[Endovascular laser methods in the treatment of arteriosclerotic cardiovascular diseases]. / Lazerny éndovaskuliarnye metody lecheniia ateroskleroticheskikh zabolevanii serdechno-sosudistoi sistemy.

Employment of laser for restoration of adequate blood flow in atherosclerotic vessels is a radically new approach to treatment of cardiovascular diseases of atherosclerotic genesis. Since 1983, wide-scale experimental work has been done at A.N. Bakulev Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences, which has formed the basis for transluminal laser angioplasty (vascular recanalisation with high-intensity laser beam), laser atherolysis (regression of atherosclerotic formations under low-intensity laser beam), and their combinations. Clinical application of these procedures was started in 1985. Sixty-two patients with ischaemic heart disease, Takayasu's and Leriche's syndromes, chronic occlusion of pelvic and lower-limb arteries, and with combined lesions of the arterial bed were exposed to targeted transluminal laser. Laser endovascular therapy alone and in combination with balloon angioplasty or bypass surgery was used. Application of these methods showed their high efficacy. Successful recanalisation and restoration of adequate flow (confirmed by Doppler echography and angiography) were achieved in 93 per cent cases; results were poor (no effect, complications) in 7 per cent cases.

[Functional test of reactive hyperemia in the diagnosis of the vertebro-subclavian steal syndrome using ultrasonic dopplerography]. / Funktsional'nyi test reaktivnoi giperemii v diagnostike sindroma pozvonochno-podkliuchichnogo obkradyvaniia metodom ul'trazvukovoi dopplerografii.

The authors used ultrasonic dopplerography (UD) and the reactive hyperemia test to diagnose the vertebral-subclavicular stealing syndrome (VSSS) with occlusion of the proximal segment of the subclavicular or innominate arteries. The sonographic and angiographic findings coincided in 92.3% of cases. It is concluded that UD is the method of choice in the evaluation of the efficiency of reconstructive surgery aimed at correcting the VSSS.

[Cerebral hemodynamics in patients with bilateral lesions of the carotid bifurcation]. / O mozgovoi gemodinamike u bol'nykh s dvustoronnim porazheniem bifurkatsii sonnykh arterii.

Sixty-eight patients with bilateral damage to bifurcations of the carotid arteries, of them 22 with attendant damage to the vertebral arteries, were subjected to operation on one carotid artery. An analysis of the findings of dopplerography, angiography and intraoperative electromanometry revealed the following factors affecting the retrograde pressure (RP) in the internal carotid artery (ICA): the state of the contralateral ICA, the functional state of the anterior connective artery of the brain, intracranial localization of injury and the attendant involvement of the vertebral arteries. There was no correlation between the RP in the ICA and the level of artificial hypertension.

[Surgical treatment of combined lesions of the proximal aortic arch using extrathoracic methods]. / Khirurgicheskoe lechenie sochetannykh porazhenii proksimal'nykh otdelov dugi aorty ékstratorakal'nymi metodami.

Results of the surgical treatment of 19 patients are discussed. Extrathoracal methods of correction of occlusive injuries of proximal portions of the brachiocephalie arteries are shown to be expedient. The intraoperative flowmetry has shown the safety of using the common carotid artery as the donor for revascularization of brachiobasilar reservoir of blood circulation.

[Role of determination of creatine kinase isoenzyme MB in the diagnosis of myocardial lesions after surgery of the major vessels]. / Znachenie opredeleniia izofermenta kreatinfosfokinazy MB v vyiavlenii povrezhdenii miokarda posle operatsii na magistral'nykh sosudakh.

A considerable increase in CPK activity is usually noted after reconstructive surgery on thoracic and abdominal aorta and its branches (75 patients), MB-CPK activity being increased in 48.0% of the cases. Increased cumulative MB-CPK activity, pointing to the isoenzyme's withdrawal from the myocardium (3.2 to 5.6 Eq), was established in 8 patients. It was only in one case (1.3%) that a typical curve and a high cumulative activity of the isoenzyme (29.14 Eq) suggested the diagnosis of acute myocardial infarction. Therefore, increased MB-CPK activity alone cannot signal focal myocardial necrosis. Although the increase in cumulative MB-CPK activity correlates, to some degree, with negative ECG developments in the patients with basic coronary disease, it is only the typical curve and high MB-CPK activity that can be used as specific criteria in the enzymatic diagnosis of myocardial infarction after reconstructive surgery on main vessels.

[Compensatory role of the external carotid artery in vascularization and revascularization of the brain following occlusion of the homolateral internal carotid artery]. / Kompensatornaia rol' naruzhnoi sonnoi arterii v vaskuliarizatsii i revaskuliarizatsii golovnogo mozga pri okkliuzii odnoimennoi vnutrennei sonnoi arterii.

An examination of 33 patients with internal carotid occlusion showed that this was a group of grave patients who had suffered an ischemic stroke with the lesion localization in the basin of the carotids. By using additional examination methods it has been found that it is also the homolateral external carotid which performs (along with the contralateral internal carotid) the principal compensatory function in the revascularization of the stroke-affected hemisphere. In patients with the internal carotid occlusion complicated by a stenosis of the external and an affection of the general carotids, sparing operations of applying a vascular prosthesis connecting the subclavicular and external carotid arteries were performed. These operations were aimed at letting the blood flow through the external carotid. In 9 patients with an isolated stenosis of the external carotid and the occlusion of the internal carotid, an endarterectomy from the external with resection of the internal artery was performed. After the operations the neurological symptoms regressed in 92.2% of the patients.

[Blood rheological and coagulation properties in abdominal aortic aneurysm]. / Osobennosti reologicheskikh i koaguliatsionnykh svoistv krovi pri anevrizme briushnoi aorty.

From the analysis of information on 158 patients who underwent operation for aneurysm of the abdominal aorta and on the basis of complications associated with impaired hemostasis, considerable disorders were revealed in the blood rheologic and coagulative properties. These disorders intensify during the operation and in the first 3 postoperative days and may lead to the development of microcirculatory and thrombotic complications. The syndrome of generalized intravascular coagulation may develop in patients with large aneurysms of the abdominal aorta, in which operations are most traumatizing. A scheme for correcting disturbances in the blood rheologic and coagulative properties in the pathological condition is given.

[Restorative vascular operations in treating severe ischemia of the lower extremities in arteriosclerosis]. / Vosstanovitel'nye sosudistye operatsii v lechenii tiazheloi ishemii nizhnikh konechnostei pri ateroskleroze.

On the basis of their personal experience in the treatment of 266 patients with severe ischemia of the lower extremity the authors believe it to be expedient under threat of amputation to perform reconstructive vascular operations on the aorto-iliac and femoral-popliteal segments. Repeated revascularization of the extremity for reocclusion in the late periods after the first reconstructive operation was conducted on 116 patients. The frequency of amputations and mortality in vascular reconstructive operations are considerably lower than those in non-operative treatment and in primary amputation of the extremity.