[Pathohistological characteristics of muscles in patients with chronic lower limb ischemia]. / Patogistologicheskaya kharakteristika myshts u patsientov s khronicheskoi arterial'noi nedostatochnost'yu nizhnikh konechnostei.

Despite the widespread occurrence of ischemic diseases of the lower extremities, including atherosclerosis and diseases with an autoimmune component of their pathogenesis, the pathohistological signs of damage and concomitant chronic ischemia, compensatory tissue responses as intracellular and cellular regeneration remain out of the field of vision in researchers. OBJECTIVE: To assess the signs of damage (the extent of necrosis and apoptosis, capillary density (CD)) and regeneration (the cross-sectional muscle fiber area (CSMFA), the proportion of centrinucleated muscle fibers (CNMFs), and that of connective tissue), by using the gastrocnemius medial head biopsy specimens obtained from patients with heterogeneous forms of chronic lower limb obliterating diseases (CLLODs). SUBJECTS AND METHODS: The investigation included the biopsy specimens obtained from 44 men under 65 years of age (their mean age was 54±9.8 years) with Stage IIB-IV chronic limb ischemia (according to the A.V. Pokrovsky-Fontaine classification) with its history of at least six months. The nosological entities were atherosclerotic lesion in 33 patients (distal atherosclerosis n=13), multistage lesion (n=8), and Leriche's syndrome (n=12); autoimmune-mediated vascular injury in 11 patients (Buerger's disease (n=7) and nonspecific aortoarteritis (n=4)). The similar muscle fragments obtained during autopsy from the deceased without obvious signs of cardiovascular system diseases were examined as a control. RESULTS: It was found that there was a statistically significant difference between the nosological entities, as compared to the control in terms of CD and CSMFA (a decrease), the proportion of CNMFs and that of connective tissue (an increase). No substantial differences were found in the studied parameters between the nosological entities. CONCLUSION: The findings may suggest the universal mechanism for damage to striated muscle tissue because of circulatory hypoxia, regardless of its etiology and the common character of tissue compensatory-adaptive responses (regeneration).

[15-year experience with PTFE-grafts "Ecoflon" in Leriche s syndrome].

Analyzed herein are the outcomes of 1,079 reconstructions of the aortofemoral segment, performed for Leriche s syndrome using polytetrafluoroethylene grafts "Ecoflon" during the period from 1997 to 2012. Hospital lethality amounted to 3.1%, frequency of thromboses was 0.53% and that of amputations equalled 0.53%. The patients were followed up at terms varying from 6 to 180 months. Cumulative patency of the bypass grafts at 1 year amounted to 99.3±0.2%, at 5 years to 97.3±0.6%, at 10 year to 91.9±1.9%, and to 90.0±2.7% after 15 years. Primary patency amounted to 97.6±0.4%, 90.9±1.1%, 75.9±2.7% and 71.4±4.1%, respectively. Grafts infection occurred in 1.3% of cases (0.2% in the early, and 0.83% in the remote postoperative periods). False aneurysms of distal anastomoses were registered in 0.5% of cases. A total of 137 reoperations were performed (104 for graft thromboses, 9 for pseudoaneurysms of anastomoses, and 7 for graft infection). Seventeen operations were carried out for ischaemia relapse due to progression of the occluding process in patent grafts. The amputation rate amounted to 6.6%. Based on the obtained findings a conclusion is drawn that polytetrafluoroethylene grafts "Ecoflon" comply with the current standards of quality.

[The experience of 500 vascular reconstructions of the aorticfemoral segment using a miniaccess].

The immediate and long-term results of 500 reconstructive operations on the aorticfemoral segment using a miniaccess were analyzed. 443 patients suffered from the obliterative atherosclerosis and 57 were operated on the infrarenal aortic aneurism. The size of the surgical access was 5-12 sm (418 through laparotomy, 82 through the retroperitoneal access). The access enlargement was necessary in 5.0% of cases. The mean time of the operation was 166.6±7.8 min (90-255 min). Time of the aortic clamping was 26.2±1.5 min by the aortic by-pass and 32.3±4.5 min by the aortic resection. The postoperative leathality rate was 1.6%, the morbidity rate was 20.0% (local vascular complications 7.2%; local non-vascular complications 7.2%, systemic complication 7.6%). 5-year by-pass patency was 91.9±2.8%, the limb was preserved in 93.6±2.4%.

[Prevalence of an abnormal ankle-brachial index in the Republic of Tatarstan].

The ankle-brachial index (ABI) was determined in a total of 1,751 employees of industrial enterprises of the Republic of Tatarstan aged from 45 to 84 years old (mean age 55,3 ± 0,14 years). An abnormal ABI was registered in 5,1% of the examined people (4,1% in the age group from 45 to 55 years, 5,4% in 56-65-year-old patients, and 12,1% in subjects over 65 years (p=0,001). An abnormal ABI was registered in 8.3% of men, and 3,1% of women (p=0,000), in 4,1% of rural population, 5,9% (p=0,138) of urban population, in 14,8% (p=0,000) of smokers, and in 45,4% (p = 0,000) of patients with a history of a cardiovascular event.

[Rational minimally invasive nature in surgical reconstructions of the abdominal aorta].

Based on a meta-analysis of the literature and own experience in a total of 490 reconstructions of the aortofemoral segment using a miniapproach, the authors carried out a comparative analysis of the main minimally invasive methods employed for treatment of the pathology concerned.

[Outcomes of using autologous peripheral-blood stem cells in patients with chronic lower arterial insufficiency].

Presented herein are the outcomes of using autologous peripheral blood stem cells (SCs) in patients with stage II В lower limb chronic obliterating diseases (according to A.V. Pokrovsky's classification). Autologous SCs had previously been stimulated by means of the recombinant granulocytic colony stimulating factor (G-CSF) for five days. On day six, we performed mobilization of the peripheral blood stem cells on the MSC+ unit by means of leukopheresis followed by intramuscular administration of half of the obtained dose into the affected extremity. The mean number of the transplanted mononuclears amounted to 6.73 ± 2.2 x 10(9) cells, with the number of CD34+ cells averaging 2.94 ± 2.312 x 10(7). Assessing the therapeutic outcomes at 3 and 6 months of follow-up showed a statistically significant increase in the ankle-brachial pressure index (ABPI) [being at baseline 0.59 ± 0.04, at 3 months - 0.66 ± 0.04 (P=0.001), and after 6 months - 0.73 ± .08 (P=0.035)], accompanied and followed by improved measures of the treadmill test, with the pain-free walking distance at baseline equalling 102.2 ± 11.55 m, after 3 months - 129 ± 11.13 m (P<0.001), and after 6 months - 140 ± 13.11 m=0.021 vs baseline). The findings of the immunohistochemical study confirmed the development of neoangiogenesis in the skeletal muscle and a 25 percent increase in the capillary-network density following administration of autologous stem cells into the muscle. The method of transplanting peripheral-blood autologous stem cells for treatment of patients presenting with distal forms of chronic obliterating insufficiency of the lower limbs proved safe and efficient. The findings obtained during this study made it possible to recommend extending the indications for its application at the expense of patients with critical ischaemia.

[Intra-operative complications and causes of conversion during aortofemoral reconstruction through mini-laparotomy].

Results of 269 reconstructive operations on infrarenal aorta (among them 30 - for aneurysms) applied using mini-laparotomy (abdominal midsection 5-10 cm) were analyzed. Complexities during the operation occurred in 12,6% of patients; among them complications were observed in 4.8%. In 7.1% of cases it resulted in conversion of access. With accumulation of experience frequency of complications decreased from 6.1 to 3.8% (p=0,616) and frequency of conversions - from 12.2 to 3.2% (p=0.017). Comparison with group of 162 patients operated using standard laparotomy showed that despite rather more frequent complexities with infrarenal aorta reconstruction from mini-access (12.6% against 9.4%, p=0.505) amount of complications didn't differ significantly (4.8% and 5.6% respectively, p=0.930). Authors consider abdominal aorta reconstruction from mini-access to be a safe operation.

[Remote results of using "ECOFLON" prostheses in management of patients with Leriche's syndrome].

The authors analysed the outcomes of 476 reconstructions performed on the aortofemoral segment for Leriche's syndrome using polytetrafluoroethylene grafts "ECOFLON" within the time frame from 1997 to 2007. The in-hospital mortality rate amounted to 2.7%, thrombosis rate to 0.46%, and amputation rate to 0.69%. The remote results were assessed at follow-up terms varying from 6 to 108 months, with the mean follow-up time thus amounting to 34.6 +/- 1.3 months. Secondary graft patency by the first postoperative year amounted to 98.0 +/- 0.62%, by 5 years to 92.5 +/-1.9%, and by 9 years to 91.4 +/- 1.9%, with primary graft patency being 97.3 < or =0.23%, 84.9 +/- 2.9%, and 82.9 +/- 3.5%, respectively. The limb salvage rate amounted to 97 +/-0.6% after 1 year, equalling 91.2< or =2.2% after 5 years, and 80.9 +/- 5.2% after 9 years. Infection of prosthetic grafts occurred in 1.04% of cases (0.42% in the short-, and 1.05 % in the long-term periods). Pseudoaneurysms of distal anastomoses were observed in 0.34% of cases. Analysing two time intervals (i. e., 1997-2002 and 2003-2007) howed a statistically significant betterment of the patency rates (with primary graft patency having increased by 5.3% and secondary graft patency by 5.8%, (P < 0.01), thus apparently suggesting improved quality of explants. It was concluded that polytetrafluoroethylene grafts "ECOFLON" comply with the present-day standards of quality.

[Remote results of aortofemoral reconstructions performed through miniaccess].

Analysed herein are long-term outcomes of 250 reconstructions of the infrarenal aorta for occlusive disease with the use of transperitoneal miniapproach (median minilaparotomy 5-10 cm long). The patients' average age amounted to 58.2±0.64 years. 60.4% of patients had critical ischaemia. Bilateral reconstruction was performed in 216 patients, and unilateral--in 34 subjects (with revascularization performed on a total of 466 limbs). Hospital lethality rate amounted to 0.8% (2 patients). There were 2 bypass-graft thromboses (in one case with successful thrombectomy). The incidence rate of amputations was 0.86% from the number of revascularized extremities. Remote outcomes were assessed in 145 patients within terms varying from 6 months to 84 months (mean follow-up duration--30.8±1.4 months). Primary patency after 1 year amounted to 97.0±0.1%, after 5 years--81.8±3.9%, after 84 months--67. ±9.8%, with the corresponding figures for secondary patency amounting to 98.0±0.83%, 91.9±2.8% and 91.9±2.8%, respectively. The limb preservation rate after one year equalled 97.0±0.9%, after 5 years--93.6±2.4%, after 84 months--93.6±2.4%. Five-year survival amounted to 73.5±6.2%. Postoperative ventral hernias were revealed in 6.9% of patients. Hence, the long-term outcomes of aortofemoral reconstructions thorough the miniapproach correspond to the commonly accepted criteria for quality of operations for occlusive pathology of the aortofemoral segment.

[Objective criteria for the invasive nature of a mini-approach in aortofemoral reconstructions. A prospective study].

The authors carried out a prospective study of the invasive nature ofaortofemoral reconstruction performed via the standard routine laparotomy (StLT, Group I, n 10) and minilaparotomy (MLT, Group II, n = 10). It was determined that the objective criteria for the invasive degree of the intervention were less pronounced in the group of the patients operated on through the MLT, with the main differences manifesting themselves to a greater extent in the early postoperative period. Despite statistically significant differences of the creatinphosphokinase (CPK) level as a marker of a parietal injury (562 U/I in Group 1, 243 U/I in Group II, P = 0.005), the concentration of Cortisol increased dramatically during the operation (by 288 and 162%, respectively) with a statistically insignificant deference between the groups (P = 0.08). Alterations in the vegetative status (determined by cardiointervalography) in the intraoperative period were ofa variously directed variable character, not differing between the groups. However, normalization ofthese parameters in the postoperative period occurred more rapidly in MLT. Group IH patients were noted to restore earlier the function of the gastrointestinal trapt with a less pronounced pain syndrome tested by the visual analogue scale, especially on postoperative days 2 and 4 (p<0.01 and. Hence, reconstruction of the infrarenal aorta through the MLT is characterized by a lesser invasive nature, with the above mentioned differences being more pronounced in the early postoperative period, since the main intraoperative factors of the invasion depend to a lesser extent on the approach size.