[Endovascular treatment of common iliac artery aneurisms]. / Rezul'taty endovaskulyarnogo lecheniya anevrizm obshchei podvzdoshnoi arterii.

OBJECTIVE: To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS: Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS: Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.

[Postoperative care in patients with DeBakey type I aortic dissection: criteria of aortic remodeling and risk factors of disease progression]. / Osobennosti techeniia posleoperatsionnogo perioda u patsientov s rassloeniem aorty I tipa po DeBakey: kriterii otsenki remodelirovaniia aorty i faktorov riska progressirovaniia zabolevaniia.

AIM: To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery. MATERIAL AND METHODS: Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared. RESULTS: There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p<0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels. CONCLUSION: Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.

[Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality.

Myocardial revascularization in CAD patients with left ventricular ejection fraction below 35%.

UNLABELLED: The aim of the present study was to compare the short- arid long-term clinical results in CAD patients with an initial LV ejection fraction below 35% after coronary stenting and coronary artery bypass grafting (CABG). METHODS AND RESULTS: the study accrued 94 CAD patients with an initial LV ejection fraction below 35%. As dependent on the revascularization techniques performed, the patients were distributed into two groups. The first group comprised patients after intracoronary stenting. The second group included patients who had undergone CABG. Both groups were comparable in terms of the basic clinical criteria. The short-term clinical success of intervention in CS and CABG groups accounted for 97.6% and 97.7% respectively (p>0.05). The hospital lethality was significantly higher in the CABG group than in the CS group and was quoted as 13.7% versus 2.3% (p<0.05). No significant differences in the clinical status were recorded among patients with the clinical success. In the long-term period, the three-year survival in the CS and CABG groups accounted for 73.2% and 79.1% respectively (p>0.05). The incidence of unfavourable clinical events (UCE) in the CABG group was recorded significantly less frequently than in the CS group and constituted 21.9% versus 39% (p<0.05). Complete "freedom" from angina and UCE in the CABG group was recorded significantly more often among CABG group patients versus the CS group: 79.1% versus 60.9% respectively (p<0.05). CONCLUSION: As regards the immediate clinical efficacy both methods of revascularization are not statistically different. However, CABG is associated with a significantly higher hospital lethality. In turn, in the long-term period with the three-year survival in the study groups being statistically comparable), the incidence of UCE is recorded significantly most frequently in the CS group.

Recanalisation of occluded peripheral arteries by excimer laser.

Laser recanalisation was attempted in 24 patients with total segmental occlusions of the lower extremity arteries and the aortic arch branches. All patients were men aged 40-82 years, in 20 the lesions were caused by atherosclerosis, in three by Buerger's thromboangiitis and in one by postembolic occlusion. Angioplasty was performed using excimer lasers with a wavelength of 308 nm and with monofiber waveguides in the transcutaneous transcatheter mode. Recanalisation of the vessel throughout the length of the obliterated segment was successful in 13 out of 24 patients. In all patients with thromboangiitis, energy losses were less than in atherosclerotic occlusions and no problems were experienced in patients with severe calcification. A high percentage of failures is a result of imperfect technology and low effectiveness of control, this must be improved. The Vishnevsky Institute of Surgery in collaboration with the Institute of General Physics has been developing a method of recanalisation of occluded arteries using excimer laser radiation. This paper is a preliminary analysis of our first clinical results.