[Use of stents with bioactive coating in treatment of patients with lesions of the superficial femoral artery]. / Primenenie stentov s bioaktivnym pokrytiem v lechenii bol'nykh s porazheniem poverkhnostnoi bedrennoi arterii.

The authors analysed the immediate outcomes of implanting stents with bioactive coating in treatment of patients presenting with atherosclerotic lesions of the superficial femoral artery. Over the period from January 2014 to December 2015, endovascular interventions on the superficial femoral artery were carried out in a total of 18 patients (mean age 61.3±9.2 years). The implants inserted were stents with bioactive coating based on titanium oxinitride, measuring 6 to 8 mm in diameter and being from 50 to 200 mm long. Prior to operation and 7 days after implantation of the stent, the immunoenzymatic assay was used to determine the level of nitrogen nitric oxide (NO) in blood. The stents' patency was assessed by the findings of ultrasound duplex scanning performed at 30 days, and then 6 and 12 months after the intervention. There were no complications either during the operation or in the early postoperative period. An increase in the ankle-brachial index was observed in all patients: with the average value prior to treatment amounting to 0.4±0.3 and equalling 1.1±0.2 after stenting (p<0.0001). Normalization of the blood NO level was revealed (was noted to normalize): the mean value prior to operation amounted to 18.9±2.3 µmol/L and after operation to 28.9±4.1 µmol/L (p<0.05). Primary patency rate of the stents was 100% at 30 days, 94.5% (1 occlusion) at 6 months and 88.8% (1 restenosis and 1 occlusion) at 12 months. The patients with occlusion or restenosis were subjected to repeat endovascular interventions, with restoration of patency of the construction (with the construction's patency restored). By now all the 18 patients show preserved patency (currently patency was preserved) of lower-limb arteries, with no evidence of restenosis in the zones of operations. It was concluded that using stents with bioactive coating based on titanium oxinitride results in normalization of the level of NO in blood, which may contribute favourably to prolongation of the period of functioning of endovascular constructions. The first data concerning primary patency of stents of this type make it possible to count on betterment of the remote results of treatment of patients presenting with atherosclerotic lesions of the superficial femoral artery.

[ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group.

[WAYS OF IMPROVEMENT OF LOOP ENDARTERECTOMY RESULTS FROM ILIAC-FEMORAL SEGMENT].

The article presents an analysis of treatment results of 91 patients with iliac-femoral segment artery occlusion at the period from 2008 to 2014. Patients were divided into 2 groups: main group (n=30) consisted of patients who undergoing a half-closed loop endarterectomy with following implantation of stent-grafts in this area and control group (n=61) had patients whom were performed routine half-closed loop endarterectomy. The II degree of ischemia of lower extremities was in 88 (96,7%) patients and III degree had 3 (3,3%) patients. The areas of abnormalities of intravascular pattern were detected in 100% of cases in intraoperative angiography. They were modified using stent-grafts. A primary vascular patency was 100% in the first group and it numbered 65% in the second group during 5 years. The intraoperative angiography control with stent-graft implantation to the area of endarterectomy allowed reliable improvement of treatment results.

[Stagewise surgical treatment in type III B chronic aortic dissection].

Presented herein is a clinical case report of successful surgical treatment (open and endovascular operation) of a patient with DeBakey type III B chronic aortic dissection. The diagnosis was verified by contrast-enhanced multispiral computed tomography (MSCT). The first stage consisted in operation of carotid-subclavian bypass grafting and aortomy with dissection of the internal membrane of the abdominal aorta, dividing the false and true channels. The second stage included endovascular prosthetic repair of the thoracic aorta with the Relay stent graft. The course of the postoperative period was uneventful. According to the MSCT findings 2 months after the intervention, the endograft was patent, with neither shift nor endoleack. The false channel along the descending thoracic aorta is thrombosed. The maximal diameter of the abdominal aorta does not exceed 4 cm. According to the findings of duplex scanning, the carotid-subclavian bypass is functioning. The patient's condition is satisfactory.

[Emergency prosthetic repair of a ruptured abdominal aortic aneurysm].

Presented herein is a case report regarding successful endovascular prosthetic repair of an abdominal aortic aneurysm in its retroperitoneal rupture in a 56-year-old male patient treated by implantation of the unilateral stent-graft «Aorfix¼, cross femoro-femoral bypass grafting, and ligation of the contralateral common iliac artery.

[Direct results of endovascular prosthetics of aneurysms of the infrarenal part of the aorta in patients with a severe concomitant pathology].

From May 2007 to March 2009 under observation there were 58 patients aged from 52 to 79 years (mean age 68) with the diagnosis of abdominal aortic aneurysm (AAA). Selection of patients for endoprosthesis was performed by the data of spiral computed aortography. The endovascular exclusion ofAAA from blood flow was performed in 15 patients. All the patients had high risk of surgery because of multiple concomitant pathologies. In 14 (93%) patients bifurcational and in 1 patient aortofemoral unilateral prostheses of AAA were made with the application of femoro-femoral bypass. All implantations were technically successful without complications. Shorter time of operation, less intraoperative blood loss, shorter tine of staying in hospital and time of rehabilitation were found to be 1.5-3 times as compared with classical surgical intervention. Implantation of bifurcational stent-graph seems to be the method of choice in treatment of AAA patients with severe concomitant pathology.

[Role of intrventional radiology in pre- and postoperative periods of liver transplantation].

The purpose of this study was to prove the use of interventional radiological procedures before and after liver transplantation (LT). Between 1998 and 2009 years, 54 LT were performed in 52 patients. 18 patients received 19 interventional radiological treatments including 11 preoperative (trans-catheter oily chemoembolization of hepatocellular carcinoma, n=3; transjugular intrahepatic portosystemic shunting, n=8) and 8 postoperative (drainage or stenting of biliary strictures, n=4; balloon dilatation and/or stenting of inferior vena cava or cava-caval anastomosis, n=3; splenic artery embolization in sleal syndrome, n=1). It is concluded that before LT, trans-catheter embolization delays the growth of hepatoma and prolongs time for donor liver waiting. Transjugular portosystemic shunt decreases the risk of fatal variceal bleeding. Post-LT complications such as vascular or biliary strictures and steal syndrome can be also effectively corrected by methods of interventional radiology.

[Treatment of hepatic malignancies with implantation of a venous port into the portal vein].

The report deals with venous port implantion into the portal vein to conduct both single and continuous courses of regional chemotherapy without recourse to repeat puncture and catheterization of the vein to avoid hemorrhagic complications and arterioportal fistula. Application of repeat courses of intraportal chemotherapy might make use of ultrasound and X-ray equipment to monitor the catheter position in portal vein lumen as well as unauthorized drug consumption unnecessary. Catheterization of the portal vein across the adjacent edge of the liver seals the punctured hole reliably with a U-shaped suture which prevents bleeding into the abdomen and secures the catheter in place.

[Methods of correcting hepatic arterial blood supply for subsequent implantation of the "port-catheter" infusion system].

The study was undertaken to investigate the feasibility of using surgical and roentgenoendovascular redistribution of the hepatic arterial blood flow for adequate implantation of the "port-catheter" infusion system. Between December 2001 and March 2008, we performed surgical (n = 25) or transcutaneous (n = 22) implantations of the infusion systems for carrying out regional chemotherapy in a total of forty-seven patients presenting with hepatic metastases of colorectal carcinoma. Anatomical variants of the hepatic arteries were observed in eleven cases. The blood stream was corrected by means of either transcatheter embolization (n = 7), ligation (n = 2), or transposition (n = 2) of the aberrant arteries. No complications were encountered. In all the cases, the "port-catheter" system was implanted successfully, with adequate hepatic perfusion achieved. Both transcatheter embolization and surgical reconstruction turned out to be efficient methods in correction of the blood flow in various anatomical structures of the hepatic arteries, thus favourably contributing to increased efficacy of regional chemotherapy.

[Modern diagnostic technologies in determination of the strategy of treatment of patients with obliterating atherosclerosis of the lower artery vessels].

The authors analyzed results of surgical treatment of 332 patients in whom 410 reconstructive operations were performed on the lower extremity arteries. During 12 months after operation on the aorto-femoral segment with high peripheral vascular resistance reocclusions were noted in 61% of the cases, with normal resistance--in 11.8%, after operation on the femoro-popliteal segment--in 77.1% and 28.3% respectively. According to the findings of computed tomography and magnetic resonance imaging, densitometry the indices were established allowing prognosis of high peripheral resistance in the lower extremity arteries at the preoperative stage. Such indices are considered to be indications to femoro-profundoplasty on the aortofemoral segments or arterio-venous fistula on the femoro-popliteal segment. Such effectively fulfilled interventions could reduce the frequency of reocclusions to 3.1% on the aorto-femoral segment and to 11.8% on the femoro-popliteal segment.

[Endovascular prosthetic repair of the infrarenal portion of the aorta with the aorfix bifurcated stent graft].

Reconstructive surgery or abdominal aortic aneurysms (AAA) currently remains one of the most complicated and dramatic divisions of the present-day vascular surgery. On the one hand, this is accounted for by the increased prevalence of the disease due to both improved diagnosis and a prolonged life span of the population, and hence more frequent occurrence ofabdominal aortic aneurysms. On the other hand, the conventional surgical treatment is known to be associated with a severe surgical injury and impairments of haemostasis on the background of a wide variety of accompanying diseases in patients who typically appear to be elderly and aged, thus sending us in search of less traumatic and more sparing techniques, with the endovascular aortic prosthetic repair being an encouraging example thereof (1-4). The recent advent of stent grafts has made it possible in the majority of cases to substantially avoid an otherwise inevitably traumatic and prolonged abdominal operation, which is particularly important in elderly and aged patients presenting with a severe concomitant pathology. The authors report herein a clinicalcase of successful endovascular prosthetic reconstruction of the infrarenal portion of the abdominal aortic aneurysm by means of the Aorfix bifurcated stent graft in a 78-year-old female patient.

[Rentgenoendovascular interventions into treatment of patients with unresectable metastases of gastric cancer into the liver].

In the period from 1992 through 2006 transcatheter therapy was carried out in 46 patients with unresectable metastases of gastric cancer (MGC) into the liver. Repeated cycles of chemoinfusions in the hepatic artery (CIHA) with 5-fluorouracil, doxorubicine, mitomicine C and carboplatin were made to 35 patients. Chemioembolization of hepatic arteries (CEHA) using the same cytostatics and oil contrast agent was made toll patients. After CIHA a partial response to treatment and stabilization of the tumor growth was noted in 14 (40%) patients, progressing metastases in 21 (60%) patients. Mean survival period of 32 dead was 14.6 +/- 1.5 month and the indices of 1-, 2- and 3 years survival were 46, 15 and 5 % respectably. After CEHA a partial response and stabilization of the tumor growth were noted in 7 (63%) patients and in the rest 4 patients (37%) there was progressing. The mean survival period of 9 dead patients was 15.5 +/- 3.3 months; the indices of 1-, 2- and 3 years survival were 55, 18 and 10 % respectively (p(CINA-CEHA) > 0.01). The methods of interventional radiology are thought to be perspective for treatment of unresectable metastases into the liver.

[Transcatheter treatment of liver metastases from breast cancer].

Transcatheter treatment for liver metastases from breast cancer was given to 55 patients (1995-2006): hepatic artery infusion (HAI) with 5-fluorouracil, doxorubicin and carboplatin--11; hepatic artery oil chemoembolization (HAOC) with doxorubicin--14; taxotere (Docetaxel)--17; HAI+HAOC--13. Partial response was reported in 18%, stabilization--27%, metastatic progression--55%. Mean survival (MS) of all deceased patients--11.9 +/- 1.5; 1-, 2- and 3-year survival--40, 20 and 0%, respectively. HAOC: partial response and stabilization--42%, progression--58%. As of January 2007, 7 patients survived 8-22 months (mean 14.3 months); 24 deceased had survived 16.8 +/- 3.3 months. HAOC+HAI: complete response--8%, partial--23%; stabilization--44%; progression--25%. Three patients have survived 24, 33 and 82 months; mean survival of 10 deceased--19.9 +/- 4.5 months, their 1-, 2- and 3-year survival was 90, 60 and 20%, respectively.. Mean survival of doxorubicin-treated patients was 18.9 +/- 1.6, taxotere--24.8 +/- 5.1 months (p < 0.05); 1-, 2- and 3-year survival- 57, 29 and 7%, and 88, 35 and 24%, respectively. HAOC+HAI was the most effective while application of taxotere was followed by longest mean survival.

[Cytoreductive surgery with placement of intra-arterial infusion pump for unresectable liver tumors].

The initial results are discussed of treatment protocol for unresectable liver tumors using combinations of cytoreductive surgery (resection and/or radiofrequency ablation (RFA)) and hepatic artery infusion pump (HAIP) placement to be followed by chemotherapy. Out of 14 patients with unresectable liver tumors (2003-2006), 12 were operated on for colorectal metastases, 1 - hepatocellular carcinoma, and 1 metastatic carcinoid. Seven patients received RFA, 4 - resection+RFA+ HAIP, and 3 - resection+ HAIP. All patients were given HAIP postoperatively. No grave complications were reported. Mean follow-up was 14 months (6-38) with an average of 6 chemotherapy cycles (2-12) per patient. At present, 8 patients have survived 6-38 months and continue to receive regional chemotherapy; overall 1- or 2- year survival is 85 and 57%, respectively. Six patients died from tumor progression within 4-21 months.

[Intraarterial chemotherapy using implantable port-catheter system in patients with colorectal liver metastases].

We evaluated the tentative clinical results of port-catheter system implantation in 32 patients (18 males and 14 females) with liver metastases of colorectal cancer (2001-2006). Laparotomic approach was used in 17 and percutaneous transfemoral implantation - in 15 patients. There were no complications nor technical problems. All patients received a total of 160 cycles of infusion chemotherapy, ranging 2-11 (4 on the average); mean follow-up - 241 (57-730) days . At present, 21 patients have survived for 5-28 months. Three of them (14%) report complete response, 13 (62%) - stabilization and 5 (24%) - tumor progression. One-year survival in all patients was in 76.5%. Eleven patients died through tumor progression unrelated to the liver.