[Surgical treatment of pseudoaneurysms of the proximal anastomosis after aortofemoral reconstructions]. / Khirurgicheskoe lechenie lozhnykh anevrizm proksimalnykh anastomozov posle aortobedrennykh rekonstruktsii.

The authors discuss surgical treatment of pseudoaneurysms of proximal anastomoses of prostheses with the aorta after reconstructive operations in the aortofemoral zone in 9 patients, whose ages ranged from 32 to 65 years. The time between the formation of the aneurysms and the operation before their diagnosis ranged from 15 days to 6 years. The pseudoaneurysms developed due to infection in 3 patients, poor-quality suture material (silk) in one patient, endarterectomy from the aorta at the proximal anastomosis in one patient, and further development of the principal disease in 2 patients; the cause of the disease in 2 patients could not be identified. Six patients were subjected earlier to bifurcation aortofemoral shunting, one patient to bifurcation aortofemoral prosthetics, and 2 patients to linear prosthetics of the infrarenal part of the aorta. The primary reconstructive operation was conducted for occlusive lesions of the aortofemoral zone in 7 patients (of atherosclerotic genesis in 6 of them and one patient had unspecific aortoarteritis), and for aneurysm of the abdominal aorta in 2 patients (of posttraumatic origin on one). The authors claim resection with repeated replacement of the aorta by a linear or bifurcation prosthesis to be the optimal method for reconstruction in pseudoaneurysms of proximal anastomoses. One patient died in the immediate postoperative period. The immediate and late-term results of repeated operations were good in 8 of 9 patients in follow-up periods of 8 months to 5 years. Recurrences of the disease were not encountered.

[Postoperative aneurysms of the thoracic aorta]. / Posleoperatsionnye anevrizmy grudnoi aorty.

An examination of 15 patients with postoperative aneurysms of the thoracic aorta was performed. The aneurysms were formed approximately within 15.6 years after operations on the thoracic aorta: for coarctation of the aorta--9 patients, aorta aneurysms--3 patients, open arterial ducts--1 patients, stenosing aortitis--2 patients. Operations were made on 13 patients, 2 patients were not operated upon. In 12 patients moderate hypothermia was used, one patient was operated under conditions of normothermia. The average time of the aorta compression was 42.7 min. Prostheses were used in 9 patients, lateral plasty with a synthetic flap--in 3 patients. Direct anastomosis of the aorta ends after aneurysm resection was used in 1 patient. There were no cases of paraplegia or lethal outcomes. Good results were obtained in all the patients.

[Restorative vascular operations in treating severe ischemia of the lower extremities in arteriosclerosis]. / Vosstanovitel'nye sosudistye operatsii v lechenii tiazheloi ishemii nizhnikh konechnostei pri ateroskleroze.

On the basis of their personal experience in the treatment of 266 patients with severe ischemia of the lower extremity the authors believe it to be expedient under threat of amputation to perform reconstructive vascular operations on the aorto-iliac and femoral-popliteal segments. Repeated revascularization of the extremity for reocclusion in the late periods after the first reconstructive operation was conducted on 116 patients. The frequency of amputations and mortality in vascular reconstructive operations are considerably lower than those in non-operative treatment and in primary amputation of the extremity.

[Comparative evaluation of reconstructive surgery in atherosclerotic occlusions of the arteries of the lower extremities]. / Sravnitel'naia otsenka vmeshatel'stv pri ateroskleroticheskikh okkliuziiakh arterii nizhnikh konechnostei.

In 118 patients 144 different reparative operative procedures were performed for ischemia of the extremity, grade II-IV, due to atherosclerotic lesion of arteries of the femoropopliteal zone. In ischemia of the extremity due to an isolated lesion of the superficial femoral artery transplantation of the reversed autovein is felt to be the best method of reconstruction. Transplantation of a synthetic prosthesis may be employed, only if other methods, as the last chance for saving the extremity from amputation, proved to be unfeasible.

[Indications for reconstructive vascular surgery in gangrenous changes in the leg]. / Pokazaniia k rekonstruktivnym sosudistym operatsiam pri gangrenoznykh izmeneniiakh nizhnikh konechnostei

Proceeding from an experience in the treatment of 195 patients with obliterative athrosclerosis of the bifurcation of the abdominal aorta and the arteries of the lower extremities in the pre-gangrene or gangrene stage (reconstructive procedures on the vessels were performed in 151 patients), the authors conclude that such interventions should be considered procedures of choice. Amputation of the extremity may be considered in such patients only after an angiographic examination that is the main method that permits to determine the possibilities of performing a reconstructive vascular operation. Good immediate results of vascular interventions were achieved in 80% of the patients with stage III--IV ischaemia.