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1.
Kardiologiia ; 62(9): 37-43, 2022 Sep 30.
Article in Russian, English | MEDLINE | ID: mdl-36206136

ABSTRACT

Aim      To compare long-term outcomes of x-ray endovascular (percutaneous coronary intervention, PCI, and lower limb angioplasty with stent placement, LLA; group 1) and combination treatments (PCI and open LLA surgery; group 2) in patients with chronic lower limb ischemia (CLLI) associated with ischemic heart disease (IHD).Material and methods  This retrospective study has been conducted in the Vishnevsky National Medical Research Center of Surgery since 2019. The study includes 92 patients with stage 2B CLLI associated with IHD who were managed from January 1, 2017 through December 31, 2020. Long-term outcomes were evaluated in 76 (82.6 %) patients. The endpoint was severe cardiovascular complications (CVC), including death, myocardial infarction, and acute cerebrovascular disease (ACVD).Results In group 1 during the long-term period, 1 (2.7%) fatal outcome due to pneumonia was observed. In group 2, 4 (10 %) patients died: 1 (2.5 %) patient due to ACVD, 1 (2.5 %) patient due to progression of oncological process, and 2 2 (5 %) patients due to COVID-19. Also, 2 (5.5 %) and 1 (2.5 %) cases of acute coronary syndrome (ACS) were observed in groups 1 and 2, respectively (p=0.61).Conclusion      In the x-ray endovascular (group1) and the combination (group 2) intervention groups, lethal outcomes due to myocardial infarction were absent. This fact confirms the importance of PCI in patients with CLLI for prevention of possible ACS in the long-term. Both therapeutic tactics in managing CLLI patients with IHD demonstrated high safety and clinical efficacy during the hospital and long-term periods and can be extensively used in routine clinical practice.


Subject(s)
Acute Coronary Syndrome , COVID-19 , Myocardial Infarction , Myocardial Ischemia , Percutaneous Coronary Intervention , Humans , Lower Extremity , Myocardial Ischemia/complications , Myocardial Ischemia/diagnosis , Myocardial Ischemia/therapy , Percutaneous Coronary Intervention/adverse effects , Retrospective Studies , Treatment Outcome
2.
Kardiologiia ; 62(2): 20-27, 2022 Feb 28.
Article in English, English | MEDLINE | ID: mdl-35272604

ABSTRACT

Aim      To compare in-hospital outcomes (severe cardiovascular complications, CVC) in patients with IIB stage chronic lower limb ischemia (CLLI) in combination with ischemic heart disease (IHD) in the following groups: stepwise percutaneous coronary intervention (PCI) and stenting and angioplasty of lower limb arteries (LLA) (group 1) and combination treatment, including PCI and open surgery on LLA (group 2).Material and methods  Since 2019, the A.V. Vishnevsky National Medical Research Center of Surgery has performed a retrospective study that includes patients with stage IIB CLLI in combination with IHD. Patients were divided into 2 groups: group 1 (n=46), stepwise X-ray endovascular treatment (PCI and stenting and angioplasty of LLA); group 2 (n=46), stepwise combination treatment (PCI and open surgery on LLA). The endpoint included severe CVCs (death, acute myocardial infarction, acute cerebrovascular disease) and severe complications in the LLA area (stent thrombosis, repeated intervention on LLA, amputation).Results In 198 surgeries, none of 92 patients had severe CVC, and no fatal outcomes were observed. In group 2, there was one (2.1 %) severe complication on LLA during the early postoperative period, for which a successful additional intervention was performed.Conclusion      Individualized approach to care of each patient with LLA pathology in combination with IHD helps avoiding severe CVCs at the hospital stage. It was shown that X-ray endovascular and combination treatments are safe and effective in the absence of fatal outcomes and acute disorders of coronary circulation at the hospital stage.


Subject(s)
Percutaneous Coronary Intervention , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Humans , Intermittent Claudication/diagnosis , Intermittent Claudication/etiology , Intermittent Claudication/surgery , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Postoperative Period , Retrospective Studies , Treatment Outcome
3.
Khirurgiia (Mosk) ; (12): 104-110, 2021.
Article in Russian | MEDLINE | ID: mdl-34941217

ABSTRACT

Incidence of postoperative sternomediastinitis depends on various risk factors and makes up 8%. Surgical debridement with local management of the wound are used to achieve wound sterility. In some cases, sternectomy or subtotal sternal resection are performed for total sternal osteomyelitis with osteoporotic bone and multiple fractures. This procedure results an extensive bone defect. The final stage is anterior chest wall reconstruction. The most popular method is wound closure with autologous muscle or omental flaps. The authors describe a patient with sternomediastinitis who underwent staged treatment. At the final stage, subtotal sternectomy with simultaneous omentoplasty were performed. Additionally, mammary-gastroepiploic bypass grafting with right internal mammary artery and right gastroepiploic artery was carried out for additional vascularization of the omental flap. We found no similar surgery for sternomediastinitis in the literature. Long-term treatment outcome was followed-up (>50 months of relapse-free period and good quality of life).


Subject(s)
Plastic Surgery Procedures , Quality of Life , Humans , Sternum/surgery , Surgical Flaps , Surgical Wound Infection/diagnosis , Surgical Wound Infection/etiology , Surgical Wound Infection/surgery
4.
Angiol Sosud Khir ; 24(2): 41-48, 2018.
Article in Russian | MEDLINE | ID: mdl-29924774

ABSTRACT

BACKGROUND: The introduction into clinical practice of contrast-enhanced ultrasonographic examination made it possible to assess patency of tibial arteries and perfusion of crural muscles in patients with occlusive lesions of lower-limb arteries. These findings are important for planning optimal treatment policy and assessing efficacy of operative or medicamentous treatment. OBJECTIVE: The study was aimed at investigating a possibility of contrast-enhanced ultrasound examination for assessment of patency of tibial arteries and quantitative assessment of perfusion of crural muscles in patient with occlusive lesions of lower-limb arteries. PATIENTS AND METHODS: We examined a total of 30 patients presenting with atherosclerotic-genesis occlusive lesions of lower limb arteries and symptomatic intermittent claudication. Five patients were examined in the postoperative period. All patients were subjected to quantitative analysis of crural muscle perfusion in the pre- and postoperative periods, determining the time of onset of contrast medium accumulation and the time to the peak of intensity. RESULTS: Contrast-enhanced ultrasound examination demonstrated that in patients with occlusive lesions of lower-limb arteries the start of contrast medium accumulation appeared to occur later than in apparently healthy people: on second 30-88, depending on the degree of limb ischaemia. The contrasting time-to-peak was also increased (from 36 to 120 s). In the postoperative period all patients were found to have improved perfusion of the crural muscles, which was confirmed by a decrease in time-to-peak contrasting. CONCLUSION: Contrast-enhanced ultrasonographic examination is currently the only non-invasive, safe method of determining perfusion of crural muscles, which may be used many times for assessment of viability of the ischaemised extremity, as well as for assessment of efficacy of the treatment performed.


Subject(s)
Arterial Occlusive Diseases , Femoral Artery , Ischemia , Lower Extremity/blood supply , Tibial Arteries , Ultrasonography/methods , Aged , Angiography/methods , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/physiopathology , Arteriosclerosis/complications , Contrast Media/pharmacology , Female , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Humans , Image Enhancement/methods , Ischemia/diagnosis , Ischemia/etiology , Ischemia/physiopathology , Male , Middle Aged , Reproducibility of Results , Tibial Arteries/diagnostic imaging , Tibial Arteries/pathology , Vascular Patency
5.
Angiol Sosud Khir ; 24(1): 171-174, 2018.
Article in Russian | MEDLINE | ID: mdl-29688212

ABSTRACT

Nonspecific aortoarteritis (NAA) is an autoimmune disease characterized by the development of an inflammatory process in large arteries such as the aorta and its branches and pulmonary arteries. Operative interventions for lesions of the aortic arch branches may be divided into extra- and transthoracic. Involvement of all branches of the aortic arch requires transthoracic interventions to be performed. According to the findings of various authors, bicarotid bypass grafting is accompanied by a high incidence rate of complications and lethal outcomes. The most serious complication is haemorrhagic stroke developing in 40% of patients. That is why commencing from 1991 the practice of simultaneous restoration of the two carotid basins was discontinued. A clinical case report presented herein demonstrates the authors' therapeutic policy in patients with NAA and multiple involvement of brachiocephalic arteries and first of all with bicarotid occlusion.


Subject(s)
Blood Vessel Prosthesis Implantation/methods , Carotid Stenosis , Cerebral Hemorrhage , Postoperative Complications/prevention & control , Takayasu Arteritis , Adult , Aorta/diagnostic imaging , Aorta/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Brachiocephalic Trunk/diagnostic imaging , Carotid Arteries/diagnostic imaging , Carotid Arteries/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/prevention & control , Echocardiography/methods , Female , Humans , Risk Adjustment/methods , Takayasu Arteritis/complications , Takayasu Arteritis/diagnosis , Takayasu Arteritis/physiopathology , Takayasu Arteritis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler, Duplex/methods
6.
Angiol Sosud Khir ; 24(1): 161-165, 2018.
Article in Russian | MEDLINE | ID: mdl-29688210

ABSTRACT

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.


Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Postoperative Complications/prevention & control , Renal Artery/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Aortography/methods , Blood Vessel Prosthesis , Humans , Male , Middle Aged , Postoperative Complications/etiology , Risk Adjustment/methods , Tomography, X-Ray Computed/methods , Treatment Outcome , Viscera/blood supply
7.
Angiol Sosud Khir ; 23(2): 118-125, 2017.
Article in Russian | MEDLINE | ID: mdl-28594804

ABSTRACT

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.


Subject(s)
Aneurysm, Ruptured/surgery , Arteriovenous Fistula/surgery , Arteriovenous Malformations/surgery , Endovascular Procedures/methods , Extracorporeal Circulation/methods , Kidney , Adult , Aneurysm, Ruptured/diagnosis , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/etiology , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/physiopathology , Female , Humans , Kidney/blood supply , Kidney/surgery , Plastic Surgery Procedures/methods , Reoperation/methods , Treatment Outcome
8.
Angiol Sosud Khir ; 23(1): 51-58, 2017.
Article in Russian | MEDLINE | ID: mdl-28574037

ABSTRACT

AIM: The study was aimed at assessing diagnostic possibilities of duplex scanning (DS) of lower limb arteries, used as 'ultrasonographic angiography' in patients presenting with critical ischaemia for appropriately planning complicated infrainguinal reconstructions at stages of surgical management, including dynamic follow up in the postoperative period. PATIENTS AND METHODS: We examined a total of 30 patients. Of these, 14 patients composed the control group and 16 patients with critical ischaemia of lower limb arteries who underwent 8 external iliac-tibial and 8 femorotibial bypass graftings with a relieving arteriovenous fistula and application of a venous cuff according to the type of 'St. Mary's boot'. All the 16 patients preoperatively underwent DS of lower limb arteries and CT angiography, as well as postoperative DS of the vessels of the zone of the operative intervention. We compared the possibilities of DS and CT angiography in the assessment of the state of various segments of lower limb arteries. The obtained findings were compared with the data of the 'golden standard' - X-ray contrast enhanced angiography or intraoperative revision. RESULTS: In assessing the state of the aortoiliac segment, sensitivity and specificity of the both methods amounted to 100%. In assessing patency of the femoropopliteal segment, sensitivity and specificity of DS amounted to 93.7 and 100%, with those for CT angiography equalling 87.5 and 100%. Assessing patency of arteries of the crus, sensitivity and specificity of the both methods amounted to 87.5 and 93.7%, respectively. In the postoperative period it was revealed that a prognostically favourable factor for shunt functioning is the value of the volumetric velocity of blood flow in the shunt at the level of the middle third of the femur, equalling the sum of volumetric velocities of blood flow in the donor artery distal to and in the relieving vein proximal to the anastomosis. Important prognostic parameters of shunt functioning were also the values of linear velocity of blood flow both in the shunt and donor artery. CONCLUSION: Strict compliance with the methodology and protocol of DS makes it possible to evaluate the condition of outflow pathways while planning the intervention, to assess functioning of the shunt in the postoperative period and to work out criteria for favourable functioning of the infrainguinal shunt for regular dynamic control over the state of the revascularized limb.


Subject(s)
Femoral Artery , Iliac Artery , Ischemia , Lower Extremity/blood supply , Tibial Arteries , Ultrasonography, Doppler, Color/methods , Vascular Grafting , Angiography/methods , Female , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Ischemia/diagnosis , Ischemia/etiology , Ischemia/physiopathology , Ischemia/surgery , Male , Middle Aged , Postoperative Care/methods , Prognosis , Tibial Arteries/diagnostic imaging , Tibial Arteries/surgery , Vascular Grafting/adverse effects , Vascular Grafting/methods , Vascular Patency
9.
Khirurgiia (Mosk) ; (1): 42-47, 2017.
Article in Russian | MEDLINE | ID: mdl-28209953

ABSTRACT

AIM: To develop the method for extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC. MATERIAL AND METHODS: The study included 37 patients with morphologically confirmed RCC pT1a-Т3bN0M0-1G1-3 with intraparenchymal and central location of the tumor in cases of single kidney, comorbidity of contralateral kidney and kidney on the side of lesion. RESULTS: Mean surgery time was 413.97±89.14 minutes. Mean time of warm ischemia was 8.39±4.75 minutes, cold ischemia - 151.41±41.29 minutes. Intraoperative and postoperative complications were detected in 3 (8.1%) and 18 (48.6%) patients respectively. CONCLUSION: Extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC is a relatively safe organ-sparing treatment. It provides resection of large tumors with any location under prolonged cold ischemia without ureter intersection.


Subject(s)
Carcinoma, Renal Cell , Cold Ischemia/methods , Kidney Neoplasms , Nephrectomy , Organ Sparing Treatments/methods , Postoperative Complications , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/surgery , Female , Glomerular Filtration Rate , Humans , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Nephrectomy/adverse effects , Nephrectomy/methods , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Russia
10.
Angiol Sosud Khir ; 22(4): 69-74, 2016.
Article in Russian | MEDLINE | ID: mdl-27935883

ABSTRACT

The article deals with the use of self-expanding stents for endovascular treatment in patients presenting with dissection of the common carotid artery, exemplified by two clinical case reports. In both cases, dissection of the common carotid artery developed after eversion carotid endarterectomy. Intimal detachment was eliminated in both cases by implanting self-expanding stents. These cases demonstrated possibilities of roentgen endovascular methods of treatment making it possible to successfully replace a repeat, technically difficult surgical intervention for iatrogenic dissection of the common carotid artery.


Subject(s)
Angioplasty, Balloon/methods , Aortic Dissection , Carotid Artery Injuries , Carotid Stenosis/surgery , Endarterectomy, Carotid/adverse effects , Postoperative Complications , Vascular Grafting/methods , Aged , Aortic Dissection/diagnosis , Aortic Dissection/etiology , Aortic Dissection/physiopathology , Aortic Dissection/surgery , Angiography/methods , Carotid Artery Injuries/diagnosis , Carotid Artery Injuries/etiology , Carotid Artery Injuries/physiopathology , Carotid Artery Injuries/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/physiopathology , Endarterectomy, Carotid/methods , Female , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Self Expandable Metallic Stents , Treatment Outcome
11.
Angiol Sosud Khir ; 20(1): 75-9, 2014.
Article in Russian | MEDLINE | ID: mdl-24722023

ABSTRACT

The authors present in the article a case report of successful use of a balloon-expandable stent graft for endovascular prosthetic reconstruction of an aneurysm of the proximal anastomosis of the iliac-femoral bypass graft by puncture approach through the brachial artery. We implanted a balloon-expandable stent graft measuring 6.0-12.0 mm in diameter and 58-mm long with good immediate and short-term results in the anastomosis with large alteration in the diameter along the length.


Subject(s)
Anastomosis, Surgical/adverse effects , Aneurysm, False/surgery , Arterial Occlusive Diseases/surgery , Balloon Occlusion/methods , Blood Vessel Prosthesis Implantation/methods , Postoperative Complications/surgery , Stents , Aged , Anastomosis, Surgical/methods , Aneurysm, False/diagnosis , Aneurysm, False/physiopathology , Angiography , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/physiopathology , Femoral Artery/pathology , Femoral Artery/surgery , Humans , Iliac Artery/pathology , Iliac Artery/surgery , Male , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Prosthesis Design , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, Duplex
12.
Angiol Sosud Khir ; 18(4): 107-12, 2012.
Article in Russian | MEDLINE | ID: mdl-23324639

ABSTRACT

Presented in the article is a rare clinical case report concerning successful treatment of a female patient with vaginal paraganglioma of the neck - a tumour extending from the level of the trunk of the common carotid artery in cranial direction to the base of the skull. Mentioned are difficulties of carrying out an operational intervention requiring the use of certain surgical techniques. The tumour was removed as a single block with the involvement into the process of the major vessels of the neck and nervous formations. The reconstructive operation performed was common carotid - internal carotid prosthetic repair with a 6.3-4.5 mm cone-shape prosthesis 'Gore-tex' on the right.


Subject(s)
Carotid Arteries/surgery , Head and Neck Neoplasms/surgery , Neck Dissection/methods , Paraganglioma/surgery , Skull Base/surgery , Vascular Grafting/methods , Adult , Carotid Arteries/pathology , Female , Head and Neck Neoplasms/pathology , Humans , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis , Neoplasm Invasiveness , Neoplasm Staging , Paraganglioma/secondary , Postoperative Period , Skull Base/pathology , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, Color
13.
Vestn Ross Akad Med Nauk ; (10): 9-19, 2010.
Article in Russian | MEDLINE | ID: mdl-21254516

ABSTRACT

Current concepts of etiology and pathogenesis of nonspecific aortoarteritis (Takayasu's disease) are considered. A.V. Pokrovsky and his team gained the largest experience with diagnostics and treatment of patients suffering this disease. In this paper, the authors describe results of the treatment of more than 200 patients including 118 operated for isolated reconstruction of aortic arch branches (n = 43), restoration of blood flow only in thoracoabdominal aorta and its branches (n = 63), reconstruction of both brachiocephalic arteries and thoracoabdominal aorta (n = 12). The authors present their view of diagnostics and treatment strategy in patients with lesioned brachiocephalic arteries, abdominal and thoracoabdominal aorta. The necessity of following up patients in the postoperative period is emphasized.


Subject(s)
Takayasu Arteritis/diagnosis , Takayasu Arteritis/therapy , Diagnosis, Differential , Female , Humans , Male , Takayasu Arteritis/epidemiology , Takayasu Arteritis/etiology , Treatment Outcome
16.
Angiol Sosud Khir ; 15(1): 148-50, 2009.
Article in Russian | MEDLINE | ID: mdl-19791589

ABSTRACT

Literature review is dedicated to the 100th anniversary of the first case presentation for nonspecific aortoarteritis. The review covers the history of the disease concept development, current knowledge on its etiology and pathogenesis, unresolved problems of management strategy for patients with this pathology.


Subject(s)
Takayasu Arteritis/history , Vascular Surgical Procedures/history , Anniversaries and Special Events , History, 20th Century , Humans , Japan , Takayasu Arteritis/diagnosis , Takayasu Arteritis/surgery , Terminology as Topic , Vascular Surgical Procedures/methods
17.
Angiol Sosud Khir ; 15(3): 9-13, 2009.
Article in Russian | MEDLINE | ID: mdl-20092176

ABSTRACT

The article deals with the findings of studying the use of rosuvastatin in patients after endured reconstructive operations on the brachiocephalic arteries and aortofemoral segment in order to prevent cardiac atherothrombotic complications. A total of thirty patients were given "Crestors" at a daily dose of 10 mg for two weeks prior to surgery and for two weeks postoperatively and were found to have a significant decrease in the average levels of total cholesterol and low-density lipoproteins, which was accompanied and followed by certain improvement in the functional state of the vascular wall, with no cardiac complications being observed in either case.


Subject(s)
Atherosclerosis/surgery , Embolism, Cholesterol/prevention & control , Fluorobenzenes/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Pyrimidines/therapeutic use , Sulfonamides/therapeutic use , Vascular Surgical Procedures/adverse effects , Adult , Aged , Aorta, Abdominal/surgery , Brachiocephalic Trunk/surgery , Dose-Response Relationship, Drug , Embolism, Cholesterol/etiology , Female , Fluorobenzenes/administration & dosage , Follow-Up Studies , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Male , Middle Aged , Postoperative Complications , Pyrimidines/administration & dosage , Rosuvastatin Calcium , Sulfonamides/administration & dosage , Time Factors , Treatment Outcome
18.
Angiol Sosud Khir ; 15(4): 114-8, 2009.
Article in Russian | MEDLINE | ID: mdl-20394341

ABSTRACT

High risk of surgical management for disseminated forms of alveococcosis appears to be associated with invasive growth of the parasite and the related necessity to perform vast resections of the liver and adjacent organs, as well as resections and prosthetic repair of the major vessels. The only alternative method of treatment could be liver transplantation. The purpose of this study was to demonstrate successful prosthetic reconstruction with the an allograft of the hepatic segment of the inferior vena cava in the course of enlarged hemihepatectomy for locally disseminated hepatic alveococcosis with the involvement of the inferior vena cava. The "Goretex" prosthesis was used as an allograft. The immediate postoperative period was accompanied and followed by mild-degree postresection liver insufficiency. During 6 months of dynamic follow up, the prosthesis was patent, with no relapses of the disease on the background of antiparasitic chemotherapy being noted. The use of allografts in vascular prosthetic repair in hepatic alveococcosis appears justified, requiring, however, further investigation.


Subject(s)
Blood Vessel Prosthesis , Echinococcosis, Hepatic/surgery , Hepatectomy/methods , Vena Cava, Inferior/surgery , Diagnosis, Differential , Echinococcosis, Hepatic/diagnosis , Female , Follow-Up Studies , Humans , Middle Aged , Portography , Tomography, X-Ray Computed , Transplantation, Homologous , Ultrasonography, Doppler, Duplex
19.
Angiol Sosud Khir ; 14(4): 105-8, 2008.
Article in Russian | MEDLINE | ID: mdl-19791560

ABSTRACT

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).


Subject(s)
Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis , Femoral Artery/surgery , Ischemia/surgery , Leg/blood supply , Polytetrafluoroethylene , Popliteal Artery/surgery , Adult , Aged , Anastomosis, Surgical/methods , Angiography , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnostic imaging , Female , Femoral Artery/diagnostic imaging , Follow-Up Studies , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Male , Middle Aged , Popliteal Artery/diagnostic imaging , Prosthesis Design , Retrospective Studies , Treatment Outcome
20.
Angiol Sosud Khir ; 13(2): 143-9, 2007.
Article in Russian | MEDLINE | ID: mdl-18004274

ABSTRACT

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).


Subject(s)
Atherosclerosis/physiopathology , Atherosclerosis/surgery , Blood Vessel Prosthesis , Femoral Artery/pathology , Femoral Artery/surgery , Ischemia/physiopathology , Ischemia/surgery , Lower Extremity/blood supply , Lower Extremity/physiopathology , Popliteal Artery/pathology , Popliteal Artery/surgery , Aged , Anastomosis, Surgical , Atherosclerosis/complications , Female , Humans , Ischemia/etiology , Male , Middle Aged , Time Factors
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