[Prevalence and influence of risk factors on coronary shunting operations in patients with aterosclerosis of abdominal aorta and peripheral vessels].

Retrospective study analysis concerning the prevalence of risk factors for unfavorable outcomes after coronary operations in patients with peripheral arterial atherosclerosis is presented. Meta-analysis of individual risk factors was carried out. Frequency of complications after coronary shunting in patients with various concomitant diseases is evaluated. The multifactorial relative risk affecting hospital lethality is defined. The study includes 131 patients with generalized atherosclerosis, which have underwent myocardial revascularization at the first stage (the main group) and at the second stage have been operated on abdominal aorta and peripheral arteries. 1128 patients without peripheral arterial atherosclerosis have made the control group. They underwent only coronary shunting. All patients were treated from December of 1994 till June of 2006. Relying on the results of the study cumulative relative risk for unfavorable outcomes after revascularization is 1.8 times higher in patients from the main group than in patients from the control group, and the risk for primary complications is 2.03 times higher. Concomitant atherosclerotic arterial involvement among cardiosurgical patients is associated with high risk for stroke in postoperative period. In case of chronic renal failure risk factors are cumulated. In the main group lethality made 5% , which was higher as compared with the control group. Correlation of such risk factors as heart failure and renal failure (creatinine level more than 1.8 mg/dl) with lethality has been revealed among patients from the main group. Lethality risk raises in 5.30 times in the presence of heart failure in medical history, and raises in 13.15 times in case of initially elevated creatinine level. Age of patient didn't have any influence on lethality in early postoperative period.

[Algorithm of cardiac risk assessment before vascular surgery].

THE OBJECT: to detect the informative value of algorithm of cardiac risk assessment recommended by American Heart Association compared with original standard enlarged protocol. Overall 456 patients underwent vascular operations. First group consisted of 198 patients who were examined according original enlarged protocol; other 258 patients (2nd group) were examined with AHA protocol. At 1st group 41% patients didn't need myocardial revascularization (according coronarography results), preventive coronary bypass surgery was performed at 32% patients. At 2nd group coronarography was performed at 133 (51%) patients according risk factors stratification and stress-examination results. Preventive coronary bypass surgery was performed at 97 patients; 27 patients refused this recommendation. Enlarged protocol increases in 2.6 times the odds of unnecessary invasive procedure. It is concluded that AHA algorithm permits to reduce in 2 times and more the number of invasive diagnostic procedures compared with standard enlarged protocol; AHA algorithm increases the clinical and economic effectiveness.

[Metha-analysis of results of stress-tests application in patients before the operations on peripheral vessels and abdominal aorta].

Results of meta-analysis of 90 publications concerning cardiac stress-tests carried out to patients before operations on vessels and abdominal aorta are presented; 11,778 patients were included in the system review. On the basis of literary data advantages and disadvantages of diverse diagnostic tests and contra-indications to them were analyzed. Findings prove that pharmacological stress-tests have the highest sensitivity and specificity. Out of various diagnostic tests--treadmill test with ECG control, Holter monitoring, radioisotope imaging with thallium-201, and dipyridamole, and stress-echocardiography with dobutamine--the last one is the most informative in predective value of positive result, relative risk of possibility development of negative cardiac event (myocardial infarction or patient's death in consequence of myocardial infarction), likelihood ratio, sensitivity and specificity. Furthermore, during stress-echocardiography with dobutamine examination of myocardial contractility and evaluation of ejection fraction are available what makes it a method of choice in cardiac risk stratification in patients before reconstructive vascular surgery.

[Surgical correction of infrarenal abdominal aorta aneurysms].

The authors compare various surgical strategies of infrarenal abdominal aorta aneurysm (IAAA) repair based on the experience of the Department of Cardiovascular Surgery, Urban Clinical Hospital No.81. Total 198 patients underwent aneurysm resection and grafting through conventional (90) or minilaparotomy (108) approaches. Mini-approach was shown to improve significantly both perioperative course and outcomes of IAAA correction. The main advantage of this approach comprised limited invasiveness together with sufficient exposure of abdominal aorta and its branches. Abandoning small bowel evisceration helps to preserve ther-moregulation and achieve volemic homeostasis with less fluid volume. Postoperative period after surgical mini-approach was characterized by shorter period of mechanical ventilation and ICU stay, earlier restoration of bowel motility, conversion to usual nutrition, patient mobilization and discharge. Minimally invasive technology significantly broadens feasibility of radical aortic reconstructions for patients with serious cardio-vascular comorbidities.

[Aneurysm of internal carotid artery. Clinical symptoms, surgical treatment, results].

Aneurysms of the extracranial portion of the internal carotid artery is rare pathology - only 2.2% of all surgical procedures on this portion of the internal carotid artery are caused by this disease. Ten-year experience in surgical treatment of these aneurysms is presented in article. Symptoms and etiology of this disease are considered. It is demonstrated that fibromuscular dysplasia is one of the main causes of these aneurysms. Strategy and policy of surgical treatment, clinical cases are analyzed. Resection of the aneurysm with angioplasty or grafting is optimal. End-to-end anastomosis is possible in patients with kinking. Results of surgical treatment are positive, there is no hospital lethality.

[Technical features of aneurysm resection and abdominal aorta reconstruction from mini-approach].

Experience of surgical treatment of infrarenal aortic aneurysm from mini-approach at 42 patients is analyzed. Techniques of mini-invasive surgery, tactical aspects are described. Peri- and postoperative data at study group were compared with ones at control group consisted of 42 patients who underwent reconstructive operation on abdominal aorta with traditional median laparotomy. The operation time, volume of intravenous infusion, time of pulmonary ventilation, stay at intensive care department and postoperative enteroparesis were significantly less at the patients of study group. Mini-invasive techniques don't increase complexity of operation, and can be performed by surgeons without special training.

[Surgical treatment of aneurysm and kinking of the internal carotid artery].

The authors describe herein a case report of a female patient with an aneurysm and kinking of the internal carotid artery, located 35 cm above the bifurcation,and accompanied by the focal neurological symptomatology. The successfully carried out surgical management consisted in excision of the aneurysm together with the kinking of the internal carotid artery and formation of an <> anastomosis. Both the aneurysm and kinking were caused by fibromuscular dysplasia.