[EXPERIENCE OF TOTALLY TRANSCUTANEOUS ENDOPROSTHESIS OF THE INFRARENAL AORTA АNEURYSM].

Endovascular endoprosthesis infrarenal aorta constitutes a miniinvasive highly technological method of treatment of a life-thretening pathology. Experience of transcutaneous endoprosthesis of infrarenal aorta in 6 patients was presented. Possibility of a common femoral artery (CFA) suturing, using Prostar XL apparatus, was estimated on a stage of the endoprosthesis dimensions calculation in accordance to a CT and duplex US scanning data and recommendations of manufacturer. In transcutaneous CFA suturing the complications were absent. Absence of a sectional access to CFA have permitted to avoid such complications, as neuralgia, paresthesia, seroma, suppuration of operative wound. In bilateral suturing of CFA a duration of the patients stationary state have reduced.

[Biodegradable coronary stents: history of application and own experience].

Experience of application of a new generation coronary stents--biodegradable stent--platforms--was summarized, in 46 patients, suffering an ischemic heart disease, 60 stents "Absorb" were implanted. Unstable course of the disease was noted in 6 (13.0%) patients, coronary angina of functional class II--III--in 40 (87%). Early stenting was accomplished in 10, aortocoronary shunting--in 4 patients, and abdominal aorta endoprosthesis--in 1. One stent "Absorb" was implanted to 33 patients, two stents--to 11, four biodegradable stents--1. In one observation the stenting of coronary arteries and a. carotis interna was conducted. In all the patients the immediate postoperative period course was uneventful, unfaithful implantation or an acute thrombosis of stent were not observed. The investigation results witnesses the possibility of application of this technology in various clinical and angiographic situations. For wide introduction of biodegradable stents into practice of interventional cardiology departments it is necessary to proceed with the immediate and late follow-up results studying.

[Aneurysm of the unpaired visceral aortal branches].

Clinical signs, data of additional methods of examination, results of surgical treatment of patients for aneurysm of unpaired visceral aortal branches were analyzed. Specific complaints and clinical signs are absent. Most informative and trustworthy method of investigation is a computer tomography. In the sizes of aneurysm more than 2 cm surgical treatment is indicated.

[Remote results of endoprosthesis of the infrarenal aorta aneurysm].

Endovascular endoprosthesis of infrarenal aorta aneurysm (EEIAA)--is miniinvasive highly technological method of treatment of a life-threatening disease. The rate of the endovascular interventions conduction for aortal aneurysm enhances every year in the world, the prosthesis construction and operative technique are upgrading constantly. The experience of the EEIAA endoprosthesis in 75 patients, aged 51-80 years old, 70 men and 5 women, was presented. The aneurysm size was from 4.3 to 8 cm. Preoperative examination of the patients have included the ultrasound scanning, computeric tomography (CT). Among existing complications there is haemorrhage from the access site more than 500 ml in volume, demanding the erythrocytic mass transfusion in 2 patients. The patients were followed up from 1 mo till 7 yrs. A hospital lethality was absent. Major cardiovascular accidents in the terms of observation up to 30 days postoperatively were absent. During the follow up period the mortality, connected immediately with the abdominal aorta aneurysm rupture, was absent.

[Renal arteries stenting using distal antiembolic devices].

Endovascular treatment of vasorenal hypertension (VRH) constitutes the operation of choice in selected groups of patients. In the Centre there was conducted a renal arteries (RA) stenting, using antiembolic devices in 6 patients (4 men and 2 women). There were applied distal filters Accunet (Abbot Vascular, USA) 12 mm in length with diameter of a cell 150 mcm. The devices application, having a net structure, is possible in optimal anatomy of artery (rectangular branching), significant stenosis of RA, primarily bad renal function, a presence of anatomically loose plaque in RA, atherosclerotic ulceration of the abdominal aorta wall. There are limitations of their application: an ischemia while performing of the procedure, complexity of the stenotic region visualization, as well as a control of a precise delivering and implantation of a stent-system and a possibility of the embolism occurrence after extraction of occluding balloon.

[A portal vein branch embolization as a method of preparation for liver resection].

The results of preoperative transcutaneous transhepatic embolization of portal vein (PTTEPV) were analyzed in 86 patients, suffering malignant hepatic tumors. Depending on a planned hepatic resection (HR) volume there was conducted embolization of a right lobar portal vein (in 45 patients), right vein with a vein of C(IV) segment (in 32), lobar portal vein with anterior right vein (in 9). In 3-4 weeks after PTTEPV there was noted the enhancement of ratio of a planned residual hepatic volume/total hepatic volume from 16.3 to 27.5%, permitting to perform HR successfully in these patients. In 4 (4.7%) patients HR was not performed because of progressing of the tumor development or a total thrombosis of portal vein. The data obtained witness, that PTTEPV constitute an effective method of the patients preparation for HR while presence of a planned small residual hepatic volume.

[Anesthesiological support during performance of endovascular prosthesis for the infrarenal aorta aneurysm].

The results of treatment of 10 patients, suffering the abdominal aorta aneurysm, using the third generation bifurcational prosthesis Excluder, are presented. Endoprosthesis was performed under local infiltrating anesthesia (LIA) and light sedation, in one observation the LIA was incidentally changed to general anesthesia and artificial lung ventilation. In the early postoperative period the complications did not occur. LIA may be successfully applied if the patient was thoroughly prepared and informed, the arteries were accurately dissected and intravascular apparatuses inserted, as well as the performance of the aorta endoprosthesis for the abdominal aorta aneurysm was not durable.

[Renal arteries stenting. Indications, procedure, results].

Vasorenal hypertension occurs approximately in 5% of patients, suffering arterial hypertension and in majority of them constitutes the consequence of the renal arteries stenosing atherosclerosis. Stenting constitutes the method of choice in the treatment of the renal artery stenosis. Endoprosthesis of renal artery was performed in 113 patients, in 10 of them--bilateral stenting. Angiographic effect was achieved in more than 98% of observations and the clinical one--in more than 85%. Severe intraoperative complications were absent, all the patients are alive. In 13 patients the restenosis in the stent had occurred in 6-18 months after the operation, presenting by the clinical signs recurrence. To these patients the balloon angioplasty in the stent was accomplished. The depiction of technical peculiarities of the diagnosis and the procedure of the renal arteries stenting was suggested. According to modern recommendations of ACC/AHA, the stenting is indicated in the patients, suffering renal artery stenosis, and cardiac weaknesparoxysms, progressing arterial hypertension, unstable stenocardia, bilateral arterial affection. In the absence of symptoms, the efficacy of revascularization is not proved.

[The carotid arteries stenting in patients suffering coronary atherosclerosis].

There are depicted immediate results of treatment of the patients, suffering multifocal atherosclerosis, using endovascular methods. Of 21 patients, suffering atherosclerotic affection of carotid and coronary arteries, in 16 endovascular interventions were performed and in 5--combined endovascular and surgical interventions. In all the patients the stenting procedure was accomplished using mechanical neuroprotective devices. In the patients, to whom aorto-coronary shunting was indicated, as a first stage of treatment the interventions on extracranial basin was performed and in 3-4 weeks afterwards--the aorto-coronary shunting operation. The order of the procedures performance in the patients was dependent on the leading clinical symptoms severity. The total of 23 carotid and 46 coronary stents was implanted in the group observed. There were no mortality afer endovascular interventions performance. Non-Q myocardium infarction had occurred in a patient, suffering affection of several coronary arteries, and the transient disorder of the brain blood flow--in a patient during the carotid stenting performance.

[Stenting of segments of stenosis in the internal carotid artery].

There are adduced the literature data and results of own investigations, devoted to diagnosis and treatment of the carotid arteries stenosis, which constitute the insult cause in 67% of patients. Conduction of endovascular interventions secures achievement of positive results of the patient's treatment, comparable with such while application of conventional surgical approach. Stenting of carotid arteries in majority of clinical situations constitutes the only available and the least risked method of treatment, especially in patients with complicated course of the main disease and in presence of concurrent illnesses.

[New technologies in diagnosis and surgical treatment of the abdominal aorta aneurysm].

Modern views about occurrence, pathogenesis, and methods of diagnosis and surgical treatment of abdominal aorta aneurysm are adduced. Application of new highly informative diagnostic methods, an adequate anesthesiological support, differentiated methods of surgical intervention have permitted to reach marked progress in the treatment of patients with abdominal aorta aneurysm.

[Clinical course of ischemic heart disease in arteriosclerotic lesions of the anterior interventricular branch of the left coronary artery]. / Klinicheskoe techenie ishemicheskoi bolezni serdtsa pri ateroskleroticheskom porazhenii perednei mezhzheludochkovoi vetvi levoi koronarnoi arterii.

A study of 67 coronary patients with isolated stenosing atherosclerosis of the anterior interventricular branch of the left coronary artery demonstrated proximal arterial stenosis in 2/3 of the cases; it was hemodynamically significant in 83% of those. Clinically, coronary heart disease in this condition was manifested as severe angina pectoris. Fifty-two percent of the patients had a history of myocardial infarction. Long-term conservative treatment, administered in 33 cases, produced an improvement in 67%, and controlled anginal attacks in 20%. Aortocoronary shunting, performed in 34 patients, had a complete antianginal effect in 2/3 of those. Clinical improvement was accompanied with somewhat improved stress tolerance.

[Contractile function of the myocardium in patients with ischemic heart disease after aortocoronary bypass]. / Dinamika sokratitel'noi funktsii miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii aortokoronarnogo shuntirovaniia.

Fifty patients with coronary heart disease underwent repeated coronary ventriculography in different periods after aortocoronary bypass. The myocardial contractility in the patients after direct myocardial revascularization was comparatively analyzed in relation to the function of imposed aortocoronary anastomoses. Myocardial segmental contractility considerably improved in 23 patients after aortocoronary bypass who had functioning shunts, the integral function being satisfactory within the whole follow-up, whereas left ventricular myocardial function progressively diminished in 27 patients with closed anastomoses. Progressive coronary bed atherosclerosis was found to have a noticeable effect on myocardial contractility.

[Characteristics and assessment of clinical course of ischemic heart disease after aortocoronary bypass surgery]. / Osobennosti i otsenka klinicheskogo techeniia ishemicheskoi bolezni serdtsa posle operatsii aortokoronarnogo shuntirovaniia.

The features of the clinical course of coronary heart disease were examined in 325 patients 40.24 +/- 1.4 months after coronary bypass grafting. Based on the results of the comprehensive examination of the patients, its following patterns were identified: 1) asymptomatic without myocardial ischemia (30.8%); 2) asymptomatic in the presence of silent ischemia (3.5%); 3) effort angina pectoris (36.0%); 4) effort-and-rest angina (17.8%); 5) non-coronarogenic pain syndrome (11.7%), that is the patients in whom myocardial ischemia could not be provoked. The objective assessment of the patient's status in the preoperative period was demonstrated to predict a postoperative prognosis to a greater extent. Arterial hypertension and two prior myocardial infarctions, the number of diseased coronary arteries, the overall cardiac artery lesions and residual myocardial reserve were ascertained to be the most informative clinicofunctional measures in the assessment of the clinical course of coronary heart disease.

[Status of the coronary vessels and functional state of autovenous shunts in patients with ischemic heart disease at remote periods after aortocoronary bypass]. / Dinamika sostoianiia koronarnogo rusla i funktsiia autovenoznykh shuntov u bol'nykh ishemicheskoi bolezn'iu serdtsa v otdalennye sroki posle aortokoronarnogo shuntirovaniia.

Repeated coronarography in 89 coronary patients at late dates after aortocoronary shunting, including 74 (83%) patients with residual or recurrent angina and only 15 (17%) angina-free patients, demonstrated that the progress of atherosclerosis continued in both the shunted and intact coronary arteries after the operation. Thrombosis of autovenous shunts had a pronounced effect on clinical condition of the patients. Only 50% of the shunts were open in patients with residual or recurrent angina, while bypass patency was 81% in the absence of anginal attacks.

[Progressive changes in the coronary arteries in patients with ischemic heart disease after aortocoronary bypass]. / Osobennosti progressirovaniia izmenenii koronarnykh arterii u bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

To examine the time course of changes in the coronary arteries in patients with coronary heart disease after aortocoronary bypass (ACB), the authors studied 2 groups of patients: (1) 23 who had conservative treatment and (2) 23 who were selected for ACB. Repeated angiography was performed 14.6 +/- 2.5 months after the initiation of the study. Following ACB, changes in lesions were observed in 17 coronary artery segments in 39.1% of the patients. Grafted artery stenoses largely proximal to the site of transplantation became progressive. There was a relationship between the changes in coronary arteries to graft patency. In Group 1, the time course of coronary atherosclerosis was found in 8 segments in 26% of the cases. Atherosclerosis progressed in all artery segments virtually in a steady way. Application of vein grafts may change intracoronary hemodynamics, creating conditions for more rapid and common progression of coronary artery lesions.

[Effects of calcium antagonists on the pattern of intracardiac hemodynamics and functional state of the myocardium in patients with angina pectoris relapsing after aortocoronary bypass operation]. / Vliianie antagonistov kal'tsiia na strukturu vnutriserdechnoi gemodinamiki i funktsional'noe sostoianie miokarda u bol'nykh so stenokardiei, vozobnovivsheisia posle operatsii aortokoronarnogo shuntirovaniia.

The hemodynamic pattern of the antianginal effects of calcium antagonists was examined in 111 patients with Functional Classes II-IV angina pectoris relapsing on an average of 36.7 +/- 1.1 months following aortocoronary bypass surgery, as evidenced by radionuclide ventriculography performed in the acute drug test with finoptin and corinfar. The clinical and functional status improved in 49 patients on finoptin and in 62 on corinfar. In three fourths, the efficacy of finoptin was achieved by decreased myocardial diastolic stiffness and only in a fourth, it was due to lower afterload. In three fourths, the efficacy of corinfar was attained by the action of the vascular component and only in a fourth, it was attributable to its effects on diastolic relaxation--to its direct action on the myocardium.