[Surgical treatment of aberrant subclavian artery]. / Khirurgicheskoe lechenie aberrantnoi podklyuchichnoi arterii.

OBJECTIVE: To determine the indications and optimal surgical treatment of aberrant subclavian artery. MATERIAL AND METHODS: There were 3 patients with aberrant subclavian artery with clinical manifestations such as dysphagia, shortness of breath, weight loss, cough and chest pain between 2005 and 2020. Right-and left-sided aberrant artery was observed in 2 and 1 case, respectively. Supraclavicular unilateral or bilateral access depended on the side of aberrant artery. Carotid-subclavian anastomosis was performed. RESULTS: All patients were discharged without any symptoms. CONCLUSION: Close location of aberrant subclavian artery to common carotid artery can disturb circulation in brain and upper limb. Abnormal discharge of subclavian artery can cause compression of nearby organs (esophagus, trachea). Abnormal vascular discharge does not always have clinical manifestations that do not require surgical correction. Only symptomatic patients are subjects to surgical correction of aberrant subclavian artery. Knowledge of variant anatomy of supra-aortic vessels can minimize the risk of complications.

[Combined operations on vessels and abdominal organs]. / Sochetannye operatsii na sosudakh i organakh bryushnoi polosti.

THE AIM OF THE STUDY: Is to describe the experience of combined operations and the expediency of choosing such a tactic for surgical treatment of patients with two or more surgical diseases. MATERIAL AND METHODS: The results of surgical treatment of 299 patients with vascular lesions in combination with other diseases requiring surgical treatment in 2014-2018 were analyzed. All operations were performed in the cardiovascular department of the GBUZ RKB on the basis of the Department of Hospital Surgery of the KBSU named after V.I. H.M. Berbekov. In the selected group, the proportion of patients of working age was 71%. Combined operations were performed in 151 patients, the remaining 148 people who underwent surgery for cardiovascular and surgical diseases were included in the comparison group. Among them, a combined operation was performed in 79 patients for vascular diseases and in 69 for other diseases. RESULTS: When analyzing the perioperative period in patients of the main and control groups, there was no significant difference in the parameters of simultaneous surgical interventions (duration of operations, volume of blood loss, the need to increase the dose of catecholamines in the operating and postoperative periods, the incidence of rhythm and conduction disturbances, the duration of artificial ventilation and stay in hospital). It was found that combined operations did not lead to an increase in the number of postoperative complications and an increase in mortality. At the same time, combined operations are possible even with a complex combination of various diseases. CONCLUSIONS: Combined operations are more justified than staged surgical treatment: 1) the patient is simultaneously cured of 2 or more surgical diseases; 2) the risk of repeated general anesthesia and its negative consequences is eliminated; 3) re-examination and preoperative preparation are excluded; 4) the frequency of progression and recurrence of diseases (infringement of a hernia, exacerbation of cholecystitis, etc.), repeated surgical interventions for concomitant diseases decreases; 5) a single access simplifies the surgical approach to the abdominal organs and is less traumatic; 6) the average time spent by the patient in the hospital, the terms of further rehabilitation and the period of incapacity for work are reduced; 7) combined surgical interventions are economically beneficial.

[Permanent vascular accesses in patients with chronic renal failure undergoing hemodialysis].

The article presents an experience of arteriovenous fistulas forming and using in 78 patients with end-stage chronic renal failure undergoing hemodialysis. New methods for permanent vascular accesses forming were suggested. These techniques increased the operation period of arteriovenous fistulas.

[Experience in treatment of critical lower limb ischaemia on the background of diffuse arterial lesions].

The article deals with general statistical data on surgical treatment of chronic critical lower limb ischaemia on the background of diffuse arterial lesions. Also presented herein is an interesting clinical example of revascularization of a lower limb in diffuse arterial lesions by means of atypical bypass grafting.

[The improved method of minilaparotomy by cholecystectomy].

The new improved method of minilaparotomy by cholecystectomy is characterized by transversal cut of the abdominal wall and using a contra aperture for inserting a clamp for the gallbladder. The use of such an access was applied in 47 patients with good immediate and long-term results.

[Successful outcome of treatment for a ruptured abdominal aortic aneurysm accompanied by inguinal hernia: a clinical case report].

The article deals with a clinical case report concerning surgical management of a male patient presenting with a ruptured abdominal aortic aneurysm. The postoperative period was complicated by strangulation of inguinal hernia inadvertently neglected during prior surgery, however then treated successfully by tension-free hernioplasty, with due conclusions eventually drawn.

[Simultaneous multi-storey bypasses in a poly-segmental lesion of lower-limb arteries in patients with critical ischaemia].

The article deals with therapeutic outcomes obtained in treating patients diagnosed with chronic critical ischaemia of the lower extremities, who were subjected to multi-storey shunting with the restoration of the major blood flow in the distal vascular bed and with the inclusion of the collateral bloodstream into the unaltered portions of the arterial segments. Also established was a distal anastomosis with the formation of an arteriovenous fistula. In the operated on patients, the manifestations of critical ischaemia of the lower limbs were coped with intraoperatively, and the check-up Dopplerograms taken during the follow-up period showed the presence of the major blood flow along the bypasses and more distally along the anterior tibial artery.

[Health care administration for the mass admission of victims to the hospital].

Experience of health care organization at district hospital on the day of armed conflict is discussed. Sixty-six patients with various injuries have been admitted during 5 hours. Optimal organization of health care system permitted to realize all the diagnostic and surgical procedures in time. Overall 98 operations have been performed at 64 patients. Rapid pre-admission care and transportation to specialized hospital allow to decrease hemorrhage volume, shock severity and lethality.

[Surgical treatment of injuries of extremity vessels].

Results of treatment of 98 patients with injuries of extremity vessels were analyzed. The present-day character of osteo-vascular wounds requires a restoration of all anatomical structures. The best results were obtained by extrafocal methods of restoration. The author calls special attention to possible technical and strategy errors in treatment of such patients.

[Surgical treatment of patients with chronic lower limb venous insufficiency and trophic disorders].

The experience in surgical treatment of 326 patients with IV-VI degree chronic lower limb venous insufficiency (CEAP) is analyzed. Correction of disorders of venous hemodynamics was performed with surgical methods and sclerotherapy. The best clinical and functional results in long-term period were achieved in patients undergone surgery in an early stage of the disease without deep veins valves insufficiency and external trophic disorders. Pathology of deep veins required correction of valves function. It is concluded that these patients require complex approach to the treatment.

[Prevention of purulent complications after reconstructive vascular operations in elderly and aged patients]. / Profilaktika gnoinylh oslozhnenii posle rekonstruktivnykh operatsii na sosudakh u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of surgical treatment of 382 patients with III-IV stages critical limb ischemia and concomitant diseases were analyzed. The mean age of the patients was 67.7 years. All the patients underwent reconstructive operations on lower limbarteries. Three variants of antibiotic therapy were compared: 1) antibiotics were administered parenterally; 2) they were injected endolymphatically; and 3) they were used parenterally and endolymphatically. Combined antibiotic, i.e. a combination of parenteral and endolymphatic routes of administration was most effective.

[Reconstructive surgeries on deep femoral artery in chronic critical limb ischemia]. / Rekonstruktivnye operatsii na glubokoi arterii bedra pri khronicheskoi kriticheskoi ishemii konechnostei.

Possibilities of revascularisation of the lower extremity through the deep femoral artery in elderly and aged patients with chronic critical limb ischemia were evaluated. Forty-nine patients with high surgical risk were studied. Safety of the extremity, decrease of ischemia degree and level of amputation were the main problems in surgical treatment. Deep-femoral-popliteal index was very important. If this index was less 0.3 surgeries on deep femoral artery were effective. If index was 0.3-0.5 results of surgery were questionable. Index more than 0.5 is the factor of unsuccessful revascularisation through the deep femoral artery.

[Application of xenogeneic bioprostheses in reconstruction of the arteries of infrainguinal localization]. / Primenenie ksenogennykh bioprotezov v rekonstruktsii arterii infraingvinal'noi lokalizatsii.

The application of 37 xenogenous bioprostheses was carried out in reconstruction of the arteries of infrainguinal localization in 37 patients (34 men and 3 women). Patients older than 60 years made up 67.2%. Most of the patients had occlusion of the femoral artery and lesions of the tibial arteries: one artery in 26 (70.2%), two arteries in 3 (8.1%) patients. The femoro-proximal-popliteal shunt was performed in 15 (40.5%) patients, in 22 (59.5%) patients long shunts were implanted (in 9--femoro-proximal-popliteal shunting, in 13--femoral-tibial). During the shunting operations a reconstruction of the inflow pathways was carried on (aorto-femoral shunting, endarterectomy from the iliac-femoral segment). The results of the reconstructive operations on the lower extremities with the application of xenoprostheses were estimated as good in 28 (75.6%) patients, in 6 (16.2%) patients--as satisfactory, in 3 (8.2%)--as bad. There were no lethal outcomes.

[Comparative assessment of different methods of treatment of chronic critical ischemia of lower extremities in elderly and senile patients]. / Sravnitel'naia otsenka razlichnykh sposobov lecheniia khronicheskoi kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of using different methods of treatment of chronic critical ischemia of lower extremities were analyzed in 267 elderly and senile patients. Ischemia of the lower extremities of the III degree was noted in 83% of the patients, the IV degree ischemia--in 17%. In 86 patients who underwent primary high amputation of the lower extremity 2 years survival was noted in 33.7%. In 89 patients treated conservatively during 12-14 days good and satisfactory results were obtained in 58.4%, amputations were made in 41.6%. The 2 years survival was 66.3%. In 92 patients primary reconstructive operations resulted in good and satisfactory outcomes in 75 (81.5%) out of them with the 2 years survival in 88.0%.