[Evaluation of revascularization efficiency using near-infrared oximetry in patients with diabetic foot syndrome]. / Otsenka effektivnosti revaskulyarizatsii u patsientov s sindromom diabeticheskoi stopy metodom parainfrakrasnoi oksimetrii.

OBJECTIVE: To evaluate prognostic significance of tissue oximetry in healing of trophic defects in patients with diabetic foot syndrome (DFS) after endovascular revascularization. MATERIAL AND METHODS: In 42 patients with DFS, tissue oximetry was performed in angiosome projection with the FORE-SIGHT MC-2000 (CASMED) device before and the next day after revascularization of lower limb arteries. The 1st group included 30 patients with wound healing throughout 3 months, the 2nd group included 12 patients with amputation or no healing of trophic defects. RESULTS: Direct revascularization was more common in the 1st group (p=0.001). On the day after intervention, oxygen saturation (StO2) increased in all angiosomes in both groups (p<0.05). StO2 increment differed significantly between groups in all angiosomes except for point I (p<0.05). According to ROC analysis, StO2 increment by 4.5% in absolute values and 7.9% in percentage leads to trophic defect healing within 3 months (sensitivity and specificity were 76.7% and 66.7% for absolute values, 80% and 58.3% for percentage, respectively). CONCLUSION: Evaluation of StO2 in target angiosome may be valuable to predict trophic defect healing after endovascular surgery.

Surgical treatment in symptomatic stenosis of the carotid artery and persistent primitive hypoglossal artery. / Khirurgicheskoe lechenie pri simptomnom stenoze sonnoi arterii i persistiruiushchei émbrional'noi pod''iazychnoi arterii.

Persistent primitive hypoglossal artery is a rare variant of intrauterine anastomosis between the carotid and basilar arteries, which may remain in adults. The presence of this artery in carotid artery atherosclerosis increases the risks for stroke in the carotid and basilar basins. Our clinical case illustrates successful carotid endarterectomy in the presence of an ipsilateral persistent primitive hypoglossal artery under cerebral oximetry control.

Treatment Tactics for Patients with Isolated Injuries of the Fifth Lumbar Vertebra.

The major management technique for lumbar burst fractures is transpedicular fixation (TPF). However, in relation to fractures of the L5 vertebra, this tactic often has no advantages over conservative treatment, and, therefore, it is expected to be supplemented with anterior decompression and reconstruction of the anterior column of the L5 vertebra. The aim of the study was to determine the most optimal treatment tactics for patients with isolated burst fractures of the fifth lumbar vertebra. Materials and Methods: We performed a retrospective study of 58 patients treated for isolated burst L5 fractures. 12 patients refused to undergo surgery and received conservative outpatient treatment. TPF was performed in 27 patients; circular spondylosynthesis (TPF + anterior column support with a Mesh implant) - in 19 patients. The effectiveness of the treatment was assessed by clinical and introscopic research methods. Results: The radiological and functional outcomes of surgery with conventional TPF for isolated L5 burst fractures are generally comparable with the outcomes of conservative treatment. In 26% of the patients, the instability of the metal construction developed within 12 months after surgical intervention. Supplementing the transpedicular system with wedging anterior column support with a Mesh implant ensures preservation in 21%, and improves the parameters of the sagittal profile of the lumbosacral transition in 79% of cases.

[Role of cerebral oximetry in prediction of hyperperfusion syndrome after carotid endarterectomy]. / Rol' tserebral'noi oksimetrii v prognozirovanii sindroma giperperfuzii posle karotidnoi éndarteréktomii.

OBJECTIVE: The purpose of the study was to carry out a retrospective analysis of alterations in regional oxygenation (rSO2) of the brain at all stages of carotid endarterectomy (CEA) in order to detect predictors of ischaemia and hyperperfusion of the brain. PATIENTS AND METHODS: In a total of 169 patients during CEA under general anaesthesia we registered rSO2 after induction of narcosis, prior to carotid artery cross-clamping, at 2 minutes and each 10 minutes after cross-clamping, before re-establishing blood flow, at 2 and 5 minutes thereafter, and finally at the end of the operation. We evaluated the baseline parameters and intraoperative alterations in regional oxygenation depending on clinical and instrumental data. We also carried out a multivariate regression analysis in order to reveal significant risk factors for ischaemia and hyperperfusion. We analysed the ROC curves in order to determine the threshold value of a decrease and increase of rSO2 in ischaemia and hyperperfusion of the brain. RESULTS: After the multivariate analysis, an independent predictor turned out to be grade III arterial hypertension (OR 9.5, 95% CI: 1.1-82.7). It was revealed that the most significant predictor of the development of hyperperfusion syndrome was the absolute increase in rSO2 after re-establishing blood flow by more than 11.3. Sensitivity, specificity, positive and negative prognostic value of the parameter revealed amounted to 87.4, 83, 35 and 98.4%, respectively. CONCLUSIONS: The multivariate analysis performed demonstrated that only long-standing grade III arterial hypertension was a significant risk factor for the development of hyperperfusion syndrome after CEA. In our study, the most accurate parameter for the Fore-Sight oximeter was the maximum increase of the absolute value of rSO2 after re-establishing blood flow above 11.3 Cerebral oximetry is a non-invasive, simple to use and interpreter method making it possible to evaluate not only ischaemia but hyperperfusion of the brain during CEA and in the early postoperative period.

[Transradial approach in carotid stenting]. / Transradial'nyi dostup pri karotidnom stentirovanii.

A femoral approach is the main access in stenting of carotid arteries, mainly due to rapid training in how to perform the procedure and a possibility of using large-diameter catheters. However, this approach is not always feasible in atherosclerosis, tortuosity of lower-limb arteries and in certain anatomical peculiarities of the aortic arch. Using a transradial approach is based on the desire to diminish the incidence rate of haemorrhagic complications in the zone of the puncture and to avoid the necessity of a long-term bed rest. The findings obtained in numerous studies of coronary stenting and in a series of works on stenting of carotid arteries have demonstrated that the transradial approach reduces the risk of haemorrhage and local vascular complications. Our study was aimed at comparative analysis of the transradial versus transfemoral approache used in carotid stenting. We retrospectively analysed the results of transradial and transfemoral stenting of carotid arteries in a total of 168 patients. The operations had been performed in two centres over the period from 2012 to 2017. We evaluated the clinical and angiographic data, technical aspects of the operations, as well as the outcomes and complications. In particular, we compared such complications as stroke, transitory ischaemic attack, myocardial infarction and local complications of the approach. We carried out a univariate analysis of the risk for the development of complications depending on the method of the approach. Stenting of carotid arteries had been performed in 75 patients through the radial approach and in 93 patients via the femoral one. Comparing the two groups, the main clinical and angiographic data appeared to have no statistically significant differences. Various techniques of catheterization had been used depending upon anatomical peculiarities. The success of the procedure was achieved in 100% of cases, with the frequency of conversion amounting to 4% for the radial approach and to 1% for the femoral one (p=0.087). Amongst complications encountered, disabling stroke was revealed in two (1.2%) patients and minor stroke in four (2.4%). The groups did not differ by the incidence of neurological complications. Within 30 postoperative days neither lethal outcomes nor myocardial infarction were registered. Neither were there haemorrhagic events or other approach-related complications, however in the transradial-approach group, seven (9.3%) patients were found to have developed asymptomatic occlusions of the radial artery. The duration of the operation, the radiation load, and the length of hospital stay had no statistically significant differences depending on the approach used. Hence, the transradial approach is an effective and safe method in stenting of carotid arteries. In patients with high risk of haemorrhagic complications from the side of the vascular approach and with difficult anatomy of the aortic arch and its branches, hampering catheterization of the carotid artery via the femoral approach, the radial artery may be considered as an advantageous site of access.

Spontaneous recanalization of chronic occlusion of the internal carotid artery.

Described in the article is a rare case concerning spontaneous recanalization of the extracranial portion of the internal carotid artery (ICA) eleven months after occlusion. Only few publications have been dedicated to recanalization of ICA chronic occlusion. Spontaneous recanalization of the ICA is more common than it is generally understood. The authors have analysed all available articles about this problem from PubMed (1957 to 2013), reviewing the mechanisms of recanalization of the ICA, methods of diagnosis and treatment. The purpose of this case report is to emphasize the importance of ICA spontaneous recanalization and consequences thereof.

[First experience with monitoring somatosensory and motor evoked potential during operations on the thoracic and thoracoabdominal portions of the aorta].

Specialists in Russia have recently gained vast experience in operations on the thoracic and thoracoabdominal portion of the aorta; however, studying evoked potentials for preventing lesions of the spinal marrow have not been studied in any clinic. The authors report herein their first experience in Russia in studying the function of the marrow during operations on the aorta followed by detailed description of the technique of registering evoked potentials. From June 2010 to January 2011, specialists of the Arterial Pathology Department of the A. N. Bakulev Scientific Centre for Cardiovascular Surgery under the Russian Academy of Medical Sciences carried out a neurophysiological study in a total of 19 patients during operations for thoracic and thoracoabdominal aortic aneurysms. The somatosensory and motor evoked potentials were studied using an 8-channel neuroenhancer Keypoint (Dantec, Denmark). The hospital mortality rate in the examined group amounted to 5.2% (1/19). Spinal stroke developed in 2 patients, i.e. in 10.5% (2/19). The alterations in the somatosensory and motor evoked potentials were subdivided into groups according to the morphological classification of Crawford-Cunningham. A further two patients were found to have during operation type III changes in the evoked potentials, with both having developed postoperative spinal stroke. Thus, the method of intraoperative monitoring of evoked potentials has high sensitivity and specificity and can be included into the protocol of operations on the thoracic and abdominothoracic portion of the aorta. During monitoring of evoked potentials it is necessary to maintain a permanent level of anaesthesia and myorelaxation with obligatory participation of the neurophysiologist in the operation.

[Extra-anatomical bypass grafting from the ascending to the descending aorta combined with removal of the thoracic-aorta stent graft and a para-aortic abscess following endoscopic repair of the descending portion of the thoracic aorta].

The outcomes of reconstructive repair operations for aneurysms of the descending portion of the thoracic aorta typically appear to be relatively satisfactory. However, a certain cohort of patients presenting with the pathology concerned require repeated secondary interventions due to the development of false aneurysms in the area of the anastomosis and infection of the synthetic vascular stent graft, with the number of such patients steadily increasing with each year. The authors describe herein a clinical case report regarding successful treatment of a patient diagnosed with an infected pseudoaneurysm of the descending portion of the thoracic aorta after an endovascular repair operation. This case report demonstrated a present-day approach to appropriate treatment of patients presenting with the pathology involved.