[Determining surgical policy in combined atherosclerotic lesion of carotid arteries in patients with uncomplicated aortic aneurysm].

Presented herein are the outcomes of managing a total of twenty-six patients suffering from an uncomplicated abdominal aorta aneurysm with a concomitant atherosclerotic lesion of the coronary arteries, referred to our Clinic over the period form 2003 to 2006. Of these, nineteen (70%) patients were diagnosed with the first (symptom-free) stage of cerebral ischaemic disease, and six presented with the second stage [to have endured a transient ischaemic attack (TIA) within the terms from 16 to 3 months prior to admission]. Two patients had residual events of the previously sustained acute cerebral ischaemia (ACI) (stage 4). The current stage ofischaemic cerebral disease was determined according to the classification of A. V. Pokrovskii (1979). The haemodynamically significant stenoses of carotid arteries (over 70%) were revealed in five patients, an aneurysm of the internal carotid artery - in one patient, and eighteen patients were presenting with the degree of carotid arteries stenosis varying from 30 to 60% (of these, in two subjects after previously endured TIA, the plaque was heterogeneous and defined as embolism-threatening). No atherosclerotic lesions of the carotid artery were revealed in two patients, though these patients had previously sustained an AIA with the preserved neurological deficit by the moment of examination. Eight patients underwent reconstruction of the internal carotid arteries. The average age amounted to 64.5 years. Al of the eight operated on patients with a combination of ischaemic cerebral disease and an aneurysm of the abdominal aorta were found to have had no neurological complications either after the first, or after the second operations. The devised algorithm of examination and surgical management for patients presenting with an abdominal aorta aneurysm and a combined lesion of the brachiocephalic arteries made it possible to reduce the rate of neurological complication from 4.3% to 1.3%.

[Abdominal aorta ruptured aneurysm in patients with previously endured endovascular grafting for aortic aneurysm: clinical case reports].

The article deals with four reports of rarely encountered clinical cases, i. e., a ruptured aneurysm of the abdominal aorta in patients having previously sustained endovascular grafting of the abdominal aorta for the pathology concerned. The incidence rate of such complications we faced for the first time in 2001 has ever since amounted to 1.6 % of the total number of patients with a ruptured aneurysm admitted to our Department over the period form 2001 to 2006 (250 patients). All the patients were emergently operated on, with the lethality rate amounting to 50 % (two of the four patients died). The time having elapsed from the primary operation (endovascular grafting of the abdominal aorta aneurysm) till the rupture ranged from 11 days to 3 years.

[Endarterectomy from the distal arterial bed in prosthetics of the aorta and iliac arteries].

The work presents an experience with surgical treatment of 32 patients with critical ischemia of the lower extremities developed against the background of two-levels occlusive lesion of the arterial bed of the lower extremities. All the patients had atherosclerosis. Occlusion of the abdominal part of the aorta was the cause of reconstruction of the aorta and iliac arteries in 15 patients, occlusion of the iliac artery - in 14 patients, aneurysm of the abdominal aorta - in 3 patients. In all the patients the proximal lesion was associated with occlusion of the femoral arteries. In addition to proximal reconstruction, retrograde endarterectomy was made with a special instrument from the femoral arteries through the arteriotomy opening intended for distal anastomosis of a synthetic prosthesis. Complete revascularisation of the arterial bed of the lower extremities was obtained in all the patients. There were no lethal outcomes.

[Prolonged endarterectomy in distal forms of arterial diseases of the lower extremities]. / Protiazhnaia endarterektomiia pri distal'nykh formakh porazheniia arterii nizhnikh konechnostei.

Six-year experience of surgical treatment of patients with critical lower limb ischemia due to a distal form of arterial lesion is presented. Surgical treatment was performed in extended occlusive lesion from inguinal fold to arteries of the calf and foot, and inadequate "ways of outflow". The king of arterial lesion did not permit the surgeon to perform typical bypass surgery or arterialisation of venous system with a traditional scheme. All the patients were candidates for amputation. For salvage of extremity 36 patients underwent prolonged semi-closed endarterectomy using special instrument which was supplemented with temporary arterio-venous fistula or popliteal-distal auto-venous bypass. In short-term period after surgery critical ischemia was eliminated in 25 (69%) patients. The rest of the patients underwent amputations. 5 years later cumulative safety of the extremities was 95% among patients with good short-term results. These variants of revascularizing surgery may be regarded as alternative to amputations in patients with critical limb ischemia due to distal lesions of lower limbs arteries.

[The simultaneous operation for rectal cancer and abdominal aortic aneurysm]. / Simul'tannaia operatsiia po povodu raka priamoi kishki i anevryzmy briushnogo otdela aorty.

The authors present a successful case of simultaneous operation for rectal cancer and abdominal aortic aneurysm.

[Surgical treatment of ruptured abdominal aortic aneurysm]. / Khirurgicheskoe lechenie bol'nykh s razryvom anevrizmy briushnoi aorty.

Over the last 30 years more than 1000 patients with abdominal aortic aneurysms (AAA) were treated. Results of treatment of 367 patients with disruption of AAA from 1989 to 2002 were analyzed. Elderly and old patients account for 92% (338) of them. In 61% (224) patients after aneurysm's disruption blood outflew into the retroperitoneal space, in 23.4% (86) - into abdominal cavity, in 13,1% (48) patients retroperitoneal hematoma and hemoperitoneum formed, 2% (7) were the patients with functioning aorto-caval fistula, in 0.5% (2) aneurysm disrupted into the duodenum. There was no surgery due to different causes in 161 patients, all these patients died. One hundred and sixty-five patients underwent surgery, lethality was 60% (99 patients). Linear grafting of the aorta or aorto-iliac grafting was performed in the majority of patients - 77 (46.7%). Based on the obtained data three types of clinical picture of AAA disruption are devined: fulminant, acute and sub-acute. Complex treatment improved results of the treatment: lethality from 1989 to 1996 was 71.6%, from 1997 to 2002 - 52%.

[Reconstructive surgery in injuries of major arteries and veins]. / Rekonstruktivnye operatsii pri raneniiakh magistral'nykh arterii i ven.

Retrospective analysis of surgical treatment for injuries of 408 major arteries and veins in 352 patients in the department of vascular surgery of N.V. Sklifossovsky Research Institute of Emergency Care from 1989 to 1996 is presented. Of 126 cases of prosthetic reconstructions in 72.2% autoveins were used, in 18.3%--synthetic prosthesis, and in 9.5% homologous arterial biologic prosthesis. Good results were obtained in 13.1% of patients, amputations were made in 4.8%. Lethality was 4.0%. Principles of treatment of combined injuries, prophylaxis of syndrome of inclusion and other complications are autlined.

[X-ray endovascular dilatation using an axillary access]. / Rentgenoéndovaskuliarnaia dilatatsiia aksilliarnym dostupom.

Based on the analysis of 39 observed cases, the authors consider various aspects of the use of roentgenovascular dilatation by an axillary access: problems of methods, indications and contraindications; they also assess the advantages and shortcomings of the access.

[Axillary approach for radiologic endovascular dilatation]. / Rentgenoéndovasculiarnaia dilatatsiia aksilliarnym dostupom.

Basing on the analysis of 39 observed cases, the authors consider various aspects of the use of roentgenovascular dilatation by an axillary access : problems of methods, indications and contraindications; they also assess the advantages and shortcomings of the access.

[Ways of lowering the level of amputation in decompensated ischemia of the lower extremities]. / Puti snizheniia urovnia amputatsii pri dekompensirovannoi ishemii nizhnikh konechnostei.

From analysis of the results of surgical treatment of 127 patients with decompensation of circulation and gangrene of the lower limbs the authors substantiate the prospective character of revascularizing operations which lower the level of the amputation. Revascularization by means of reconstructive operations on the main arteries of the limbs makes it possible to not only lower the level of the amputation, but reduce considerably the lethality, the incidence of postoperative complications, and the degree of invalidation.