[Bypass grafting in patients with infected vascular grafts]. / Obkhodnoe shuntirovanie pri infitsirovanii sosudistogo proteza.

Analysed herein are the results of treating a total of 17 patients presenting with pathology of the aorta and lower-limb arteries, who from 2010 to 2018 required redo interventions due to infection of a previously implanted synthetic vascular graft. At admission, 3 patients were diagnosed as having an open infected wound, 11 were found to have a fistula, 2 had a false aneurysm in the area of the distal anastomosis of the branch of the bifurcation aortofemoral prosthesis, and 1 had thrombosis of the branch of the prosthesis with evidence of infection. As redo surgery, 4 patients underwent subclavian-femoral bypass grafting, 2 were subjected to crossover iliac-femoral bypass grafting, 8 to unilateral iliac-femoral bypass grafting, 3 to loop endarterectomy. In the majority of cases (14 of the 17) we used bypass grafting with creation of the tunnel through the muscular lacuna. Lethal outcomes were registered in 35% (n=6) of cases in the early postoperative period. Death was caused by acute renal failure in 6% (n=1), by acute mesenteric thrombosis in 12% (n=2), by gastrointestinal haemorrhage in 6% (n=1), and by multiple organ failure in 12% (n=2). Long-term mortality amounted to 33% (n=3) within 12 months. The main causes of death were increasing renal failure in 10% (n=1) and cardiovascular insufficiency on the background of heart diseases in 10% (n=1), as well as respiratory insufficiency in 10% (n=1). Reinfection in the remote period was diagnosed in 1 patient. A conclusion was drawn that bypass grafting is traumatic, however, it may be the only way to save the limb or patient's life in a complicated clinical situation. Using the superficial femoral vein as a shunt demonstrated good long-term results as to patency and resistance to surgical infection. Using a flap of the greater omentum, retroperitoneal fat, as well as wrapping of the prosthesis with a muscular flap ensured good tolerance of the zone of bypass grafting to reinfection.

[Antithrombotic therapy in patients with peripheral artery diseases]. / Antitromboticheskaia terapiia u bol'nykh s zabolevaniiami perifericheskikh arterii.

Complications of cardiovascular diseases whose substrate is atherothrombosis continue to occupy leading positions in the structure of mortality worldwide. Peripheral artery diseases (PAD), in particular, are characterized by an especially unfavourable life prognosis for patients with cardiovascular diseases. In order to decrease the risks of ischaemic complications in patients with PAD, various approaches to antithrombotic therapy have over the last two decades been studied, with the resulting standard of therapy continuing to be acetylsalicylic acid. Even more difficult today is the task of selecting antithrombotic therapy in patients having endured revascularization.

[Esophagoplasty in non-standard situations: an analysis of 130 observations].

An experience with 130 esophagoplastics in non-standard situations has been analyzed. In all patients there was defectiveness of one or several organs--potential donors, in 48 observations the operation being repeated. Decision on the plastic material had to be individual and required systematized approach: in 87 patients the jejunum was used, in 26 patients--stomach, in 9--colon and in 8--ileum. In 69 cases plasty was followed by surgical reconstruction and different variants of revascularization of the shifted or free intestinal transplant with using microsurgical technique. The transplant was located in the posterior mediastinum (56), antethoracally (40), retrosternally (23) or on the neck (11). Complete clinical effect was obtained in 125 patients (96.1%), plasty was not completed in 2 (1.6%), 3 patients died (2.3%). The authors are discussing the ways of achieving and conditions of success of plasty of the esophagus in non-standard situations.

Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication.

PURPOSE: We tested the hypothesis that propionyl-L-carnitine would improve peak walking time in patients with claudication. Secondary aims of the study were to evaluate the effects of propionyl-L-carnitine on claudication onset time, functional status, and safety. SUBJECTS AND METHODS: In this double-blind, randomized, placebo-controlled trial, 155 patients with disabling claudication from the United States (n = 72) or Russia (n = 83) received either placebo or propionyl-L-carnitine (2g/day orally) for 6 months. Subjects were evaluated at baseline and 3 and 6 months after randomization with a graded treadmill protocol at a constant speed of 2 miles per hour, beginning at 0% grade, with increments in the grade of 2% every 2 minutes until maximal symptoms of claudication forced cessation of exercise. Questionnaires were used to determine changes in functional status. RESULTS: At baseline, peak walking time was 331 +/- 171 seconds in the placebo group and 331 +/- 187 seconds in the propionyl-L-carnitine group. After 6 months of treatment, subjects randomly assigned to propionyl-L-carnitine increased their peak walking time by 162 +/- 222 seconds (a 54% increase) as compared with an improvement of 75 +/- 191 seconds (a 25% increase) for those on placebo (P <0.001). Similar improvements were observed for claudication onset time. Propionyl-L-carnitine treatment significantly improved walking distance and walking speed (by the Walking Impairment Questionnaire), and enhanced physical role functioning, reduced bodily pain, and resulted in a better health transition score (by the Medical Outcome Study SF-36 Questionnaire). The incidence of adverse events and study discontinuations were similar in the two treatment groups. CONCLUSIONS: Propionyl-L-carnitine safely improved treadmill exercise performance and enhanced functional status in patients with claudication.

[The surgical treatment of aneurysms of the abdominal aorta]. / Khirurgicheskoe lechenie anevrizm briushnoi aorty.

Based on an experience with treatment of 107 patients with aneurysms of the abdominal aorta subjected to planned or urgent operations the authors discuss the problems of the clinical course, diagnosis, indications for operative treatment, the technique of operative interventions and their results. In planned operations lethality was 4.1%, in ruptures of the aneurysm-64.2%. One year after the operations 90% of the patients were practically healthy, 5 years later they were 70%.

Microvascular reconstruction of the esophagus with pedicled small intestine.

A modified procedure for total reconstruction of the esophagus with small intestinal transfer is suggested. It includes reconstruction of marginal and lymphatic vessels of its mesentery using microsurgical technique. With application of the modified procedure, the transplant may be longer, its loops may be straightened and better vascularized, and lymphatic drainage of the intestine may be preserved.

Long-term follow-up of hand function after digit replantation.

A long-term follow-up study of 26 patients with 28 replanted digits was performed with respect to circulatory, sensory, and motor function. Peripheral circulation in the replanted digits was comparable with corresponding uninjured digits on the opposite hand. Excellent sensory recovery was observed in the territories supplied by 30 of the 36 repaired digital nerves. Best functional results were noted with the thumb and with fingers amputated through the middle phalanx. By objective criteria, 21 of the 28 replanted digits demonstrated satisfactory function. Subjectively, however, only 1 patient was dissatisfied with the outcome.

[Restoration of the reproductive function in women with tubal infertility by the method of plastic microsurgery of the fallopian tubes]. / Vosstanovlenie reproduktivnoi funktsii u zhenshchin s trubnym besplodiem metodom mikrokhirurgicheskoi plastiki matochnykh trub.

The authors considered the scope for using plastic microsurgical techniques in the reconstructive surgery of uterine tubes in females with tubal infertility. Analysis of 51 surgical outcomes demonstrated the correlation between the results of the treatment and the adequate selection of patients, operating technique and the extent of postsurgical rehabilitation measures.

[Surgical tactics in post-mastectomy edema of the arm]. / Khirurgicheskaia taktika pri postmastéktomicheskom oteke konechnosti.

Based on examinations and treatment of 210 patients with postmastectomy edema of the extremity (with operations made on 75 of them) the authors have developed a clinico-surgical classification of the postmastectomy edema with special reference to the character of morphologic alterations of soft tissues which determinates tactics of treatment and choice of surgical methods (LVA, phlebolysis of the subclavian vein, RRO or their combination in different succession). Phlebographic and tonometric examinations are shown to be necessary, their findings being compared for the establishment of indications for phlebolysis for stenosis of the vein resulting from X-ray therapy and long stump of the musculus pectoralis minor in radical mastectomy after Holsted.

[Vascular prosthesis made of polyester threads for microsurgery]. / Protez krovenosnogo sosuda iz poliefirnykh nitei dlia mikroangiokhirurgiiu.

The results of experimental and medical application of worked out by the authors synthetic microvascular prosthesis with the internal diameter from 1 to 3 mm. The prostheses were implanted to the abdominal aorta and to the tail vein of rats and also to femoral and carotid arteries of cats for a period of 1 till 15 months. The angiographic and morphologic experiments of blood flow were carried out. The patency of the microprosthesis in the experiments was to 92.7%. The micro-implant adaptation was characterized by complete tissue isolation of a synthetic skeleton with formation of thin and even internal membrane covered with endothelium layer. In fact the possibility of arterial and venous prostheses having a 1-2 mm diameter with synthetic substitutional textile products creates new possibilities for the further development of the microvascular surgery. The microvascular prosthesis was applied to 10 patients in plastic surgery of small circumferential arteries of limbs achieving positive results.

[A Soviet-made blood vessel bioprosthesis and its clinical use]. / Otechestvennyi bioprotez krovenoshogo sosuda i ego primenenie v klinike.

The authors describe their experience with the using of Soviet made bioprosthesis of blood vessels made of skeleted conserved vein of the human umbilical vein showing its high effectiveness and positive properties such as: high thromboresistent properties of the bioprosthesis and its firmness, the absence of reaction of rejection and pronounced inflammatory reactions of the recipient organism to bioprosthesis, high possibility of the bioprosthesis in remote periods, its fitness for plasty of average diameter arteries.

Soviet-made vascular prostheses.

The authors present some facts concerning the history of developing synthetic vascular prostheses in the Soviet Union, the data pertinent to the Soviet and some foreign models of synthetic vascular grafts, dwell on their characteristics. The authors discuss further possible modifications of vascular prosthesis. The vascular prosthesis is considered as an artificial false aneurysm within a synthetic frame, in this connection they discuss favourable possibilities of application of vascular grafts in arterial injuries and its consequences. The authors also provide information on some new types of vascular prostheses, velour and rough ones in particular, as well as microprosthesis.

[Treatment of postmastectomy edema of the upper extremity using microsurgical technics]. / Lechenie postmastéktomicheskogo oteka verkhnei konechnosti s ispol'zovaniem mikrokhirurgicheskoi tekhniki.

Reconstructive microsurgery carried out in 25 cases of postmastectomy edema of the upper extremity proved to be the most effective and safest in treatment of the said complication. The procedure should be supplemented with phlebolysis of the subclavicular vein (when occlusion of the latter exceeds 50%) or with resection of dermatofascial flap of the brachial area (fibrous stage of lymphostasis). Sequence of stages and the results of the surgical treatment are discussed.

[Long-term results of emergency microsurgery operations in severe injuries and amputations of large segments of the upper limbs]. / Otdalennye rezul'taty ékstrennykh mikrokhirurgicheskikh operatsii po povodu tiazhelykh povrezhdenii i otchleneniia krupnykh segmentov verkhnei konechnosti.

Under study were blood circulation, innervation and functions of distal parts of upper arms in 114 patients operated upon for traumatic abjunction and severe injuries of large segments. The state of blood circulation was found to be satisfactory within the terms of from 4 to 27 months. The degree of the extremity reinnervation was dependent on the level of the nerve injury and when observed longer than a year it was found to repair up to the level of hypesthesia without hyperpathia. The functional results of such operations were noted to depend on the character of trauma, the completeness and quality of repair of damaged nerves and tendons, on adequacy of rehabilitation therapy in the postoperative period.