[Combined use of minimally invasive methods in treatment of varicose veins in an elderly woman]. / Sochetannoe primenenie maloinvazivnykh metodov v lechenii varikoznoi bolezni u pozhilogo patsienta.

The authors describe herein a clinical case report regarding a 70-year-old woman presenting with lower-limb varicosity in the system of the great and small saphenous veins, aneurysmal dilatation of the proximal portion of the great saphenous vein, and an open trophic ulcer of the crus with concomitant hypertension and coronary artery disease. Given these factors, she was subjected to endovenous laser coagulation of the great and small saphenous veins, microfoam echosclerotherapy of the distal portion of the trunk of the great saphenous vein and an incompetent perforating vein of the crus, followed by complete obliteration thereof. On POD 7, she developed positive dynamics in the process of healing of the trophic ulcer, and on POD 50 the ulcer healed completely. Thus, in elderly patients with lower limb varicose veins with incompetence of trunks of the great and small saphenous veins and pronounced trophic impairments of the crus, preference should be given to minimally invasive methods of treatment. Their combination ensures a good therapeutic effect without increasing the risk for local and systemic complications.

[Repeat surgical treatment of a patient with chronic type A aortic dissection an cerebral malperfusion syndrome]. / Povtornoe khirurgicheskoe lechenie bol'nogo s khronicheskim rassloeniem aorty tipa A i sindromom tserebral'noi mal'perfuzii.

Described in the article is a clinical case report regarding repeat surgical intervention with prosthetic repair of the aortic arch and brachiocephalic arteries. The findings of computed tomography demonstrated residual proximal aortic dissection extending to the brachiocephalic trunk and the right common carotid artery. The patient was subjected to redo surgery consisting in aortic arch repair according to the fresh elephant trunk technique and reconstruction of the brachiocephalic arteries with a 24-mm multiple-branched graft Vascutek Gelweave Plexus 4 in conditions of extracorporeal circulation and circulatory arrest with antegrade bihemispheric cerebral perfusion. The postoperative period was complicated by reactive pneumonia. The patient was discharged on POD 30 in a satisfactory condition. Computed tomography at 6 months revealed nothing to be particularly noted. This case report is suggestive of the necessity of working out a protocol of appropriate management of patients presenting with acute type A aortic dissection, which would make it possible to carry out treatment that would ensure no need for repeat interventions.

[Upper thoracic sympathectomy in treatment of upper limb ischaemia in distal lesions of the arterial bed].

Analysed herein was efficacy of 76 videothoracoscopic upper chest sympathectomies performed for upper limb ischaemia in a total of 61 patients. Of these, 15 patients were found to suffer bilateral lesions. The findings of clinical follow up and instrumental examinations (laser Doppler flowmetry, rheovasography, measuring transcranial oxygen tension in tissues) made it possible to draw a conclusion on efficacy of upper chest sympathectomy in distal lesions of the vascular bed of the upper extremities.

[Comparative characteristics of new PTFE vascular patches in experiment].

Presented herein are the findings of a comparative experimental study of 64 novel patches made of porous polytctrafluoroethylene (PTFE). The PTFE explants with various number of technological layers were examined both in vitro and in vivo. The authors performed plasty of the canine aorta with explants followed by morphological assessment of the tissues with PTFE at various terms of follow up. Based on the results obtained during intraoperative assessment of the patches' properties and histological examination thereof, we selected better patches for plasty of the aorta and major arteries to be implemented into clinical practice.

Use of preliminarily prepared v. cephalica in operations of femoral-distal bypass grafting.

Presented herein is the authors'experience in using a preliminarily prepared lateral subcutaneous vein of the arm (v. cephalica) for femoral-distal reconstructions in a total of nine patients with lower-limb critical ischaemia (LLCI). The choice of the vein referred to above as a bypass graft was a forced one because of a loose-type, insufficient-diameter greater saphenous vein (GSV), varicose and postphlebitic alterations therein or merely the total lack thereof after previous phlebectomy, with such a decision also influenced by no adequate lesser saphenous vein (LSV) available. Given the anticipated level of the would-be distal anastomoses, utilizing synthetic prosthetic grafts of blood vessels seemed fterly undesirable, and immediately employing upper-limb veins as bypass grafts turned out virtually impossible owing to their small diameter. The preparation of the bypass graft consisted in first forming a fistula between the radial artery and v.cephalica in the lower third of the forearm. Theprocedure involvinga 2-to-3-week functioning of the fistula and the so-called "training", of the vein according to a specially devised technique was followed by a noticeable widening of the lumen of the v. cephalica, thus allowing us in the long run to successfully use it for femoral-distal reconstructions.

[Indices of antioxidant system of blood in differential diagnosis of obliterating atherosclerosis and obliterating thromboangiitis of the lower limbs].

The work was aimed at elucidating the role of the indices of the antioxidant system (AOS) of the blood and nitrogen oxide content in differential diagnosis of atherosclerosis obiiterans (AO) and thromboangiitis obiiterans (TO) of the lower extremities. Presented herein are the findings of examining a total of one hundred and thirteen 30-to-45-year-old patients (of these, 60 had TO and 53 had AO) with various level of occlusion (from the femoropoplietal segment to the aortoiliac zone) and the stage of chronic arterial insufficiency (CAI IIA-IV). The control group was composed of 30 apparently healthy age-matched male subjects. Besides the clinical, laboratory and special instrumental methods of study, we determined the parameters of the AOS of blood and the content of nitrogen oxide degradation products. It was determined that the directedness and pronouncedness of deviations in the parameters of the AOS and nitrogen oxide from the physiological norm depended on not only the aetiology of the disease involved, but on the degree of tissue hypoxia predetermined by the stage of CAI of the lower limbs. For differential diagnosis between AO and TO, the most informative should be considered the coefficient: SOD activity/catalase activity, index of peroxide-luminol-dependent chemiluminescence and the content of nitrogen oxide degradation products.

[Microsurgical reconstruction of incompetent femoral vein valve in varicose disease].

We report here the results of examination and treatment of 2.178 patients with clinical class 3-6 varicose disease (CEAP). Comprehensive examination of the patients included Doppler ultrasonography, duplex scanning of the lower limbs veins with dynamic and energy mapping, retrograde femoral videophlebography, and intraoperative the test. Based on the findings of the examination, insufficiency of the femoral vein valve was revealedin 1.357 (62.3%) patients. The authors determined the indications for and contraindications to correction of valvular insufficiency in varicosity of the lower extremities, having performed a total of 1.168 microsurgical reconstructions of the femoral venous valve according to own methodology. There were neither any thromboses of the reconstruction zone observed, nor were any lethal outcomes noted to ensue. The obtained intraoperative outcomes were assessed as good in 722 patients (61.8%), as satisfactory in 427 (36.6%), and as poor in 19 (1.6%). During the early postoperative period, good short-term outcomes were observed in 972 patients (83.2%), satisfactory in 177 (15.2%), and unsatisfactory in 19 patients (1.6%).

[Role of sympathectomy in upper-limb critical ischaemia induced by distal lesion of arteries].

The work was based on the experience gained in treatment of 40 patients with degree IV ischaemia of the upper extremities, induced by involvement of the distal arterial bed. Assessing blood circulation in the upper extremities included rheovasography, laser Doppler flowmetry with functional loads, and transcutaneous oxygenometry. Analyzing the obtained findings became it possible to draw a conclusion that the upper thoracic sympathectomy is an efficacious method of treatment for upper limb ischaemia secondary to the lesions of the distal arterial bed. This operative intervention turned out to be most efficient in patients with Raynaud's syndrome.

[Roentgeno-endovascular occlusion of congenital arteriovenous fistula of the neck]. / Rentgenoéndovaskuliarnaia okkliuziia vrozhdennogo arteriovenoznogo svishcha pozvonochnoi arterii.

We report here a successful outcome of X-ray endovascular occlusion of congenital indirect macrofistular arteriovenous fistula between the first segment of the left subclavian artery and vertebral venous plexus with a manifested shunt into the brachiocephalic vein. Described in detail herein are the diagnosis of the disease and technical peculiarities of performing transcatheter endovascular occlusion.

[Surgical management of elderly and senile patients with critical lower extremity ischemia]. / Osobennosti khirurgicheskoi taktiki pri kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

This paper describes an experience with examination and surgical treatment of 194 elderly (60-74 years); and senile (75 years and more) patients with critical lower extremity ischemia (CLEI) of atherosclerotic genesis. The patient group examined was marked by multiple coexistent pathology (primarily cardial)), appreciably increasing the risk of surgical intervention. The patients of both groups were provided altogether 345 operations. Because of remarkable concomitant pathology and compromised distal bed the greater part of patients underwent little traumatic non-reconstructive operations (56.5%); in many cases (41.3%), the necessary scope of intervention was divided into stages. On analysis of the results account was taken of the limited potential of performing in geriatric patients of prolonged operations as well as of the way of life of the overwhelming majority of old-group patients. The results were evaluated according to the scale suggested by the authors. The indicated treatment policy allowed to reach, the beneficial results in 80.1% of patients in the immediate period. In the long-term period (6 to 60 months), the positive results turned out stable in more than 70% of patients. This allows to recommend the approaches worked out for use in clinical practice for the treatment of geriatric patients presenting with CLEI.

[The role of endoscopic ligation of the perforating veins in the treatment of chronic venous insufficiency under conditions of the one-day surgery center]. / Rol' éndoskopicheskoi pereviazki perforantnykh ven pri lechenii khronicheskoi venoznoi nedostatochnosti v usloviiakh tsentra khirurgii odnogo dnia.

The present work is concerned with the results of endoscopic ligation of the perforating veins (SEPS) in 179 patients with chronic venous insufficiency, class 4-6, performed at the one-day surgery center. In patients suffering from varicosity, SEPS was accomplished in combination with phlebectomy in 52 (29.1%) patients. The second stage after phlebectomy involved the combination of SEPS with microsurgical reconstruction of the femoral vein valve. SEPS alone was provided to 89 (49.7%) patients suffering from postthrombotic disease. No life-threatening complications or lethal outcomes were recorded. The postoperative events were observed in 20 (11.2%) patients. Good results were obtained in 128 71.5%) patients, satisfactory in 42 (23.5%) and unsatisfactory in 9 (5%) subjects. The data obtained allow to regard SEPS as an effective, drastic and little traumatic technique which can be used successfully under conditions of the one-day surgery center.