[Combined use of minimally invasive methods in treatment of varicose veins in an elderly woman]. / Sochetannoe primenenie maloinvazivnykh metodov v lechenii varikoznoi bolezni u pozhilogo patsienta.

The authors describe herein a clinical case report regarding a 70-year-old woman presenting with lower-limb varicosity in the system of the great and small saphenous veins, aneurysmal dilatation of the proximal portion of the great saphenous vein, and an open trophic ulcer of the crus with concomitant hypertension and coronary artery disease. Given these factors, she was subjected to endovenous laser coagulation of the great and small saphenous veins, microfoam echosclerotherapy of the distal portion of the trunk of the great saphenous vein and an incompetent perforating vein of the crus, followed by complete obliteration thereof. On POD 7, she developed positive dynamics in the process of healing of the trophic ulcer, and on POD 50 the ulcer healed completely. Thus, in elderly patients with lower limb varicose veins with incompetence of trunks of the great and small saphenous veins and pronounced trophic impairments of the crus, preference should be given to minimally invasive methods of treatment. Their combination ensures a good therapeutic effect without increasing the risk for local and systemic complications.

[Upper thoracic sympathectomy in treatment of upper limb ischaemia in distal lesions of the arterial bed].

Analysed herein was efficacy of 76 videothoracoscopic upper chest sympathectomies performed for upper limb ischaemia in a total of 61 patients. Of these, 15 patients were found to suffer bilateral lesions. The findings of clinical follow up and instrumental examinations (laser Doppler flowmetry, rheovasography, measuring transcranial oxygen tension in tissues) made it possible to draw a conclusion on efficacy of upper chest sympathectomy in distal lesions of the vascular bed of the upper extremities.

[Comparative characteristics of new PTFE vascular patches in experiment].

Presented herein are the findings of a comparative experimental study of 64 novel patches made of porous polytctrafluoroethylene (PTFE). The PTFE explants with various number of technological layers were examined both in vitro and in vivo. The authors performed plasty of the canine aorta with explants followed by morphological assessment of the tissues with PTFE at various terms of follow up. Based on the results obtained during intraoperative assessment of the patches' properties and histological examination thereof, we selected better patches for plasty of the aorta and major arteries to be implemented into clinical practice.

Use of preliminarily prepared v. cephalica in operations of femoral-distal bypass grafting.

Presented herein is the authors'experience in using a preliminarily prepared lateral subcutaneous vein of the arm (v. cephalica) for femoral-distal reconstructions in a total of nine patients with lower-limb critical ischaemia (LLCI). The choice of the vein referred to above as a bypass graft was a forced one because of a loose-type, insufficient-diameter greater saphenous vein (GSV), varicose and postphlebitic alterations therein or merely the total lack thereof after previous phlebectomy, with such a decision also influenced by no adequate lesser saphenous vein (LSV) available. Given the anticipated level of the would-be distal anastomoses, utilizing synthetic prosthetic grafts of blood vessels seemed fterly undesirable, and immediately employing upper-limb veins as bypass grafts turned out virtually impossible owing to their small diameter. The preparation of the bypass graft consisted in first forming a fistula between the radial artery and v.cephalica in the lower third of the forearm. Theprocedure involvinga 2-to-3-week functioning of the fistula and the so-called "training", of the vein according to a specially devised technique was followed by a noticeable widening of the lumen of the v. cephalica, thus allowing us in the long run to successfully use it for femoral-distal reconstructions.

[Role of sympathectomy in upper-limb critical ischaemia induced by distal lesion of arteries].

The work was based on the experience gained in treatment of 40 patients with degree IV ischaemia of the upper extremities, induced by involvement of the distal arterial bed. Assessing blood circulation in the upper extremities included rheovasography, laser Doppler flowmetry with functional loads, and transcutaneous oxygenometry. Analyzing the obtained findings became it possible to draw a conclusion that the upper thoracic sympathectomy is an efficacious method of treatment for upper limb ischaemia secondary to the lesions of the distal arterial bed. This operative intervention turned out to be most efficient in patients with Raynaud's syndrome.

[Surgical management of elderly and senile patients with critical lower extremity ischemia]. / Osobennosti khirurgicheskoi taktiki pri kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

This paper describes an experience with examination and surgical treatment of 194 elderly (60-74 years); and senile (75 years and more) patients with critical lower extremity ischemia (CLEI) of atherosclerotic genesis. The patient group examined was marked by multiple coexistent pathology (primarily cardial)), appreciably increasing the risk of surgical intervention. The patients of both groups were provided altogether 345 operations. Because of remarkable concomitant pathology and compromised distal bed the greater part of patients underwent little traumatic non-reconstructive operations (56.5%); in many cases (41.3%), the necessary scope of intervention was divided into stages. On analysis of the results account was taken of the limited potential of performing in geriatric patients of prolonged operations as well as of the way of life of the overwhelming majority of old-group patients. The results were evaluated according to the scale suggested by the authors. The indicated treatment policy allowed to reach, the beneficial results in 80.1% of patients in the immediate period. In the long-term period (6 to 60 months), the positive results turned out stable in more than 70% of patients. This allows to recommend the approaches worked out for use in clinical practice for the treatment of geriatric patients presenting with CLEI.

[The role of endoscopic ligation of the perforating veins in the treatment of chronic venous insufficiency under conditions of the one-day surgery center]. / Rol' éndoskopicheskoi pereviazki perforantnykh ven pri lechenii khronicheskoi venoznoi nedostatochnosti v usloviiakh tsentra khirurgii odnogo dnia.

The present work is concerned with the results of endoscopic ligation of the perforating veins (SEPS) in 179 patients with chronic venous insufficiency, class 4-6, performed at the one-day surgery center. In patients suffering from varicosity, SEPS was accomplished in combination with phlebectomy in 52 (29.1%) patients. The second stage after phlebectomy involved the combination of SEPS with microsurgical reconstruction of the femoral vein valve. SEPS alone was provided to 89 (49.7%) patients suffering from postthrombotic disease. No life-threatening complications or lethal outcomes were recorded. The postoperative events were observed in 20 (11.2%) patients. Good results were obtained in 128 71.5%) patients, satisfactory in 42 (23.5%) and unsatisfactory in 9 (5%) subjects. The data obtained allow to regard SEPS as an effective, drastic and little traumatic technique which can be used successfully under conditions of the one-day surgery center.