[Stage wise treatment of uterine arteriovenous malformation complicated by recurrent haemorrhage]. / Étapnoe lechenie arteriovenoznoi mal'formatsii matki, oslozhnennoi retsidiviruiushchimi krovotecheniiami.

Uterine arteriovenous malformation is a rarely encountered disease threatening with massive haemorrhage. The article describes a clinical case report regarding a 37-year-old woman presenting with this pathology and previously hospitalized twice with severe posthaemorrhagic complications at a 5-month interval due to refusal from timely hysterectomy. A vascular formation in the womb was detected at ultrasonography, however its pattern was identified only by computed tomography of small pelvis organs with intravenous contrasting. However, the complete picture of the architectonics of uterine arteriovenous malformation and extension of the pathology was obtained by selective subtraction angiography, making it possible not only to perform diagnosis but also, if necessary, to immediately perform selective embolization of the supplying vessels. Due to massive uterine bleeding on the background of womb malformation, the woman was twice subjected to roentgenoendovascular embolization of afferent vessels, with the achievement of persistent haemostasis. Hysterectomy was performed after stabilization of the state. Thus, an extensive angiomatous uterine lesion accompanied by recurrent bleedings, along with roentgenoendovascular methods of treatment there is a need of additional surgical resection with the removal of the angiodysplasia focus.

[Thrombectomy for acute iliofemoral thrombosis in prevention of pulmonary embolism]. / Trombéktomiia pri ostrom podvzdoshno-bedrennom tromboze v profilaktike TÉLA.

BACKGROUND: Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS: Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS: After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION: Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.

[Cell therapy of critical lower limb ischemia (problems and prospects)].

Critical limb ischemia is a syndrome that combines several peripheral artery diseases with different ethiology and pathogenesis but with similar prognosis, high morbidity and mortality. Possibility of surgical and conservative treatment of critical limb ischemia almost completely exhausted. Some hopes have arisen due to progress in cell technology. The article provides a critical analysis of pathogenic prerequisites of stem/progenitor cells for the treatment of patients with a critical limb ischemia in detail the basic results of preclinical and clinical studies on the safety and efficacy of cell technology. Unsolved problems and prospects of practical application are also discussed.

[D-dimer in diagnosis of acute thromboses of lower-limb deep veins].

Analysed herein is a potential role the D-dimer plays in diagnosis of acute venous thromboses of the lower limbs. The D-dimer blood plasma levels were determined in a total of 195 patients with either suspected or known acute thrombosis of the lower-limb deep veins. The D-dimer concentration was measured by the immunoturbidimetric method. Acute venous thrombosis (AVT) was either confirmed or negated by means of ultrasonographic scanning. Of the 195 patients examined, thrombosis in the system of the inferior vena cava was detected in 161 subjects, whereas in the remaining 34 cases the tentative diagnosis was not confirmed. Amongst the patients with established AVT, the D-dimer level was elevated in 156 (96.9%). Of the 34 patients with unconfirmed AVT, the test for the presence of D-dimer was negative in 20 (58.8%) patients and positive in 14 (41.2%) subjects. Hence, the sensitivity of the test understudy amounted to 96.9%, while its specificity did not exceed 58.8%. A direct correlation between the incidence of AVT and the D-dimer level was revealed. Given high sensitivity of the D-dimer in AVT, this test should be used in a suspicion for or a high risk of phiebothrombosis in order to reliably exclude the diagnosis if the result proves negative.

[Replacement of lumbosacral intervertebral disks using artificial prostheses: surgical tactics and technique].

The mail goal of the study is to present surgical technique of intervertebral disk replacement using artificial disks and to completely evaluate effectiveness of this modality of treatment of degenerative spine disease using a set of original scales, clinical data and neuroradiological examination. Since 2002 to 2007 14 patients underwent intervertebral disk replacement by artificial prostheses in the Department of Spinal Neurosurgery in Burdenko Neurosurgical Institute (Moscow, Russia). Analysis of results of treatment was performed using multidimensional assessment scales. Potential complications of intervertebral disk replacement by artificial disks are evaluated.

[Transillumination-assisted phlebectomy with the help of the TriVex system in comprehensive management of varicose disease of lower-limb veins].

The present work was undertaken to evaluate a new minimally invasive method of surgical management of varicose disease by means of the TriVex unit. The method is based on transillumination of saphenous veins in an aqueous medium, which makes it possible to perform radical removal thereof form separate punctures under visual control with the help of a specially designed vein stripper. Transillumination-assisted phlebectomy (TIP) was compared with microphlebectomy (MPE) according to the Varady's technique. We operated on a total of one hundred and eight patients suffering from varicose disease of the lower extremities. All of them underwent duplex scanning of the veins. Group One (study group) was composed of fifty-six patients subjected to TIP within the scope of a comprehensive treatment for varicose disease. Group Two consisted of fifty-two patients who were subjected to removal of varicosely altered affluents on the crus by means of microphlebectomy. The results of surgical management for varicose disease were analysed according to the following parameters, the duration of a surgical intervention, intensity of the pain syndrome in the postoperative extremity, a cosmetic outcome by visual analogue scales, and the incidence rate of complications. The obtained findings demonstratively showed that the duration of the operation in the study group was substantially shorter, averagely amounting to 35.5+/-6.2 minutes, as compared with as long as 65.0+/-6.2 minutes (P<0.0001) in the control group. The number of incisions in the study group turned out to be also significantly less than that in the control group, amounting to 4.0+/-1.3 vs. 12.0+/-2.5 (p<0.0001), which largely contributed to both a decrease in the level of the pain syndrome and obtaining aesthetically pleasing cosmetic outcomes. Hence, TIP being a minimally invasive procedure in surgical management of varicose disease, by its clinical efficiency appeared to be not inferior and at least equivalent to microphlebectomy, displaying at the same time certain advantages over the latter, consisting in the very positive cosmetic outcome obtained, a lesser operative injury inflicted, and shorter terms of rehabilitation of the patients involved.

[Stimulation of tissue lymphatic drainage in the treatment of patients with arterial diseases]. / Stimuliatsiia limfaticheskogo drenazha tkanei v lechenii bol'nykh s zabolevaniiami arterii.

The results of treatment of 17 patients with endarteritis obliteran and 44 patients with atherosclerosis obliteran of the lower limbs were analysed. The complex of therapeutic measures included direct and indirect stimulation of lymphatic drainage in the tissues. The effect of lymphostimulation on regional hemodynamics, microcirculation, and metabolism in the tissues of the ischemic lower limb are appraised. Changes in the lymphatic system resorption capacity, in microcirculation, in the composition and properties of the peripheral lymph in the limb in stimulation of lymphatic drainage of tissues are analysed. Indirect lymphostimulation contributed to the improvement of the indices under study in patients with IIb and IIIa stages of ischemia. Direct stimulation of lymphatic drainage caused a more pronounced effect in cases of stage IIIa ischemia of the limb and may be applied in preoperative and postoperative management of patients with stage IIIb ischemia.

[The lymphatic system of the lower extremities in patients with obliterating diseases of the terminal portion of the aorta and its branches]. / Limfaticheskaia sistema nizhnikh konechnostei u bol'nykh s obliteriruiushchimi zabolevaniiami terminal'nogo otdela aorty i ee vetvei.

The paper deals with the results of X-ray lymphographic and morphological studies of the peripheral lymphatic system in 82 patients with various stages of chronic lower extremity arterial insufficiency. Destructive and sclerotic changes in lymphatic vessels, inguinal lymph nodes, and impairments in lymph flow whose severity was in proportion to the stage of chronic ischemia were detected. The associated immune, barrier-filtration and transport dysfunctions called for their adequate correction. In patients with Stages II and III ischemia, direct controlled endolymphatic therapy promotes the improvement of tissue lymphatic drainage and hemocirculation in the diseased extremity and recovery of immune homeostasis in the region.

[Status of lymphatic vessels, lymph flow and lymph toxicity in patients with obliterating arterial diseases of the lower extremities]. / Sostoianie limfaticheskikh sosudov,limfotoka i toksichnost' limfy u bol'nykh s obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei.

The condition of the lymph vessels, the lymph flow, and the toxicity of peripheral lymph were studied in 46 patients with obliterating diseases of the arteries of the lower limbs. The results of the study showed the severity of the destructive changes in the peripheral lymphatic system to be directly dependent on the severity of the arterial ischemia of the limb. Block of the lymphatic system, deceleration of the lymph flow, and changes in the lymph vessels themselves lead to deterioration of the tissue drainage function and intensification of regional endotoxicosis. In view of which correction of the peripheral lymphatic system should be included in the complex of measures for the treatment of patients with obliterating diseases of the lower limb arteries.

[Evaluation of the results of arterial reconstructions supplemented by the creation of an arteriovenous anastomosis]. / Otsenka rezul'tatov arterial'nykh rekonstruktsii, dopolnennykh sozdaniem arteriovenoznogo anastomoza.

Arterial reconstructions supplemented with arteriovenous anastomosis were studied experimentally. The ischemic changes in the operated dog limb were evaluated by various methods, including electronic diagnostic technique. When the diameter of arteriovenous anastomosis was equal to 40-60 per cent of arterial graft diameter, the best postoperative results were observed.

[Endovascular balloon dilatation in the treatment of atherosclerotic lesions of the iliac artery]. / Endovaskuliarnaia ballonnaia dilatatsiia v lechenii ateroskleroticheskikh porazhenii podvzdoshnoi arterii.

Roentgen-endovascular balloon dilatation was used in 16 patients with segmentary stenoses and occlusions of arteries and lower extremity ischemias. The results obtained suggest high efficiency of roentgen-endovascular balloon dilatation for the reestablishment of major blood flow.

[Transcutaneous intravascular balloon dilatation in renal artery stenosis and arterial hypertension]. / Chreskoznaia vnutrisosudistaia ballonnaia dilatatsiia u bol'nykh so stenozom pochechnoi arterii i arterial'noi gipertenziei.

In 20 patients with stenosis of the renal artery and arterial hypertension Gruentzig balloon catheter was introduced transcutaneously into the artery with subsequent dilatation. In 2 cases arterial pressure became normal, in 8 the course of the disease improved, in 4 high hypertension was retained but responded to hypotensive agents, in 2 there was no effect, and in 4 balloon dilatation could not be carried out due to the impossibility of pushing the catheter through the stenosed segment of vessel. According to the data of renal scintigraphy plasma flow on the affected side rose by 16-66% after dilatation as compared to the initial figures, there was no significant change in the contralateral kidney.