[Iliac artery reconstruction in patients with chronic critical limb ischemia: endarterectomy or replacement]. / Vybor metoda rekonstruktsii podvzdoshnykh arterii u bol'nykh khronicheskoi kriticheskoi ishemiei: endarterektomiya ili protezirovanie.

OBJECTIVE: To evaluate the effectiveness and postoperative morbidity after endarterectomy from the iliac arteries in comparison with ilio-femoral and aorto-femoral replacement in patients with chronic critical lower limb ischemia. MATERIAL AND METHODS: There were 95 patients with chronic critical lower limb ischemia. Iliac artery replacement was carried out in 43 (45.3%) patients, endarterectomy from the iliac arteries - in 52 (54.7%) cases. Trophic disorders on the lower extremities occurred in 36 (37.9%) patients. RESULTS: Iliac artery replacement was accompanied by postoperative wound suppuration and infection of prosthesis in 3 (6.9%) patients, postoperative ventral hernia in 2 (4.7%) patients. The total number of complications specific for endarterectomy (iliac artery perforation - 1 (1.9%) patient, iliac artery thrombosis - 3 (5.8%) patients) was similar to the literature data. Successful endarterectomy was performed in 52 (88.1%) patients. Iliac segment patency was similar in both groups throughout a 12-month follow-up period. CONCLUSION: Endarterectomy from the iliac arteries has some advantages over replacement and should be preferred for trophic complications on the lower extremities.

['Proper conduit' technique for chronic critical lower limb ischemia]. / Ispol'zovanie metodiki 'sobstvennogo konduita' pri lechenii patsienta s khronicheskoi kriticheskoi ishemiei nizhnei konechnosti.

The authors describe the technique of using autologous superficial femoral artery after endarterectomy for redo vascular surgery in case of unusable great saphenous vein.

[Ruptures of popliteal artery aneurysms]. / Razryv anevrizmy podkolennoi arterii.

AIM: To improve diagnosis and surgical outcomes in patients with ruptured popliteal artery aneurysm. MATERIAL AND METHODS: Eight patients with ruptured popliteal artery aneurysm have undergone surgery for the period from 1999 to 2015 at the Vascular Surgery Department of Sklifosovsky Research Institute for Emergency Care. Incidence of rupture was 2.9% from total number of popliteal artery aneurysm. 7 patients with rupture had signs of lower limb ischemia (acute form grade I in 2 (25%) cases, grade IIA in 1 (12.5%), grade IIB in 1 (12.5%) case, chronic ischemia grade IIB in 2 (25%) patients, grade III in 1 (12.5%) patient). 1 (12,5%) patient had not lower limb ischemia. Preoperatively all patients underwent sonography of lower limb arteries and soft tissues, computed tomography of the same structures was carried out in 3 patients, 5 patients underwent subtraction digital angiography. Presence and dimensions of soft tissues hematoma, arterial perfusion proximally and distally to popliteal artery, aneurysms of contralateral limb and other localizations were assessed. RESULTS: Amputations after surgical repair were absent in 6 patients. Five patients were discharged with patent graft, completely compensated blood flow and primary healing of postoperative wound. Severe postoperative complications followed by amputation occurred in 2 patients. One patient died with reperfusion syndrome, hematoma and graft infection, sepsis. CONCLUSION: 1) Ruptured popliteal artery aneurysm is extremely rare complication, however it is a formidable event with high risk of amputation and death. 2) Early diagnosis of popliteal artery aneurysm and surgical treatment prior to embolism, thrombosis and rupture are necessary to prevent formidable complications. 3) Timely detection of aneurysms and their complications by general practitioners is extremely low due to rarity and specificity of the disease, presence of various symptoms. It is necessary to popularize knowledge about this disease among general practitioners. 4) Sonography is screening method for differential diagnosis. 5) CT-angiography or subtraction angiography are advisable to assess distal perfusion if patient's state is stable without severe ischemia. 6) Aneurysm repair with popliteal artery replacement should be performed in early period after rupture in order to reduce time of ischemia and to prevent infection of hematoma in view of ischemia and anemia.

[Treatment of abdominal aortic thrombosis]. / Lechenie bol'nykh s trombozom briushnoi aorty.

AIM: To improve the outcomes in patients with abdominal aortic thrombosis. MATERIAL AND METHODS: 83 patients with acute lower limbs ischemia caused by abdominal aortic thrombosis were enrolled. They have been treated at the emergency vascular surgery department of Sklifosovsky Research Institute for Emergency Care for 10-year period (2006-2016). RESULTS: We described surgical tactics and preferable procedure depending on severity of atherosclerotic lesion, reasons of abdominal aortic thrombosis, lower extremities ischemia severity. CONCLUSION: Timely diagnosis of abdominal aortic thrombosis and surgical treatment are essential to improve the outcomes.

[Use of the "Multitask" device while performing endarterectomy from iliac arteries]. / Ispol'zovanie instrumenta «Multitasc¼ pri vypolnenii endarterektomii iz podvzdoshnykh arterii.

AIM: The study was aimed at assessing efficacy of using the "MultiTASK" device manufactured by the Le Maitre Company while performing extended endarterectomy from iliac arteries in patients presenting with multilevel atherosclerotic lesions of the arterial bed and chronic ischaemia of lower extremities. PATIENTS AND METHODS: We analysed the outcomes of surgical management of a total of 37 patients presenting with multilevel atherosclerotic lesions of the common and external iliac arteries and arteries below the inguinal ligament over the period from 2012 to 2015 at the Department of Emergency Vascular Surgery of the Scientific Research Institute of Emergency Ambulance Care named after N.V. Sklifosovsky. Twenty one (56.8%) patients presented with haemodynamically significant stenoses of the iliac artery. Eleven (29.7%) patients had occlusion of the external iliac artery and five (13.5%) patients presented with occlusion of the common iliac artery in the distal portion. In all cases there was a second block, i. e. occlusion of the superficial femoral artery. RESULTS: The primary patency rate of the external iliac artery after endarterectomy amounted to 100%. Immediate complications directly associated with endarterectomy from the external iliac artery were encountered in one (2.7%) case - during back traction of the loop there occurred perforation of the wall of the external iliac artery by a calcified plaque, thus requiring external-iliac-common-femoral prosthetic repair. Amputation was performed in two (5.4%) patients (in both cases due to thrombosis and the development of ischaemic gangrene owing to poor condition of the distal arterial bed). One (2.7%) patient died of acute myocardial infarction. CONCLUSION: Extended endarterectomy by means of the "MultiTASC" device turned out efficient, yielding good immediate outcomes in atherosclerotic lesions of femoral arteries both as an independent operation and when combined with reconstruction of arteries beneath the inguinal ligament.

[The treatment of postinjection false aneurisms with arrosive bleeding of the magistral arteries in drug abuse patients].

The recent 10-15 years revealed such a disease in Russia as a false postinjection aneurism, complicated by the arrosive bleeding of the magistral arteries in drug abuse patients. It is a severe disease, by which the lethality and amputation rates are as high as 50%. The authors represent the experience of treatment of 30 patients. The goal of the study was to set the treatment algorythm of such patients. All the patients were operated on, the amputation was necessitated in 1 (3.3%) case.

The treatment of patients with injury to the great arteries of the lower extremities.

This paper analyzes the results of the treatment of 92 patients with injury to the great arteries of the lower limbs, which accounted for 15.9% of the number of all patients with injury to the great vessels. As regards lower limb ischemia, the patients were distributed in the following way: 15 (16%) patients had degree I, 27 (29%) degree IIA and 50 (55%) had degree IIB-IIIA ischemia (according to the classification of acute ischemia by I. I. Zatevakhin). All casualties with arterial trauma of the lower limbs were operated on. In the postoperative period, the patients were administered conservative therapy using anticoagulants, spasmolytics, and antiplatelet agents. Intraarterial infusion therapy, detoxification techniques and HBO therapy were applied. Good and satisfactory results were obtained in 78 (80.5%) patients; amputations were performed in 10 (10.8%) patients. The lethality constituted 8.7% (n=8). The authors hold that early hospitalization to the multi-discipline continuous medical institutions forms the basis for refinement of the treatment results in patients with injury to the great arteries of the lower limbs.

[Treatment of patients with post-traumatic decompensated ischemia of the limbs]. / Lechenie bol'nykh s posttravmaticheskoi dekompensirovannoi ishemiei konechnostei.

The article analyses results of treatment of 48 patients with severe posttraumatic decompensated ischemia of extremities. Operations were performed on 484 patients with injuries of 573 major vessels, 374 of them having traumas of the extremity vessels. All the patients were admitted to the hospital with severe hemorrhagic and traumatic shock of the III-IV degrees, 58% of them had combined traumas. The time from admission to operation was 0.5-24 hours. The "end-to-end" anastomoses were applied for the restoration of the vessels and prostheses with autovein and homoarterial prosthesis "Homograft" were used. Lethality was 16.7%. Reconstruction of the injured artery must be always made after performing "stable" osteosynthesis, predominantly with the apparatus of external fixation. Early start of active detoxication is of importance. Positive results with saved extremities were obtained in 68.8% of the patients. Multiprofile medical institutions with a 24-hours regimen of work of different diagnostic and medical units can give effective help to patients of this category.

[Mechanism of local anesthesia: long-range orientation effects]. / Mekhanizm mestnoi anestezii: orientatsionnye éffekty na dal'nikh rasstoianiiakh.

The orientation interaction of a molecule of a local anesthetic with a biomembrane and cell-like liquid was studied, based on the model of adsorption of the anesthetic from a cell-like solution on the surface of a biomembrane for compounds of the trimecaine series. A statistically significant correlation equation was obtained, which relates the minimum blocking concentration to the projection of the dipole moment of the anesthetic on the plane X(1)0X2 of the principal axes of inertia. A model is prosed according to which the "anesthetic-biomembrane" interaction is most effective the molecule of the anesthetic rotates around the axis of the maximum moment of inertia.

[Changes in the mass of the principal components of the body and classification of the severity of lipid-protein insufficiency in patients with burns]. / Izmenenie massy osnovykh komponentov tela i klassifikatsiia stepeni tiazhesti lipidnobelkovoi nedostatochnosti u bol'nykh s ozhogami.

On the basis of studying the dynamics of losses in the reserve fat and active body mass during a catabolic phase of the burn disease, in 124 sufferers with the burns of 5 to 80% of the body surface, a classification of the severity degree of lipido-protein deficiency, which distinguishes a compensated, subcompensated and decompensated grade and subdivides the latter into the reversible and irreversible forms, is suggested. The classification permits to assess more objectively the severity of the state and prognosis in burned patients, and as well to define purposefully the methods for correction of the revealed disorders.