[Ten-year results of abdominal aortic and great vessels aneurysms management]. / Desiatiletnie rezul'taty lecheniia bol'nykh s anevrizmami briushnoi aorty i magistral'nykh arterii.

AIM: To present own 10-year experience of abdominal aortic and great vessels aneurysms management. MATERIAL AND METHODS: There were 369 patients with abdominal aortic aneurysms (AAA) for the period 1995-2016 at the Yaroslavl Regional Clinical Hospital. 25% of patients suffered from abdominal aortic and great vessels aneurysms. Mean age was 70.3±7.5. There were 79 (86%) men and 13 (14%) women. 93 patients had 212 aneurysms of other sites besides AAA (from 1 to 6 aneurysms in each case). 63 (68%) patients have been treated and followed-up for the period from 1 to 10 years (mean 105±11.8 months). RESULTS: 1-, 5-, 8- and 10-year survival after AAA repair was 98%, 81%, 54% and 38% respectively. CONCLUSION: The common complications of great vessels aneurysms are distal thrombosis and embolism (40%). Ruptures of aneurysms are less common (13%). These complications require active surgical tactics that allows to preserve the limbs in 85% of patients. Progressive nature of disease in overwhelming numbers of patients (95%) with aneurysms enlargement and their occurrence in other sites requires regular lifelong clinical examination with mandatory ultrasound 2 times per year.

[Five-year results of treating patients with chronic lower limb ischaemia by means of gene engineering]. / Pyatiletnie rezul'taty lecheniya bol'nykh khronicheskoi ishemiei nizhnikh konechnostei s ispol'zovaniem gennoi terapii.

The authors share their experience in comprehensive conservative treatment of patients presenting with chronic lower limb ischaemia (CLLI) associated with atherosclerosis of peripheral arteries by means of the first Russian registered gene therapeutic agent "Neovasculgen" (plasmid with the vegf165 gene), analysing the long-term outcomes of treating a total of 45 patients with stage II and III CLLI according to the classification of Pokrovsky-Fontain. The patients were followed up for 5 years. Efficacy of treatment was assessed by registering the dynamics of the pain-free walking distance (PFWD), linear blood velocity (LBV), ankle-brachial index (ABI), as well as the limb salvage rate and survival of patients. All patients showed good tolerance of treatment, with neither side effects nor complications noted. Clinical improvement in stage IIB CLLI was observed in 91% of patients with complete stabilization of the clinical course during 5 years. The limb salvage rate in this group amounted to 95%, with the survival rate equalling 82%. In patients with stage III CLLI, improvement was noted in 78% of cases, manifesting itself by a decrease of its degree to stage IIB (44.4%) and to stage IIA (33.3%). Progression of CLLI followed by amputation was registered in 22% of cases, with the survival rate of 78%. Hence, the use of a single course of combined treatment including the gene therapeutic agent "Neovasculgen" in patients with stage II and III CLLI resulted in a persistent positive effect in a considerable majority of patients in the remote period of not less than 5 years.

[Remote results of treatment of patients with chronic lower-limb ischaemia by means of indirect revascularization and gene therapy].

Presented herein are comparative remote results of combined surgical treatment of 121 patients with stage IIB-III lower limb chronic ischaemia (LLCI) by means of indirect revascularization (lumbar sympathectomy--LSE and revascularizing osteotrepanation of the tibial bone--ROT) and gene therapy using the first registered Russian gene therapeutic agent Neovasculgen®. Depending on the LLCI degree and the method of treatment, during 3 years we assessed such parameters as the limb salvage rate, pain-free walk distance (PFWD), ankle-brachial index (ABI) and linear blood velocity (LBV). An increase in the PFWD in patients with initial stage IIB LLCI in the group of gene therapy was considerably higher than in other types of treatment (p=0.0001-0.0004). Using indirect methods of revascularization was accompanied and followed by less positive alterations in the PFWD values which by the end of the third year of follow up were observed to decrease. The values of PFWD after ROT at 2 and 3 years were higher than after LSE (p=0.006). During the first year of follow up the highest increment of the ABI was observed after ROT. At two years, the ABI values after ROT and gene therapy became equal. The worst result during 3 years as compared with other methods of treatment was demonstrated by LSE (p=0.006). Changes in ABI after gene therapy were statistically significant at all terms of follow up (p=0.008-0.02). There were no limb amputations in the remote period of follow up in patients with the initial stage IIB of the disease. Patients with initial stage III LLCI also showed a considerably better result by the increment of increased PFWD after gene-therapeutic treatment (p=0.001-0.0005). A small increment of the PFWD after LSE maintained during 1 year and after LSE during 2 years. The ABI values in all periods of follow up were higher after gene therapy (p=0.01-0.003). During the 2- and 3-year period the increment of this parameter after ROT was more significant than after LSE (p=0.046-0.05). Changes in the ABI after gene therapy at all terms also turned out to be more substantial (p=0.03-0.008). An increase in the LBV during the first and second years after ROT turned out more significant as compared to LSE (p=0.05). The limb salvage rate in patients with initial stage III LLCI during the whole period after gene therapy amounted to 78%, after ROT being 54% and after LSE equalling 45%.

[REMOTE 3-YEAR RESULTS OF APPLICATION OF <> WAYS OF REVASCULARIZATION IN PATIENTS WITH CHRONIC ISCHEMIA OF LOWER EXTREMITIES].

There are several ways of <> revascularization such as revascularizated osteotrepanation of shinbone and lumbar sympathectomy (LS) for treatment of patients with chronic ischemia of lower extremities. They appeared to be sufficiently effective for the patients with II stage of the disease. Patients with critical ischemia (III stage) had persistent positive results after lumbar sympathectomy during 3-year period only in 33% of cases and using revacularized osteotrepnation - 46%. The difference in efficacy of treatment using LS and standard conservative therapy is statistically low significant, so that isn't allowed.recommending the sympathectomy for treatment of III stage ischemia. The method of revascularizated osteotrepanation of shinbone showed a reliably better result, therefore this way is reasonable to apply in surgery in case of III stage ischemia.

[Efficacy of using VEGF165 gene in comprehensive treatment of patients with stage 2A-3 lower limb chronic ischaemia].

The authors share their experience in treating a total of 100 patients presenting with stage 2A-3 chronic lower limb ischaemia according to the classification of Pokrovsky-Fontain (the clinical group was composed of 75 patients and the control group comprised 25 subjects), in whom it was impossible to perform surgical revascularization. The clinical group patients received in addition to the conventional vascular therapy local intramuscular injections of Neovasculogen (plasmid genetic construction containing human gene VEGF165) at a course dose of 2.4 mg. The results were assessed after 1 year. It was shown that administration of this gene therapeutic agent is safe with no local or systemic allergic reactions and free form neoplastic processes. Efficacy of treatment was assessed by registering the pain-free walking distance (PFWD), transcutaneous oxygen tension (TCPO2), linear velocity of blood flow, ankle-brachial index (ABI), angiography, and by means of SF-36 questionnaire. It was determined that after 12 months the statistical significance of intergroup and intragroup differences was reached for PFWD (increment 167.2%), TCPO2 (increment 20.4%). The highest clinical response for the PFWD was registered in patients with stage 3 of the disease (547.5%), as well as in those with multi-storey vascular lesions (269.1%). The obtained findings make it possible to consider gene therapy with Neovasculogen as an efficient component of comprehensive treatment of this cohort of patients.

[Therapeutic angiogenesis in treatment of patients with chronic obliterating diseases of lower limb arteries].

The authors share their experience gained in realization of the concept of "therapeutic angiogenesis" by means of the first Russian gene therapeutic agent Neovasculogen in comprehensive treatment of patients with stage II-III chronic obliterating disease of lower limb arteries (CODLLA) according to the Pokrovsky-Fontain classification. A total of 45 patients were treated. The findings were assessed and analyzed depending on the stage of chronic lower limb ischaemia. The clinical results including such measures such as the pain-free walk (PFW), ankle/brachial index (ABI), transcutaneously determined oxygen tension (TDOT), linear blood velocity (LBV) were followed up for 2 years. All patients were found to have good tolerance and at terms up to 2 years, and no side effect or complications were revealed. Patients with stage IIB of the disease after one year demonstrated statistically significant results suggesting improved blood circulation in the ischemized lower limbs after using the agent according to the indices of PFW, TDOT, LBV (p<0.05). In stage III of the disease? significant results were observed for PFD and TODT (p<0.05). Considerable part of patients with stage IIB and III CODDLLA (84.4%) showed increased physical capabilities for ambulation at the expense of considerably increased PFW (p<0.01). It was observed that using the agent was enough for obtaining a persistent satisfactory result preserving for not less than one year, with 50% of patients from stage IIB and 16.7% from stage III transferred to stage IIA of the disease. The effect of treatment persisted during the second year of follow up.

[Informative value of various methods of radiodiagnosis of anastomotic pseudoaneurysms after reconstructive operations on lower-limb major arteries].

The work was aimed at determining and comparing sensitivity and specificity of various methods of radiodiagnosis of anastomotic pseudoaneurysms after reconstructive operations on the aortic-iliac-femoral segment. The authors identified and analysed the findings of examination of 87 patients presenting with anastomotic false aneurysms following the above-mentioned interventions (with the incidence rate amounting to 5.9%), having diagnosed a total of 105 cases of the formation of false aneurysms of proximal and distal anastomoses. The diagnosis was made using of the following methods: ultrasonographic duplex scanning (USDS), selective contrast- enhanced angiography (CEA), spiral and multispiral CT angiography (SCTA and MSCTA), and magnetic resonance angiography (MRA). Sensitivity and specificity of the methods employed were determined in relation not only to their ability to detect anastomotic pseudoaneurysms but also to identify different characteristics thereof with due regard for the number of the true positive (TPR), true negative (TNR), false positive (FPR), and false negative (FNR) results. Comparing the findings of the comprehensive examination of the patients demonstrated that all methods of the study, except for selective angiography (sensitivity of 85.7%) yielded high sensitivities and specificities in diagnosis of false aneurysms.

[The nearest and remote results in treatment aneurysms of the abdominal aorta and the main arteries].

In the modern literature are taken widely up questions of medical tactics at an aneurysm of abdominal aorta (AA) depending on its sizes, presence of signs and presence of risk factors. The purpose of work was studying current aneurysm illnesses in various arterial parts, developments of optimum tactics of conducting patients and its influence on the remote results of operative treatment. Into research have entered 51 patient, suffering aneurism of an aorta, it branches and other main arteries. The nearest and remote results of dynamic supervision and operative treatment have been studied. The age of patients was within the limits of from 50 till 88 years, and has on the average made 71,8 ± 6,16. A parity men and women 8:1. Diameter AA changed from 3 up to 12 sm. Aneurysms combination met in an ascending part of an aorta, subclavian arteries, brachiochephalic trunk, carotid, iliofemoral, popliteal and limb arteries. All patients had accompanying cardial pathology. Patients have been divided into 2 groups. The first was made by 34 patients by whom resection AA has been made. Patients of the second group (17 patients) has been executed by dynamic supervision. The remote results are studied at 32 (62,7%) persons. Term of supervision has made from 6 till 168 months on the average. Postoperative lethal cases at scheduled operations were 4,7%, the general postoperative lethal cases were about - 11,7%. At the analysis of the remote results it is established, that the survival rate in a year has made 100 %, 5 years - 83,3% of patients. Average life expectancy in the given group of patients has made 76,4 ± 4 years, that there corresponds to data the WOHC for a healthy population. Dynamic supervision in both groups has shown progressing current of aneurysms combination in all arterial parts. Our data show perspectivity of surgical treatment aneurysms of an aorta and the main arteries except for patients with multistorey aneurysmosis arteries of legs in a combination to the continued thrombosis, in which treatment we adhere conservative tactics.