[Multistage endovascular treatment of multifocal atherosclerosis].

We present a report of a clinical case of multistage endovascular treatment of multifocal atherosclerosis with involvement of coronary arteries, left renal artery, and arteries of lower extremities. A 54 year old patient with type 2 diabetes, impaired renal function, vasorenal hypertension, and lowered left ventricular contractility had history of stroke and myocardial infarction. Endovascular treatment was carried out in 6 stages with sequential angioplasty and stenting of coronary arteries, arteries of lower extremities, and left renal artery. Overall 20 stents were implanted (17 with drug covering): 10 in coronary vascular bed, 9 in arteries of lower extremities, 1 in renal artery. Control examination in 9 months showed good remote angiographic and clinical result.

[Selection of surgical tactics in infected vascular transplants]. / Vybor khirurgicheskoi taktiki pri infitsirovanii sosudistykh transplantatov.

The article analyzes a 10-years experience of the clinic work with choice of surgical tactics in infecting vascular transplants after reconstructive operations on the aorta and arteries of lower extremities in 57 of 1079 patients operated upon. The active-waiting tactics using conservative antibacterial methods of treatment was unsuccessful since in 89.7% of cases it resulted in the development of erosive bleedings and in 62.8%--in lethal issues. Preventive reoperations (atypical shunting included) before the development of erosive bleeding in infected vascular transplants reduced the frequency of amputations from 46.2% to 26.6% (in the discharged patients), and reduced lethality almost 4 times (from 62.8% to 16.7%).

[Endolymphatic antibiotic therapy in the prevention and treatment of purulent-septic complications in vascular surgery]. / Endolimfaticheskaia antibiotikoterapiia v profilaktike i lechenii gnoino-septicheskikh oslozhenii v sosudistoi khirurgii.

With the aim of prophylaxis and treatment of purulent-septic complications, in 12 patients with IV stage chronic arterial insufficiency (group 1) before the operation, the direct endolymphatic antibioticotherapy (ELAT) was performed, in 13 patients with IIB-III stage of the disease (group 2) after the operation with the aim of treating purulent septic complications. The control group consisted of 10 patients with IV stage chronic arterial insufficiency. In group 1 patients, after the operation, there were no inflammatory changes in the wound, the wound healed by primary intention. In 7 control patients, the suppuration of inguinal wounds was noted. In group 2 patients, against the ELAT background, the regress of inflammation, reduction of the degree of bacterial contamination of the wounds, their cleaning and healing by secondary intention were noted.

[Doppler sphygmomanometry in the diagnosis of obliterating atherosclerosis]. / Dopplerosfigmomanometriia v diagnostike obliteriruiushchego ateroskleroza.

The diagnostic possibilities of regional systolic pressure measurement was appraised in examination of 76 patients with various localization of the occlusive lesion and stages of the disease. The indices of regional systolic pressure (IRSP) were compared for precise comparative analysis. The indices of changes of systolic pressure (ICP) between the measurement zones were calculated for comparison of pressure changes along the length of certain limb segments. The malleolar systolic pressure index is of highest diagnostic importance in identifying the occlusive lesion, whatever its type. IRSP changes at different levels give a precise idea of the hemodynamic conditions of each type of occlusive lesion. The ICP should be accepted as the criterion of the spread of the occlusive process in arteries below the inguinal ligament. The suggested method makes it possible not only to detect the occlusive process, but to differentiate an aorto-iliac and femoropopliteal blockade or their combination.

[Hemodynamic aspects of the treatment of patients with "critical ischemia" of the lower extremities]. / Gemodinamicheskie aspekty lecheniia bo'lnykh s "kriticheskoi ishemiei" nizhnikh konechnostei.

A complex examination of 60 patients with different stages of disturbances of blood circulation (by the Fontain classification) with chronic arterial insufficiency was performed. Specific features of regional hemodynamics were revealed in patient with "critical ischemia" (3rd and 4th stages of the disease). Threshold values of the "critical ischemia" were determined, most informative of them being the malleolus index and oxygen pressure on the foot. An analysis of results of the investigation in the dynamics of the treatment performed has shown possible effectiveness of restorative operations in treatment of patients with severe stages of chronic arterial insufficiency.

[Potentials of ultrasonic diagnosis in acute obstruction of the major arteries of the extremities]. / Vozmozhnosti ul'trazvukovoi diagnostiki pri ostroi neprokhodimosti magistral'nykh arterii konechnostei.

The possibilities of ultrasonic doppler-diagnosis in acute occlusion of the main arteries of the upper and lower limbs were studied in 529 patients with acute arterial occlusion (embolism in 425, acute thrombosis in 104) and 25 patients without arterial pathology. The criteria of exact topical diagnosis and the method for quantitative assessment of hemodynamic disorders were developed. The data of ultrasonic diagnosis were compared with those of angiography, intraoperative findings, and the results of autopsy. The results obtained point to the high diagnostic value and high degree of precision of ultrasonic doppler-diagnosis in patients with acute thrombosis and embolism of the peripheral limb arteries.