[Surgical treatment of aberrant subclavian artery]. / Khirurgicheskoe lechenie aberrantnoi podklyuchichnoi arterii.

OBJECTIVE: To determine the indications and optimal surgical treatment of aberrant subclavian artery. MATERIAL AND METHODS: There were 3 patients with aberrant subclavian artery with clinical manifestations such as dysphagia, shortness of breath, weight loss, cough and chest pain between 2005 and 2020. Right-and left-sided aberrant artery was observed in 2 and 1 case, respectively. Supraclavicular unilateral or bilateral access depended on the side of aberrant artery. Carotid-subclavian anastomosis was performed. RESULTS: All patients were discharged without any symptoms. CONCLUSION: Close location of aberrant subclavian artery to common carotid artery can disturb circulation in brain and upper limb. Abnormal discharge of subclavian artery can cause compression of nearby organs (esophagus, trachea). Abnormal vascular discharge does not always have clinical manifestations that do not require surgical correction. Only symptomatic patients are subjects to surgical correction of aberrant subclavian artery. Knowledge of variant anatomy of supra-aortic vessels can minimize the risk of complications.

[Combined operations on vessels and abdominal organs]. / Sochetannye operatsii na sosudakh i organakh bryushnoi polosti.

THE AIM OF THE STUDY: Is to describe the experience of combined operations and the expediency of choosing such a tactic for surgical treatment of patients with two or more surgical diseases. MATERIAL AND METHODS: The results of surgical treatment of 299 patients with vascular lesions in combination with other diseases requiring surgical treatment in 2014-2018 were analyzed. All operations were performed in the cardiovascular department of the GBUZ RKB on the basis of the Department of Hospital Surgery of the KBSU named after V.I. H.M. Berbekov. In the selected group, the proportion of patients of working age was 71%. Combined operations were performed in 151 patients, the remaining 148 people who underwent surgery for cardiovascular and surgical diseases were included in the comparison group. Among them, a combined operation was performed in 79 patients for vascular diseases and in 69 for other diseases. RESULTS: When analyzing the perioperative period in patients of the main and control groups, there was no significant difference in the parameters of simultaneous surgical interventions (duration of operations, volume of blood loss, the need to increase the dose of catecholamines in the operating and postoperative periods, the incidence of rhythm and conduction disturbances, the duration of artificial ventilation and stay in hospital). It was found that combined operations did not lead to an increase in the number of postoperative complications and an increase in mortality. At the same time, combined operations are possible even with a complex combination of various diseases. CONCLUSIONS: Combined operations are more justified than staged surgical treatment: 1) the patient is simultaneously cured of 2 or more surgical diseases; 2) the risk of repeated general anesthesia and its negative consequences is eliminated; 3) re-examination and preoperative preparation are excluded; 4) the frequency of progression and recurrence of diseases (infringement of a hernia, exacerbation of cholecystitis, etc.), repeated surgical interventions for concomitant diseases decreases; 5) a single access simplifies the surgical approach to the abdominal organs and is less traumatic; 6) the average time spent by the patient in the hospital, the terms of further rehabilitation and the period of incapacity for work are reduced; 7) combined surgical interventions are economically beneficial.