[Endoprosthetic repair of iliac artery aneurysm with a branch of the Anaconda stent graft]. / Éndoprotezirovanie anevrizmy podvzdoshnoi arterii branshei ot stent-grafta Anaconda.

An iliac artery aneurysm is characterized by arterial lumen dilatation which is more than 1.5 times greater than the normal diameter of the artery. In clinical practice, this pathology is rarely encountered, being associated with arterial hypertension and smoking, and more often observed in men. Its natural course inevitably leads to aneurysmal rupture. Treatment is only operative. Is admissible to use both open and endovascular techniques, with preference given to endovascular interventions using special linear endografts. Presented herein are two clinical case reports concerning endoprosthetic repair of an iliac artery aneurysm with a branch of the bifurcated stent graft Terumo Aortic Anaconda. The operative interventions had no complications in either peri- or postoperative periods. Our experience shows that endoprosthetic repair of an isolated aneurysm of the common iliac artery with a branch of the bifurcated stent graft Terumo Aortic Anaconda combines safety and efficacy and may be used by a wide range of vascular and roentgenoendovascular surgeons.

[Peculiarities of diagnosis and emergency surgical care in aorto-oesophageal fistula]. / Osobennosti diagnostiki i neotlozhnoi khirurgicheskoi pomoshchi pri aorto-pishchevodnom svishche.

An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.

[Choice of optimal treatment policy in patients with descending aortic dissection]. / Vybor optimal'noi taktiki lecheniia patsientov s rassloeniem niskhodiashchei aorty.

Contemporary approaches to treatment of patients with dissection of the descending aorta (DA), as well as the data of international registries and guidelines are contradictory. The endovascular method of treatment of patients with descending aortic dissection has been recognized to be revolutionary. However, there seems to be no commonly accepted concept concerning appropriate use of currently available techniques of treating patients with DA dissection. This study was aimed at analysing the experience gained in using various methods of treatment of patients with descending aortic dissection (DAD). We retrospectively examined the results of surgical treatment of 78 patients with DAD. Of these, 45 patients were found to have Stanford type B dissection and 33 patients had type A dissection, who underwent treatment during ten years from January 2008. The decision concerning the type of care for patients with DAD (conservative, surgical, endovascular or combined methods of treatment) directly depends on the patient's state stability, technical feasibility of the intended procedure, and the presence of concomitant pathology. The findings obtained in our study demonstrated better immediate outcomes of the endovascular approach compared with the hybrid and surgical ones. In order to achieve complete haemodynamic correction of the pathology, to minimize the risk of aortic remodelling and the development of aorta-related complications, the treatment should not be limited to endoprosthetic repair of the thoracic portion of the DA with a stent graft, but should rather be supplemented with stenting of more distal segments, including with uncoated stents at the level of the visceral branches. Only such staged approach may provide better conditions for obliteration of the aortic false lumen and formation of a 'neo-frame' of the aortic wall.

[Role of multislice computed tomography in the diagnosis of acute rupture of the thoracic aorta and hepatic artery in a patient with severe concomitant injury].

Acute traumatic aortic rupture is associated with extremely high mortality rates and requires emergency diagnosis and treatment. This clinical example shows the role of multislice spiral computed tomography in the emergency diagnosis of rupture of two large arterial vessels in severe concomitant injury. It presents the benefits of this rapid and noninvasive imaging technique, an algorithm of the study and the semiotics of injuries in patients with suspected traumatic aortic rupture. The paper also shows the importance of this method in defining treatment policy and then in the assessment of the results of the performed correction.

[Diagnostics and treatment of abdominal injuries with retroperitoneal organs involvement].

The results of treatment of 66 patients with non-gunshot abdominal injuries, involving retroperitoneal organs, are described. Preoperative clinical and ultrasound investigations are not accurate enough to diagnose retroperitoneal lesions, which were diagnosed intraoperatively in 57,6% of patients. In 97% retroperitoneal haematoma was located 2-10 sm from the posterior parietal peritoneum. In case of aorta injury, postcava or renal injury grade IV, retroperitoneal haematoma is large and bulging, though absence of these signgns does not exclude serious injuries of retroperitoneal organs and structures. Retroperitoneal cavity revision by the dissection of the wound canal can provoke further bleeding, so it should be performed only after visualization and cross-clamping the afferent vessel.

[Traumatic hemobilia].

Authors describe experience of diagnosis and treatment of hemobilia at 10 of 743 patients with trauma of liver. At 7 patients hemobilia was due to closed trauma, and at 3--due to injuries. For diagnosis of hemobilia the USE, Doppler examination of hepatic vessels, esophagogastroduodenoscopy, selective angiography of liver were used. Selective embolization was effective at 7 of 8 patients. Hemobilia has been cured conservatively at 2 patients. Two patients died. It is concluded that complex examination including dopplerography of hepatic liver, esophagogastroduodenoscopy, selective angiography is necessary for diagnosis of traumatic hemobilia. Traumatic hemobilia must be suspected at patients with symptoms of gastrointestinal bleeding in postoperative (posttraumatic) period, and diagnosis of other sources of bleeding does not exclude hemobilia. Selective angiography and embolization of afferent arterial branch is the most effective and safe method of traumatic hemobilia treatment.