[Aneurysm of the extracranial portion of the internal carotid artery combined with kinking of its distal segment]. / Anevrizma ékstrakranial'nogo otdela vnutrennei sonnoi arterii v sochetanii s kinkingom ee distal'noi chasti.

Presented herein is a clinical case report regarding successful operation for an aneurysm of the left internal carotid artery (measuring 4.5*8.3 cm) combined with pathological tortuosity in its distal portion. The patient was subjected to aneurysmectomy of the left internal carotid artery with prosthetic repair. Kinking in the distal portion of the aneurysm made it possible with minimal technical difficulties to establish a distal anastomosis during prosthetic repair. The diagnosis of an atherosclerotic-aetiology aneurysm was morphologically confirmed.

[Efficacy of oral drug Thrombovasim® in therapy of lower extremity deep vein thromboses]. / Éffektivnost' peroral'nogo preparata Trombovazim® v terapii trombozov glubokikh ven nizhnikh konechnostei.

Within the framework of the multicenter randomized placebo-controlled double-blind clinical trial "VETTER-1" the authors carried out assessment of therapeutic efficacy and safety of oral drug Thrombovasim® possessing a thrombolytic effect in comprehensive treatment of lower-extremity deep vein thrombosis (LEDVT). The clinical study comprised a total of 154 patients. All patients received standard therapy accepted in LEDVT. The patients were subdivided into 4 groups. Patients from the three study groups received Thrombovasim® at a daily dose of 1,600, 3,200, and 4,800 IU. The control group patients were given placebo. Efficacy was assessed by the results of ultrasound duplex scanning first performed before treatment commenced and then after it terminated. The relative frequency of positive dynamics according to the findings of instrumental methods of study in patients taking Thrombovasim® amounted to 0.728 and in the group of patients receiving placebo to 0.585, p=0.0031. Comparing the degree of blood flow normalization in the zone of the compromised blood flow revealed a pronounced dose-dependent effect: in patients taking the drug at a daily dose of 1,600 IU, the relative frequency of positive dynamics amounted to 0.707 corresponding to an increase in therapeutic efficacy by 21%, for a dose of 3,200 IU these parameters amounted to 0.0257 and 24% and for 4,800 IU - 0.747 and 28%, respectively. In patients taking Thrombovasim® there were no cases of negative dynamics observed. Of the patients taking Thrombovasim®, none developed undesirable or severe adverse events. Inclusion of Thrombovasim® into the composition of comprehensive therapy for LEDVT increases efficacy of treatment at the expense of a spontaneous thrombolytic effect. The most effective dose amounted to 4,800 IU daily. Thrombovasim® turned out to be an efficient and safe agent in treatment of venous thromboses.

[The assesment of significance of the retroperitoneal lymph node dissection in proximity of metastatic tumor with main vessels in patients with germ cell testicular tumors].

The therapeutic approach should be defined more exactly in proximity of residual retroperitoneal metastases of germ cell testicular tumor and main vessels (left after chemotherapy). The data of 29 (24%) patients were analyzed over a period of time since 2003 till 2011. The general survival was 82% in the group without lymph node dissection (17 patients) in median observation of 27.5 months. The proximity with main vessels was registered in half of the cases in the group of operated patients (12 people), a single vascular reconstruction was required. The general survival was 97% in median observation for 35 months. The involvement of main vessels of retroperitoneal space significantly complicated the retroperitoneal lymph node dissection, but didn't have negative prognostic value.

[Resection of leiomyosarcoma of the inferior vena cava].

Experience in treatment of leiomyosarcoma of the retrohepatic segment of the inferior vena cava at any separately taken clinic is scarce. Given a rare nature of the pathology involved, whose diagnosis and management require joint participation of various-specialty physicians, we have considered it wise to present our own clinical case report.

[Surgical treatment of leiomyosarcoma of the inferior vena cava].

The presented review of the literature is generalization of the currently existing data of foreign and Russian literature concerning treatment of a rare non-organic retroperitoneal tumour from smooth-muscle tissue, i. e., leiomyosarcoma of the inferior vena cava. The authors also formulate and lay down the basic principles of surgical interventions depending on the scope and level of the lesion, as well statistical analysis of the outcomes of surgical management of the this severely ill patient cohort.

[Clinical peculiarities of posttraumatic arteriovenous fistulas].

Analysed herein are clinical manifestations of, and outcomes of successful surgical management for postoperative arteriovenous fistulas.

[A case report of successful surgical management for a combined wound of the neck with a rare variant of an injury of the vertebral artery].

Presented herein is a clinical case report regarding successful surgical management of a male patient presenting with a concomitant injury of the neck and involvement of the second portion of the contralateral vertebral artery.

[A case report of successful surgical management of lower-limb critical ischaemia on the background of femoropopliteal atherosclerotic aneurysms].

Presented herein is a case report of successful surgical management of a male patient presenting with lower-limb critical ischaemia on the background of thrombosis of femoropopliteal atherosclerotic aneurysms and the presence of a necrobiotic process on the stump of the foot. The reconstructive intervention performed resulted in salvation of the extremity, followed by uneventful wound healing on his left foot with complete medical and social rehabilitation of the patient.

[Positive experience in long-term follow-up and surgical management of a stenosing lesion of the thoracoabdominal portion of the aorta and its branches in non-specific aortoarteritis].

The article is based on experience gained in 25-year follow-up of a female patient presenting with pathology of the thoracoabdominal aorta and its branches in non-specific aortoarteritis. Discussed herein are clinical peculiarities of the development and course of the disease, analysing the outcomes of the reconstructive operations performed, followed by due assessment of efficacy of long-term treatment.

The clinical diagnosis of cranial nerve injuries at operations on the carotid arteries.

Operation on the carotid arteries (CA) prevent strokes in patients with occlusions and stenoses of these arteries. We have worked out the measures for preventing perioperative strokes. During interventions on the CA, iatrogenic injuries to the cranial nerves (CN) are paid little attention. 1186 patients underwent 1362 operations. There were 26 lethal outcomes and 38 strokes. 146 (0.7%) cases of CN injuries were documented. Of these, there were 2 (0.1%) injuries to the accessory nerve, 14 (1%) to the glossopharyngeal nerve, 28 (2%) to the hypoglossal nerve, 46 (3.4%) injuries to vagal nerve branches, and 56 (4.2%) to facial nerve branches. In 42 patients, neuropathies acquired the 'permanent' character. We describe the symptomatology of injuries to different CN pairs consequent on carotid operations and the algorithm of their diagnosis. CN injuries deteriorate the results of operations and decrease quality of life of the patients. Early diagnosis and correction of the sequelae of iatrogenic injuries to the CN is a reserve for the refinement of the results of operations on the CA.

[Use of the superficial femoral vein in reconstructive-corrective vascular surgery]. / Ispol'zovanie poverkhnostnoi bedrennoi veny v rekonstruktivno-vosstanovitel'noi khiurgii sosudov.

The paper describes the procedure and results of using the femoral vein in reconstructive-corrective operations on arteries. The femoral vein was used in infection of a synthetic vascular prosthesis in the inguinal area in 24 patients, in the reconstruction of arteries below the inguinal ligament in the absence or in applicability of the large subcutaneous vein in 17 patients, in vascular plasty during a radical removal of malignant tumors in 5 patients. A good result was achieved in 83.4 +/- 7.6% in prosthesis infection, in 70.6% in plastic operations of the femoral-popliteal segment, and in all 5 cases in arterial plasty during removal of tumors of various sites. Pronounced phenomena of transient venous insufficiency were observed in 3 patients.

[Freezing an acutely necrotized extremity for the purpose of preparing the patient for amputation]. / Zamorazhivanie ostro omertvevshei konechnosti s tsel'iu podgotovki bol'nogo k amputatsii.

102 patients of a high operative risk were prepared for amputation of a lower extremity with acute ischemic gangrene by its freezing and tourniquet application. A special portable freezing chamber was used in most cases which could be installed in any surgical hospital. The refrigeration ranged from 18 hours to 14 days. Purposeful intensive treatment of all disorders suffered by the patient was conducted at the same time. In 92 patients the condition improved and the extremity was amputated. As compared to the control group, the postoperative mortality due to refrigeration reduced from 41 to 18.4%. The method was found to be highly effective in cases with gangrene and diabetes mellitus.

[Replacement of infected vascular prosthesis by the femoral vein]. / Zameshchenie infitsirovannogo sosudistogo proteza bedrennoi venoi.

The article discusses restorative treatment of 12 patients with an infected prosthesis in the inguinal region after aortobifemoral, unilateral common iliofemoral, and submusculofemoral shunting. The infected segment of the prosthesis was removed 9 days to 5 weeks after the first operation by cutting it in tissues which were not involved in inflammation. The lacking segment of the shunt was replaced by the patient's femoral vein which was drawn through the infected wound. In 11 patients the wound in the inguinal region healed with maintained patency of the shunt. In 2 patients the extremity was amputated. Marked temporary venous insufficiency was encountered in one case.

[Pre-amputation freezing of the extremity in acute ischemic gangrene]. / Predamputatsionnoe zamorazhivanie konechnosti pri ee ostroi ishemicheskoi gangrene.

When preparing for amputation in 153 patients with acute ischemic gangrene of a lower extremity, the tourniquet-cold isolation was used. In 137 patients, the damaged extremity was freezed by means of a special portable freezing chamber, which can be used in any surgical in-patient department. The duration of cooling ranged from 18 hrs to 14 days. The state improved in 136 patients, the amputation of the extremity was performed in them. The use of freezing of the damaged extremity permitted to reduce the postoperative lethality from 41 to 19.1%. A high effectiveness of the method in gangrene of the extremity against the background of diabetes mellitus was noted.