[Preoperative planning of mini-laparotomy in patients with abdominal aortic aneurysms]. / Dooperatsionnoe planirovanie mini-laparotomii u bol'nykh anevrizmami bryushnoi aorty.

OBJECTIVE: To improve postoperative outcomes in patients with abdominal aortic aneurysms undergoing abdominal aorta replacement via mini-laparotomy by preoperative planning of localization and optimal length of incision. MATERIAL AND METHODS: There were 40 patients with abdominal aortic aneurysms who underwent abdominal aorta replacement via mini-laparotomy. Preoperative planning of mini-laparotomy was carried out in the main group (n=17), empirical mini-laparotomy - in the control group (n=23). Intraoperative parameters, postoperative recovery, complications, and conversion rate were evaluated. RESULTS: Significant differences were observed for conversion rate, duration of surgery and mechanical ventilation. Baseline characteristics and postoperative morbidity were similar. CONCLUSION: Preoperative planning of optimal length of skin incision and analysis of anterior abdominal wall topography using CT angiography significantly reduce duration of surgery, mechanical ventilation and conversion rate. Postoperative morbidity was similar in both groups. Thus, this approach should be used to assess advisability of mini-laparotomy in patients with abdominal aortic aneurysms.

[The efficacy of pharmacological preconditioning in carotid endarterectomy].

OBJECTIVE: To assess the efficacy of pharmacological preconditioning with actovegin in carotid endarterectomy. MATERIAL AND METHODS: The study was based on the results of surgical treatment of 80 patients with hemodynamically significant uni- and bilateral lesions of carotid arteries. Half of the patients was operated immediately and others after pharmacological preconditioning with actovegin in dose of 1200 mg/daily during 1,5 months. RESULTS: Pharmacological preconditioning with actovegin increased the cerebral perfusion determined with one-photon emission computed tomography that improved significantly results of the surgery. There were significant changes in patient's state 7 days and 6 months after surgery. The improvement was correlated with the less number of asymptotic post-surgery ischemic strokes in different brain areas. CONCLUSION: A positive role of pharmacological preconditioning with actovegin in surgical treatment of carotid artery stenosis has been demonstrated.

[Surgical treatment of pathological kinking of the internal carotid artery].

The study was aimed at improving surgical policy in management of patients presenting with pathological tortuosity of the internal carotid artery. The study comprised a total of 105 patients with pathological kinking of the internal carotid artery undergoing a total of 117 reconstructive operations. In order to determine the indications for the operation the patients were subjected to triplex scanning, transcranial Dopplerography and monitoring of blood flow in the median cerebral artery, contrast-enhanced computed tomography or magnetic resonance tomography. Depending upon the degree of intimal proliferation in the area of the maximal bend («septal tortuosity¼), the patients were divided into two groups: group I - pathological kinking of the internal carotid artery without intimal proliferation - 75 patients, Group II - pathological kinking with intimal proliferation - 30 patients. The indications for the operation were determined depending upon the degree of cerebrovascular insufficiency, haemodynamical significance of pathological tortuosity, the presence of intimal proliferation in the zone of the maximal bend - «septal tortuosity¼. An operation of choice for Group I patients was resection of the internal carotid artery with redressation and reimplantation into the own bed, and all Group II patients underwent resection of the area of kinking of the internal carotid artery with an end-to-end anastomosis in order to remove the septal portion. Immediately after the operation 85% of patients were found to have their cardiovascular insufficiency symptoms relieved and all patients showed improved haemodynamic parameters (p<0.01). Neither postoperative strokes nor lethal outcomes were registered.

[Aortic-bicarotid-subclavian trifurcation bypass grafting with a synthetic prosthesis].

The authors describe herein a case of successful surgical management of a 55-year-old male patient presenting with a multifocal atherosclerotic lesion of brachiocephalic arteries. The diagnosis was confirmed by DS with CDM, MSCT angiography. Intraoperatively revealed were up to 80% stenosis of the ostium of the left common carotid artery and up to 80% stenosis of the brachiocephalic trunk. The patient underwent aortic-bicarotid-subclavian trifurcation bypass grafting with a synthetic prosthesis. Analysing the early postoperative period and the findings obtained by MSCT angiography showed satisfactory therapeutic outcomes.

[Noninvasive methods of the examination in surgery of obliterating atherosclerosis of lower extremity arteries]. / Neinvazivnye metody issledovaniia v khirurgii obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

The purpose of the study was to determine surgical policy in atherosclerotic lesions of aorta and lower extremities arteries on the basis on non-invasive diagnostic methods--duplex scanning (DS) and computer tomographic angiography (CTA). From 1998 to 1999 47 patients were examined on this program (DS + CTA). At the first stage of the study, 17 patients underwent translumbal aorto-arteriography at the same time with DS and CTA. Analysis of the angiograms revealed that sensitivity of angiography for detection of lesions in aorto-iliac segment was 94%, in femoro-popliteal segment--78%. Diagnostic mistakes were associated with partial thrombosis of aneurysm's lumen, as a result of which the aorta looked non-dilated in angiograms. Femoral arteries contrasted unsatisfactory in 4 patients because of low collateral blood velocity distal to occlusion of iliac arteries. Initial segments of deep and superficial femoral arteries closed each other in angiograms on anterior-posterior projection, and it also led to low potential of angiography in assessment of femoral arteries state. Complex of non-invasive diagnostic methods (DS + CTA) allowed to correct diagnosis in each case. The methods complemented one another: CTA permitted to make three-dimensional reconstruction of vascular tree and to study its on various projections; DS--to study the vascular wall's state and hemodynamical parameters of blood flow. At the second stage of the study, high sensitivity of DS and CTA allowed to reject traditional angiography in preoperative period. Intraoperative findings confirmed the provisional diagnosis completely.

[Ultrasonic diagnosis of complications after bypass operations in lower extremities arteries]. / Ul'trazvukovaia diagnostika oslozhnenií posle shuntiruiushchikh operatsií na arteriiakh nizhnikh konechnosteí.

After reconstructive vascular operations the patients need dynamic control and non-invasive monitoring. The purpose of the study was to reveal the potential of duplex scanning (DS) in assessment of bypasses function and diagnosis of postoperative complications. 148 patients after aorto-femoral and femoro-popliteal bypass, including patients with late postoperative complications (shunt thrombosis, stenosis or spurious aneurysm of anastomosis) were examined. Energy colored DS was performed in scans "Toshiba" SSH-140 and "Acuson" Sequoia-512. In ultrasonic diagnosis the vascular graft was imaged as a tube structure with hyperechogenic walls and distinct pulse; it was easy to detect the material of vascular graft. In examination of distal anastomosis the initial portions of efferent arteries were usually imaged distinctly. In satisfactory distal vascular bed, the shunt's blood flow did not differ from normal blood flow. In patients with multifocal lesions the spectrum of shunt's blood flow was similar to main-changed blood flow. Substantial change of blood velocity was revealed in complications (aneurysm or stenosis of anastomosis). Spurious aneurysm was imaged as a hypoechogenic pulsating formation. Thrombotic masses in aneurysm's cavity were distinctly detected at DS, unlike at angiography. In case of anastomosis insufficiency, the suture's disrupted filaments and free branch's ends could be imaged. Stenosis of anastomosis was characterized by visible lumen's stenosis, local thickening and unevenness of wall, spectrum's change and blood velocity increase. In shunt's thrombosis the DS permitted to follow the thrombed graft's path, to reveal the cause of thrombosis and to detect the condition of outflow tract. The authors regard DS as a method of choice in dynamic control for state of bypasses and arteries in patients after reconstructive operations in lower extremities arteries.