Endovascular treatment of stenosis of autogenous arteriovenous access for hemodialysis.

Retrospectively review of long-term outcome of balloon angioplasty (TBA) in the treatment of native dialysis A-V fistulae stenosis was conducted. From February 2008 to January 2009, seven hemodialysis patients (5 women and 2 men; mean age 46.4 years) were treated for stenosis of the A-V fistula at the venous outflow tract. Angioplasty was performed with the use of high-pressure balloons. Percutaneous transluminal angioplasty was used. There were no any complications during and after procedure. In 4 cases residual stenosis did not exceed 10% and in 3 cases 30%. After 3 month the improvement rate was 85%. Two patients required surgical treatment. None of the patients displayed any major complications from the procedure. This study confirms the efficacy of PTA in the treatment of vascular access stenosis. Elevated dialysis blood line pressure can be the first sign of fistula stenosis. Although our series is small, we have nevertheless demonstrated that the concerted efforts of nephrologists, interventional radiologists, and surgeons are the key to maintaining and prolonging vascular access survival in this group of patients.

[Multispiral computed tomography-assisted angiography in diagnosis of diseases of the aorta and lower limb arteries].

PURPOSE OF THE STUDY: Our work was aimed at determining the diagnostic value of multislice computed tomography-assisted angiography in atherosclerotic lesions of the aorta and arteries of the lower limbs, taking into consideration the condition of the peripheral bed, as well as at making an angiographic assessment of the quality of the reconstructive operations performed. MATERIAL AND METHODS: Over the period from October 2005 to July 2006, multispiral computed tomography-assisted angiography (hereinafter referred to as MSCTA) followed by an operative intervention was carried out in a total of 59 patients who were diagnosed with diseases of the aorta and arteries of the lower extremities. The average age of the patients was 59.1 years (range from 17 to 83 years). MSCTA was carried out using a 16-slice CT scanner (Somatom Sensation Cardiac 16, <>) during the arterial phase of injecting the non-ionic radiopaque material <> (<>, Germany). RESULTS: Studying the dissemination of the obliterating processes revealed an aneurysm of the abdominal portion of the aorta (n=10), while in the remaining cases atherosclerotic lesions were observed to be localized in the aorto-femoral (n=17) and femoropopliteal segments (n=32). Comparing the findings obtained by the comprehensive examination and analysis of the angiograms, we determined that the sensitivity, specificity and accuracy of MSCTA in the mentioned groups amounted to 96%, 92% and 94%, respectively. CONCLUSION: MSCTA performed using the novel software appears to be an alternative to other diagnostic methods of examining patients presenting with occlusive diseases of the lower limb arteries.

[Effect of patients' preoperative condition on the outcome of the surgical repair of the infrarenal abdominal aortic aneurism].

During the past decades there is an evidence of the increase in the number of patients with the aneurism of the infrarenal abdominal aorta (IRAAA). As a rule, there is an increased operative risk among these patients due to presence of concomitant diseases. The aim of this study was to investigate effect of patients' preoperative condition on the outcome after the surgical repair of the IRAAA. We studied 78 patients with IRAAA, who underwent elective surgery during 1982-2006. Age ranged from 30 to 84 with the main age of 64. Concomitant diseases were detected in 99% of patients. Postoperative complications occurred in 55% and in 14% there was a lethal outcome. The effect of patients' preoperative condition on the postoperative course was investigated. The role of the thorough preoperational evaluation in an effort to reduce complications in the postoperative course was emphasized.

[Diagnosis and surgical treatment of renovascular hypertension in patients with a single kidney]. / Diagnostik und chirurgische Behandlung der vasorenalen Hypertonie bei Patienten mit Einzelniere.

The study is based on an analysis of the results in operative treatment of 55 patients with vasorenal hypertension, when a functional single kidney is existing. The examinations showed that in the majority of patients function of the kidneys and renin activity in the peripheral blood were normal. The operation performed most frequently in this group of patients were the transaortal endarterectomy by means of the turning-up technique and the resection of the renal arteries with following reimplantation into the aorta or the end-to-end anastomosis. The analysis of the early and late results showed that the surgical intervention in patients with functional single kidney renders possible not only a normalisation or decrease of the arterial blood pressure but also significantly improves the renal function.

[Our experience with the surgical treatment of renovascular hypertension]. / Nash opyt khirurgicheskogo lecheniia vazorenal'noi gipertenzii.

The experience with 785 operations performed for the period from 1962 to 1983 on 697 patients is presented. The advantage of direct reconstructive operations over restorative interventions with the employment of explantation materials is proved. In the remote period after operation positive results were noted in 85% of patients with fibrose-muscular dysplasia of renal arteries and in 70% of patients with non-specific aorto-arteritis.