[Thrombectomy for acute iliofemoral thrombosis in prevention of pulmonary embolism]. / Trombéktomiia pri ostrom podvzdoshno-bedrennom tromboze v profilaktike TÉLA.

BACKGROUND: Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS: Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS: After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION: Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.

[X-ray endovascular dilatation of coronary arteries in patients with unstable angina pectoris]. / Rentgenovaskuliarnaia dilatatsiia koronarnykh arterii u bol'nykh nestabil'noi stenokardiei.

The outcomes of X-ray endovascular dilatation of coronary arteries in 46 patients with unstable angina pectoris are presented. Angioplasty proved to be angiographical-ly effective in 15 cases, anginal episodes ceased in 13. In 5 patients, successful dilatation was accompanied by coronary intimal dissection, as evidenced by angiography; however, its clinical effect was good. Low incidence rates of complications was likely to be associated with the relative normalization of the patients' condition during intensive drug therapy.

[Unstable angina: effect of aspirin and heparin on treatment outcome in hospital patients (a double-blind, placebo-controlled study)]. / Nestabil'naia stenokardiia: aspirin i geparin v dvoinom slepom platsebo-kontroliruemom issledovanii, vliianie na iskhod zabolevaniia v period gospitalizatsii.

Aspirin and heparin are regarded as drugs that improve a prognosis in patients with unstable angina, but their comparative efficiency has not been elucidated yet. A randomized double-blind placebo-controlled study of oral aspirin (165 mm once daily) versus intravenous infusion of heparin (1,000 units per hour) was carried out in 94 patients with acute unstable angina (the mean interval after the last anginal attack 5.7 +/- 4.6 hours). During hospital stay, cardiac events (Q wave myocardial infarction or cardiac death) developed in 6 out of 46 patients on aspirin and 6 out of 48 patients on heparin. A significant superiority of heparin during its infusion (1 case of myocardial infarction versus 4 on aspirin) disappeared during the following 24 hours when 2 patients on heparin developed myocardial infarction (due to rebound phenomenon?). Two patients on heparin underwent coronary artery bypass surgery. Among complications only minor bleeding occurred. The results of this study demonstrated no significant benefits of intravenous heparin infusion over oral aspirin during hospitalization in patients with unstable angina. A high incidence (13%) of poor outcomes observed with the two drugs indicates that it is necessary to search for more beneficial antithrombic interventions.

[Diagnosis of restenosis of the coronary artery following x-ray endovascular dilatation]. / Diagnostika restenoza koronarnoi arterii posle rentgenoéndovaskuliarnoi dilatatsii.

Altogether 40 patients with stable angina of effort were investigated in a long-term period after roentgenovascular dilatation of one or two coronary arteries. Control coronography was performed in 22 patients with lowered exercise tolerance. A reliable feature in the development of hemodynamically significant restenosis and/or "new" coronary stenosis in 11 patients was a combination of average and low exercise tolerance with its negative dynamics. For patients with I functional class, a sign of restenosis and/or "new" stenosis was the appearance of the ischemic shift of the CT-segment on ECG during bicycle testing. An efficient selection of patients resulted in increased sensitivity and specificity of noninvasive tests.

[Diagnosis of coronary artery restenosis after radiologic endovascular dilatation]. / Diagnostika restenoza koronarnoi arterii posle rentgenoéndovaskuliarnoi dilatatsii.

Altogether 40 patients with stable angina of effort were investigated in a long-term period after roentgenovascular dilatation of one or two coronary arteries. Control coronarography was performed in 22 patients with lowered exercise tolerance. A reliable feature in the development of hemodynamically significant restenosis and/or "new" coronary stenosis in 11 patients was a combination of average and low exercise tolerance with its negative dynamics. For patients with I functional class, a sign of restenosis and/or "new" stenosis was the appearance of the ischemic shift of the CT-segment on ECG during bicycle testing. An efficient selection of patients resulted in increased sensitivity and specificity of noninvasive tests.

[Thromboxane and prostacyclin in patients with stenocardia in induced and spontaneous ischemia of the myocardium]. / Tromboksan i prostatsiklin u bol'nykh stenokardiei pri indutsirovannoi i spontannoi ishemii miokarda.

The levels of TxB2 and 6-keto-PGI alpha in the coronary sinus and thoracic aorta blood were determined in 14 patients with angina pectoris and signs of coronary atherosclerosis. 12 patients were involved in a dynamic study: before, during and 10 minutes after ischaemia-inducing atrial pacing. In all the patients atrial pacing resulted in a typical episode of angina, in 7 of them ST-segment depression of not less than 2 mm was seen on the ECG. In one patient arachidonic acid metabolites were evaluated during the control period and during a spontaneous episode of angina accompanied by ST-segment elevations. In 8 of 9 patients TxB2 was produced by the myocardium during atrial pacing. During monitored evaluation of arachidonic acid metabolites one patient with spontaneous angina demonstrated a gradual lowering of the 6-keto-PGI alpha, it being minimal by the beginning of the episode; TxB2 level increased more rapidly.

[Experience with intraluminal balloon dilatation of constricted coronary arteries in ischemic heart disease]. / Opyt primeneniia vnutriprosvetnoi ballonnoi dilatatsii stenozirovannykh koronarnykh arterii pri ishemicheskoi bolezni serdtsa.

Twenty-seven attempts at coronary arterial intraluminal balloon dilatation (CAIBD) were made in 24 patients; 16 of those were successful. The procedure could only be accomplished in patients with affected anterior interventricular branch. Thrombotic occlusion of the dilated segment was recorded in 3 patients, and 2 of those developed intramural myocardial infarction. While the procedure is not yet fully set up, it is indicated to patients with an isolated lesion of the anterior interventricular artery that does not exceed 90%, no apparent signs of coronary spasm and no effect of conventional antianginal therapy.