[Subfascial endoscopic dissection of perforant veins in ambulatory surgery of varicose disease].

The results of ambulatory application of subfascial endoscopic dissection of perforant veins (SEDPV) in 47 patients, suffering C4-C5 functional class varicose disease (according to CEAP classification) were presented. In all the patients SEDPV was performed in combination with miniinvasive methods of vertical reflux and varicosely changed tributaries elimination. The complications have had occurred in 6 (12.77%) patients, but they were not severe, did not need secondary hospitalisation of the patients, did not impact essentially restoration of ability to work and did not worsened the treatment outcome. Duration of inability to work period have lasted 12 - 25 days after the operation, 14.7 days at average. There was proved, that SEDPV permits to perform radical surgical intervention in patients, suffering chronic venous insufficiency class C4-C5 in ambulatory conditions.

[Algorithm of modern technologies for outpatient surgical treatment of varicose disease of the lower extremities].

The results of ambulatory surgical treatment for the 2007 - 2012 yrs period of 736 patients, suffering varicose disease of lower extremities (VDLE) with chronic venous insufficiency Class C0-C6, according to CEAP (Clinical Etiological Anatomical Pathophysiological) classification, were analyzed. In 258 patients intraoperative truncal scleroobliteration was used and in 124 -endovenous laser coagulation, in 47 - subfascial endoscopic dissection of perforant veins, in 307 - microsclerotherapy, compressive treatment, medicinal therapy. The treatment algorithm of ambulatory surgery of VDLE was elaborated, basing on the analysis of the results of treatment.

[Clinical efficacy of alprostan in treatment of obliterating multifocal atherosclerotic affection of arteries in patients with critical ischemia of lower extremities]. / Klinicheskiaia éffektivnost' alprostana pri lechenii obliteriruiushchego multifokal'nogo ateroskleroticheskogo porazheniia arterii u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

Experience of application of alprostan (PGE1, alprostadil) in 19 patients with atherosclerotic affection of vessels, chronic and acute ischemia of lower extremities in III-IV stage in combination with affection of other vascular basins was summarized. In 10 patients, to whom operative vascular reconstruction was contraindicated and/or technically unrealizable, the conservative treatment was conducted using alprostan during 12-25 days up to the clinical effect achievement (total dose up to 1.6 mg). In 9 patients after performance of conservative treatment using alprostan the vascular bed reconstruction was done. Daily infusion of alprostan in 0.1 mg dose diluted in 250-400 ml of isotonic solution of sodium chloride during 2.5-3 h with duration of course not less than 15 days and 1.2-2.2 mg total dose of preparation constitutes an optimal scheme of treatment. Good result was noted in treatment of patients in stage II of ischemia, application of alprostan in stage IV of ischemia had permitted to reduce the extremity amputation volume or to escape it on the whole, and to restore more rapidly the cutaneous integrity in the trophic disorders regions. The alprostan usage is trustworthy in patients with multifocal atherosclerosis with the cardiac coronary vessels affection in an ischemic heart disease.

[Application of clexane in reconstructive surgery of the aorta arch vessels for the arterial thrombosis prophylaxis]. / Ispol'zovanie kleksana v rekonstruktivnoi khirurgii sosudov dugi aorta dlia preduprezhdeniia vozniknoveniia arterial'nogo tromboza.

Results of treatment of 114 patients for ten-year period, operated on for diseases of extracranial vessels, were adduced. Up to 1998 after performance of reconstructive operation as anticoagulant heparin was used in 80 patients and in last time--low-molecular heparin clexane in 34. After operation all patients survived. An ischemic insult occurred in 2-3 days after the operation in 2(2.5%) patients, while application of heparin, in 5--positive changes of the disease course were absent, in 19(23.75%)--postoperative hemorrhagic complications occurred. When clexane was administered in 2(5.9%) patients the cerebral hemodynamics improvement was not noted, complications in the early and late postoperative periods were absent. In term of observation up to 5 years good results was noted in 21(62.3%) patient, fair--in 9 (27.2%). In late postoperative period the brain hemodynamics improvement was not noted in 2 (5.9%) patients. Application of clexane for the arterial thrombosis prophylaxis is clinically substantiated and permits to reduce significantly the risk of the complications occurrence, which are observed with usage of heparin.

[Pathogenesis, indications and choice of surgical treatment method in juxta- and suprarenal aortic aneurysm]. / Patogenez, pokazaniia i vybor metoda operativnogo lecheniia iuksta- i suprarenal'noi anevrizmy aorty.

Experimental part of the work included the aortic aneurysm simulation in animals and the studying of the disease course. The results of observation of 12 operated on in clinic and 17 nonoperated patients are presented. Pathogenesis of the disease was studied, indications for the operation and the criterions of the treatment method choice were determined.

[Surgical treatment of ischemic colitis in patients with abdominal aortic aneurysm]. / Sposob khirurgicheskogo lecheniia ishemicheskogo kolita pri anevrizme briushnoi aorty.

The authors suggest an original method for revascularization of the inferior mesenteric artery for the prevention and treatment of ischemic colopathy in operative treatment of abdominal aortic aneurysm. The essence of the method consists in shunting the blood flow from the channel of the celiac trunk by anastomosing the right gastroepiploic artery with the inferior mesenteric artery by the end-to-end techniques. Topographoanatomical studies of the right gastroepiploic and inferior mesenteric arteries were conducted on 22 cadavers for experimental substantiation of the suggested method. Besides that, selected angiograms of the celiac trunk and its branches were studied in 50 patients. The suggested method for revascularization of the inferior mesenteric artery in resection of aneurysm of the abdominal aorta with intraluminal prosthetics was applied in eight patients with good results.

[Surgical treatment of multiple occlusions of the aortic arch arteries]. / Khirurgicheskoe lechenie mnozhestvennogo okkliuzionnogo porazheniia arterii dugi aorty.

The results of treatment of 174 patients with lesions of the arteries of the aortic arch are presented. Multiple lesions of the coronary arteries were revealed in 78 patients, of the brachiocephalic trunk--in 45, their combination--in 52. In patients with the ischemic heart disease, in average, 3,4 aortocoronary shunts were placed. In patients with the impaired cerebral circulation, reconstruction of 2-3 arteries was performed simultaneously in their unilateral lesions. In case of their bilateral lesions, the blood flow restoration was performed in two stages with a 2-4 week interval. Improvement of the indices of intravascular hemodynamics was achieved in 97.5% of the patients, neurologic symptoms were completely eliminated in 71% of the patients. Three patients died from cardio-vascular failure.

[Reconstructive surgery of abdominal aortic aneurysm]. / Rekonstruktivnaia khirurgiia anevrizmy briushnoi chasti aorty.

The authors have developed the methods for performance of a reconstructive operation for abdominal aortic aneurysms which permit to avoid prolonged clamping of the abdominal aorta. On the basis of the results obtained, a conclusion of the high effectiveness of these methods has been drawn.

[Choice of the approach in the performance of reconstructive surgery of the abdominal aorta]. / Vybor dostupa pri vypolnenii rekonstruktivnykh operatsii na briushnoi chasti aorty.

The experience with surgical treatment of 630 patients with the use of extraperitoneal and transabdominal approaches to the abdominal aorta is summarized. Their advantages and disadvantages are noted. The expediency to use a new extraperitoneal approach to suprarenal and infrarenal portions of the abdominal aorta has been proved. The results of a topographic-anatomic study are presented. The technique for performance of a new approach to the abdominal aorta at this region, its advantages over the existing approaches are described.

[Clinico-experimental evaluation of the new reconstructive operations on the popliteal and crural veins in postphlebitic syndrome during recanalization]. / Kliniko-éksperimental'naia otsenka novykh rekonstruktivnykh operatsii na podkolennoi i bertsovykh venakh pri post- tromboflebiticheskom sindrome v stadii rekanalizatsii.

The experimental data on studying surgical anatomy of the popliteal vein and its branches are presented. On the basis of the findings obtained, the experimental models of reconstructive operations--transposition of the small saphenous and muscular veins with the functioning valves to the position of a popliteal vein, its bifurcation or one of the sural veins--have been developed. The clinical assessment of the performed reconstructive operations on the veins of the popliteal -sural segment was carried out. The results of reconstructive operations are good. A conclusion about the expediency to use in the clinic of the developed methods of operative interventions on the major veins of the lower extremities was drawn.

[Surgical treatment of vertebrobasilar insufficiency]. / Khirurgicheskoe lechenie vertebrobaziliarnoi nedostatochnosti.

The results of surgical correction of blood flow in the vertebrobasilar basin in 58 patients ranging in age from 32 to 65 years were analysed. In 75.9% of cases, the disease was secondary to atherosclerosis. The tortuosity of the vertebral artery was noted in 12% of the patients. Transitory symptoms of ischemia were observed in 20.6% of the patients, chronic vascular cerebral insufficiency--in 53.6%, sequelae to the ischemic insult--in 25.8%. For diagnosis, the Doppler ultrasound, rheoencephalography, computerized tomography were used. The preference was given to extracranial operative interventions: +carotid-subclavian shunting was performed in 19, +intimo-thrombectomy from the subclavian and ostium of the vertebral artery--in 22, ++aorto-subclavian shunting--in 3 patients. Plasty of the vertebral artery was accomplished in 12 patients. The positive dynamics of neurologic status was noted in 91.3% of the patients.

[Intestinal complications after reconstructive operations on the abdominal aorta and their prevention]. / Kishechnye oslozhneniia posle rekonstruktivnykh operatsii na briushnoi chasti aorty i ikh profilaktika.

The results of treatment of 1229 patients with diseases of the abdominal aorta (AA) have been analysed. Two original methods for prevention of colonic ischemia in performance of a reconstructive operation on AA are suggested.

[Surgical treatment of diseases of the brachiocephalic arteries]. / Khirurgicheskoe lechenie zabolevanii brakhiotsefal'nykh arterii.

The authors have summarized the experience with surgical treatment of 147 patients with the brachiocephalic arterial pathology. Transient disorders in the cerebral circulation were noted in 54%, chronic vascular cerebral insufficiency--in 15%, ischemic insult and its sequelae--in 19% of the patients. Occlusive-stenotic lesions of the extracranial vessels, aneurysms, tortuosity of the brachiocephalic++ trunk, compression of the carotid arteries by chemodectoma were the indications for operative treatment. When choosing a method for operative intervention, the preference was given to extrathoracic techniques. The positive results were achieved in 90% of the patients.