[Use of endovascular drug-coated devices in lesions of femoropopliteoltibial arteries]. / Ispol'zovanie éndovaskuliarnykh ustroistv s lekarstvennym pokrytiem pri porazhenii arterii bedrenno-podkolenno-bertsovogo segmenta.

Endovascular intervention is one of the main methods of treatment in atherosclerotic lesions of the infrainguinal segment in patients with chronic lower limb ischaemia. Recent years have witnessed active use of drug-eluting techniques, significantly improving the long-term outcomes of peripheral reconstructions. This article is a review of publications on the results of using modern drug-eluting balloon catheters and stents in the femoropopliteoltibial position. The accumulated data will help solve the main problems of the classic balloon angioplasty, reducing the incidence of restenosis, improving primary patency, and decreasing the need for repeat interventions in the remote period of follow-up.

[Comparison of efficacy of rivaroxaban and warfarin after open operations on the infrainguinal segment]. / Sravnenie éffektivnosti rivaroksabana i varfarina posle otkrytykh operatsii na infraingvinal'nom segmente.

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.

[Results of hybrid loop endarterectomy from the superficial femoral artery with the MultiTASC]. / Rezul'taty gibridnoi petlevoi éndarteréktomii iz poverkhnostnoi bedrennoi arterii petlei MultiTASC.

The purpose of this study was to analyse the results of hybrid loop endarterectomy from the superficial femoral artery (SFA) in its occlusion, preformed in a total of forty-two patients. Of these, 27 patients had prior to the intervention been diagnosed with stage II B ischaemia and 15 patients had been diagnosed as having critical ischaemia. Technical success of the operation amounted to 88%, with the frequency of early thromboses equalling 2.7%. In the early postoperative period, one patient died of acute myocardial infarction. The 1-, 2- and 3-year remote cumulative primary patency rate amounted to 81, 74 and 74%, respectively. There were no amputations performed within the timeframe of the follow-up period. The technique of hybrid loop endarterectomy with the MultiTASC loop followed by stenting of the proximal portion of the popliteal artery in occlusion of the SFA and stenoses of the common femoral artery has proved to be a highly efficient intervention yielding good immediate and remote results.

[Outcomes of hybrid operations in multi storeyed lesions of arteries of the aortoiliac and femoropopliteal segments].

The work was aimed at analysing immediate and remote outcomes of hybrid operations in storey atherosclerotic lesions of the aortoiliac and femoropopliteal segments. Over the period from 1997 to 2012 hybrid operations were performed in a total of 224 patients presenting with multi-storeyed lesions of iliac and lower-limb arteries, classified as TASC A, B, C, and D. The operations were carried out at departments of vascular surgery of Clinical Hospital No 83 of the Federal Biomedical Agency of Russia and the Centre of Cardiovascular and Endovascular Surgery of Clinical Hospital No 119 of the Federal Biomedical Agency of Russia. All operations were simultaneous. The patients were subdivided into groups according to the character of intervention on iliac arteries: 1 - balloon angioplasty of iliac arteries, 2 - stenosing of iliac arteries, 3 - loop endarterectomy from iliac arteries followed by implantation of a covered stent into the zone of rupture of the intimal cylinder. In all cases the interventions of the arteries of the aortoiliac segment were combined with various open surgical reconstructions of the femoropopliteal segment. Technical success amounted to 99.1%. Interventional complications of the endovascular stage requiring conversion occurred in 2 cases. The immediate period complications influencing patency of the reconstructions performed were noted in 10 (4.5%) patients. Patency on the hospital stage with the deduction of cases of technical failures amounted to 98.6%. The remote results were followed up during 5 years in 76.5% of patients. Five-year primary assisted patency of the aortoiliac zone amounted to: in group 1 - 79.2%, in group 2 - 77.9%, and in group 3 - 89.4%. Five-year assisted patency of the femoropopliteal segment amounted to: for EAE of the common femoral artery - 98.2%, for profundoplasty - 100%, femoral proximal popliteal bypass grafting - 77.3%, femoral distal popliteal bypass grafting - 74.1%, femoral-tibial bypass grafting - 61.4%. There were no statistically significant differences in patency of the reconstructions of the femoropopliteal segment depending upon the type of intervention on the aortoiliac segment.

[A hybrid operation for chronic type III B aortic dissection].

Presented herein is a clinical care report of a successful hybrid reconstruction (i.e., an open operation and endovascular intervention) for a chronic type III B aortic aneurysm in the setting of the renal and lower-limb arteries malperfusion syndrome. Of obvious interest are the circumstances of the operation performed in a 36-year-old male patient who was subjected to a simultaneous reconstruction of the supra- and inter-renal portion of the aorta and endovascular treatment for lower-limb chronic ischaemia. A detailed description thereof is followed by a brief review of the literature related to appropriate decision-making regarding the scope of the reconstruction in the pathology involved.

[Simultaneous reconstruction of visceral aortic branches and renal arteries].

The paper presents a case report of simultaneous reconstruction of visceral aortic branches and renal arteries. The case is interesting because of special operative particularities, that occurred in 54-year-old patient who received previously radiotherapy for abdominal lymphogranulomatosis. Follow-up investigation 4 years after vascular intervention has shown that the patient remained in a satisfactory condition. The paper includes brief literature review concerning the strategy of reconstructive volume choice for this disease.

Successful percutaneous endovascular treatment of a ruptured femoral aneurysm.

Popliteal and femoral aneurysms account for about 70% of the incidence of peripheral aneurysms. Only 4% of aneurysms run their course with the clinical evidence of rupture. The ruptured aneurysm is dangerous because of a potential limb loss as well as due to the threat of lethal outcome in patients at a high surgical risk. Presented herein is a successful experience (first in this country) gained with the treatment of a ruptured femoral aneurysm by means of endoprosthetics using a new stent graft with PTFB coating in a patient at a high risk for traditional surgical treatment.

Combined operations for multilevel lesions of the aortoiliac and femoropopliteal segments.

This paper describes the results of the treatment of 53 patients with combined arterial lesions of the iliofemoral and femoro-popliteal segments. Altogether 56 primary one-step operations were performed. The initial success was achieved in 53 (94.6%) cases. The long-term results were followed up in 43 (81.1%) patients, in the long-term period, repeated endovascular interventions were accomplished in 6 (1.8%) patients with re-stenoses of the iliac arteries. The best long-term results were obtained in the groups of patients who had undergone balloon angioplasty and stenting of the iliac arteries.

[Phenotypes of smooth muscle cells in carotid arteries in Takayasu's disease]. / Fenotipy glsadkomyshechnykh kletok v sonnykh arteriiakh pri bolezni Takaiasu.

The phenotype of smooth-muscle cells (SMC) of carotid arteries in health and Takayasu's disease were studied using immunofluorescence. In contrast to unaffected carotid artery, medial SMC were represented by heterogenic cell population. Many SMC in this disease expressed fibronectin with ED-A sequence, contained cytokeratin 8 and were deprived of h-caldesmon. Similar phenotypic characteristics are typical for SMC of embryonal phenotype. SMC with this phenotype are observed in the thickened intima of the carotid arteries in Takayasu's disease. It is supposed that SMC precursors in arterial media are activated in this disease, migrate into subendothelial layer and are responsible for the thickening of the intima.