[Advisability of carotid endarterectomy in asymptomatic patients]. / Tselesoobraznost' karotidnoi endarterektomii u asimptomnykh bol'nykh. Analiticheskii obzor.

OBJECTIVE: To determine the optimal treatment strategy for patients with asymptomatic carotid stenosis. MATERIAL AND METHODS: The authors reviewed clinical guidelines for the management of patients with asymptomatic carotid stenosis 60-99%, as well as medical studies and meta-analyses comparing carotid endarterectomy and optimal drug therapy in asymptomatic patients between 1993 and 2023. RESULTS: The choice of treatment strategy for patients with asymptomatic carotid artery stenosis is still a controversial issue. There were several large randomized clinical trials comparing carotid endarterectomy with optimal medical therapy in asymptomatic patients at the end of the 20th century. However, drug therapy has undergone significant changes calling into question the relevance of previous results. This review highlights the evolution of management of patients with asymptomatic carotid stenosis and also presents modern approaches to the treatment of these patients. CONCLUSION: Patients younger 75 years old gain an advantage from carotid endarterectomy with small perioperative risk compared to optimal drug therapy and yearly risk of cerebral embolism. Patients with asymptomatic carotid stenosis 80-99% are candidates for carotid endarterectomy due to higher risk of acute cerebrovascular accident at least until more data are available. The choice of the best tactics for a particular patient should be made individually depending on own experience and patient's adherence to therapy and lifestyle correction. The results of the ACTRIS (2025) and CREST-2 (2026) studies are expected to clarify this issue.

[Additional vascularization of the omental flap using mammary-gastroepiploic bypass grafting in the treatment of deep sternal wound infection]. / Mammaro-gastroepiploichnoe shuntirovanie kak sposob dopolnitel'noi vaskulyarizatsii transplantata pri torakoomentoplastike u patsienta so sternomediastinitom.

Incidence of postoperative sternomediastinitis depends on various risk factors and makes up 8%. Surgical debridement with local management of the wound are used to achieve wound sterility. In some cases, sternectomy or subtotal sternal resection are performed for total sternal osteomyelitis with osteoporotic bone and multiple fractures. This procedure results an extensive bone defect. The final stage is anterior chest wall reconstruction. The most popular method is wound closure with autologous muscle or omental flaps. The authors describe a patient with sternomediastinitis who underwent staged treatment. At the final stage, subtotal sternectomy with simultaneous omentoplasty were performed. Additionally, mammary-gastroepiploic bypass grafting with right internal mammary artery and right gastroepiploic artery was carried out for additional vascularization of the omental flap. We found no similar surgery for sternomediastinitis in the literature. Long-term treatment outcome was followed-up (>50 months of relapse-free period and good quality of life).

Structural-and-functional alterations in the arterial wall and clinical manifestations of nonspecific aortoarteritis.

The authors studied structural-and-functional properties of the arterial wall, also assessing elastic properties of the common femoral artery and the brachial artery flow-dependent dilatation (FDD) index in a total of thirty-six patients presenting with nonspecific aortoarteritis (NAA). The overwhelming majority of the patients, i. e., twenty-four (89%), showed a statistically significant decrease in the FDD as compared with the control-group patients (P<0.05). We revealed a statistically reliable (P=0.0005) inverse correlation between the level of systolic arterial pressure and an increase in the rigidity index of the common femoral artery wall. Also determined was a correlation of the femoral artery wall rigidity (systolic AP equalling 140 mm Hg and higher) and the brachial artery flow-dependent dilatation index (r=-0.61). All the patients suffering from non-specific aortoarteritis were diagnosed as having a decrease in the elasticity values, accompanied by an increase in systolic arterial pressure (r=0.36; P=0.07). Comparing the level of systolic arterial pressure with the values of the distensibility coefficient and compliance coefficient revealed a weak inverse correlation (r=-0.28 and 0.21, respectively). Evaluating the impact of duration of the disease on the distensibility coefficient, compliance coefficient and the rigidity index made it possible to detect a statistically significant (P=0.0039) direct correlation between the rigidity index and the duration of non-specific aortoarteritis. To a leaser degree, the duration of the inflammatory process influenced the distensibility coefficient and compliance coefficient (r=-0.28; r=-0.30, respectively; P=0.06).