[Outcomes of hybrid operations in multi storeyed lesions of arteries of the aortoiliac and femoropopliteal segments].

The work was aimed at analysing immediate and remote outcomes of hybrid operations in storey atherosclerotic lesions of the aortoiliac and femoropopliteal segments. Over the period from 1997 to 2012 hybrid operations were performed in a total of 224 patients presenting with multi-storeyed lesions of iliac and lower-limb arteries, classified as TASC A, B, C, and D. The operations were carried out at departments of vascular surgery of Clinical Hospital No 83 of the Federal Biomedical Agency of Russia and the Centre of Cardiovascular and Endovascular Surgery of Clinical Hospital No 119 of the Federal Biomedical Agency of Russia. All operations were simultaneous. The patients were subdivided into groups according to the character of intervention on iliac arteries: 1 - balloon angioplasty of iliac arteries, 2 - stenosing of iliac arteries, 3 - loop endarterectomy from iliac arteries followed by implantation of a covered stent into the zone of rupture of the intimal cylinder. In all cases the interventions of the arteries of the aortoiliac segment were combined with various open surgical reconstructions of the femoropopliteal segment. Technical success amounted to 99.1%. Interventional complications of the endovascular stage requiring conversion occurred in 2 cases. The immediate period complications influencing patency of the reconstructions performed were noted in 10 (4.5%) patients. Patency on the hospital stage with the deduction of cases of technical failures amounted to 98.6%. The remote results were followed up during 5 years in 76.5% of patients. Five-year primary assisted patency of the aortoiliac zone amounted to: in group 1 - 79.2%, in group 2 - 77.9%, and in group 3 - 89.4%. Five-year assisted patency of the femoropopliteal segment amounted to: for EAE of the common femoral artery - 98.2%, for profundoplasty - 100%, femoral proximal popliteal bypass grafting - 77.3%, femoral distal popliteal bypass grafting - 74.1%, femoral-tibial bypass grafting - 61.4%. There were no statistically significant differences in patency of the reconstructions of the femoropopliteal segment depending upon the type of intervention on the aortoiliac segment.

[Colour duplex scanning in assessing efficacy of roentgeno-endovascular operations on lower-limb arteries].

The authors analysed efficacy of colour duplex scanning (CDS) in patients after roentgen- assisted endovascular interventions on lower-limb arteries. The study comprised 303 patients presenting with chronic obliterating diseases of lower extremities, who underwent a total of 456 endovascular interventions, including 375 stenting procedures. Efficacy of roentgen-assisted endovascular interventions was assessed l-to-3 days after surgery. We determined the main ultrasonographic criteria for successful balloon angioplasty, i. е., vessel's geometry restoration, haemodynamic alterations in the endovascular intervention site, the presence of residual stenosis less than 25%, accuracy of stent/stents' positioning, commensurability of the diameters of the stent and artery, exclusion of the aneurysm from blood flow. Also studied were ultrasonographic criteria for arterial complications following endovascular interventions, including thromboses of the zone of angioplasty the stent, the presence of less-than-25-percent stenosis, subintimal insertion of the stent, incomplete opening of the stent, incomplete capture of the stenosis area by the stent, and stent dislocation. CDS is an important method to assess evaluating efficacy of roentgen-assisted operations and the state of arteries after angioplasty.

[First experience with the Anaconda modular endovascular stent graft used for treatment of infrarenal aortic aneurysms].

Described herein is a favourable outcome following endovascular repair of an infrarenal abdominal aortic aneurysm using the Anaconda modular stent-graft system (manufactured by the Vascutek Co., Ltd.). The device employed and the technique pertaining thereto have proved both safe and effective in terms of good clinical outcomes obtained in the immediate and early longer-term postoperative periods.

[Prolonged endarterectomy in distal forms of arterial diseases of the lower extremities]. / Protiazhnaia endarterektomiia pri distal'nykh formakh porazheniia arterii nizhnikh konechnostei.

Six-year experience of surgical treatment of patients with critical lower limb ischemia due to a distal form of arterial lesion is presented. Surgical treatment was performed in extended occlusive lesion from inguinal fold to arteries of the calf and foot, and inadequate "ways of outflow". The king of arterial lesion did not permit the surgeon to perform typical bypass surgery or arterialisation of venous system with a traditional scheme. All the patients were candidates for amputation. For salvage of extremity 36 patients underwent prolonged semi-closed endarterectomy using special instrument which was supplemented with temporary arterio-venous fistula or popliteal-distal auto-venous bypass. In short-term period after surgery critical ischemia was eliminated in 25 (69%) patients. The rest of the patients underwent amputations. 5 years later cumulative safety of the extremities was 95% among patients with good short-term results. These variants of revascularizing surgery may be regarded as alternative to amputations in patients with critical limb ischemia due to distal lesions of lower limbs arteries.

[Embolization of uterine arteries in gynecological patients with uterine bleeding of various etiology]. / Embolizatsiia matochnykh arterii u ginekologicheskikh bol'nykh s matochnymi krovotecheniiami razlichnoi razlichnoi étiologii.

Embolization of internal iliac and uterine arteries is one of the surgical treatments for hemorrhages that complicate the course of uterine myoma, cancer diseases and medical treatment-unresponsive conditions. Endovascular hemostasis was performed in 24 patients. The causes of hemorrhage were uterine myoma with intramural or submucous nodal location in 15 patients, cancer of the uterus corpus in 6 patients, cancer of the uterus cervix in 2, and uterine sarcoma with tumor grown in the adjacent organs in 1. In all cases, free Gianturco-type spirals were used for embolization of internal iliac and ulterine arteries. For better visualization and superselective catheterization of uterine arteries, a study was performed in the right or light oblique projections at an angle of 20-25 degrees. After embolization of iliac and uterine arteries, hemostasis was attained in all patients. At the same time there were no complications. Thus, embolization of uterine arteries is a safe and highly effective alternative to radical surgical intervention in patients with acute gynecological disease complicated by bleeding, which provides effective hemostasis and permits either avoidance of surgical intervention or a significant reduction in the volume of intraoperative blood loss.

[X-ray endovascular dilatation using an axillary access]. / Rentgenoéndovaskuliarnaia dilatatsiia aksilliarnym dostupom.

Based on the analysis of 39 observed cases, the authors consider various aspects of the use of roentgenovascular dilatation by an axillary access: problems of methods, indications and contraindications; they also assess the advantages and shortcomings of the access.

[Axillary approach for radiologic endovascular dilatation]. / Rentgenoéndovasculiarnaia dilatatsiia aksilliarnym dostupom.

Basing on the analysis of 39 observed cases, the authors consider various aspects of the use of roentgenovascular dilatation by an axillary access : problems of methods, indications and contraindications; they also assess the advantages and shortcomings of the access.

[Pathomorphologic changes in the arterial wall following x-ray endovascular dilatation in chronic ischemia of the lower extremities]. / Patomorfologicheskie izmeneniia stenki arterii posle rentgenoéndovaskuliarnoi dilatatsii pri khronicheskoi ishemii nizhnikh konechnostei.

Intravital and postmortem (7 and 14 cases, respectively) x-ray endovascular dilatation of the limb arteries studied morphologically is shown to induce traumatic lesion of the vascular wall presenting with plaque cracking and detachment, disintegration of the cover, necrosis of smooth muscle cells. A clear-cut change of the plaque size was not recorded. Vascular dilatation at the site of stenosis treated by the balloon may be caused mainly by the plaque cracks and detachment from the vessel wall entailing partial recovery of its elasticity. Mechanical aftereffects of the balloon introduction noted morphologically involve also smoothing of convolution of the internal elastic membrane and the absence of the typical vascular superficial microrelief.