[Outcomes of revascularizing operations on lower-limb arteries in patients with critical ischaemia and multifocal atherosclerosis]. / Iskhody revaskuliariziruiushchikh operatsii na arteriiakh nizhnikh konechnostei u bol'nykh s kriticheskoi ishemiei i mul'tifokal'nym aterosklerozom.

The purpose of this study was to evaluate the amputation-free survival rate and predictors of major adverse cardiovascular events (extracardiac and cardiac mortality, non-fatal myocardial infarction, non-fatal stroke) in patients with atherosclerotic occlusive-stenotic lesions of the femoropopliteal-tibial segment and critical ischaemia. We analysed the results of treating a total of 122 patients with atherosclerotic lesions of the superficial femoral artery and lower limb critical ischaemia. Of these, 35 patients had no lesions of other arterial basins, 24 patients presented with a concomitant lesion of the carotid basin, 41 subjects had lesions of the coronary basin, and 22 had lesions of the coronary and carotid basins. The patients were subjected to either bypass graft operation (n=75) or endovascular intervention (n=47). The evaluated outcome measures were amputation-free survival and the frequency of major adverse cardiovascular events. The average duration of follow up amounted to 38.2±4.3 months. The carried out multivariate logistic regression analysis demonstrated that the factors associated with lower limb amputation and the development of major adverse cardiovascular events were as follows: a concomitant lesion of the coronary (p=0.044) and coronary-carotid (p<0.05) basins, a history of endured myocardial infarction (p=0.003), a C-reactive protein level not less than 17.0 mg/l (p<0.05) and the value of the apolipoprotein B/A1 ratio above 1.0 (p=0.004).

[Peculiarities of diagnosis and surgical policy in elderly patients with pathological tortuosity of the internal carotid artery].

The study was aimed at optimizing surgical treatment management of elderly patients presenting with pathological tortuosity of the internal carotid artery (ICA). We examined a total of 94 patients with unilateral haemodynamically significant tortuosity of the ICA. Depending on the age, the patients were subdivided into two groups: Group One comprising forty-six (49%) 50-to-60-year-old patients and Group Two consisting of 48 (51%) patients above 60 years (from 61 to 84 years). 37% of patients had were found to have pathological tortuosity combined with haemodynamically significant ICA stenosis. In these patients linear blood velocity in the zone of the largest deformation was by 15% less than in patients with isolated tortuosity (p<0.05). All patients underwent reconstructive operations of carotid arteries with a good clinical effect. A combination of stenosis and pathological tortuosity of the ICA was treated by eversion carotid endarterectomy with lowering down and reimplantation of the artery into the previous ostium; microaneurysms present in the ICA wall were managed by resection of the artery's portion with autovenous prosthetic repair or bringing down the artery into the previous ostium. In 77% of patients above 60 years the operation was carried out under regional anaesthesia. According to the findings of duplex scanning, rectilinearity of the ICA after surgery was restored in 100% of cases, blood flow was of major type, with no turbulence registered. It was demonstrated that surgical management of elderly patients with pathological tortuosity is an effective method of prevention of ischaemic stroke. The complications rate in patients presenting with combined atherosclerotic lesions of the ICA and its pathological tortuosity, should adequate surgical policy be employed, falls within the framework of the accepted standards and does not depend on the type of ICA lesion.

[Choosing the method of reconstruction for lower-limb critical ischemia].

Presented herein are long-term outcomes of surgical treatment of 74 patients with atherosclerotic occlusive-stenotic lesions of the femoral-popliteal-tibial segment and critical ischaemia. 51 (68.92%) patients underwent femoropopliteal shunting into the isolated segment of the reversed great saphenous vein. Of these, three patients were subjected to a hybrid operation consisting of femoropopliteal bypass grafting and balloon angioplasty of the popliteal and one tibial artery. 23 (31.08%) patients endured percutaneous balloon angioplasty with stenting of the superficial femoral artery and balloon angioplasty of one tibial artery. Two-year patency of the zone of reconstruction of the femoropopliteal segment in these groups was identical, amounting to 64.71 and 56.52%, respectively. However, the group of patients with endovascular intervention demonstrated rather a high rate of intraoperative complications--21.74%, technical success in balloon angioplasty of arteries of the crus amounted to 65.22%. Once the method of operative treatment is chosen, preference is given to shunting in the isolated popliteal artery with sufficient collateral blood flow. Further studies are required to determine angiographic indications for endovascular intervention on tibial arteries.