[Prophylaxis and treatment of purulent-septic complications of reconstructive operations on abdominal aorta and peripheral arteries].

The results of examination and complex treatment of 230 patients, suffering purulent-septic complications of reconstructive operations on abdominal aorta and peripheral arteries, were analyzed. The terms of diagnosis of the infected soft tissues and transplants had constituted 4.7 years at average. There was performed complex prophylaxis and diagnosis of complications, using invasive and noninvasive methods of investigation. An important role of early diagnosis of the vascular transplant infectioning (VTI), using radionuclide scanning and leukocytes, traced with 99mTc, determination of proinflammatory interleukin-6 and anti-inflammatory interleukin-4 content while radical treatment of purulent-septic complications before arrosive hemorrhage and fistula occurrence was substantiated. The advantages of extraanatomic shunting in total VTI and sepsis, using autovenous transplants and the autologous tissue defense of the anastomoses area were shown. In 90.5% patients, in whom reoperations were performed, the results were good, the transplants passability without their reinfectioning was secured in 12 months after the operation in 71% patients.

[Use of simvatin for obliterating atherosclerosis after reconstructive operations on the main arteries of the lower extremities].

The results of application of simvatin in 207 patients after performance of reconstructive operations on the main arteries of femoro-popliteo-tibial segment were analyzed. Durable usage of simvatin had permitted to improve the immediate and the late results of reconstructive operations, to lower postoperative lethality significantly, caused by cardiovascular and vascular-cerebral insufficiency.

[New technologies in diagnosis and surgical treatment of the abdominal aorta aneurysm].

Modern views about occurrence, pathogenesis, and methods of diagnosis and surgical treatment of abdominal aorta aneurysm are adduced. Application of new highly informative diagnostic methods, an adequate anesthesiological support, differentiated methods of surgical intervention have permitted to reach marked progress in the treatment of patients with abdominal aorta aneurysm.

[Changes of regional hemodynamics and microcirculation in tissues of lower extremities in patients with obliterating atherosclerosis in stages I and II]. / Izmeneniia regionarnoi gemodinamiki i mikrotsirkuliatsii v tkaniakh nizhnikh konechnostei u bol'nykh s obliteriruiushchim aterosklerozom v I i II stepeni.

Basing on analysis of results of ultrasonic investigation and laser Doppler flowmetry, performed in 125 patients with obliterating atherosclerosis of lower extremities arteries in I-II stages, the criterions of the chronic arterial insufficiency severity diagnosis were determined. There was established, that in high functional reserve of microcirculation present it is expedient to recommend to the patients the conservative treatment, as well as physiotherapeutic and sanatorium health resort procedures.

[Standardization of the report on clinical effects of surgical treatment of patients with obliterating atherosclerosis of the lower extremities]. / Standartizatsiia otcheta o klinicheskom effekte operativnogo lecheniia bol'nykh s obliteriruiushchim aterosklerozom arterii nizhnikh konechnostei.

To achieve the objectivization of the operation results performance, to compare them, to conduct a dynamic control of the reconstructed arterial segments passability and the course of the disease as well, the estimation of treatment efficacy in patients with obliterating atherosclerosis of the lower extremities arteries must be standardized for some factors, considering the change in the patient state and locus morbi. The authors had performed the analysis of approaches to solve this problem and proposed the criterions of the operative treatment efficacy estimation in patients with intermittent claudication and critical ischemia of lower extremities.

[Surgical treatment of occluding lesion of the subclavian artery]. / Khirurgicheskoe lechenie okkliuziruiushchego porazheniia podkliuchichnoi arterii.

Results of cerebral hemodynamics investigation and operative treatment of 53 patients with the subclavial artery (SA) occlusion were presented. It was established that the course of the cerebral vascular disorders occurrence in patients with the SA proximal segment occlusion is the vertebro-subclavial robbing syndrome. The consider that the SA resection with her implantation to ipsilateral a. carotis communis (ACA) is operation of choice. The vessel prosthesis is indicated in presence of widespread affection. It is expedient to performed one-stage correction of blood flow in the vessels mentioned in patients with ipsilateral localization of the SA and ACA affection.

[Venous thromboembolic complications in abdominal and vascular surgery. The risk factors and measures of prophylaxis]. / Venoznye tromboémbolicheskie oslozhneniia v abdominal'noi i sosudistoi khirurgii. Faktory riska i mery profilaktiki.

There were analyzed 4675 histories of cases of patients, who were operated on for disease of the digestion organs (3349) and for obliterating atherosclerosis of abdominal aorta and peripheral arteries (1326). The risk factors of occurrence were established, the prophylaxis methods for venous thromboembolic complications (TEC) in postoperative period were elaborated. High efficacy of application of fraxiparine in the venous TEC prophylaxis in abdominal and vascular surgery was noted.

[Chronic arterial insufficiency of lower extremities and pelvis: the ways of its treatment optimization]. / Khronicheskaia nedostatochnost' nizhnykh konechnostei i taza: puty optimizatsii ee lecheniia.

Results of application of preparation alprostan in 30 patients with chronic arterial insufficiency of lower extremities of III-IV stages were presented. Changes of regional blood flow and microcirculation of lower extremities under the influence of alprostan were studied. Positive result of treatment was achieved in more then 73% of patients.

[Collateral compensation of blood flow and hemodynamics of the lower extremities in atherosclerotic occlusion of abdominal aorta]. / Kollateral'naia kompensatsiia krovotoka i gemodinamika nizhnikh konechnostei pri ateroskleroticheskoi okkliuzii briushnoi chasti aorty.

Results of investigation of collateral blood flow in 159 patients with atherosclerotic occlusion of abdominal aorta of various kinds were presented. There was shown, that a. mesenterica superior constitutes the main visceral branch, securing the blood circulation compensation in total, high and middle occlusion of abdominal aorta and in low occlusion--a. mesenterica inferior. The change of direction and enhancement of blood flow along a. epigastric inferior was noted in all the patients. In spite of identity of total volumetric blood flow along the collateral branches, the volumetric blood flow velocity along the lower extremities arteries is determined by the level and spread of aortal occlusion.

[Indications and choice of method of treatment of the lower extremities obliterating arterial atherosclerosis in elderly and senile patients with diabetes mellitus]. / Pokazaniia i vybor metoda operativnogo lecheniia obliteriruiushchego ateroskleroza arterii pozhylogo i starcheskogo vozrasta.

Results of treatment of 93 patients with diabetes mellitus and occlusive-stenotic affection of arteries of femoro-popliteal and popliteal-tibial segments were analyzed. Indications for performance of operation were established, basing on analysis of clinical manifestations of the disease and results of instrumental methods of investigation. Femoro-popliteal autovenous shunting performed in 47 (50.5%) patients, endarterectomy from the same segment--in 26 (28%), roentgenoendovascular dilatation of segments of femoral superficial and popliteal arteries--in 11 (11.8%), popliteal-tibial autovenous shunting--in 9 (9.7%). In 84 (90.4%) of patients succeeded to preserve the extremity. Postoperative lethality was 4.3%. Passability of autovenous femoro-popliteal-tibial shunts during 5 years was noted in 49.5%, passability of arteries after endarterectomy--in 38.7% of observations.

[Diagnostic and surgical treatment of chronic abdominal aneurysm rupture]. / Diagnostika i khirurgicheskoe lechenie khronicheskogo razryva anevrizmy briushnoi chasti aorty.

Examination and treatment of 8 patients with the abdominal aorta aneurysm (AAA) chronic rupture (CHR) was done. The interval between the aneurysm rupture occurrence and of the operation performance had constituted 3.6 months. The disease was diagnosed basing on the anamnesis data, on the results of clinical, invasive and noninvasive methods of investigation. The authors suggest necessary to operate all the patients with the AAA CHR.

[Choice of surgical strategies in aorto-femoral transplant infections]. / Vybor taktiki khirurgicheskogo lecheniia pri infitsirovanii aorto- bedrennogo transplantata.

Reconstructive operation was performed in 4926 patients for occlusive affection of the abdominal aorta, of them in 132 (2.7%) the infectioning of aorto-femoral transplant was noted. Original methods of reoperation were presented, depending on the prevalence of the infection. Preventive performance of reoperation before the erosive hemorrhage occurred, had permitted to lower postoperative mortality from 52.3% to 13.5% and to achieve the lower extremities revascularization in 77.5% of patients.

[Ultrasonic duplex scanning in occlusion of abdominal aorta, arteries of iliac segment and of lower extremities]. / Ul'trazvukovoe dupleksnoe skanirovanie pri okkliuzii briushnoi chasti aorty, arterii podvzdoshnogo segmenta i nizhnikh konechnostei.

The regional hemodynamics peculiarities were studied in patients with various types of occlusive-stenotic affection of abdominal aorta and iliac arteries, using ultrasonic duplex scanning. The character of the blood flow peculiarity along main arteries and collateral branches was determined depending on the affection level. The quantitative indexes of blood flow along the most significant collaterals were studied as well as their role in the compensation process of the disordered distal blood flow.

[Chronic venous insufficiency of the lower extremities in patients with post-thrombophlebitic syndrome]. / Kronicheskaia venoznaia nedostatochnost' nizhnikh konechnostei u bol'nykh s posttromboflebiticheskim sindromom.

The results of examination and treatment of 734 patients with postthrombophlebitic syndrome of lower extremities were adduced. The pathogenesis diagram for chronic venous insufficiency was proposed. The possibilities of the regional blood flow correction using reconstructive operations on veins were shown. In 73% of patients good result in immediate postoperative period was noted and in late follow-up period--in 64%.

[Pathophysiology, prophylaxis and treatment of reperfusion syndrome in the surgery of abdominal aorta aneurysm]. / Patofiziologiia, profilaktika i lechenie reprefuzionnogo sindroma v khirurgii anervrizmy briushnoi chasti aorty.

The peroxidal oxidation of the lipids state was studied up, as well as of the whole blood neutrophils functional activity, hemodynamics and microcirculation of lower extremities in surgical treatment of the abdominal aorta aneurysm. The main significance in the reperfusional syndrome pathophysiology, caused by temporary overcompression of aorta, has the neutrophils activation, their interrelationship with the endothelium cells and the activity lowering of the tissue antioxidant system, manifestated by vascular spasm, which is mostly expressed in the patients with stenotic affection of the lower extremities arteries. Positive effect was noted in application of preparation corvitin, which has antioxidant action.

[The treatment of acute and chronic venous insufficiency of the lower extremities by using Lioton-1000 gel]. / Lechenie ostroi i khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei s primeneniem gelia Lioton-1000.

The results of treatment of 110 patients with an acute and chronic venous insufficiency of the lower extremities were analysed. The original access to the v. saphena magna opening of the leg and the vein stripper are proposed. The necessity of the concomitant veins excision was substantiated, and the expediency of the antibiotics, antiaggregants and the heparin-containing preparations administration also.

[Collateral blood circulation in the occlusion of femoro-popliteal segment of the lower extremity arteries]. / Kollateral'noe krovoobrashchenie pri okkliuzii bedrenno-podkolennogo segmenta arterii nizhnikh konechnostei.

Method of ultrasonic duplex scanning was applied for studying of hemodynamics of lower extremities in the norm and while the femoropopliteal segment occlusion. Three most hemodynamically significant ways of the blood flow collateral compensation in a. femoralis superficialis and a. poplitea occlusion: in upper third of femur--a. femoralis profunda, in canalis adductorius region--a. genus descendens; on the crus--a. suralis. Spectral characteristics of the main and collateral blood flow were studied, the criterions of the lower extremities hemodynamics compensation were established.