Hybrid technology in treatment of severe combined pathology.

The present report describes a clinical case concerning a two-stage hybrid operative intervention in a patient presenting with an aortic arch aneurysm associated with coronary artery disease. The first stage consisted in performing mammary coronary artery bypass grafting of the anterior descending artery, coronary artery bypass grafting of the right coronary artery, endoventricular plasty of the left ventricle according to the Dor technique, switching over of the brachiocephalic arteries to the ascending portion of the aorta with the vascular multiple-branch prosthesis Intergard. The second stage consisted in endoprosthetics of the aortic arch with a stent graft. The patient concerned belongs to a high-risk group for the development of postoperative complications. Endovascular techniques in the pathology involved may be an alternative to the conventional surgical treatment, since there is no necessity to use extracorporeal haemocirculation or deep hypothermal circulatory arrest. It is necessary to analyse the remote results, to work out the indications for the interventions concerned, especially in elderly and aged patients presenting with a variety of accompanying pathology.

[Retrograde type A aortic dissection after endovascular repair of the thoracic artery].

Retrograde type A aortic dissection is a severe and prognostically unfavourable complication of endovascular repair of the thoracic aorta. The aim of the present article is to describe a clinical case report concerning a hybrid operative intervention for retrograde type A aortic dissection in a patient having endured two-stage endovascular repair of the thoracic artery.

[Efficacy of the use of sirolimus covered stents in the treatment of diffuse atherosclerotic lesions of coronary arteries].

Aim of the study was to compare efficacy of sirolimus covered (116 patients, group 1) and bare (117 patients, group 2) stents. Groups were comparable according to main characteristics. Proportion of patients with diabetes was 19 and 13.7%, with multivessel lesions--87.1 and 80.4%, with arterial diameter <2.75 mm--46.5 and 23.9% in group 1 and 2, respectively. Lesion length was 25.9+/-6.6 mm (28-93 mm) in group 1 and 22.1+/-7.8 mm (26-102 mm) in group 2. Overall 473 stents were implanted into 232 arteries (2.1 per artery). In group 1 184 stents were implanted in 116 arteries, in group 2--289 stents in 117 arteries. Immediate success rate was 97.4 and 99.1% in groups 1 and 2, respectively (p=0.74). There were no cases of acute stent thrombosis. Subacute thrombosis (after 1-3 weeks) occurred in 2 patients (1.7%) of group 1 and in 1 patient (0.85%) of group 2 (p=0.47). Angiographic restenosis was observed in 12 (10.6%) and 66 (56.9%) patients in groups 1 and 2, respectively (p<0.0025). In 47 of 66 patients (71.2%) in group 2 restenosis was diffuse. There was no case of diffuse restenosis in group 1. Twelve months survival without angina and major coronary events was 79.8% in group 1 and 31%--in group 2.

[The treatment of coronary atherosclerosis: effect of the use of stents on immediate and long term results of coronary angioplasty]. / Lechenie koronarnogo ateroskleroza: vliianie massovogo primeneniia stentov na blizhaishie i otdalennye rezul'taty koronarnoi angioplastiki.

Immediate and long term results of 2 methods of coronary angioplasty (balloon dilatation and stenting) were analyzed retrospectively. During 10 years proportion of stent implantations increased 30-fold reaching 95-97% of coronary interventions. This was associated with improvement of immediate results of angioplasty: lowered rates of myocardial infarctions, urgent coronary artery bypass graftings and acute coronary artery occlusions (from 2.7% after balloon angioplasty to 0.6% after stenting). Improved long-term prognosis after stenting manifested in lower frequency of cardiovascular events. Five year survival was 98,8 and 92.7% after stenting and balloon angioplasty, respectively (p=0.004). However effect of stenting on rates of angiographic restenosis and repeat revascularizations was less pronounced (27.1 and 30.4%, respectively, after stenting vs. 30.1 and 34.5%, respectively, after balloon angioplasty).

[Rupture of thoracic aorta aneurysm 6 years after endoprosthetic surgery]. / Razryv anevrizmy grudnoi aorty cherez 6 let posle ee éndoprotezirovaniia.

A case of 6-year stay of a nitinol stent in the lumen of atherosclerotic aneurysm of the descending thoracic aorta is reported. Problems of the prosthesis integration into the organism, nitinol are activity and toughness as well as causes of the aneurysm rupture are discussed. Literature data on endovascular treatment of the aortic aneurysm including in the beginning of its rupture and in old persons with grave concomitant diseases are presented.

[Radiologically-guided vascular prosthesis after laser recanalization of occlusive lesions of the blood vessels of the lower limbs]. / Rentgenoéndovaskuliarnoe protezirovanie posle lazernoi rekanalizatsii okkliuziruiushchikh porazhenii sosudov nizhnikh konechnostei.

The article deals with the first clinical experience in radiologically-guided prosthetics after laser recanalization of occluded vessels of the lower limbs in 20 patients. The method was introduced into clinical practice after applying separately the methods of radiologically-guided endovascular prosthetics and laser recanalization with subsequent dilatation and experimental substantiation on dogs with artificially created chronic occlusions of the femoral artery. The first results are promising, although the true place of the method in sparing treatment of vessels will be ascertained after rich clinical experience is accumulated and the late-term results studied.