[Remote results of infrainguinal bypass graft procedures for critical lower limb ischaemia]. / Otdalennye rezul'taty infraingvinal'nykh shuntirovanii pri kriticheskoi ishemii nizhnikh konechnostei.

AIM: The study was aimed at assessing the remote results of infrainguinal reconstructions in patients with critical lower limb ischaemia depending upon the bypass graft material used. PATIENTS AND METHODS: Analysed herein are the results of 237 infrainguinal bypass procedures performed over a 9-year period from January 1st, 2010 to December 31st, 2018. The patients were divided into three groups depending on the level of the distal anastomosis. Each group was then subdivided into subgroups based on the bypass graft material. Group One comprised 40 patients having endured femoral-proximal-popliteal bypass grafting. Group Two was composed of 77 patients after femoral-distal-popliteal bypass graft operations. Group Three included 120 patients after femorotibial bypass graft procedures. The comparative analysis was carried out in the first group between autovenous and synthetic grafts, in the second group - between autovenous, synthetic grafts and xenografts, and in the third group - between autovenous, composite grafts and xenografts. RESULTS: The primary patency rates at 1, 3, and 5 years in the first group amounted to 92, 88, and 73%, in the second group to 68, 60, 45% and in the third group - to 58, 49, and 43%, respectively. The 1-, 3-, and 5-year limb salvage rates in the first group were 100, 100, and 87%, in the second group - 90, 85, 73%; and in the third group - 90, 80, and 79%, respectively. Statistically significant differences were observed only when comparing the femoral-proximal and tibial grafts (p=0.039). Patients' survival at 1, 3, and 5 years in all groups turned out to be approximately similar, amounting in the first group to 92, 84, and 61%, in the second group to 96, 91, 71%, and in the third group to 88, 77, and 69%, respectively (p=0.87). In the first group, there were no significant differences between autovenous and synthetic grafts for any of the parameters studied. In the second group, the synthetic grafts (20%) were significantly inferior by the 5-year patency to autovenous grafts (65%) and xenografts (56%), as well as by the limb salvage rate to autovenous grafts (47 versus 84%). In the third group, the 5-year patency was the worst for the subgroup of composite grafts (15%), with the patency of xenografts being slightly inferior to that of autovenous grafts (33 vs. 55%). CONCLUSION: In patients presenting with critical ischaemia and requiring infrainguinal bypass grafting, as an alternative to an autovein if unavailable may serve synthetic prostheses when shunting to the proximal portion of the popliteal artery, or xenografts when shunting to the distal portion of the popliteal artery or tibial arteries. Despite worse patency, with their help it is possible to achieve regression of critical ischaemia and an acceptable limb salvage rate, which is comparable to the results of autovenous grafts.

[Endovascular revascularisation in patients with necrotic wounds and extended infrainguinal arterial disease]. / Endovaskulyarnaya revaskulyarizatsiya u patsientov s gnoino-nekroticheskimi ranami nizhnikh konechnostei s infraingvinal'nym protyazhennym porazheniem arterial'nogo rusla.

OBJECTIVE: To report own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. MATERIAL AND METHODS: We have analyzed literature data and own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. RESULTS: Endovascular strategy is preferable in a certain subgroup of patients with extended infrainguinal lesions. CONCLUSION: Considering own data, we assumed the need for routine correction of outflow pathways (simultaneous angioplasty of at least 2 tibial arteries). Primary results are encouraging, but further research is required.

[Two-year results of infrainguinal reconstructions using autovenous shunts and xenografts]. / Dvukhletnie rezul'taty infraingvinal'nykh rekonstruktsii s ispol'zovaniem autovenoznykh shuntov i ksenoprotezov.

The authors analysed two-year results of inftrainguinal distal arterial reconstructions using xenograft ("kemAngioprosthesis") as compared with an autovein. Ours was a retrospective study including a total of 110 patients who endured 57 femoropopliteal (distal) and 54 femorotibial bypasses by means of both an autovein and a xenograft used as a shunt. The indications for reconstructive operation in the majority of cases was critical ischaemia induced by an atherosclerotic lesion of the femoropoplitealtibial segment corresponding to type D according to the TASC II classification. A xenograft was used only in case when the patient had neither great nor small saphenous vein suitable for use. Xenografts were used in 38 operations. In femoropopliteal (distal) bypasses the primary two-year patency of the xenograft virtually did not differ from that of autovenous shunts (70.1 and 76.5%, respectively). The two-year limb salvage rate for xenografts and autoveins used as shunts amounted to 87.1 and 88.7%, respectively. In For femorotibial bypass grafting, primary 2-year patency of xenografts was considerably worse and amounted to 35.8 versus 73.7% for autovenous shunts. The two-year limb salvage rate did not depend upon the type of the shunt, amounting in both cases to 80.2%. A characteristic complication for using xenografts was aneurysmatic degeneration of the shunts, which was observed in 21% of cases averagely 2 years after surgery. A conclusion was made that using xenografts for infrainguinal bypass operations may be considered as an adequate alternative in case of no autovenous material available.

[Acute thrombosis of abdominal aortic aneurysm: three case reports].

Presented herein are three clinical case reports concerning patients with acute thrombosis of an abdominal aortic aneurysm. In all three instances, the true cause of the acute limb ischaemia syndrome had been recognized not immediately at admission but only after instrumental examination or during laparotomy. The mechanisms of the development of acute thrombosis of the aneurysmatic sac in all three cases turned out to be different. Two patients endured direct reconstruction of the abdominal aorta, and the remaining one sustained extra-anatomical bypass grafting. Of these, two patients survived, and one patient subjected to aortofemoral bypass grafting unfortunately died of renal failure on postoperative day 3.

[Natural course of acute symptomatic abdominal aortic aneurysms].

PURPOSE OF THE STUDY: To examine the natural course of acute symptomatic aneurysms of the abdominal aorta. PATIENTS AND METHODS: From 1995 to 2005, admitted to our clinic were a total of 29 patients presenting with acute symptomatic aneurysms of the abdominal portion of the aorta (hereinafter referred to as AAA). Any aneurysmal ruptures were excluded based on the findings of an ultrasonographic duplex study and computed tomography. Eight patients were operated on urgently, one of whom died. The causes of refusal to perform either an emergency or planned operative intervention in other patients were as follows: age over 90 years old, patient's refusal to undergo the operation, pronounced concomitant pathology, small dimensions of the aneurysm in a combination with complete arrest of the pain syndrome. The subject of the study was follow-up of non-operated patients. RESULTS: Over the time of follow-up, ten patients died of AAA rupture. AAA ruptured in 4 patients within the first 10 days after admission, with the rest having died of the AAA rupture averagely after 18 months. Of the remaining patients, three died of various causes not related to AAA, one having endured a successful planned resection of the AAA, and two non-operated patients are still alive. None of the patients with a small AAA died of a rupture during the early follow-up period. CONCLUSION: According to our findings, about one fourth of acute symptomatic AAAs would develop within the first 24 hours after the beginning of the pain syndrome. It is impossible to predict the natural course of such AAAs based only on the aneurysm's diameter and degree of the pain syndrome. Perspective patients without pronounced accompanying pathology should be operated on urgently.