[Functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis]. / Vazhnost' dinamicheskoi funktsional'noi otsenki patologicheskoi izvitosti vnutrennikh sonnykh arterii u bol'nykh s mul'tifokal'nym aterosklerozom.

The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.

[Dynamic functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis]. / Dinamicheskaya funktsional'naya otsenka patologicheskikh izvitostei vnutrennikh sonnykh arterii u bol'nykh s mul'tifokal'nym aterosklerozom. Klinicheskii sluchai.

A personalized approach with attention to anamnesis and specific symptoms is necessary in patients with internal carotid artery tortuosity. Neuroimaging (especially before elective surgery) or functional stress tests following ultrasound of supra-aortic vessels may be necessary depending on medical history and complaints. In addition to standard Doppler ultrasound, these patients should undergo rotational and orthostatic transformation tests. We analyze changes in shape and hemodynamic parameters within the tortuosity area in various body positions. This is especially valuable for patients with concomitant carotid artery stenosis. The article presents a clinical case illustrating the importance of such approach.

[An analysis of blood flow indicators in pathological kinked internal carotid arteries with their orthostatic and rotational positions]. / Analiz pokazatelei krovotoka v patologicheski izvitykh vnutrennikh sonnykh arteriiakh pri ikh ortostaticheskoi i rotatsionnoi transpozitsiiakh.

AIM: To assess the dynamics of blood flow in patients with hemodynamically significant pathological kinked internal carotid arteries (PK ICA) with their orthostatic and rotational positions. MATERIAL AND METHODS: Eighty-six patients, including 35 with PK ICA due to fibromuscular dysplasia (FMD) and 51 with PK ICA due to hypertensive heart disease, and 20 healthy people were examined. All patients underwent Doppler ultrasound scanning. All indicators were evaluated in the position of the patient lying on his back and functional stress tests (orthostatic, rotational). RESULTS: The peak systolic velocity, end diastolic velocity, peripheral resistance index did not differ significantly in patients with PK ICA due to FMD and hypertensive heart disease. The increase of blood flow in bends was significantly higher with S-shaped kinking, regardless of the reason for their formation (p<0.05). In orthostatic position, significant changes of hemodynamic parameters in ICA in healthy people did not occur. Moreover, more frequent formation of turbulent blood flows in the group with hypertensive heart disease (78%) and a decrease in LBFV in the standing position were found in patients with PK ICA due to FMD. Rotational position did not alter the hemodynamics in ICA in healthy people and significantly influenced the values of LBFV in patients with PK ICA. CONCLUSION: Changes in hemodynamic parameters in the area of kinking with orthostatic and rotational positions of ICA demonstrate more significant impairments in patients with PK ICA due to hypertensive heart disease compared to patients with FMD. The rotational position of PK ICA is the most informative for identifying turbulent blood flow and an increase in peak systolic velocity in the area of kinking.

[Carotid endarterectomy or carotid stenting: optimal therapeutic decision-making for patients with carotid artery stenoses].

The work was aimed at comparatively studying the outcomes of carotid endarterectomy and carotid stenting for optimal therapeutic decision-making in patients presenting with carotid artery stenoses. We examined and treated a total of one hundred and sixty-seven patients. In the group of endarterectomy, we performed a total of 91 operations in 85 patients, and in the group of carotid stenting, a total of 87 stenting procedures were carried out on the internal carotid artery with cerebral protection in 82 patients. This was followed by analysing both short- and long-term outcomes with a follow-up period ranging from 1 year to 3 years. We examined the following postoperative parameters: «stroke + lethality¼, incidence of transitory ischaemic attacks, as well as the rate of craniocerebral neuropathy and acute myocardial infarction. In the remote period we evaluated the prevalence rate of the parameter «stroke + myocardial infarction + lethality¼, as well as restenosis recurrence. In the carotid-endarterectomy group, the predictors of unfavourable surgical outcomes were contralateral occlusion (p=0.048) and cardial pathology (p=0.0245). In the group of carotid stenting, these predictors turned out to be a heterogeneous atherosclerotic plaque with an uneven or ulcerated contour (p=0.004), and the degree of cerebrovascular insufficiency (p=0.005).

[Role of entropy-based neuromonitoring during cardiac surgery].

The paper deals with a role of spectral entropy-based neuromonitoring at cardiac surgery. Eighty cardiosurgical patients were examined. The depth of entropy-based anesthesia was monitored in all the patients. The patients enrolled into the study were divided into 2 groups. Anesthesia was carried out in the study group (n=40), by taking into account entropic parameters, and in the control group (n=40) on clinical grounds. Information on entropic parameters in this group was accessible only to an investigator and inaccessible to an anesthesiologist who had made anesthesia. The results of the study indicated that entropy-based neuromonitoring permits more controllable and predictable anesthesia to be achieved, makes an individual adjustment of the doses of sedatives easier for each patient, at the induction of anesthesia particularly, enables hypo- and hyperhypnotic episodes to be timely revealed, thus reducing the frequency of hypo- and hyperdynamic reactions by 2.4 times.

[Ultrasound transcranial monitoring during aortocoronary bypass surgery under extracorporeal circulation].

The paper deals with the assessment of hemodynamic parameters in the region of the circle of Willis, by using various exercise tests and transcranial Doppler study during cardiac operations under extracorporeal circulation. Some points of the timely diagnosis of air and material microembolisms are specified. There is evidence that the application of these procedures is substantiated and they may be employed in clinical practice to undertake earlier preventive measures against cervical circulatory disorders.

[The specific features of ocular blood flow and brachiocephalic arteries in patients with non-exudative senile macular degeneration].

A hundred and twenty patients (240 eyes) aged 40-65 years (mean age 56.9 +/- 2.1 years) who had non-exudative age-related (AMD) macular degeneration (AMD) were examined. Ultrasound studies, including Doppler color mapping, were conducted to study blood flow in ophthalmic vessels and brachiocephalic arteries. Hemodynamic parameters deteriorated in all patients with non-exudative AMD, which suggests that blood flow deficit in the ophthalmic arterial system, central retinal artery, and posterior ciliary arteries. 88.3% of patients with non-exudative AMD were diagnosed as having brachiocephalic arterial deformities of which bilateral C- and S-shaped pathological tortuosity of carotid and vertebral arteries were most common.

[Role of valvular insufficiency of the femoral vein in clinical course and relapse of lower limb varicosity].

The authors carried out a comparative analysis of 488 patients with varicose disease. Of these, 107 patients suffered from class 4 varicosity and reflux along the femoral vein down to the middle third of the femur and below with the duration of more than 1.5 s, and 381 subjects had class 2 - 3 varicose disease without reflux along the femoral vein. The patients in the both groups were sex- and age-matched, with the overwhelming majority of them being women. Group One patients in the preoperative period had clinical class II and III chronic venous insufficiency (CVI) according to the CEAP classification, with the prevailing of class III. The majority of these patients were postoperatively transferred to CVI of clinical classes 0 and I. A similar picture with a difference in the outcome was observed in Group Two patients, the majority of whom had clinical class II CVI according to the CEAP classification, with the overwhelming majority of them having postoperatively been transferred to clinical class 0 and I CVI. Initially, all the patients from Groups One and Two were diagnosed to have been suffering from varicosity of lower-limb subcutaneous veins. During one year after the operation, varicosity was virtually absent in the patients of the both groups, however by ten years of dispensary follow-up the pathology was observed to have reappeared in approximately the same percentage of the patients involved. Studying the long-term surgical outcomes showed that the number of relapsing varicosity in the both groups did not differ significantly, having amounted to 25% and 23% of the patients in Groups One and Two, respectively. According to the findings obtained, the relapses having developed in the overwhelming majority of the patients in the both groups were caused by a reflux along the perforated veins, which either reappeared, or had not been duly removed intraoperatively, as well as by a long stump of the great saphenous vein with an altered influx, or varicosity in the previously intact basin. The integral score of the quality of life (according to the CIVIQ 2 scale) in the groups after the operations did not differ significantly. However, within the groups, there was certain difference between the subgroups comprising the patients in whom complete recovery was attained and those having developed relapses, with this difference in Group One patients commencing to emerge approximately after 7 - 8 postoperative months, to become statistically significant by the 4th - 5th year of the dispensary follow-up, while in Group Two patients this difference began to be seen as early as 2 months after surgery, also becoming statistically reliable 4 - 5 years later. According to our findings, a vertical venous reflux is not the cause of recurrent lower limb varicosity, nor does the dynamics of the quality of life of the patients involved depend upon either presence or absence of a reflux. Therefore, a reflux along the femoral vein does not exert any significant influence on either the course, or relapses of varicose disease.

[Comparison of variceal surgery methods]. / Sravnitel'naia otsenka metodov khirurgicheskogo lecheniia varikoznoi bolezni.

Combined ablation of great saphenous vein (GSV) remains the most common way of lower limb variceal management. In recent years different surgical methods were proposed for the treatment of varices. Nevertheless, their invasiveness, poor esthetic outcome, prolonged postoperative rehabilitation and recurrences cail for the development of new minimally invasive and highly effective methods. In the last 5 years a new procedure of intraoperative trunk catheter scieroobliteration of GSV and its tributaries was introduced. From 1997 to 2002 total 493 surgical corrections of lower limb varices were fulfilled, among them 374 patients were operated for primary variceal vein dilatations including 188 standard combined venectomies (1st group) and 186 trunk obliterations (2nd group). Groups were similar in age, sex and lesion extension. Outcomes were followed up to 4 weeks - 5 years. Outcomes comparison between groups has demonstrated significantly lower incidence of postoperative subcutaneous hematomas in the 2nd group, absence of saphenous nerve injuries, better esthetics in the absence of additional incisions (remaining variceal tributaries were sclerosed postoperatively by puncture scieroobliteration). Besides postoperative rehabilitation period was double shorter in ihe 2nd group then in the 1st one. Recurrence rate in long-term period was similar in both groups. Thus intraoperative trunk scieroobliteration of GSV can be a valuable alternative for standard combined venectomy.