[Experience with endovascular treatment of iliac artery aneurysms]. / Opyt éndovaskuliarnogo lecheniia anevrizm podvzdoshnykh arterii.

Iliac artery aneurysms are relatively uncommon, however requiring early diagnosis and treatment because of high mortality once ruptured. Endovascular correction is currently a method of choice. The standard iliac components of aortic stent grafts have a linear or distally widening shape, whereas the anatomy of aneurysms of iliac arteries requires, as a rule, a larger diameter of the proximal zone of shrinkage. Optimal is considered to be the use of reversed stent grafts, i. e. those tapering distally. The authors herein share their experience in treating iliac artery aneurysms using a flared reversed endograft of the iliac branch of the Anaconda stent graft in three patients presenting with iliac artery aneurysms. Technical success was achieved in all cases. In the remote period (6-12 months postoperatively) the grafts were patent, with no leakage.

[Surgical treatment of patients with superior vena cava syndrome associated with permanent vascular access]. / Khirurgicheskoe lechenie bol'nykh s sindromom verkhnei poloi veny, assotsiirovannogo s postoiannym sosudistym dostupom.

Presented herein are two clinical case reports concerning surgical treatment for superior vena cava syndrome in patients suffering from end-stage renal disease and undergoing programmed haemodialysis. Initially attempted roentgen-endovascular recanalization turned out to be unsuccessful. The patients were then subjected to ipsilateral extrathoracic bypass grafting, which made it possible to preserve the vascular access for programmed haemodialysis and to relieve venous hypertension of the limb and the brain, as well as to improve quality of life. In one case, the duration of graft patency amounted to 6 months, during which time collateral circulation developed, with no relapse of venous hypertension observed, and the access functioned for a further 14 months. Thus, survival of the permanent vascular access increased by 20 months. In the second case, the duration of graft patency and functionality of the vascular access at the time of writing this article amounted to 12 months.

[Reconstructive operations in pathology of central veins, associated with vascular approach].

Presented herein are the results of treatment of 28 patients with stenosis/occlusion of central veins undergoing replacement therapy by means of programmed haemodialysis for terminal renal failure. The clinical symptomatology in all patients manifested itself by chronic lymphovenous insufficiency of the upper limb, dysfunction of the vascular access (14 patients, thrombosis of the vascular approach (5 patients), venous hypertension of the brain (4 patients). 17 patients had aneurysms of the vascular approach in the zone of puncture. In 18 cases for correction of the venous outflow we performed roentgenoendovascular angioplasty, including 3 cases in combination with stenting. Technical success amounted to 83.3% (15 of 18 cases). 13 patients underwent open reconstructive operations, including 5 cases of thrombectomy from the vein (in all cases failed one), in 8 cases bypassing operations (cross cephalic anterior jugular shunting - 5, subclavian-femoral bypass grafting - 1, transposition of the external jugular vein into the internal jugular vein - 1. In-hospital patency of bypasses amounted to 87.5% (7 shunts of 8). The remote results were followed up within the terms up to 43 months (averagely 12.3 ± 2.2 months). In the group of endovascular treatment more than half of patients (8 of 15) required secondary endovascular interventions. The cumulative requirements in re-do manipulations amounted to 52.4% during the first year and to 89.4% during the second year. The function of the approach was preserved in 93.3% of patients. Of the seven shunts patent in the early postoperative period, occlusion occurred in three cases at 1, 5 and 13 months. The 1-year patency amounted to 50.0%. The function of the approach was preserved in 75.0% of cases.