[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%.

[Experience in treating embologenic thromboses of deep veins of lower extremities].

The present work deals with analysing the outcomes of surgical management carried out in a total of five hundred and sixty-six patients diagnosed as having embologenic thrombosis of the lower-limb deep veins. Of these, 377patients received a cava filter implanted, with the remaining 189 patients being subjected to thrombectomy from the iliac and femoral veins. In nineteen patients, the operation was supplemented by establishing an arteriovenous fistula. The decision of whether or not to perform a surgical intervention in patients presenting with thrombosis of deep veins of the lower extremities was made based on the type and pattern of the thrombus concerned. First of all, such surgery was indicated primarily for those diagnosed with a floating, embolus-hazardous thrombus. Thrombectomy was carried out in the patients with a favourable prognosis of the underlying disease, if activation of the pathological process was possible. Cava filters were implanted to the patients diagnosed as having a recurrent embolism, with an unfavourable prognosis of the course of the underlying disease, as well as to those presenting with a severe concomitant pathology. Ultrasonography-guided control is obligatory at all stages of management.

[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.

Formation of a genuine aneurysm of the vein graft 16 years after femoropopliteal bypass grafting.

Presented herein is a case of vein graft aneurysm formation 16 years after femoropopliteal bypass grafting using the reverse autogenous vein.

[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%.

[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.

[Bypass surgeries from remote vascular beds in the treatment of critical limb ischemia in elderly and old patients]. / Operatsii shuntirovaniia iz otdalennykh sosudistykh basseinov v lechenii kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

The problem of surgical treatment of elderly and old patients with critical limb ischemia and severe concomitant diseases is discussed. Surgical bypass from remote vascular beds is the only real possibility of effective care for such patients with the lowest risk. The results of treatment of 90 patients with critical limb ischemia were analyzed. The surgical technique is described in details. Modified methods of proximal anastomosis creation and technology of safe installation of graft into subcutaneous canal in subclavial-femoral bypass, surgical technique in femoral-femoral and ileo-femoral cross-over bypass are also described. Results demonstrate high efficacy of these surgeries and their lower risk. It is concluded that improved surgical technique permits to expand indications for surgery in elderly and old patients and to improve immediate and long-term results.

[On validity of the term "chronic" rupture of abdominal aortic aneurysm]. / O pravomernosti termina "khronicheskii" razryv anevrizmy briushnoi aorty.

Treatment of patients with abdominal aortic aneurysms has been analyzed. From 506 patients (265 emergency and 241 elective cases) treated in the department of urent vascular surgery 36 had "chronic disruptions". Validity of this term is discussed. The authors consider the term "repeated disruption" as the most adequate.