[Impact of diabetes mellitus on other cardiovascular risk factors in patients with stenosis of the internal carotid artery].

AIM: To examine cardiovascular risk factors, clinical features and their impact on the results of carotid endarterectomy in diabetic patients with stenosis of the internal carotid artery. MATERIAL AND METHODS: We analysed data on 100 diabetic and 607 nondiabetic patients who underwent carotid endarterectomy in Vilnius University Emergency hospital from 1995 through 2005. RESULTS: Diabetic patients with carotid artery stenosis were younger (p < 0.05), they smoked less often (p < 0.001) and were more often obese (p < 0.001) than nondiabetic patients. 93% of diabetic patients had arterial hypertension or hypercholesterolemia or even more cardiovascular risk factors. Diabetic were more likely to have nonspecific symptoms and severe bilateral carotid stenosis (p < 0.01). Perioperative stroke and mortality rate was 12% for diabetic and 3.4% for nondiabetic patients (p < 0.001), but no perioperative myocardial infarction was identified in diabetic patients. Four clinical factors increased the odds of complications: age 75 > (odds ratio--OR 2.2; 95% confidence interval--CI 1-4.9), smoking (OR 2.7, 95% CI 1.8-4.2), obesity (OR 6.1; 95% CI 3.9-9.5) and severe bilateral carotid stenosis (OR 2.1; 95% CI 1.3-3.6). CONCLUSION: Diabetes mellitus in patients with severe carotid artery stenosis changes conventional risk factors, clinical picture of the disease and increases the risk of carotid endarterectomy.

[Surgeries on the carotid arteries]. / Operatsii na sonnykh arteriiakh.

The article lays emphasis on the main causes of restenosis after endarterectomy from the bifurcation of the carotid artery and shows the methods of its prevention. A new method for endarterectomy of the bifurcation of the carotid artery is suggested, which consists in reimplantation of the internal carotid artery. The authors claim this method to be optimal in combined affection: atherosclerotic constriction of carotid artery bifurcation and pathological tortuosity of the internal carotid artery. The authors possess an experience in 351 operations on the carotid arteries, 177 of them were conducted for loops and kinks of the carotid arteries; 152, for endarterectomy in atherosclerotic affection of the carotid arteries; and 22 for other, less frequently encountered affections of the carotid arteries.

[Surgical technic of straightening kinks of the internal carotid arteries]. / Khirurgicheskaia tekhnika pri vypriamlenii petel' vnutrennykh sonnykh arterii.

The article describes surgical techniques used in 11 cases for correcting loops and pathological tortuosity of the internal carotid arteries. Resection of the proximal segment of the artery with its reimplantation into the bifurcation of the carotid artery is the technically simplest method. In marked degeneration of the arterial wall in the region of the loop, the latter must be resected and arterial end-to-end anastomosis established. The authors describe a method which they developed for resecting a high loop of the internal carotid artery.

[Changes in the internal carotid artery in its loop-shaped kinking and their clinical significance]. / Izmeneniia vnutrennei sonnoi arterii pri ee petleobraznykh izgibakh i ikh klinicheskoe znachenie.

Loops and kinks of the internal carotid, common carotid, and vertebral arteries which were resected in operations on 45 patients were examined histologically and histochemically. Gross pathological changes were found in the arterial wall in the region of the loops and kinks: destruction of the smooth muscles and elastic fibrils and fragmentation of the internal elastic membrane. Fibrous tissue prevailed in all layers of the arterial wall, forming its soft framework and in this way preventing the straightening out of the kinked artery or its loop. The changes were most marked in the loops of the internal carotid artery, microaneurysms with parietal thrombosis were even encountered. The findings of microscopic and histochemical study compel the surgeon to resort to excision of the loop or kink and subsequent establishment of an end-to-end anastomosis or replacement of the whole pathologically changed arterial segment by a graft of autologous vein, as the most radical method of surgical treatment of this pathological condition. In children and in some adults, however, favourable results can be produced by total mobilization of the loop, its downward transposition, resection of its proximal segment, and reimplantation into the bifurcation of the carotid artery.

[Restoration of blood flow in the external carotid artery]. / Vosstanovlenie krovotoka po naruzhnoi sonnoi arterii.

The external carotid artery revascularization procedures were performed in 19 cases. Fourteen patients had ischemic stroke history. Ten patients had occluded the ipsilateral internal carotid artery to the stenosed external carotid artery. Six patients had occluded the common as well as internal carotid artery on the same side. Positive neurologic changes were obtained in 73.7% of the operated patients. The external carotid artery revascularization procedures are recommended in cases when the ipsilateral internal carotid artery is occluded.

[Clinical aspects of circulatory disorders in the vertebral arteries and the possibilities for their surgical treatment]. / Nekotorye klinicheskie aspekty narushenii krovoobrashcheniia v pozvonochnykh arteriiakh i vozmozhnosti ikh khirurgicheskogo lecheniia.

Experience in the follow-up of 84 patients who underwent operation for transient cerebral vascular insufficiency in the vertebro-basilar bed is summarized. It was found that most patients with abnormally tortuous or anomalously branching vertebral arteries had transient disorders of the carciac rhythm or increased arterial pressure. Operative treatment of such patients contributes to correction of the neurologic symptoms and leads to normalization of the cardiac rhythm and arterial pressure.