[Reconstruction of caval veins]. / Rekonstruktsiya polykh ven.

OBJECTIVE: To study the possibilities and results of reconstruction of caval veins. MATERIAL AND METHODS: We analyzed the results of reconstruction of caval veins in 31 patients (19 men and 12 women) including superior vena cava (SVC) in 5 cases and inferior vena cava (IVC) in 26 cases. Penetrating wounds with vascular damage were found in 8 patients. Iatrogenic damage to IVC was observed in 19 patients (nephrectomy for kidney cancer - 2, nephrectomy for secondary kidney wrinkling - 1, echinococcectomy from retroperitoneal space - 1, adrenalectomy for adrenal tumors - 5, right-sided lumbar sympathectomy - 1, resection of abdominal aortic aneurysm - 1, resection of a large retroperitoneal tumor - 6). Iatrogenic damage to SVC occurred in 2 patients during resection of mediastinal tumor. In other 4 cases, elective surgery for mediastinal tumor (1), pancreatic head cancer (2) and liver alveococcosis (1) was accompanied by resection and replacement of caval veins. RESULTS: All interventions for caval vein injury were performed under adequate infusion therapy. Seven (22.6%) patients died. One patient with blunt chest trauma and damage to SVC died during thoracotomy. In another patient, infrarenal IVC was intersected during mobilization of retroperitoneal hydatid cyst that required ligation for vital indications. High venous hypertension below the ligature led to eruption of sutures on the venous stump. The patient died from hypovolemia after additional IVC ligation. Other 5 patients died in early postoperative period without leaving the state of shock. These patients had damage to retrohepatic segment of IVC (1), vascular-organ (1) and iatrogenic (3) injuries. One patient died from pulmonary embolism, two patients - from venous bleeding between the 2nd and the 5th postoperative days. Patients died before reoperations. Two patients with postoperative bleeding underwent redo surgery with favorable outcomes. One patient underwent redo surgery for peritonitis with a favorable result. Thus, 7 (22.6%) patients with caval vein injury died in intraoperative and early postoperative period. Non-specific complications occurred in 4 (12.9%) patients. These events were corrected by conservative measures. Other 24 (77.4%) patients with traumatic and iatrogenic injuries of caval veins were discharged. CONCLUSION: Caval vein injury is less common event compared to other vascular damages. Nevertheless, this complication is accompanied by severe blood loss, shock and hypovolemia. We can only assume damage to a great vessel in patients with penetrating wounds before surgery and appropriate symptoms of internal bleeding. However, final diagnosis is made during surgery. Hemostasis is a responsible and difficult surgical stage in these patients. There is usually no alternative to reconstructive surgery in these cases. However, ligation is permissible in extremely ill patients and only in infrarenal segment of IVC. Vascular suture is a more acceptable and effective option for reconstruction. However, patch repair is advisable for large defects. In our opinion, this approach is better regarding long-term patency compared to total replacement with synthetic prostheses.

[Endoleaks in endovacular infrarenal abdominal aortic aneurysm repair. (Part II)]. / Endoliki pri endovaskulyarnom protezirovanii infrarenal'nykh anevrizm bryushnoi aorty. (Chast' II).

Searching for literature data was performed in the PubMed, Scopus and eLIBRARY databases. In the second part, we considered modern classifications of endoleaks type 3, 4 and 5 after endovascular infrarenal abdominal aortic aneurysm repair, etiology, risk factors, classification of endoleaks. Modern data on effectiveness of their treatment by various methods are presented.

[Endoleaks in endovacular treatment of infrareneral abdominal aortic aneurysm (part I)]. / Endoliki pri endovaskulyarnom protezirovanii infrarenal'noi anevrizmy bryushnoi aorty (chast' I).

We analyzed the PubMed, Scopus databases and the eLIBRARY electronic library regarding appropriate literature data. In the first part, modern classifications of endoleaks type 1 and 2 after stenting of infrarenal aortic aneurysm are considered. We described causes, risk factors and effectiveness of various treatment options.

[Some aspects of iatrogenic vessel injury]. / Nekotorye aspekty yatrogennykh povrezhdenii sosudov.

Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.

[Review of the proceedings of the 68th International Congress of the European Society of Cardiovascular and Endovascular Surgery (May 22-25, 2019)]. / Obzor materialov 68-go Mezhdunarodnogo kongressa Evropeiskogo obshchestva kardiovaskuliarnykh i éndovaskuliarnykh khirurgov (22-25 maia 2019 g.).

This article covers the main trends of the work of the 68th International Congress of the European Society of Cardiovascular and Endovascular Surgery, reviewing the papers encompassing current problems in not only vascular but also cardiac surgery.

[Review of the proceedings of the 34th Annual Meeting of the German Society for Vascular Surgery and Vascular Medicine (October 17-20, 2018)]. / Obzor materialov 34-go Ezhegodnogo kongressa Germanskogo Obshchestva sosudistoi khirurgii i sosudistoi meditsiny (17-20 oktiabria 2018 g.).

This article is a review of the proceedings of the 34th Annual Meeting of the German Society for Vascular Surgery and Vascular Medicine held in Bonn, Germany, from October 17 to 20, 2018. The programme of the Meeting contained reports concerning treatment of aortic dissections and aneurysms, lower-limb ischaemia, management of wounds in vascular pathology, infection in vascular surgery, carotid artery diseases, venous system pathology, vascular biology, as well as vascular access in patients on programmed haemodialysis.

[30th Annual Meeting of the European Society for Vascular Surgery (Copenhagen, Denmark, september 28-30, 2016)]. / 30-i kongress evropeiskogo obshchestva sosudistykh khirurgov (Kopengagen, Daniia, 28-30 sentiabria 2016 g.).

The article is a brief review of the proceedings of the 30th Annual Meeting of the European Society for Vascular Surgeons, held on September 28-30, 2016 in Copenhagen, Denmark. The papers presented reported the results of managing patients with pathology of carotid arteries, aortic aneurysms, pathology of peripheral arteries, also discussing current achievements and prospects of methods of treatment of arterial and venous diseases.

[Late conversions following endoprosthetic repair of abdominal aortic aneurysms]. / Pozdnie konversii posle éndoprotezirovaniia anevrizm briushnoi aorty.

Presented herein is a review of the literature concerning late open conversions after endoprosthetic repair of abdominal aortic aneurysms, followed by analyzing the data on frequency and terms of performing late conversions, indications, options of surgical technique, lethality, and remote results.

Stroke/Death Rates Following Carotid Artery Stenting and Carotid Endarterectomy in Contemporary Administrative Dataset Registries: A Systematic Review.

BACKGROUND: Randomised trials have reported higher stroke/death rates after carotid artery stenting (CAS) versus carotid endarterectomy (CEA). Despite this, the 2011 American Heart Association (AHA) guidelines expanded CAS indications, partly because of the Carotid Revascularization Endarterectomy versus Stenting Trial, but also because of improving outcomes in industry sponsored CAS Registries. The aim of this systematic review was: (i) to compare stroke/death rates after CAS/CEA in contemporary dataset registries, (ii) to examine whether published stroke/death rates after CAS fall within AHA thresholds, and, (iii) to see if there had been a decline (over time) in procedural risk after CAS/CEA. METHODS: PubMed/Medline, Embase, and Cochrane databases were systematically searched according to the recommendations of the PRISMA statement from January 1, 2008 until February 23, 2015 for administrative dataset registries reporting outcomes after both CEA and CAS. RESULTS: Twenty-one registries reported outcomes involving more than 1,500,000 procedures. Stroke/death after CAS was significantly higher than after CEA in 11/21 registries (52%) involving "average risk for CEA" asymptomatic patients and in 11/18 registries (61%) involving "average risk for CEA" symptomatic patients. In another five registries, CAS was associated with higher stroke/death rates than CEA for both symptomatic and asymptomatic patients, but formal statistical comparison was not reported. CAS was associated with stroke/death rates that exceeded risk thresholds recommended by the AHA in 9/21 registries (43%) involving "average risk for CEA" asymptomatic patients and in 13/18 registries (72%) involving "average risk for CEA" symptomatic patients. In 5/18 registries (28%), the procedural risk after CAS in "average risk" symptomatic patients exceeded 10%. CONCLUSIONS: Data from contemporary administrative dataset registries suggest that stroke/death rates following CAS remain significantly higher than after CEA and often exceed accepted AHA thresholds. There was no evidence of a sustained decline in procedural risk after CAS.

[Review of the proceedings of the congress "Controversies and updates in vascular surgery" (Paris, France, January 22-24, 2015)].

The article is a brief review of the papers presented at the Congress "Controversies and Updates in Vascular Surgery - CACVS) held in Paris (France) on January 22-24, 2015. An emphasis is placed upon the problems of open and endovascular interventions for aortic aneurysms, lower-limb ischaemia, infection in vascular surgery, pathology of the venous system, choosing an approach for endovascular operations and a vascular access for haemodialysis.

[Review of materials on vascular surgery presented at the Congress of the International Society of Surgery (Helsinki, Finland, August 25-29, 2013)].

The article contains a brief review of the materials concerning vascular surgery presented at the Congress of the International Society of Surgery held on August 25-29, 2013 in Helsinki (Finland), showing the outcomes of open and endovascular operations performed in patients presenting with abdominal aortic aneurysms, lower-limb critical ischaemia, obtained in various clinics. This is followed by determining the prospects of further increasing efficiency of surgical methods of treatment of vascular diseases.

[The efficacy of arterio-venous fistulas in the treatment diffuse arterial diseases].

The experience of treatment of 32 patients with diffuse peripheral arterial diseases was analyzed. All patients underwent the by-pass surgery with the formation of unloading arterio-venous fistulas. Indications to the formation of A-V fistula was the high peripheral resistance of the vascular wall. 4 variants of by-pass were used: the side-by-side by-pass n=14; the preanastomotic adjuvant arterio-venous shunt n=7; and 2 original author modification. The analysis of the results demonstrated no statistical difference between A-V shunts modifications. However, the methods, proposed by the authors has some advantages due to the higher increase of the perfusion area.

[Substantiation of surgical decision making in congenital lesions involving the inguinal major vessels n injection drug abusers].

The article is dedicated to surgical policy pursued in lesions involving femoral major vessels in the inguinal region, having developed due to long-term abuse of injection narcotic drugs. Analysed herein are the outcomes of surgical management of thirty-one patients presenting with a pulsating haematoma and inguinal pseudoaneurysms of post-injection aetiology. According to the authors' opinion, choosing the appropriate scope of the would-be operation is too complicated largely due to peculiarities of the pyo-necrotic process in this zone. Revealed and systematized characteristic of this category of risk factors that pose a real threat of severe consequences when any type of surgery. The authors recommend using only 2 categories of operations: ligation of damaged vessels in the groin area as an independent operation and ligation of vessels with the restoration of blood flow through lateral bypass autovein. Indications for their use, particularity of performing the ligated operations in the inguinal region was given.

[Successful surgical repair of aortic arch torsion and aneurysm].

Described herein is a rarely encountered in clinical practice case regarding surgical management of pathological tortuosity of the aortic arch with a simultaneously present aneurysm thereof. The defect was surgically corrected in the setting of extracorporeal circulation. The tortuous and aneurysmatic aortic arch was resected within the boundaries of the healthy tissues, duly followed by establishing an end-to-end anastomosis between the edges of the resected aorta.