the main causes of death. The use of adjuvant therapeutic stimulation of angiogenesis in combat vascular pathology seems promising. Objective. To investigate the influence and dynamics of angiogenesis regulation and determine the role of VEGF in the pathogenesis of limb artery injuries in an experimental model of acute hind limb ischemia (AHLI) in laboratory animals.
Materials and methods. An experimental model of acute hind limb ischemia (AHLI) was developed, dynamic observation and evaluation of the effect of drug-induced angiogenesis and systemic administration of antiangiogenic antibodies in laboratory animals (male White Giant rabbits) of one batch weighing 3673±113 g (n=36).
Results. In Group Ia (drug-induced angiogenesis), there was a long-term positive survival rate of up to 24 days of the experimental study, in contrast to the other 3 groups. The survival data in Group Ia correlates with the quantitative determination of VEGF in blood serum, which by day 30 is 87.08±2.44 pg/ml (p<0.001). By 30 day of the experimental study, the level of tissue perfusion after ligation of the femoral artery was 81.75±4.2% (p<0.05).
Conclusions. Gene and cellular technologies can become one of the most important methods for restoring perfusion in ischemic tissues due to the formation and growth of the microvascular network, which subsequently significantly reduces the number of amputations performed and improves the final result of treatment for this pathology. The results obtained indicate the effectiveness of adjuvant stimulation of angiogenesis, which also affected the survival of laboratory animals.

A rare clinical case of combined orbital lesion is presented: carotid-cavernous fistula (CCF) and ipsilateral hemangioma in a 67-year-old patient. The differential diagnosis of CCF and orbital tumors presents certain difficulties. The gold standard for imaging this orbital pathology is computed tomography (CT) and magnetic resonance imaging (MRI) with angiography. However, these methods are expensive, not always available, have a number of limitations and contraindications, and their implementation is not always possible. Ultrasound examination (US) with assessment of blood flow is an accessible and highly informative method that allows assessing changes in blood flow in the retrobulbar vessels, differentiating avascular and vascular structures of the orbit. US in the mode of color Doppler mapping (CDM) is used in the diagnosis of CCF, which makes it possible to visualize the expansion of the diameter of the superior ocular vein (SOV) with signs of arterial blood flow and assess hemodynamic parameters in the orbital vessels. In the presented clinical case, the patient underwent ultrasound of the right orbit, which reviled an increase in the diameter of SOV in the upper-outer quadrant of the retrobulbar zone with signs of arterialization of venous blood flow in the CDM mode, which is an objective echographic sign of CCF. In the lower-outer quadrant of the orbit, a rounded formation of moderate echogenicity with clear contours was visualized, in the thickness of which vessels were not registered in the CDM mode, which corresponded to the acoustic characteristics of a benign tumor of the orbit. This clinical case is interesting because the MRI performed earlier on the patient at the first treatment did not allow a definitive diagnosis to be established, and only a comprehensive examination, including US Doppler examination, showed the presence of CCF with ipsilateral hemangioma even before using contrast-enhanced imaging techniques. Hence, the use of ultrasound in CDM mode and Doppler imaging is a highly informative method for diagnosing vascular diseases of the orbit.

A clinical case of arteriovenous malformation of the plantar surface of the foot is presented. Based on clinical data and ultrasound duplex scanning, an extratruncular form, a high-flow AVM, was identified (ISSVA, 2014). The patient’s case was discussed at a clinical review together with endovascular surgeons, and it was decided to perform an open surgical procedure. During the intervention, access was used from the lateral surface of the foot, which allowed removal of the formation with minimal tissue injury.