[Adventitial cyst of the popliteal artery]. / Adventitsial'naya kista podkolennoi arterii.

Vascular cystic adventitious degeneration (CAD) is a rare disease of unclear etiology that affects mainly the popliteal artery (up to 85-90% of cases). Clinical manifestations are similar to aneurysm of the popliteal artery. CAD occurs mainly in males of the 4th and 5th decades of life (range 10-77 years). These patients usually have no risk factors of cardiovascular diseases. Unilateral symptoms prevail. We report a review and a 46-year-old patient with CAD of the popliteal artery.

[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.

[Administration of the generic prostaglandin E1 VAP 20® in patients with lower limb critical ischaemia: a prospective study].

OBJECTIVE: The study was aimed at assessing efficacy and safety of administering the generic alprostadil VAP in patients presenting with lower limb critical ischaemia. MATERIAL AND METHODS: We carried out a prospective study including a total of 30 patients with lower limb critical ischaemia. The patients' mean age was 67.7±7.8 years, with men predominating - 60%. Trophic ulcers were observed in 40% of patients. The proximal level of the lesion was localized in the arteries below the inguinal ligament in 19 (63.3%) patients, in the aortofemoral segment - in 9 (30%) patients, and in the popliteal-crural-plantar segment - in 2 (6.6%) subjects. The average ankle-brachial index amounted to 0.49±0.4. The studied agent was used at a dose of 40 mcg once a day in patients with stage III ischaemia and a dose of 40 mcg twice daily in patients with stage IV ischaemia. The drug was administered for 14 days followed by a 14-day follow-up period. RESULTS: The pain syndrome score over the 14 days of treatment decreased twofold from 6.1±2.5 to 3.5±2.6 and within the subsequent 14 days it did not increase - 2.4±3.1 (p< 0.05). The number of patients in whom the pain syndrome decreased by 50% amounted to 19 (63.3%). The consumption of analgesic agents decreased from 60% (at the beginning of treatment) to 12 (40%) (14 days after treatment) and to 8 (26.6%) (at the end of the follow-up period). In patients with trophic ulcers, the average size of the ulcers during treatment decreased from 3.3±3.7 cm to 2.8±3.8 after 14 days, and at the end of the follow-up period the size of the ulcers amounted to 2.1±2.8 cm (p >0.05). The number of patients responding to treatment amounted to 22 (77.3%). The ABI during treatment did not change, being 0.49 ± 0.4 at the beginning of treatment, 0.53±0.4 after 14 days of treatment, and 0.47±0.3 at the end of the follow-up period. There were no amputations either during treatment or within the follow-up period. Only one lethal outcome occurred which was related to acute coronary insufficiency. The "response to treatment" was significantly influenced only by the level of the proximal lesion and age (p<0.05). CONCLUSION: VAP 20® demonstrated good efficacy and tolerability comparable to those of the original preparations.

[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.

[Bypass surgeries from remote vascular beds in the treatment of critical limb ischemia in elderly and old patients]. / Operatsii shuntirovaniia iz otdalennykh sosudistykh basseinov v lechenii kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

The problem of surgical treatment of elderly and old patients with critical limb ischemia and severe concomitant diseases is discussed. Surgical bypass from remote vascular beds is the only real possibility of effective care for such patients with the lowest risk. The results of treatment of 90 patients with critical limb ischemia were analyzed. The surgical technique is described in details. Modified methods of proximal anastomosis creation and technology of safe installation of graft into subcutaneous canal in subclavial-femoral bypass, surgical technique in femoral-femoral and ileo-femoral cross-over bypass are also described. Results demonstrate high efficacy of these surgeries and their lower risk. It is concluded that improved surgical technique permits to expand indications for surgery in elderly and old patients and to improve immediate and long-term results.