[Comparative analysis of safety of carotid endarterectomy performed in acutest and acute periods of ischaemic stroke]. / Sravnitel'nyi analiz bezopasnosti vypolneniia karotidnoi éndarteréktomii v ostreishii i ostryi periody ishemicheskogo insul'ta.

Surgical revascularization of the carotid basin in the acutest period of ischaemic stroke, i.e., within 72 hours, will make it possible to prevent the development of recurrent stroke by removing an embologenically dangerous atherosclerotic plaque of the symptomatic carotid artery and to improve cerebral blood supply, having eliminated haemodynamic stenosis of the carotid artery. However, the problem of safety of carotid endarterectomy in patients during the acutest period of ischaemic stroke still remains debatable. PURPOSE: To comparatively analyse safety of eversion carotid endarterectomy performed in the acutest (0-72 hours) and acute (4-14 days) periods of minor ischaemic stroke. PATIENTS AND METHODS: Between January 2015 and December 2019, specialists of the Department of Vascular Surgery of Municipal Clinical Hospital # 7 of Kazan performed a total of 80 eversion carotid reconstructions in the period of minor ischaemic stroke within 14 days. The patients were divided into 2 groups depending on the terms of performing carotid endarterectomy. The first group comprised 32 (40.0%) patients operated on in the acutest period of ischaemic stroke, i.e., within 72 hours from the onset of first symptoms of neurological deficit. The second group included 48 (60.0%) patients subjected to carotid endarterectomy within 4 to 14 days from the onset of first signs of neurological deficit. RESULTS: According to the obtained findings, haemorrhagic transformation in the early postoperative period occured in 2 Group Two patients, with one lethal outcome on POD 3. Cerebral ischaemia increased in one patient of each group without enlargement of the ischaemic zone according to brain computed tomography, with residual neurological deficit in Group I in remote period (Rankin scale score 1) and complete restoration in Group II (Rankin scale score 0). Recurrent minor ischaemic stroke on POD 1 developed in Group II with formation of a new lacunar region of ischaemia of the brain in the operated carotid basin and was verified by the findings of cerebral MRI with persisting neurological deficit for 6 months (Rankin scale score 2). The comparative assessment of severity of stroke on the day of operation and at discharge, as well as that of neurological symptomatology during the 1st and 6th months of follow up in both groups proved positive. No events of acute coronary syndrome, recurrent strokes or lethal outcomes were observed during the follow-up period. CONCLUSION: According to the findings of our study, patients with acute cerebral circulation impairment caused by embologenically dangerous lesions of internal carotid arteries should be operated on within the first 72 hours, if there are no accompanying changes requiring time for correction thereof.

[Method of surgical treatment of venous thrombosis using proximal protection]. / Sposob khirurgicheskogo lecheniia venoznogo tromboza s ispol'zovaniem proksimal'noi zashchity.

Pulmonary embolism ranks third among causes of death from cardiovascular diseases after acute coronary syndrome and impairment cerebral circulation. A factor provoking pulmonary embolism in the majority of cases is thrombosis of deep veins of lower limbs. Presented in the article is a clinical case report concerning treatment of a 35-year-old female patient with acute bilateral phlebothrombosis of internal iliac veins with floatation of thrombotic heads in the inferior vena cava and common iliac vein on the left. By means of a hybrid technique, we successfully performed operative intervention: thrombectomy from the inferior vena cava and common iliac veins on both sides with the use of proximal protection TREX (thromboextractor). Control X-ray contrast tomography and ultrasound examination of lower limb veins showed no evidence of rethrombosis. After surgical treatment, the woman received anticoagulant therapy. On POD 5, she was discharged home in a satisfactory condition.

[Carotid endarterectomy in acute period of ischemic stroke]. / Khirurgicheskaia revaskuliarizatsiia karotidnogo basseina v ostreishem periode ishemicheskogo insul'ta.

A review is devoted to carotid endarterectomy for symptomatic carotid stenosis in acute period of ischemic stroke. Patient selection criteria, dates of surgical intervention and perioperative risk were analyzed.

[Emergency prosthetic repair of a ruptured abdominal aortic aneurysm].

Presented herein is a case report regarding successful endovascular prosthetic repair of an abdominal aortic aneurysm in its retroperitoneal rupture in a 56-year-old male patient treated by implantation of the unilateral stent-graft «Aorfix¼, cross femoro-femoral bypass grafting, and ligation of the contralateral common iliac artery.

Reconstruction of the aortofemoral segment using a minilaparotomy access. Experience with 100 operations.

This paper analyzes the results of 100 aortofemoral reconstructions using a miniaccess (patient group I), performed between July 2002 and December 2004. Of these, 92 reconstructions were bilateral and 8 unilateral. The patients' age ranged within 29-83 years (mean 58.3+/-0.9 years). The access to the aorta was gained through a median minilaparotomy (MLT) measuring 5-12 cm in length. The proximal anastomosis was formed above or at the level of the inferior mesenterial artery. The intra- and postoperative data were compared with the results of 162 aortofemoral reconstructions performed using a standard laparotomy (StLT) group II. The times of operation and aortic clamping did not increase during MLT (the time of operation was 192.3+/-4.0 and 207.7+/-5.1 min., the time of aortic clamping 24.3+/-1,6 and 25.8+/-1.7 min in groups I and II respectively). The lowering of traumatic injury during MLT resulted in a decrease of the amount of myorelaxants (by 17.1%; P<0.001) and of the volume of intraoperative infusion (by 12.4%; p<0.05). The short-term postoperative period in group I patients ran a milder course. The painful syndrome was less pronounced and bowel function returned to normal earlier. The incidence of local vascular complications was not different (9.0% during MLT and 10.5% during StLT). In group I, the incidence of local non-vascular complications decreased (from 14.8 to 8.0%, p=0.15) due to the absence of eventrations. The incidence of systemic complications during MLT dropped from 21.0% to 11.0% (p=0.056). During StLT the postoperative lethality accounted for 3.1%, that during MLT for 1.0% (p=0.49). The postoperative hospital stay decreased by 27.8% (p<0.001).

[Assessment of the results of surgical treatment of multiple lesions of lower limb arteries]. / Otsenka rezul'tatov khirurgicheskogo lecheniia bol'nykh s mnozhestvennym porazheniem arterii nizhnikh konechnostei.

121 one-stage "two-floor" reconstructions were performed in multiple lesions of lower limbs arteries. Their results were compared with results of 197 reconstructions of aorto-iliac segment with revascularisation of the firifory of deep femoral artery (DFA). In immediate postoperative period better results were achieved after one-stage "two-floor" reconstructions. There were 70.9% of good results after revascularisation of DFA and 88.4%--after one-stage "two-floor" reconstructions. In long-term period (up to 5 years) after "two-floor" reconstructions the patency of the distal bypasses was lower than that of proximal bypasses since the second year of follow-up. Patency of the distal bypasses after one-stage "two-floor" reconstructions depends on a type of plastic material, location of distal anastomosis of the femoro-popliteal bypass and does not depend on location of the proximal anastomosis. Patency of combined bypasses was lower than one of autovenous bypasses and biografts since the second year of follow-up, patency of femoro-tibial bypasses was lower than that of femoro-popliteal bypasses since the third year of follow-up.