[Choice of hybrid interventions for iliac-femoral arterial lesions]. / Vybor ob"ema gibridnogo vmeshatel'stva pri porazhenii arterii podvzdoshno-bedrennogo segmenta.

OBJECTIVE: To compare the short-term and long-term outcomes of hybrid interventions after various infrainguinal reconstructions (restoration of blood flow through superficial femoral artery and pulsatile blood flow through deep femoral artery) in patients with iliac-femoral arterial disease. MATERIAL AND METHODS: A retrospective analysis included patients after hybrid iliac-femoral interventions between 2014 and 2018. These interventions included stenting of iliac arteries and various open infrainguinal reconstructions. The first group (n=41) consisted of patients who underwent reconstruction of superficial femoral artery, the second group (n=88) - restoration of pulsatile blood flow in deep femoral artery. We analyzed the Rutherford score, perioperative complications, primary patency rates and limb salvage rates after 12 months in both groups. RESULTS: Significant improvement (Rutherford score +3) was achieved in 28 (70%) and 14 (15.9%) patients, respectively (p<0.05). There were no significant between-group differences in the number of postoperative complications. Surgery time was longer in the first group (median 160 and 130 min, respectively, p<0.05). However, intraoperative blood loss was similar. Primary patency rates after 12 months were 82.4% and 95.1%, respectively (p=0.054). Limb salvage rates after 12 months were 94.7% and 100%, respectively (p<0.05). CONCLUSION: This study highlights the potential advantages of restoring pulsatile blood flow through the deep femoral artery in hybrid interventions. Higher primary patency and limb salvage rates in the second group indicate better long-term outcomes after restoration of blood flow through the deep femoral artery. Further prospective studies are needed to confirm these results and determine the underlying mechanisms of differences.

[Hybrid operations in treatment of patients with multi-level lesions of lower limb arteries]. / Gibridnye operatsii v lechenii patsientov s mnogourovnevym porazheniem arterii nizhnikh konechnostei.

The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.

[Surgical treatment of pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion]. / Opyt uspeshnogo khirurgicheskogo lecheniya anevrizmy pankreatoduodenal'noi arterii v sochetanii s okklyuziei chrevnogo stvola.

We report successful surgical treatment of inferior pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion. Considering angioarchitectonics of the afferent and efferent arteries (significant tortuosity), possible liver ischemia during endovascular occlusion of pancreaticoduodenal artery and expected low efficiency of embolization, the patient underwent open surgery (celiac trunk replacement and resection of pancreaticoduodenal artery aneurysm). Postoperative period was uneventful. The first and subsequent postoperative controls showed an adequate function of the prosthesis and no contrast enhancement of the aneurysm. We concluded that rational surgical approach ensured optimal solution of the problem, i.e. surgical treatment of pancreaticoduodenal artery aneurysm was the most radical and functional.

[Secondary intrathoracic reconstruction after prosthetic repair of the brachiocephalic trunk for traumatic aneurysm of the right subclavian artery].

The article deals with a case report of successful secondary surgical treatment of a patient who endured prosthetic repair of the brachiocephalic trunk for a traumatic false aneurysm of the right subclavian artery complicated by thrombosis of the reconstruction zone. Long-term conservative treatment resulted in progression of cerebrovascular insufficiency, invalidization, increasing ischaemia of the right upper limb, which required performing secondary intrathoracic reconstruction with prosthetic repair of the common carotid artery, vertebral artery and axillary artery on the right. Presented herein are the results of check up contrast-enhanced and CT-angiography performed at 10 months after the operation.

Surgical management of multiple posttraumatic arteriovenous fistulas of femoral vessels.

Presented herein are two case reports concerning surgical management of posttraumatic arteriovenous fistulas of femoral vessels. Case 1. A 45-year-old female patient attended with a history of a shotgun injury wound of her left femur and crus sustained when a girl of eight. She sought medical attention for a progressively deteriorating condition, accompanied by pain, and breathlessness dyspnea at rest. Detected were multiple fistulas between the deep femoral artery and superficial femoral artery and femoral vein. Management consisted in separation of the arteriovenous fistulas, followed by prosthetic repair of the deep femoral artery. Case 2. A 32-year-old male patient after an accidentally inflicted shotgun injury of the his left femur underwent within a time period of 3 year three vascular operations including ligation of the deep femoral artery and femoral vein followed by having later on developed secondary lymphedema of his left lower limb and pronounced manifested chronic venous insufficiency. Management included dissociation of the numerous arteriovenous fistulas between the branches of the deep femoral artery and the common femoral artery, as well as between the superficial femoral artery and femoral vein.

[Femoro-popliteal bypass above popliteal fossa with PTFE graft: which graft diameter is better?].

The paper presents the results of 80 femoro-popliteal bypasses above popliteal fossa for patients with lower limb atherosclerotic lesions that were fulfilled with the use of polytetrafluoroethylene (PTFE) graft in the Department of Vascular Surgery, AV Vishnevsky Institute of Surgery, from February 1992 till December 2005. 50% of patients had lower limb ischemia grade IIb, 13.7% - grade III and 36.3% - grade IV. Distal circulation was good in 41.2%, satisfactory - in 48.5% and unsatisfactory - in 10.3% of patients. The technique of surgical reconstruction was conventional. In 50% of cases the diameter of PTFE grafts was 8 mm, in another 50% - 6 mm. A statistically significant difference in bypass patency was revealed between prostheses with different diameter in late postoperative period. For the 8-mm grafts the patency rate was 93%, 64% and 51% in 12, 30 and 60 months, respectively, while for the 6-mm grafts the same rate was 62%, 44% and 31%, respectively (p=0.004).

[Long-term outcomes of femoropopliteal bypass above the knee-joint fissure by means of vascular prosthesis <> in patients with atherosclerotic lesions of lower limb arteries].

Presented herein are the remote results of a total of 110 operations of femoropopliteal shunting above the knee-joint fissure, carried out using the vascular: prosthesis <> in patients diagnosed with atherosclerotic lesions of arteries of the lower limbs over the period between November 1995 and December 2005 at the Department of Vascular Surgery of the A. V. Vishnevsky Institute of Surgery of the Russian Academy of: Medical Sciences. The operative interventions were carried out according to the conventionally accepted technique. Fifty-four (49.1%) patients were operated on for grade II B ischemia, 26 (23.6%) suffered from grade III ischaemia, and 30 (27,3%) subjects were found to have grade IV ischaemia. The average age of the patients was 60.2+/- 7.4 years. The mean values of the ankle-brachial index (ABI) along the posterior greater femoral artery (PGFA) and the anterior greater femoral artery (AGFA) in patients presenting with grade II B ischaemia amounted to 0.52+/-0.21 and 0.55+/-0.15, respectively. In patients with critical ischaemia, the respective ABI values equalled 0,37+/-0,23 and 0.4+/-0.22 Studying the state of the distal bed showed that the condition of the outflow tracts was <> in 54.3% of patients, being defined as <> in 37%, and as <> in 8,7%. The total duration of the long-term follow-up period amounted to: 100 months, averaging 28.4+/-19.5 months. The main clinical factors determining the remote: patency of the vascular prostheses <> in the femoropopliteal position were as follows; the values of the outflow score, the diameter of the popliteal artery, and the ankle-brachial index after surgery. With <> outflow tracts, the patency of the transplants after 3 years amounted to 57%., after 5 years being 48%. In cases of <> outflow tracts, the patency of the vascular prostheses 3 years, after surgery amounted to 26%. In <> outflow tracts, none of the bypasses remained passable for more than 12 months (P<0.01). The dependence between the value of the lumen of the popliteal artery and the patency of the vascular prosthesis was observed to be persisting during the first 2 years following fiurnory, In patients with arterial lumen <3 mm, the patency after 6. 12 and 18 months amounted to 61%, 47% and 41%, respectively; with the popliteal artery's lumen equalling 3.5 mm and more, the patency amounted to 77%, 63%, 42% and 86%, 68% and 56%, respectively, at the above-mentioned time intervals (P<0.05). When the value of the ABI following surgery was >1, the patency of the vascular prostheses after 60 months amounted to 41%, with the ABI>1, after 50 months, the patency amounted to 17%. With the ABI<0.9, none of the shunts remained patent for more than 31 months (P<0.05). Using the pattern of prediction of the outcomes of the femoropopliteal shunting by means of the vascular prosthesis <> above the knee-joint fissure, with due regard for the condition of the distal vascular bed the value of the lumen of the popliteal artery and the value of the ABI after surgery made it possible to rather reliably predict the patency of the prosthesis in the remote terms after surgery (P<0.01).

[Liprimar in prevention of coronary complications in patients following reconstructive vascular surgery].

The article is dedicated to analyzing the outcomes of an open prospective study of efficacy of Liprimai administered in the postoperative period. The study comprised a total of 30 patients presenting with atherosclerotic lesions of the arteries of the carotid bed and aorto-femoral segment, who were subjected to reconstructive vascular operations. The aim of the present study was to look into a possibility of preventing cardiac complications in patients after endured reconstructive vascular surgery. Liprimar was administered at a daily dose of 10 mg seven days prior to the operation, and for eight days thereafter.

[Femoropopliteal bypass above the knee-joint fissure by means of a vascular prosthesis made of PTFE: choosing an appropriate diameter of the prosthesis].

Presented herein are the outcomes of a total of 80 operations of femoropopliteal grafting above the knee-joint fissure, carried out using a vascular prosthesis made of polytetrafluoroethylene (PTFE) in patients diagnosed with atherosclerotic lesions of the arteries of the lower extremities over the period between February 1995 and December 2005 at the Department of Vascular Surgery of the A. V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences. Fifty percent of the patients were operated on for grade II B ischemia, while 13.7% of the patients suffered from grade III ischaemia of the lower limb, and 29 (36.3%) subjects were found to have grade IV ischaemia. The condition of the distal bed was considered <> in 41.2% of the patients, being defined as <> in 48.5%, and as "poor" in 10.3%. The operative intervention was carried out according to the conventionally accepted technique. 50% of the reconstructions were performed using the prosthesis 8 mm in diameter, and 50% - using that measuring 6 mm in diameter. A statistically significant impact of the diameter of the prosthesis used on the patency of the graft in the remote postoperative period was revealed: with the prosthesis 8-mm in diameter, the patency after 12, 30 and 60 months amounted to 93%, 64% and 51%, respectively, while with the transplant measuring 6 mm in diameter, these indices at the above-mentioned time intervals did not exceed 62%, 44% and 31%, respectively (P=0.004).

[Estimation of the protective effect of Nebilet for perioperative cardiac complications in patients underwent vascular surgery: results of prospective study].

We report results of our prospective study - administration of Nebilet in 30 patients in perioperative period. Aim of this study is to estimate the protective effect of Nebilet for perioperative cardiac complications (nonfatal myocardial infarction and cardiac death) in patients which underwent recostructive vascular surgery. Patients were administrated Nebilet (2.5 to 7.5 mg/per day, according to arterial pressure and heart rates) 20 days before operation and 2 months after surgery. In early postoperative period we performed the control examinations: troponin T (1, 3, 7 days), ECG (1 day), echocardiography (1-2 day) and 2 months after operation (ECG and echocardiography). During whole follow up period we controlled in patients arterial pressure and heart rates.

Carotid artery dissection (literature review and a case report).

The paper presents a literature review on the internal carotid artery (ICA) dissection and an original case report. The dissected ICA segment was resected and grafted.

[The long-term results and indications for use of Gore-Texgrafts in the femoropopliteal position in patients with atherosclerotic lesion of lower limb arteries]. / Otdalennye rezul'taty i pokazaniia k ispol'zovaniiu proteza "Gore-Tex" v bedrenno-podkolennoi pozitsii u bol'nykh s ateroskleroticheskim porazheniem arterii nizhnikh konechnostei.

Presented herein are the long-term results of femoropopliteal reconstructions above the knee joint fisure in patients with atherosclerotic lesion of the femoropopliteal segment using Gore-Tex grafts. The retrospective study accrued 108 patients. Of these, IIB degree lower limb ischemia (according to the A.V. Pokrovsky classification) was initially present in 64 (60.2%) and critical ischemia in 52 (40.8%) patients. Patients suffering from lower limb ischemia of varying degree did not significantly differ in the age or coexistent diseases. The mean value of the ankle/brachial index (ABI) accounted for 0.46+/-0.23 in patients with IIB degree ischemia and for 0.40+/-0.27 in patients with critical lower limb ischemia. All the patients were evaluated for the condition of the distal bed according to the scheme proposed by Rutherford et al. in 1997. The patients were distributed into three groups: patients with "good" runoff (from 1 to 4 points, n=65), patients with "satisfactory" runoff (from 5 to 7 points, n=36), and those with an "unsatisfactory" condition of the distal bed (runoff point over 7, n=7). The long-term results were assessed in 81 (75%) patients over the period as long as 105 months. The mean follow up accounted for 58,4 months. One year later the graft patency in the total patient group constituted 73.1%, after 3 years it was equal to 54.8%, and after 5 years to 49.9%. It is demonstrated that the initial runoff point exerted a significant effect on the graft patency. It is noteworthy that in patients with an initially "good" runoff point, 57.5% of the grafts were patent 5 years after operation whereas in patients with a "satisfactory" point only 35.3% turned out patent (p<0.05). Patients with an initially "unsatisfactory" runoff point developed thrombosis of all grafts over the period as long as 6 months following operation. The five-year limb salvage was observed in 77.6% of patients. It has been revealed over the 5-year period that the degree of initial limb ischemia did not produce any significant effect on the graft patency or limb salvage. The scheme for runoff assessment allows to define in a differentiated way the indications for use of Gore-Tex grafts in the femoropopliteal position. The runoff point had a significant effect on the long-term 5-year patency of the grafts.