[Selection of surgical tactics in infected vascular transplants]. / Vybor khirurgicheskoi taktiki pri infitsirovanii sosudistykh transplantatov.

The article analyzes a 10-years experience of the clinic work with choice of surgical tactics in infecting vascular transplants after reconstructive operations on the aorta and arteries of lower extremities in 57 of 1079 patients operated upon. The active-waiting tactics using conservative antibacterial methods of treatment was unsuccessful since in 89.7% of cases it resulted in the development of erosive bleedings and in 62.8%--in lethal issues. Preventive reoperations (atypical shunting included) before the development of erosive bleeding in infected vascular transplants reduced the frequency of amputations from 46.2% to 26.6% (in the discharged patients), and reduced lethality almost 4 times (from 62.8% to 16.7%).

[The procedure for treating patients with a late thrombosis of the vascular prostheses or of the reconstructed arteries of the pelvis and lower extremities]. / Taktika lecheniia bol'nykh s pozdnim trombozom sosudistykh protezov ili rekonstruirovannykh arterii taza i nizhnikh konechnostei.

Results of the investigation of clinical observations of 235 patients with late thrombosis of vascular prostheses or reconstructed arteries of the pelvis and lower extremities enabled the authors to develop a medical tactics based on the active surgery method aimed at the reestablishment of the disturbed blood flow. The time of reconstructive reoperations depends on the clinical course of recurrent ischemia. The conservative treatment, as less effective, is indicated to some patients with not severe ischemia and without local or general conditions for operations. The authors believe that differentiated medical approach will allow improvement of results of treatment of patients with this severe disease.

[Use of ultrasonics and antibiotics in the treatment of wounds in patients with high risk of infection of vascular transplants]. / Primenenie ul'trazvuka i antibiotikov dlia obrabotki ran u bol'nykh s vysokim riskom infitsirovaniia sosudistykh transplantatov.

The level of bacterial colonization of the operative wounds in performance of the reconstructive operations on the vessels equal to 10(3) bacteria in 1 g of tissue is critical for the development of suppuration. The use for treating the wounds of the low-frequency ultrasound and gentamycin solution in 17 patients permitted to reduce the critical level of bacterial wound colonization, and due to this, to decrease the incidence of the purulent-septic complications from 35.7 to 5.9%. In 14 patients after the operations for late reocclusion performed in presence of cicatrices of the tissues, there was no wound suppuration.

[Recurrence of ischemia of the lower limbs in patients with functioning vascular prosthesis]. / Retsidiv ishemii nizhnikh konechnostei u bol'nykh s funktsioniruiushchimi sosudistymi protezami.

On the basis of experience in surgical treatment of 242 patients with recurrent ischemia of the lower limbs in late periods after operations on the aorta and peripheral arteries, the authors singled out a group of patients (44) with unobstructed but hemodynamically incompetent vascular prostheses. Their hemodynamic changes were caused by stenosis of the vascular anastomoses and shunts or by the development of occlusions of arteries beyond the reconstructed segments. The authors relate all these complications to the prethrombotic stage of late reocclusions and insist in their recognition before the development of thrombosis of the vascular prosthesis. The important role of dynamic Doppler flowmetry in early diagnosis is shown. Reoperations for correction of the blood flow were conducted on 40 patients. The results were good in 92.5% of them. The authors recommend wider use of preventive operations which contribute to the improvement of surgical treatment of patients with late reocclusions of arteries and vascular prostheses.