[Outcomes of revascularizing operations on lower-limb arteries in patients with critical ischaemia and multifocal atherosclerosis]. / Iskhody revaskuliariziruiushchikh operatsii na arteriiakh nizhnikh konechnostei u bol'nykh s kriticheskoi ishemiei i mul'tifokal'nym aterosklerozom.

The purpose of this study was to evaluate the amputation-free survival rate and predictors of major adverse cardiovascular events (extracardiac and cardiac mortality, non-fatal myocardial infarction, non-fatal stroke) in patients with atherosclerotic occlusive-stenotic lesions of the femoropopliteal-tibial segment and critical ischaemia. We analysed the results of treating a total of 122 patients with atherosclerotic lesions of the superficial femoral artery and lower limb critical ischaemia. Of these, 35 patients had no lesions of other arterial basins, 24 patients presented with a concomitant lesion of the carotid basin, 41 subjects had lesions of the coronary basin, and 22 had lesions of the coronary and carotid basins. The patients were subjected to either bypass graft operation (n=75) or endovascular intervention (n=47). The evaluated outcome measures were amputation-free survival and the frequency of major adverse cardiovascular events. The average duration of follow up amounted to 38.2±4.3 months. The carried out multivariate logistic regression analysis demonstrated that the factors associated with lower limb amputation and the development of major adverse cardiovascular events were as follows: a concomitant lesion of the coronary (p=0.044) and coronary-carotid (p<0.05) basins, a history of endured myocardial infarction (p=0.003), a C-reactive protein level not less than 17.0 mg/l (p<0.05) and the value of the apolipoprotein B/A1 ratio above 1.0 (p=0.004).

[Remote results of carotid endarterectomy in patients with type 2 diabetes mellitus]. / Otdalennye rezul'taty karotidnoi éndarteréktomii u bol'nykh s sakharnym diabetom II tipa.

The authors comparatively analysed the remote results of carotid endarterectomy and risk factors for unfavourable outcomes in patients with and without type 2 diabetes mellitus (DM). The outcomes of carotid endarterectomy were studied in a total of 168 patients, with the follow-up terms up to 8 years. Depending on the presence or absence of DM, the patients were divided into two groups. Group One comprised 79 patients with an atherosclerotic lesion of the internal carotid artery and accompanying DM, with Group Two consisting of 89 non-diabetic patients. There were no lethal outcomes in the early postoperative period. The composite measure 'lethality + stroke' in Group One amounted to 2.5% and in Group Two to 2.2%. In the remote period the survival rate was as follows: 65 (82.3%) people for Group One and 83 (93.3%) for Group Two, with the 5-year cumulative survival rate amounting to 75.1±6.4% and 92.5±3.0%, respectively. The index of freedom from acute vascular complications (myocardial infarction, ischaemic stroke) at 5 years in Group One was 54.2±7.2% and in Group Two 86.1±4.3%. Acute vascular complications were causes of lethal outcomes in 13 cases in the group with DM and in 3 cases in the group without DM. Death was most often caused by acute coronary complications. The index of freedom from restenosis at 5 years in Group One amounted to 74.5±8.0% and at 7 years of follow-up in Group Two to 92.3±7.3%. The risk factors for the development of acute vascular complications in diabetic patients according to the findings of the Cox regression analysis were as follows: age above 65 years, DM duration of more than 5 years; the level of glycated haemoglobin above 7.5%; a history of myocardial infarction; presence of degree III arterial hypertension. The risk factors for restenosis included: DM duration of more than 5 years, the level of glycated haemoglobin above 7.5% and presence of degree III arterial hypertension. The results of the study make it possible to regard carotid endarterectomy efficient and safe for both cohorts of patients (with and without DM). In the remote postoperative period, such parameters as survival rate, indices of freedom from acute vascular complications and restenosis turned out to be statistically significantly lower in diabetic patients than in non-diabetic, with the predominating coronary complications induced by insufficient assessment of the coronary reserve and the presence of occult forms of ischaemic heart disease. Long-term results may be improved by means of widening the indications for performing coronarography in patients with DM.