Surgical treatment and prevention of vasculopathic impotence in conjunction with revascularisation of the lower extremities in Leriche's syndrome.

The results are presented of combined revascularization of the lower extremities and the penis in 29 patients with Leriche's syndrome. This was effected by placing an autogenous venous shunt between the branch of a prosthesis or the common femoral artery and one of the dorsal arteries of the penis. Preoperatively lost sexual function was restored in 6 patients, while in 16 the sexual function was maintained at the preoperative level or improved in the late postoperative period. A comparison of the results obtained with the sexual performance of patients who had undergone bifurcated aortofemoral shunting only, prompted the conclusion that this surgical procedure was effective in the prevention and treatment of vasculopathic impotence in Leriche's syndrome.

[A new method of surgical treatment of vasculogenic impotence]. / Novyi sposob khirurgicheskogo lecheniia vaskulogennoi impotentsii.

The authors describe a method of surgical management of vasculogenic impotence consisting in the formation of an anastomosis of an autovenous shunt with the dorsal artery of the penis. To prevent revascularization of the cavernous bodies of the penis with the restoration of erection, the dorsal artery of the penis is divided transversely at the root of the penis, the distal end of the autovenous shunt is given the shape of a trapezium with the upper side sutured, after which the autovenous shunt is anastomosed end to end with both the distal and proximal segments of the dorsal artery of the penis at the lateral sides of the trapezium where the angles were not sutured. The method allows incompetence and thrombosis of the vascular anastomosis to be prevented, raises the efficacy of revascularization of the cavernous bodies of the penis by creating favourable hemodynamic conditions through separation of the blood flow into the distal and proximal segments of the dorsal artery of the penis, which provides retrograde supply of blood into the deep artery of the penis sufficient for adequate revascularization of the cavernous bodies.

[Diagnosis and microsurgical correction of impotence of vascular origin]. / Diagnostika i mikrokhirurgicheskaia korrektsiia vaskulogennoi impotentsii.

The authors worked out an original complex of instrumental methods for the diagnosis of impotence of vascular origin, which includes ultrasonic Dopplerography of the genital arteries, radionuclide examination of hemodynamics of the penis, and radiocontrast phalloarteriography with the use of intracavernous pharmacological load. The results of the study make it possible to increase essentially the efficacy of microsurgical correction of impotence of vascular origin through objective indications for operative treatment on the basis of the suggested diagnostic methods, improvement of the techniques of revascularization of the cavernous bodies, and pathogenetically substantiated tactics of postoperative rehabilitation of patients.

[Surgical treatment and prevention of angiogenic impotence in combination with revascularization of the lower extremities in Leriche's syndrome]. / Khirurgicheskoe lechenie i profilaktika vaskulogennoi impotentsii v sochetanii s revaskuliarizatsiei nizhnikh konechnostei pri sindrome Lerisha.

The article deals with the results of combined revascularization of the lower limbs and penis in 29 patients with Leriche's syndrome. It was accomplished by creating an autovenous shunt between the blades of the prosthesis or common femoral artery with the dorsal artery of the penis. In the late-term postoperative period the initially lost sexual function was restored in 6 patients and improved or maintained on the preoperative level in 16 patients. On the basis of comparison of the results with the sexual function in patients who were treated by bifurcation aortofemoral shunting it is concluded that the suggested surgical tactics in the prevention and treatment of vasculogenic impotence in Leriche's syndrome produces a significant clinical effect.

Predicting postoperative arterial pressure in renovascular hypertensive patients.

The authors have developed a method for forecasting the degree of the hypotensive effect of surgery for renovascular hypertension. Fifteen digital parameters were determined in 36 patients with unilateral lesions of the renal arteries by the following methods of preoperative examination: the establishment of the duration of hypertension, radio-isotope renography, determination of renin activity in the peripheral and renovascular (venous) blood, rheonephrography. The obtained set of characteristics was used for the prediction of postoperative arterial pressure values by means of one of the methods of mathematical statistics, the regression analysis in an "SM-4" electronic computer according to a specially created multivariate regression program in the "Fortran-4" language. The high accuracy of predicting the arterial pressure by this method was confirmed by clinical trials. Forecasting postoperative arterial pressure by this method allows us to substantiate with a high degree of fidelity the advisability of reconstructive surgery and opens up realistic prospects for improving its results.

[Mathematical modeling of the degree of nephroarteriolosclerosis in vasorenal hypertension]. / Matematicheskoe modelirovanie vyrazhennosti nefroarteriolo- skleroza pri vazorena'lnoi gipertenzii.

Comparison of the findings of clinical, instrumental, and laboratory examination of patients with vasorenal hypertension with the results of morphological analysis of renal bioptic material showed that multivariate regression analysis of the parameters of examination of the patients provides for authentic calculation of the quantitative index of nephroarteriolosclerosis--the vascular index of the afferent arterioles of the renal glomeruli. The calculated values of the vascular index for both kidneys are criteria for choosing the method of operative intervention in vasorenal hypertension.

[Prognostication of the degree of the hypotensive effect of revascularization of both kidneys in patients with renovascular hypertension]. / Prognozirovanie stepeni gipotenzivnogo éffekta revaskuliarizatsii obeikh pochek u bol'nykh s vazorenal'noi gipertenziei.

A method for prognosticating the degree of a hypotensive effect of revascularization of both kidneys was developed on a group of 22 patients with vasorenal hypertension caused by bilateral affections of the renal arteries. It was based on mathematical treatment by the method of multidimensional regressive analysis of some parameters of preoperative examination of the patient and allowed the postoperative arterial pressure value to be calculated in mm Hg.

[Relation of the effectiveness of surgical treatment of vasorenal hypertension and morphologic changes of the kidneys]. / Zavisimost' éffektivnosti khirurgicheskogo lecheniia vazorenal'noi gipertenzii ot morfologicheskikh izmenenii pochek.

Renal puncture and incision biopsy specimens were investigated, using light and electron microscopic techniques, in 34 patients with vasorenal hypertension. The magnitude of the hypotensive effect of reconstructive surgery on renal arteries is shown to be largely dependent on the severity of arteriolosclerosis in the ischemized kidney rather than the contralateral one. Quantitative assessment of the severity of renal arteriolar sclerosis has established a critical vascular index (the ratio of arteriolar wall thickness to lumen diameter) above which the probability of reconstructive surgery producing a hypotensive effect becomes rather low.

[Angiographic and morphologic criteria of the manifestation of arteriolonephrosclerosis in vasorenal hypertension]. / Angiograficheskie i morfologicheskie kriterii vyrazhennosti arteriolonefroskleroza pri vazorenal'noi gipertenzii.

Parallel comparison of angiographic and morphologic indices of arterial nephrosclerosis levels was performed in 34 patients with vasorenal hypertension secondary to unilateral lesion of renal arteries. Coefficient of vascular picture absence zone in the kidney (30) presenting a percentage ratio of a vascular zone of kidney cortical layer and the total area of its section was employed. Amount of vascular index (ratio between the wall density of afferent glomerular arteriole and its lumen diameter) was used to assess arteriolosclerosis in morphologic examination of renal biopsy specimens. High level of reliable coefficient 30 in the evaluation of arteriolar nephrosclerosis degree was substantiated morphologically. Critical level of coefficient 30 was stated for the affected and contralateral kidneys, and its increase was suggestive of irreversible sclerosis of renal microvascular bed.

[Importance of morphologic examination of the kidneys of patients with vasorenal hypertension for predicting the results of surgical treatment]. / Znachenie morfologicheskogo issledovaniia pochek bol'nykh vazorenal'noi gipertenziei dlia prognoza rezul'tatov khirurgicheskogo lecheniia.

Light-optical, electron microscopic and morphometric studies of biopsy material from kidneys of 24 patients with vasorenal hypertension were performed. It was determined that sclerosis of the arteries and arterioles on the side of the lesion was more marked, than in the contralateral kidney. At a later stage of the disease (more than 3 yr.) there were occasional signs of increased renin-synthesizing activity of the juxtaglomerular apparatus (JGA) with its simultaneous decrease at the stenotic side. JGA activation in the contralateral kidney can be one of the mechanisms supporting hyperrenin arterial hypertension and can prevent the decrease of the blood pressure after surgery. Studying of the biopsy material with the estimation of the sclerosis degree of the arterial tree vessels, as well as JGA activity, is important for prognosing the results of surgical treatment of vasorenal hypertension.

[Complex clinical and morphofunctional study of vasorenal hypertension]. / Kompleksnoe kliniko-morfofunktsional'noe issledovanie u bol'nykh vazorenal'noi gipertoniei.

Hemodynamics, elastic characteristics of the greater arteries and blood renin activity were studied at the different stages of the disease in 23 patients with renovascular hypertension, caused by unilateral stenosis of the renal arteries. In 14 cases electron microscopy of the bioptic specimens of the impaired kidney was performed. It was shown that the peripheral plasma renin activity plays the leading role in the pathogenesis of arterial hypertension in the disease duration up to 3 years. The irreversible changes of the renal juxtaglomerular apparatus and the depression of their renin synthesizing function occur with progressing hypertension, and the secondary pressor mechanisms and factors prevail in the pathogenesis of hypertension. The loss of the arterial elastic properties as well as the depression of the renal hypotensive function may be one of the factors determining the failure of surgery at the late stages of the disease.

[Potential use of mathematical methods for predicting the surgical treatment results in renovascular hypertension]. / O vozmozhnosti ispol'zovaniia matematicheskikh metodov dlia prognozirovaniia rezul'tatov khirurgicheskogo lecheniia bol'nykh vazorenal'noi gipertoniei.

The duration of the case history was determined in 16 patients with vasorenal hypertension caused by unilateral lesion of the renal arteries, as well as renal activity in peripheral and reno-venous blood, Tmax and T1/2 according to the findings of renography, and blood flow in the renal artery before and after reconstruction according to the results of intraoperative flow measurement. The set of characteristics obtained was used in prognosing the parameters of arterial pressure (AP) in the postoperative period by means of regression analysis. The relative root-mean-square error in prognosing systolic AP was 15% and diastolic AP 20%. Nomograms for determining AP parameters according to the combination of characteristics were elaborated.