[PRP-therapy and regular physical load in complex treatment of patients with distal form of arterial occlusion].

In a structure of the cardio-vascular system diseases in Ukraine the part of chronical ischemia of the lower extremities tissues constitutes more than 20%. Due to diffuse affection of the distal parts of arterial bed it is impossible to succeed in performance of a direct" revascularization in 40% of patients. In 60-87% of such patients a severe ischemia of the lower extremities tissues occurs, causing the necessity of their high amputation performance on the hip level. The results of surgical treatment of 36 patients, suffering inoperable types of the peripheral arteries occlusion were analyzed. In 18 patients the algorithm of intraoperative ultrasound duplex scanning was applied, surgical interventions were performed using optimized procedures. As a second stage the PRP-therapy was conducted, since the second post-operative day all the patients have had performed the elaborated complex of physical exercises, directed on the shin and hip muscles strengthening. Optimization of the lower extremities indirect revascularization methods have permitted to increase the rate of the treatment positive results from 55.6 to 88.9%, to reduce the unsatisfactory results rate--from 44.4 to 11.1%. The PRP-therapy and complex of regular physical exercises conduction have promoted the VEGF content enhancement in the blood serum by 15.6%. malleolar-brachial index--by 28.9% in the patients, suffering occlusion of femoro-popliteo-tibial segment. PRP-concentrate constitutes a potent cell biological activator of the VEGF, improves metabolism and microcirculation in muscles and cells of the skin.

[Surgical treatment of the brain ischemic disease].

There were examined 825 patients, in whom affection of extracranial arteries was revealed, including 340 (41.2%) men and 485 (58.8%) women, 27 to 73 years old. Atherosclerotic stenosis and occlusion of extracranial arteries was diagnosed in 305 (40.0%), pathologic kinking of vessels on atherosclerosis and hypertonic disease background--in 196 (23.8%), pathological kinking, caused by aortoarteriitis and fibrose--muscular displasia--in 197 (23.9%), hypoplasia of arteries--in 54 (6.5%), aortoarteriitis--in 73 (8.8%) patients. Stages I-IV ischemia together with proven affection of extracranial arteries served as indication for surgical treatment of chronic cerebro-vascular insufficiency. Depending on character of the arteries affection 11 kinds of operative interventions were conducted, using complex intraoperative program of the brain defense. Total number of reconstructive operations performed was 967. In 752 (91.2%) patients immediate good and satisfactory results were noted. In the late period 450 patients were examined: good results were achieved in 64.9%, satisfactory--in 22%, in 30 (6.7%) improvement did not occur and 28 (6.2%) died. Introduction of the proposed complex examination and surgical treatment program have permitted to improve the results of treatment of the patients, suffering chronic brain ischemia.

[Surgical infection in reconstructive vascular surgery]. / Khirurgicheskaia infektsiia v rekonstruktivnoi angiokhirurgii.

There were analyzed the results of treatment of 1514 patients, to whom different reconstructive operations on vessels were performed. In 88 (5.8%) of them infectious-inflammatory complications occurred. Three groups of complications were assigned: superficial (in 43.2% observations), deep (in 44.3%) and common infectious (in 12.5%). To all the patients treatment was conducted, in 93.2% of observations positive result was noted, mortality had constituted 2.3%, amputation of lower extremity was performed in 4.5% of patients. There were assigned predisposing factors for the infectious complications occurrence. Complex of curative and prophylactic measures for application in reconstructive vascular surgery was elaborated.

[The use of greater omentum in revascularization of ischemia-affected organs]. / Ispol'zovanie bol'shogo sal'nika v revaskuliarizatsii ishemizirovannykh organov.

Anatomo--morphological peculiarities of greater omentum (GO) in 63 patients, in whom its flap was applied for revascularization of ischemized tissues of extremities, myocardium and the brain, were studied up. Microsurgical transplantation of the GO free flap was performed in 41 patient, omentocardiopexy without the break of the GO vascular pedicle--in 22. Possibilities of the GO application for the ischemized organs revascularization were estimated.

[Estimation of the cerebral hemodynamics in patients with pathological kinking of arteries originated from the aortal arch according to angiography]. / Otsenka sostoianiia tserebral'noi gemodinamiki u bol'nykh s patologicheskoi izvitost'iu arterii, iskhodiashchikh iz dugi aorty, po dannym angiografii.

The state of cerebral blood flow was studied in 81 patients with chronic disorder of cerebral blood circulation using angiographic investigation. Various kinds of pathological kinking of the vessels, originated from the aortic arch, the reducing of their contrasting, the lowering of the blood flow velocity were disclosed. Enhancement of the capacity reserve of vascular channel while conducting the probe with sodium nitroprusside more than by 10% gave evidence about possibility of the blood flow restoration after reconstruction of the affected artery.

[Surgical treatment of symptomatic arterial hypertension]. / Khirurgicheskoe lechenie simptomaticheskoi arterial'noi hipertenzii.

During ten years 57 patients with symptomatic arterial hypertension were examined. The suprarenal gland disease was diagnosed in 31 patient, the renal arteries disease--in 16, the thoracic aorta coarctation--in 10; 35 patients were operated on. The radical intervention conduction have promoted the arterial pressure normalization in early postoperative period.

[The choice of the surgical procedure in treating a chronic disorder of the arterial blood supply to the brain]. / Vybor khirurgicheskoi taktiki pri lechenii khronicheskogo narusheniia arterial'nogo krovosnabzheniia golovnogo mozga.

Results of surgical treatment of 336 patients with chronic disorder of the brain arterial blood supply were summarized. Surgical tactics provided for maximum brain revascularization by means of simultaneous intervention on two-three arteries. Technical aspects of operative procedures elaborated in clinic are presented. Late follow-up results noted were good in 60.1% and fair--in 25.7%.

[The effect of ticlid on the late result after the surgery of the brachiocephalic trunk arteries]. / Vliianie tiklida na otdalennyi rezul'tat posle vypolneniia operatsii na arteriiakh plechegolovnogo stvola.

No ischemic insult, myocardial infarction, death due to cardiovascular pathology was observed in 138 patients, to whom after the operation on the arteries of truncus brachiocephalicus the ticlid was administered. At a comparison group (120 patients) in 3 the myocardial infarction have occurred (one patient died), in 2--an ischemic insult. After the ticlid application the positive late follow-up result was noted in 93.1% patients, without it--in 70.5%. The preparation compliance is good.

[Reconstructive surgery in atherosclerosis of the femoral-popliteal- tibial segment]. / Rekonstruktivnye operatsii pri ateroskleroticheskom porazhenii bedrenno-podkolenno-bertsovogo segmenta.

Results of surgical treatment of 368 patients with atherosclerotic occlusions of popliteal-tibial segment are analyzed. The operation method choice was based on classification, discerning five types of lesion: I type--isolated a. femoris superficialis (AFS) occlusion; II type--AFS occlusion, a. femoris profunda stenosis; III type--extended occlusions of superficial, popliteal, deep arteries and shin arteries; IV type--the lesion of distal part of a. femoris communis and a. poplitea; V type--the popliteal artery occlusion with the process transient on shin arteries.

[Surgical treatment of patients with pathologic flexure of the extracranial cerebral arteries]. / Khirurgicheskoe lechenie bolnykh s patologicheskoi izvitostíu ékstrakranialnykh arterii golovnogo mozga.

The results of surgical treatment of 112 patients with pathologic tortuosity of the extracranial cerebral arteries have been analysed. Indications and choice of a method for operative intervention are substantiated. Arterial torsion and loop formation were the most severe types of deformity, which often caused impairement in the cerebral circulation.

[The potentials of angiographic studies in the diagnosis of cardiovascular diseases]. / Vozmozhnosti angiograficheskikh issledovanii v diagnostike serdechno-sosuditsykh zabolevanii.

Studies of the cardiovascular system in 1150 patients were performed by means of angiographic complex of the firm "Thompson" (USA) equipped with a computer "DG-300" (USA). The morphofunctional characteristics of circulation--capacity of vascular bed, elasticity of a vessel, degree of its stenosis, time of circulation and perfusion were studied. Four (0.3%) patients developed complications: 2--bleeding from the femoral artery, 2--cardiac arrest during coronarography.

[The choice of a method of treating chronic disorders of the cerebrovascular circulation]. / Vybor metoda khirurgicheskogo lecheniia khronicheskogo narusheniia mozgovogo krovoobrashcheniia.

The results of surgical treatment of 106 patients with occlusive lesions of the brachiocephalic trunk vessels have been analysed. A necessity of reorientation of the conservative approach to the treatment of patients in favour of surgical angioneurology is stressed.

[Surgical treatment of circulatory disorders in the upper extremities]. / Khirurgicheskoe lechenie narushenii krovoobrashcheniia v verkhnikh konechnostiakh.

The authors operated on for circulatory disturbances in the upper extremities 216 patients. Differential approach to the choice of a method for surgical correction permitted to achieve excellent and good results in 89% of them.

[Cross femorofemoral shunting in atherosclerotic lesions of the artery]. / Perekrestnoe bedrenno-bedrennoe shuntirovanie pri ateroskleroticheskom porazhenii arterii.

The authors analyse the angiographic and functional data in 41 patients who were subjected to cross femoral-femoral shunting. Five groups of patients were set apart with a more or less probable risk of the development of the steal syndrome depending on the variants of the affection of the "donor" limb channel. Measures for the prevention of the steal syndrome were developed. Additional reconstruction of the "donor" limb arteries and dilatation of the iliac artery improve circulation in the "donor limb", which makes it possible to undertake cross femoral-femoral shunting in patients with a high risk of aorto-femoral reconstruction in atherosclerotic affection of the "donor" limb.