[Some comments on the 2017 European Guidelines on treatment of atherosclerotic lesions of brachiocephalic arteries]. / Nekotorye kommentarii k Evropeiskim rekomendatsiiam 2017 g. po lecheniiu ateroskleroticheskikh porazhenii brakhiotsefal'nykh arterii.

Analysed herein are the indications for primary interventions in patients with atherosclerotic lesions of internal carotid arteries according to the recommendations laid down in the 2017 Guidelines of the European Society for Vascular Surgery.

[Remote results of eversion carotid endarterectomy depending on the suture material used]. / Otdalennye rezul'taty éversionnoi karotidnoi éndarteréktomii v zavisimosti ot ispol'zuemogo shovnogo materiala.

BACKGROUND: It is known that namely long-term presence of suture material as the only foreign body in autologous conditions may lead to restenosis in the remote period. Such hypothesis was put forward based on good results of reconstructive cardiovascular operations in case of using absorbable suture material. OBJECTIVE: Our study was aimed at comparative analysis of remote results of using absorbable suture material polydioxanone and non-absorbable suture material polypropylene in eversion carotid endarterectomy. PATIENTS AND METHODS: Over the period from 2002 to 2007, at the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky performed a total of 408 carotid reconstructions according to the eversion technique. The study was based on comparative analysis of the remote results of this procedure in two groups of patients: the first group consisted of 121 patients in whom replantation of the internal carotid artery into the common carotid artery was performed using absorbable suture material polydioxanone with the metric sizes 5-0 and 6-0 and the second group comprising 135 patients in whom similar manipulations were performed using non-absorbable suture material polypropylene with the metric size 6-0. In the course of the study it turned out that the remote results might also be influenced by the metric size of polydioxanone, therefore the first group was further subdivided into subgroups: polydioxanone 5-0 - 79 patients and polydioxanone 6-0 - 42 patients. RESULTS: At baseline, with statistically significant differences by the gender, incidence of unstable atherosclerotic plaque, diameter of the ipsilateral internal carotid artery ≤4 mm, the groups of patients turned out to be in the remote period statistically significantly comparable by such parameters as frequency of the development of a pseudoaneurysm, restenosis of the internal carotid artery, ipsilateral stroke, restenosis-associated stroke, and by survival. However, when comparing the subgroup of patients wherein polydioxanone 6-0 was used and the second group with the initially statistically significant differences by incidence of unstable atherosclerotic plaque and myocardial infarction, in the remote period there was a statistically significant decrease in the incidence rate of restenosis of the internal carotid artery in the first case. CONCLUSIONS: The obtained findings suggested that the absorbable suture material polydioxanone with the metric size 6-0 might be considered as quite a substantiated alternative to the used in cardiovascular surgery non-absorbable suture material polypropylene. Polydioxanone with the metric size 6-0 made it possible to remove or considerably decrease the incidence rate of the development of restenosis of the internal carotid artery after eversion carotid endarterectomy.

[State of the carotid artery bifurcation after surgery involving the use of absorbable suture material].

The authors present herein a clinical case report assessing the state of the carotid artery bifurcation zone while performing secondary operation for restenosis 7 years after the primary operation (eversion carotid endarterectomy). The redo operation was carried out using absorbable suture material during anastomosis formation. This suture material used in arterial reconstructions turned out to result in good reparation of the anastomosis, not inducing coarse deformity of the vascular wall, thus in the long run making it possible to simplify the course of the redo operation.

[Analysis of remote results of eversion carotid endarterectomy].

Analysed herein are remote results of surgical management of patients presenting with atherosclerotic stenoses of carotid arteries by means of eversion carotid endarterectomy. Over the period from 2002 to 2007 specialists of the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health carried out a total of 393 eversion carotid endarterectomies in 356 patients. We assessed the remote results of 338 (86%) operations in 303 (85%) patients, analysing survival, freedom from stroke, patency of the reconstructed internal carotid artery and effects of risk factors on these indices. The average duration of follow-up amounted to 84 ± 31 months (max - 146 mos). A total of 242 (71.2%) patients survived. The cumulative 5-year survival rate amounted to 84%, with 10-year survival equalling 63%. Severity of the initial atherosclerotic lesion of the arterial bed, progression of atherosclerosis, and control over risk factors for atherosclerosis exerted a statistically significant influence on total survival. Acute disorders of cerebral circulation (of any localization) at a median follow-up of 81 ± 33 months (max - 146 mos) developed in 38 (12.1%) patients, of whom in 15 (4.8%) it terminated with a lethal outcome. Five-year cumulative freedom from stroke amounted to 92%, equalling 80% 10 years after. The risk factors which influenced the freedom from stroke included a history of acute impairments of cerebral circulation, restenoses of the reconstructed ipsilateral internal carotid artery (>70%), and diabetes mellitus. Amongst the examined by means of ultrasonography 164 patients, patency of the reconstructed ipsilateral internal carotid artery at an average follow-up of 75 ± 28 months (max - 135 mos) amounted to 95%. Haemodynamically significant restenoses (≥ 70%) were revealed in eight (5%) cases. Of these, three (2%) patients had narrowing of 70-89% and the remaining five (3%) patients had narrowing of ≥ 90% (including 2 occlusions of the reconstructed ipsilateral internal carotid artery). We revealed no risk factors influencing the development of restenosis of the reconstructed ipsilateral internal carotid artery after eversion carotid endarterectomy. The obtained findings give grounds to consider eversion carotid endarterectomy as a safe and reliable method for treatment of atherosclerotic lesions of carotid arteries and, consequently, for prevention of stroke. Control of risk factors may improve remote results of surgical treatment.

[Protocol of preventing perioperative strokes in reconstructions of carotid artery bifurcation].

Presented herein is a protocol of preventing perioperative strokes in reconstructions of bifurcation of the carotid artery, used at the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky. The authors analysed the results of 630 primary carotid endarterectomies performed for atherosclerosis under general anaesthesia over the period from 2008 to 2010. Tolerance of the brain to carotid clamping was determined by measuring cerebral retrograde arterial pressure. Of the 630 operations, 65 (10.3%) interventions were carried out under temporal internal bypass. It was shown that the incidence rate of perioperative neurological complications among those tolerating carotid artery clamping was slightly lower than in the non-tolerating patients, with the incidence rate of strokes amounting to 1.8 and 3.1%, and that of "stroke + stroke-related mortality" amounting to 2.1 and 3.1%, respectively, but the differences were not statistically significant (p>0.5). Perioperative strokes in the absence of thrombosis of the reconstruction zone were observed in 0.6% of cases.

[Does the method of carotid reconstruction influence the outcomes of the intervention?].

AIM: to carry out comparative assessment of the immediate outcomes of eversion carotid endarterectomy, classical carotid endarterectomy and prosthetic repair of the internal carotid artery in atherosclerotic-genesis stenoses thereof. MATERIAL AND METHODS: the study was based on a retrospective analysis of the immediate results of 630 isolated primary open interventions on the bifurcation of the common carotid artery in atherosclerosis, performed at the Department of Vascular Surgery of the A.V. Vishnevsky Institute of Surgery over the period from January 2008 to December 2010. The choice of the method of intervention was based on the indications developed worked out at our Department with due regard for the clinical and morphological peculiarities of the lesion of the carotid bifurcation. RESULTS: the incidence of performing eversion carotid endarterectomy (416; 66%) in the entire group was significantly higher than that of classical carotid endarterectomy (127; 20%) and that of prosthetic repair of the internal carotid artery (87; 14%) (p=0.000). Thrombosis of the reconstructed internal carotid artery developed significantly more often (p<0.05) after prosthetic repair (4.6%) and classical carotid endarterectomy (3.9%) as compared with the eversion technique (0.7%). Frequency of the development of homolateral stroke after prosthetic repair of the internal carotid artery (4.6%) was higher than after eversion carotid endarterectomy (1.2%) and classical carotid endarterectomy (2.36%), however, these differences were statistically significant only when compared with the group of the eversion technique (p=0.000). All techniques were accompanied by low mortality from stroke (the eversion technique - 0.24%, classical carotid endarterectomy (0%), prosthetic repair of the internal carotid artery - 1.15%), and the groups did not differ significantly by this parameter (p>0.05). CONCLUSION: the choice of the method of carotid endarterectomy should be determined by the character of lesions of the carotid bifurcation, anatomical interrelationships in the operation wound, and tolerance of the brain to clamping of carotid arteries. Eversion carotid endarterectomy, once possible to perform, is the most preferable method of reconstruction in atherosclerotic lesions of the carotid bifurcation.

Remote results of reconstructive operations in pathological deformity of the internal carotid artery.

OBJECTIVE: to study remote results of surgical treatment of patients presenting with a pathological deformity of the internal carotid artery. METHODS: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (ICA), who underwent a total of 166 reconstructive operations. RESULTS: 7% of patients were operated on at the asymptomatic stage, more than half (56%) of the patients were found to have transient (21%) or persistent neurological deficit (35%), 37% of patients had stage III cerebrovascular insufficiency. Twenty-five (15%) operations were performed for C- and S-shape tortuosity, ninety-seven (58%) procedures for kinking of the internal carotid artery, and forty-four (27%) interventions for coiling. The operation of choice was resection with redressation of the internal carotid artery and reimplantation into the old ostium (74%). Analysing the results of surgical treatment showed its high neurological efficiency in prevention of cerebral circulation impairments (93% of patients at terms up to 25 years had no such complications), as well as clinical efficacy (relief of cerebrovascular insufficiency symptoms in 91.1% of patients). The effect obtained appeared to preserve during 2 and 5 years in 96% and 92% of patients, respectively, and at terms up to 25 years in 83%. The 3-, 5- and up- to-25-year survival amounted to 95%, 92% and 75%, respectively. Restenosis of the internal carotid artery was significantly more often observed after prosthetic repair of the artery (p <0.05) as compared with other methods of reconstruction employed. Thromboses of the internal carotid artery were encountered with similar frequency (8%) only after prosthetic repair and resection of the internal carotid artery with an «end-to-end¼ anastomosis, which was significantly more often than in resection with redressation (p <0.05). Stroke incidence in the remote postoperative period amounted to 0.8% and the «stroke + stroke-related mortality¼ parameter equalled 1.6%. CONCLUSION: the remote results of surgical treatment for pathological deformity of the internal carotid artery are strongly suggestive of high efficacy of this method of prevention of impairments of cerebral circulation and treatment of cerebrovascular insufficiency in patients with the pathology concerned. The operation of choice in pathological deformity of the internal carotid artery is resection with redressation of the internal carotid artery and reimplantation into the original ostium.

[In vitro accumulation of the photosensitizer Photosens in the atherosclerotic plaque of the human carotid artery].

The investigation was undertaken to study the accumulation of the photosensitizer Photosens in arterial atherosclerotic plaques and to immunohistochemically identify cellular elements in them. Specimens were obtained during carotid endarterectomy. The preferential accumulation of Photosens occurred in the plaque areas containing the largest number of cells, such as macrophages and lymphocytes. The photosensitizer accumulated to a greater extent in the unstable plaques than in the stable ones, which seems to be associated with the more marked infiltration of unstable plaques by the cells involved in the inflammatory reaction.

Clinical manifestations and diagnosis of pathological deformity of the internal carotid artery.

OBJECTIVE: to study clinical and morphological aspects of pathologically deformed pathological deformity of the internal carotid artery. METHODS: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (1СA), who underwent a total of 166 reconstructive operations. RESULTS: more than half (58%) of the patients were operated on for 1С A kinking, 27% for coiling and only 15% were found to have C- and S-shape tortuosity. The patients were predominantly women, with a male-to-female ratio of 1:1.6 (Р<0.01). The majority of the patients (61%) were operated on at the age varying from 51 to 70 years (P<0.01). Patients under 40 years appeared to more often (92%) suffer bilateral lesions (P<0.01). 56% of patients had a history of acute cerebral circulation impairment (P<0.05). A symptom-free course of the disease was more frequently encountered in unilateral lesions (P<0.01). Patients under 30 years were more often operated on at the pre-stroke stage of the disease (P<0.05). Patients with kinking of the internal carotid artery had a significantly higher risk (63%) of acute cerebral ischaemia (p<0.01). Arterial hypertension was revealed in 74% of patients. Incidence of acute cerebral ischaemia events was significantly higher in hypertensive patients (P<0.01). Pronounced haemodynamic impairments (bloodflow turbulence) were significantly more often (92%) detected in patients with kinking of the internal carotid artery (P<0.05). CONCLUSION: patients with clinical signs of cerebrovascular insufficiency, being relatively young and having concomitant arterial hypertension even with no objective signs of a stenotic lesion of coronary arteries should be referred to duplex scanning of brachiocephalic arteries in order to verify a pathological deformity of the internal carotid artery at the pre-stroke stage of the disease. An algorithm of examination including duplex scanning of brachiocephalic arteries and comprehensive magnetic resonance imaging made it possible to in short time obtain the in-depth information about the anatomical and topographical peculiarities of the pathological deformity of the internal carotid artery and to assess its haemodynamic significance, which in turn makes it possible to clearly and timely determine the treatment policy for the patient concerned.

[Immediate outcomes of reconstructive operations for pathological deformity of the internal carotid artery].

OBJECTIVE: To investigate the immediate outcomes of surgical treatment of patients presenting with pathological deformity of the internal carotid artery. METHODS: The study was based on retrospective analysis of the outcomes of surgical management of 142 patients with isolated pathological deformity of the internal carotid artery who underwent a total of 166 reconstructive procedures. RESULTS: Resection with redressing of the internal carotid artery and reimplantation into the old bed was a method of choice of repairing the deformed artery (74%). More often it was possible to have performed it in kinking, C- and S-shape tortuosity of the internal carotid artery, whereas prosthetic repair was more often in coiling (P < 0.05). A positive clinical effect of the operation was achieved in 97% of the patients. Neurological efficacy of the performed interventions depended upon the baseline degree of cerebrovascular insufficiency and the duration of clamping of carotid arteries (P < 0.05). The incidence of the development of thrombosis of the reconstructed internal carotid artery (1.2%) did not depend on either the form of pathological deformity or the method of reconstruction thereof. Cerebral circulation impairments in two (1.2%) cases were transitory and in three (1.8%) resulted in ischaemic stroke, one of which having become the cause of the patient's death. The index "stroke + lethality from stroke" amounted to 2.4%. Neurological complications had been caused by rheological impairments, instability of haemodynamics and inadequate redressing of the internal carotid artery. CONCLUSION: Analysing the immediate outcomes confirmed that surgical treatment of pathological deformity of the internal carotid artery is an effective method aimed at preventing cerebral circulation impairments and removal of cerebrovascular insufficiency in patients with the disease concerned.

[Variants of reconstruction of carotid bifurcation in patients with atherosclerosis: history and current state of the art].

A historical review of reconstructive surgery for atherosclerotic lesions of carotid bifurcation is presented along with indications for the use of various methods of vascularization of internal carotid artery based on the experience gained at the Department of Vascular Surgery, A.V. Vishnevsky Institute of Surgery.

[When should a pathological deformity of the internal carotid artery be operated on?].

The present study was aimed at optimizing the algorithm of examination and indications for operation in patients with a pathological deformity of the internal carotid artery. The work was based on a retrospective analysis of the therapeutic outcomes in 142 patients with an isolated pathological deformity of the internal carotid artery, who underwent a total of 166 reconstructive operations. Based on assessment of the diagnostic accuracy of the employed methods of diagnosis, we proposed an optimal algorithm of patient's examination including coloured duplex scanning and magnetic resonance angiography of the brachiocephalic arteries with simultaneous magnetic resonance tomography of the brain, followed by determining due indications for surgical treatment, depending on the baseline degree of cerebrovascular insufficiency and haemodynamiс significance of the pathological deformity of the internal carotid artery. The developed algorithm of examination makes it possible to timely and efficiently diagnose the disease and to determine due indications for surgical treatment of patients presenting with a pathological deformity of the internal carotid artery.

In memoriam of Michael Ellis DeBakey. Alternative reconstructions of carotid bifurcation for atherosclerosis: the history and the latest advances.

The paper overviews the history of reconstructive surgery for atherosclerotic lesions of carotid bifurcation, as well as indications for various revascularization procedures for internal carotid artery, based on the experience of the Vascular Surgery Department, A. V. Vishnevsky Institute of Surgery, and in particular, on 205 interventions that were carried out in 2006.

Remote results after prosthetic repair of the internal carotid artery for atherosclerotic lesions.

Presented herein is the authors' experience gained in employing a method of prosthetic repair of the internal carotid artery in patients suffering from atherosclerotic stenosis. Special attention is paid to intraoperative factors having led to arterial prosthetic reconstruction. Also analysed are the remote results of treatment in 81 of 97 operated patients. The mean duration of follow-up amounted to 28 +/- 3 months. All the patients in the remote period were subjected to colour duplex scanning of the reconstructed tone and that of the contralateral internal carotid artery (ICA), immediately followed by assessing the neurological status. Two patients were found to have developed single transient ischaemic attacks, with their grafts remaining patent. A further three patients had developed thrombosis of the graft, with restenosis of the anastomosis zone being revealed in four patients more. All complications were symptom-free. The obtained findings showed that, taking into consideration the remote results and in certain indications, prosthetic repair of carotid arteries is an efficient method of treatment for atherosclerotic lesions of the ICA and in this relation is at least not inferior to the conventional techniques of carotid endarterectomy.

Carotid artery grafting for restenosis after carotid endarterectomy.

The paper analyzes outcomes of 12 internal carotid artery (ICA) graftings for repeat stenosis after carotid endarterectomy (CEA) in 11 patients. In 6 cases restenosis occurred after eversion CEA, in 5 - after conventional patch CEA, and in 1 case - after ICA patch angioplasty for post-CEA restenosis. Critical restenosis >75% in reconstruction area was an indication for surgical intervention. There was 1 case of graft thrombosis in early postoperative period with hemispherical stroke and lethal outcome. Eight patients were examined in late postoperative period. Mean follow-up was 34?+/-?8.44 months (from 16 to 48 months). No cerebrovascular disturbances in operated ICA feeding area were detected. In 6 patients graft patency was good, while 2 smoking patients with diabetes mellitus and hyperlipidemia demonstrated repeat restenosis of proximal anastomosis >70%.

Comparative analysis of carotid endarterectomy late outcomes related to intervention modality.

The paper presents a comparative analysis of late outcomes after 105 carotid endarterectomies (CEA) performed in 89 patients from 1997 to 2003, including 95 patients (90.5%) operated for atherosclerotic stenosis of internal carotid artery (ICA) and 7 patients (6.6%)--for combined ICA stenosis and tortuosity. The severity distribution of cerebrovascular insufficiency (CVI) was the following: grade I--in 22.8%, grade II--in 12.4%, grade III--in 25.7% and grade IV--in 38.1% of patients. CEA methods included eversion endarterectomy in 50.4% cases and open (classic) surgical CEA with PTFE patch angioplasty in 49.6% cases. Mean follow-up period was 31.8 months for the eversion CEA group and 37 months--for the open CEA group (from 3 to 72 months). In 76.4% patients the duration of follow-up period exceeded 1 year. During the follow-up period all patients underwent clinical examination and color duplex scanning of reconstructed CA segment with assessment of diameter, vascular wall thickness and blood flow. TIA was registered in 1 patient from eversion CEA group and in 1 patient from open CEA group. Thus, in the long-term postoperative period 98% of patients were free from neurological complications. Hemodynamically significant restenoses developed in 8 cases (7.6%), including 4 patients from the eversion CEA group and 4 patients from the open CEA group. Myointimal hyperplasia (> 3 mm) accompanied by hemodynamical alterations occurred in 1 patient from the eversion CEA group and in 2 from the open CEA group. In the rest of cases restenoses were related to atherosclerotic plaque formation. In conclusion, the long-term outcomes indicate that CEA is effective in the prevention of cerebrovascular events regardless of carotid angioplasty strategy. The rate of late postoperative restenoses was similar for eversion and open CEAs. Both modalities can be promising for the surgical correction of CA stenoses.

Carotid thromboses in the early postoperative period after carotid endarterectomy.

The paper analyzes 10 cases of internal carotid artery (ICA) thrombosis, which occurred after 635 carotid endarterectomies (CEA), carried out from January 1997 to July 2004. CEA procedures included 346 (54.5%) open CEAs with PTFE patch angioplasty and 289 (45.5%) eversion CEAs. Patients with thromboses in the reconstructed area (n=10) had the profiles of comorbidities and cerebrovascular insufficiency grade similar to the total CEA group (p>0.1). Differences concerned the higher rate of atrial fibrillation cases (10%), diabetes mellitus (30%) and contralateral ICA occlusions (20%) in the group of thromboses (p>0.1). Among these 10 patients, 5 underwent eversion CEA (1.44% of the total eversion CEA group) and 5 - open CEA with patch angioplasty (1.73%). In 8 patients thromboses manifested as local neurological symptoms in the area supplied by the operated carotid artery. One patient demonstrated the progression of general cerebral symptomatology, while in the tenth patient thrombosis was accompanied with cerebral coma. Urgent ultrasonography in 7 patients failed to detect a blood flow in ICA, that proved the diagnosis of ICA thrombosis; in 3 patients ultrasonography showed a mural thrombosis. Nine patients underwent reoperation in emergency, while for the tenth patient an intervention was contraindicated due to the thrombosis of middle cerebral artery, unstable clinical state (cerebral coma) and progression of neurological symptomatology. PTFE arterial graft was implantedin 7 reoperated patients with ICA thrombosis, thrombectomy from ICA was carried out in 1 patient and in another one patient a thrombectomy from reconstructed segment with PTFE patch angioplasty of the arteriotomy defect was fulfilled. In 3 reoperated patients a complete resolution of neurological symptoms was evident 24 hours after intervention, in 2 patients neurological symptomatology regressed over 2-4 weeks. In another 3 reoperated patients local neurological symptoms persisted; 1 patient demonstrated postoperative progression of neurological symptomatology and coma with fatal outcome. The last patient, for whom a reoperation was contraindicated, died due to aggravation of cerebral coma. Dynamic follow-up in early postoperative period after CEA, especially in the first 6 hours, as well as an urgent duplex scanning of the reconstructed area in case of neurological symptoms development, provides timely diagnosis of postoperative thrombosis and the success of reoperations. Adjustments to patient's cardiac status and appropriate intraoperative heparinization can decrease the risk of this complication. An urgent reoperation aimed at the restoration of carotid blood flow, immediately after the diagnosis of thrombosis (provided the absence of deep coma), promotes a complete or partial regression of neurological symptoms and helps to prevent a progression of cerebrovascular disturbances.

A comparative study of the long-term results of open operations and endovascular interventions for atherosclerotic stenoses of the brachiocephalic trunk.

AIM: Our aim was to carry out a retrospective comparison of the long-term results of open and endovascular interventions for atherosclerotic stenoses of the brachiocephalic trunk (BCT). MATERIAL AND METHODS: Forty-five patients with BCT stenoses underwent 18 consecutive intrathoracic reconstructions and 27 balloon angioplasties. The long-term results of open interventions were followed up for a mean of 70+/-17 months (up to 169 months maximally). The long-term results of balloon angioplasties were followed up for a mean of 68+/-8 months (up to 117 months maximally). In a subgroup of patients who underwent intrathoracic operations, we studied the destiny of 12 (71%) of the 17 patients whereas in a subgroup provided dilatations, we examined the destiny of 18 (75%) of the 24 patients. RESULTS: Graft patency was preserved in 92% of patients, that of the dilated arteries in 94%. The clinical effect of surgery in the subgroups provided open reconstructions and endovascular interventions persisted in 83% and 89% of patients respectively, the incidence of strokes in the long-term period was 8% and 6%, the lethality reached 25% and 17%. CONCLUSION: Endovascular intervention is the method of choice in the treatment for atherosclerotic lesions of the BCT without injury to its bifurcation.

The short-term results of internal carotid reconstructions by absorbable suture material.

Analysis was made of the results of 11 internal carotid reconstructions using polydioxanone (PDS) sutures 6 months after intervention performed in 10 patients. All operations on the carotid bifurcation were accomplished using 5/0 PDS continuous suture. Nine eversion carotid endarterectomies and 2 internal carotid reconstructions were performed for Kinkiking. There were no neurologic complications, thromboses, bleedings or repeated operations after interventions on the brachiocephalic arteries. Six months later the patients were examined under ambulatory conditions and were provided color duplex scanning (CDS) of the reconstructed area. Measurements were made of the diameter of the common carotid artery (CCA) right beneath the anastomosis between the CCA and the internal carotid artery (ICA), of the maximal diameter of the anastomosis between the CCA and the ICA, and of the size of the proximal ICA segment right the anastomosis. During the 6-month period following surgical intervention, all 10 patients did not demonstrate any ischemic attacks (TIA) or strokes. No cases of anastomotic aneurysms were recorded. After 9 reconstructions no ICA restenoses were marked. In one case, restenosis accounted for 40% because of atherosclerosis progression and after one operation there developed asymptomatic thrombosis of the ICA. The study has demonstrated that the use of PBS absorbable suture for autoarterial ICA reconstruction provides for anastomosis integrity minimally over the period as long as 6 months.

What influences the standards of "quality" of carotid endarterectomy?

This paper analyzes the short-term results of 463 consecutive primary reconstructive operations on the carotid bifurcation based on the standards of "quality". In 383 (82.7%) cases, the patients were operated on for stenosis of the internal carotid artery (ICA); 60 (13%) patients had combination of stenosis and kingking of the ICA and 20 (4.3%) presented with isolated kinking of the ICA. Classic open carotid endarterectomy (CEAE) was performed in 240 cases, eversion CEAE in 144, resection with ICA redressment in 45, and ICA grafting in 28 cases. The perioperative lethality accounted for 1.54% (7 cases), per 463 operations, with the standard of "quality" being equal to 2%. Myocardial infarction was the cause of death in 5 cases, one patient developed homolateral stroke which eventuated in lethal outcome, and one more patient developed lethal stroke in the contralateral hemisphere. The incidence of homolateral strokes which did not eventuate in lethal outcome accounted for 1.94% (9 cases). The indicator "stroke plus lethality from stroke" in the general patient group was 2.38% which is even lower versus the standard of "quality" for asymptomatic patients and constitutes 3%. Among asymptomatic patients proper, the indicator "stroke plus lethality from stroke" was equal to 0, among TIA patients to 0 at a 5% standard, and in patients with initial stroke, initial stroke, it amounted to 3.19% at a 7% standard. Perioperative strokes were not recorded in patients with ICA kingking or at ICA grafting. The basic factor of the risk of perioperative neurologic deficit was a history of stroke. Patients with different stages of cerebrovascular insufficiency did not significantly differ as regards age, sex distribution, the presence of CAD, arterial hypertension, diabetes mellitus, the degree of stenosis of the operated ICA and the time of its clamping at operation. Patients with a history of strokes differed significantly from the general group only in the incidence of lesion of the contralateral ICA and in the frequency of the use of internal shunt. Analysis of the risk factors of perioperative stroke in patients with a history of strokes has shown that they were diabetes mellitus and the use of internal shunt. The development of perioperative stroke among patients with a history of stroke was not influenced by the incidence of contralateral ICA lesion, the standing of cerebral circulatory distress or the size of an ischemic focus. The initial character of ICA lesion and the type of reconstruction did not affect the origin of perioperative focal deficits or lethality.