[Contrast-enhanced ultrasonographic study in patients with lower limb arterial lesions]. / Ul'trazvukovoe issledovanie s kontrastnym usileniem u patsientov s porazheniiami arterii nizhnikh konechnostei.

BACKGROUND: The introduction into clinical practice of contrast-enhanced ultrasonographic examination made it possible to assess patency of tibial arteries and perfusion of crural muscles in patients with occlusive lesions of lower-limb arteries. These findings are important for planning optimal treatment policy and assessing efficacy of operative or medicamentous treatment. OBJECTIVE: The study was aimed at investigating a possibility of contrast-enhanced ultrasound examination for assessment of patency of tibial arteries and quantitative assessment of perfusion of crural muscles in patient with occlusive lesions of lower-limb arteries. PATIENTS AND METHODS: We examined a total of 30 patients presenting with atherosclerotic-genesis occlusive lesions of lower limb arteries and symptomatic intermittent claudication. Five patients were examined in the postoperative period. All patients were subjected to quantitative analysis of crural muscle perfusion in the pre- and postoperative periods, determining the time of onset of contrast medium accumulation and the time to the peak of intensity. RESULTS: Contrast-enhanced ultrasound examination demonstrated that in patients with occlusive lesions of lower-limb arteries the start of contrast medium accumulation appeared to occur later than in apparently healthy people: on second 30-88, depending on the degree of limb ischaemia. The contrasting time-to-peak was also increased (from 36 to 120 s). In the postoperative period all patients were found to have improved perfusion of the crural muscles, which was confirmed by a decrease in time-to-peak contrasting. CONCLUSION: Contrast-enhanced ultrasonographic examination is currently the only non-invasive, safe method of determining perfusion of crural muscles, which may be used many times for assessment of viability of the ischaemised extremity, as well as for assessment of efficacy of the treatment performed.

[Staged surgical treatment of a woman with nonspecific aortoarteritis and bilateral occlusion of carotid arteries]. / Poétapnoe khirurgicheskoe lechenie bol'noi nespetsificheskim aortoarteriitom s dvukhstoronnei okkliuziei sonnykh arterii.

Nonspecific aortoarteritis (NAA) is an autoimmune disease characterized by the development of an inflammatory process in large arteries such as the aorta and its branches and pulmonary arteries. Operative interventions for lesions of the aortic arch branches may be divided into extra- and transthoracic. Involvement of all branches of the aortic arch requires transthoracic interventions to be performed. According to the findings of various authors, bicarotid bypass grafting is accompanied by a high incidence rate of complications and lethal outcomes. The most serious complication is haemorrhagic stroke developing in 40% of patients. That is why commencing from 1991 the practice of simultaneous restoration of the two carotid basins was discontinued. A clinical case report presented herein demonstrates the authors' therapeutic policy in patients with NAA and multiple involvement of brachiocephalic arteries and first of all with bicarotid occlusion.

[Hybrid approach to treatment of a patient with a thoracoabdominal aortic aneurysm]. / Gibridnyi podkhod k lecheniiu patsienta s anevrizmoi torakoabdominal'nogo otdela aorty.

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.

[Chronic venous diseases: valvular function and leukocyte-endothelial interaction, possibilities of pharmacotherapy]. / Khronicheskie zabolevaniia ven: funktsiia klapanov i leikotsitarno-éndotelial'noe vzaimodeistvie, vozmozhnosti farmakoterapii.

This article provides a review of the literature focusing on the data elucidating the pathogenesis of chronic venous diseases from the positions of macrohaemodynamic (venous valvular function) and microcirculatory impairments. Presented herein are confirmations of the interaction between two important mechanisms, as well as the literature data concerning the role of the venous microvalvular structures and possible haemodynamic impairments in functional venous insufficiency. Also presented are substantiations in confirmation of the theory of leukocyte-endothelial interaction, forming the basis for contemporary understanding of the pathogenesis of chronic venous diseases. This is followed by elucidating the role of venoactive drugs in conservative treatment of patients with chronic venous diseases, and, finally, touching upon current problems and promising approaches to solve them.

[Diagnostic significance of the color duplex scanning in estimation of the arteries state at different stages of infrainguinal reconstructions]. / Diagnosticheskoe znachenie tsvetovogo dupleksnogo skanirovaniia v otsenke sostoianiia arterii na étapakh infraingvinal'nykh rekonstruktsii.

AIM: The study was aimed at assessing diagnostic possibilities of duplex scanning (DS) of lower limb arteries, used as 'ultrasonographic angiography' in patients presenting with critical ischaemia for appropriately planning complicated infrainguinal reconstructions at stages of surgical management, including dynamic follow up in the postoperative period. PATIENTS AND METHODS: We examined a total of 30 patients. Of these, 14 patients composed the control group and 16 patients with critical ischaemia of lower limb arteries who underwent 8 external iliac-tibial and 8 femorotibial bypass graftings with a relieving arteriovenous fistula and application of a venous cuff according to the type of 'St. Mary's boot'. All the 16 patients preoperatively underwent DS of lower limb arteries and CT angiography, as well as postoperative DS of the vessels of the zone of the operative intervention. We compared the possibilities of DS and CT angiography in the assessment of the state of various segments of lower limb arteries. The obtained findings were compared with the data of the 'golden standard' - X-ray contrast enhanced angiography or intraoperative revision. RESULTS: In assessing the state of the aortoiliac segment, sensitivity and specificity of the both methods amounted to 100%. In assessing patency of the femoropopliteal segment, sensitivity and specificity of DS amounted to 93.7 and 100%, with those for CT angiography equalling 87.5 and 100%. Assessing patency of arteries of the crus, sensitivity and specificity of the both methods amounted to 87.5 and 93.7%, respectively. In the postoperative period it was revealed that a prognostically favourable factor for shunt functioning is the value of the volumetric velocity of blood flow in the shunt at the level of the middle third of the femur, equalling the sum of volumetric velocities of blood flow in the donor artery distal to and in the relieving vein proximal to the anastomosis. Important prognostic parameters of shunt functioning were also the values of linear velocity of blood flow both in the shunt and donor artery. CONCLUSION: Strict compliance with the methodology and protocol of DS makes it possible to evaluate the condition of outflow pathways while planning the intervention, to assess functioning of the shunt in the postoperative period and to work out criteria for favourable functioning of the infrainguinal shunt for regular dynamic control over the state of the revascularized limb.

[Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment]. / Ispol'zovanie tekhniki ex vivo u patsienta s arteriovenoznoi mal'formatsiei pochek pri oslozhnenii éndovaskuliarnogo lecheniia.

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.

[Angiodysplasias of the head and neck: present-day principles of treatment using elements of plastic surgery].

The authors assessed the outcomes of treatment of fifty-one patients presenting with angiodysplasias of the head and neck. Of these, 24 patients suffered from the venous form and 27 had the arteriovenous form. The 51 patients accounted for 23.5% of the total number of patients with congenital vascular malformations over a five-year period. The topicity and angioarchitectonics of the lesion were specified by means of the standard diagnostic complex (i. e., duplex scanning of the vessels, ultrasonographic study of the soft tissues and osseous structures, computed and magnetic resonance tomography, echocardiography, and angiography). Radical excision of the angiomatous tissues was performed in 15 patients and palliative one - in 36 cases. Eight patients were subjected to stagewise resection interventions, ten patients underwent stagewise sessions of laser coagulation, and seven patients endured stagewise roentgenoendovascular embolisations of the afferent arteries. Two patients with the venous form were postoperatively subjected to sessions of sclerotherapy of the residual venous caverns. Two patients in the remote period (7-10 days) underwent autodermoplasty with a free perforated cutaneous flap. This technique was used while closing the wound surface after removing the angiomatous tissues of the parotid region and hairy portion of the head. In five patients the wound surface was closed with a mobilized cervical fat-cutaneous flap. Taking into consideration the importance of the cosmetic outcome after excising the angiomatous tissues on the face and neck, it is necessary to seek for wide application of plastic methods of closing the wound. These methods simultaneously allow of making operative interventions for angiodysplasias more radical.

Remote results of reconstructive operations in pathological deformity of the internal carotid artery.

OBJECTIVE: to study remote results of surgical treatment of patients presenting with a pathological deformity of the internal carotid artery. METHODS: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (ICA), who underwent a total of 166 reconstructive operations. RESULTS: 7% of patients were operated on at the asymptomatic stage, more than half (56%) of the patients were found to have transient (21%) or persistent neurological deficit (35%), 37% of patients had stage III cerebrovascular insufficiency. Twenty-five (15%) operations were performed for C- and S-shape tortuosity, ninety-seven (58%) procedures for kinking of the internal carotid artery, and forty-four (27%) interventions for coiling. The operation of choice was resection with redressation of the internal carotid artery and reimplantation into the old ostium (74%). Analysing the results of surgical treatment showed its high neurological efficiency in prevention of cerebral circulation impairments (93% of patients at terms up to 25 years had no such complications), as well as clinical efficacy (relief of cerebrovascular insufficiency symptoms in 91.1% of patients). The effect obtained appeared to preserve during 2 and 5 years in 96% and 92% of patients, respectively, and at terms up to 25 years in 83%. The 3-, 5- and up- to-25-year survival amounted to 95%, 92% and 75%, respectively. Restenosis of the internal carotid artery was significantly more often observed after prosthetic repair of the artery (p <0.05) as compared with other methods of reconstruction employed. Thromboses of the internal carotid artery were encountered with similar frequency (8%) only after prosthetic repair and resection of the internal carotid artery with an «end-to-end¼ anastomosis, which was significantly more often than in resection with redressation (p <0.05). Stroke incidence in the remote postoperative period amounted to 0.8% and the «stroke + stroke-related mortality¼ parameter equalled 1.6%. CONCLUSION: the remote results of surgical treatment for pathological deformity of the internal carotid artery are strongly suggestive of high efficacy of this method of prevention of impairments of cerebral circulation and treatment of cerebrovascular insufficiency in patients with the pathology concerned. The operation of choice in pathological deformity of the internal carotid artery is resection with redressation of the internal carotid artery and reimplantation into the original ostium.

[Possibilities of surgical management of paraganglioma of the neck extending to the base of the skull].

Presented in the article is a rare clinical case report concerning successful treatment of a female patient with vaginal paraganglioma of the neck - a tumour extending from the level of the trunk of the common carotid artery in cranial direction to the base of the skull. Mentioned are difficulties of carrying out an operational intervention requiring the use of certain surgical techniques. The tumour was removed as a single block with the involvement into the process of the major vessels of the neck and nervous formations. The reconstructive operation performed was common carotid - internal carotid prosthetic repair with a 6.3-4.5 mm cone-shape prosthesis 'Gore-tex' on the right.

Clinical manifestations and diagnosis of pathological deformity of the internal carotid artery.

OBJECTIVE: to study clinical and morphological aspects of pathologically deformed pathological deformity of the internal carotid artery. METHODS: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (1СA), who underwent a total of 166 reconstructive operations. RESULTS: more than half (58%) of the patients were operated on for 1С A kinking, 27% for coiling and only 15% were found to have C- and S-shape tortuosity. The patients were predominantly women, with a male-to-female ratio of 1:1.6 (Р<0.01). The majority of the patients (61%) were operated on at the age varying from 51 to 70 years (P<0.01). Patients under 40 years appeared to more often (92%) suffer bilateral lesions (P<0.01). 56% of patients had a history of acute cerebral circulation impairment (P<0.05). A symptom-free course of the disease was more frequently encountered in unilateral lesions (P<0.01). Patients under 30 years were more often operated on at the pre-stroke stage of the disease (P<0.05). Patients with kinking of the internal carotid artery had a significantly higher risk (63%) of acute cerebral ischaemia (p<0.01). Arterial hypertension was revealed in 74% of patients. Incidence of acute cerebral ischaemia events was significantly higher in hypertensive patients (P<0.01). Pronounced haemodynamic impairments (bloodflow turbulence) were significantly more often (92%) detected in patients with kinking of the internal carotid artery (P<0.05). CONCLUSION: patients with clinical signs of cerebrovascular insufficiency, being relatively young and having concomitant arterial hypertension even with no objective signs of a stenotic lesion of coronary arteries should be referred to duplex scanning of brachiocephalic arteries in order to verify a pathological deformity of the internal carotid artery at the pre-stroke stage of the disease. An algorithm of examination including duplex scanning of brachiocephalic arteries and comprehensive magnetic resonance imaging made it possible to in short time obtain the in-depth information about the anatomical and topographical peculiarities of the pathological deformity of the internal carotid artery and to assess its haemodynamic significance, which in turn makes it possible to clearly and timely determine the treatment policy for the patient concerned.

[Present-day approach to comprehensive ultrasonographic study of patients with pathological deformity of the internal carotid artery].

The authors report herein the findings of a comprehensive ultrasonographic study comprising a total of fifty-eight patients diagnosed with a pathological deformity of the internal carotid artery (PD ICA). A special emphasis was placed on investigating the structural and functional properties of the arterial wall, with the assessment of elastic properties of the common carotid artery (CCA) and the values of the flow-dependent dilation (FDD) of the brachial artery, also evaluating the anatomical shape of the pathological deformity concerned, analyzing the blood flow linear velocity all along the length of the ICA, with the calculation of the velocity gradient, accompanied and followed by studying spectral characteristics of the blood strec, n, also assessing the functional state of the arteries of the circle of Willis. The overwhelming majority of the examined patients appeared to demonstrate a statistically significant decrease in the FDD index, distensibility coefficient and the compliance coefficient, accompanied and followed by an elevation of the rigidity index, as compared with the control group (p < 0.05). We determined certain correlation between the appearance of the signs of blood flow turbulence and the values of the velocity gradient depending on the shape of the deformity. To this was added the analysis of the state of the value of the cerebral circulatory reserve depending upon the clinical manifestations of the disease.

[Ultrasound diagnosis of extrahepatic portal hypertension in chronic pancreatitis].

AIM: To evaluate the potential of the color duplex scanning in revealing of the portal hypertension in patients with chronic pancreatitis. MATERIALS AND METHODS: 94 patients with chronic pancreatitis were investigated. In 61 patients (65%) pancreatitis was complicated by extrahepatic portal hypertension (EHPH) and 31 patients (35%) were without signs of rising of the portal pressure. RESULTS: Investigations in B-regime have shown that in patients with EHPH chronic calculous pancreatitis was revealed in 48%, development of pancreatic hypertension in 75%, increase of the pancreas head up to more than 40 mm in 58% of patients. We did not reveal statistically significant differences in pseudo-cysts in pancreas, extension of extrahepatic and intrahepatic ducts and infiltrative changes in parapancreatic cellular tissue in patients with and without EHPH. A development of EHPH in 31 (51%) patients was preconditioned by an extravasal compression of veins of portal system, combination of extravasal compression with thrombosis was found in 11 (18%) patients, in 12 (20%) patients thrombosis of the magistral veins of portal system was revealed and in 7 (11%) patients hemodynamics was not changed. Resections were found to be preferable operations for recovery of portal circulation. Increase and normalization of portal circulation found after transversal section of pancreas (Beger operation, pancreo-duodenal resection, distal resection of pancreas). A tendency to normalization of the blood flow was observed after the Frey operation.

[When should a pathological deformity of the internal carotid artery be operated on?].

The present study was aimed at optimizing the algorithm of examination and indications for operation in patients with a pathological deformity of the internal carotid artery. The work was based on a retrospective analysis of the therapeutic outcomes in 142 patients with an isolated pathological deformity of the internal carotid artery, who underwent a total of 166 reconstructive operations. Based on assessment of the diagnostic accuracy of the employed methods of diagnosis, we proposed an optimal algorithm of patient's examination including coloured duplex scanning and magnetic resonance angiography of the brachiocephalic arteries with simultaneous magnetic resonance tomography of the brain, followed by determining due indications for surgical treatment, depending on the baseline degree of cerebrovascular insufficiency and haemodynamiс significance of the pathological deformity of the internal carotid artery. The developed algorithm of examination makes it possible to timely and efficiently diagnose the disease and to determine due indications for surgical treatment of patients presenting with a pathological deformity of the internal carotid artery.

[Current trends in diagnosis and treatment of arteriovenous angiodysplasia].

A total of 240 patients with arteriovenous angiodysplasia (AVD) were examined and treated in A.V. Vishnevsky Institute of Surgery during 1997-2009. Embolization was performed in 196 (81.7%) patients. Staged embolization was the principal treatment modality in 84 (35%) patients presenting with inoperable lesions. The mean number of sessions was 3.6. Intraoperative embolization using hydrogel embols, Gianturco coils, and 96% alcohol was done in 17 (7.1%) patients. Radical surgery with the removal of angiomatous tissues was given to 33 (13.8%) patients. Palliative resections were made in patients with extensive lesions and impossibility of total removal of angiomatous tissues. Minor and major amputations were needed in 15 patients. It is concluded that intervention for microfistulous and confined macrofistulous lesions should be performed only in case of absolute indications for surgery. That in asymptomatic or subclinical cases is justified only for minor surface lesions fit for radical resection. Minor amputation is indicated in certain patients with arteriovenous fistulas on distal limb segments. Extensive delayed resections should be planned with the use of plastic surgical techniques (autodermoplasty using free flaps, mobilized flaps, and flaps with microvascular anastomosis).

[Main aspects of ultrasound studies of carotid artery atherosclerotic lesions in clinical practice].

The authors summarize results of the joint work of Departments of Vascular Surgery and Ultrasound Diagnosis, A.V. Vishnevsky Institute of Surgery. The main aspects of US study of patients with atherosclerotic carotid lesions are discussed necessary for comprehensive and high-quality examination taking into account severity of occlusion and anatomical features of carotid arteries. Structural characteristic of atherosclerotic plaques is presented based on the comparison of results of US and morphological studies. Analysis of plaque morphology and clinical features of the disease was used to develop classification distinguishing 6 main types of atherosclerotic plaques. Complicated diagnostic situations are considered that can be encountered during US diagnostics of atherosclerotic carotid lesions.

[Transcutaneous laser coagulation in treatment of venous forms of angiodysplasias].

Presented herein is the authors'experience with transcutaneous laser coagulation (TLC) used for treatment of various-localization venous angiodysplasias in a total of twenty-one patients. Also described are the issues concerning the methodology involved and the course of the operational procedure. The main criteria used while analysing the outcomes of TLC were the clinical patterns and the findings of duplex scanning. Good to satisfactory results were eventually observed in 71.4% of the patients. Based on the outcomes obtained after TLC, the authors worked out the principles of appropriate practical application of laser-mediated technologies in patients presenting with venous angiodysplasias.

[Aneurysm of the popliteal vein. Review of the literature and a case report].

The article deals with a brief review of the literature dedicated to rather an uncommonly encountered pathology of the major veins, i. e., an aneurysm of the popliteal vein. Described herein are variants of the clinical pattern and possible complications, with an emphasis placed on methods of diagnosis and differential diagnosis of tumour-like neoplasms in the infragenicular region. Also presented is a clinical case report of successful treatment of a female patient diagnosed with a popliteal vein aneurysm.

[The role of laser doppler flowmetry in the assessment of microcirculatory disturbances at angiodysplasias].

The paper presents the data on the use of laser Doppler flowmetry (LDF) for microcirculation assessment in patients with lower limb angiodysplasias. Preliminary results suggest that LDF can be successfully used both for the quantification of microcirculatory disturbances and for the diagnosis of arterio-venous micro fistulas. LDF was used as a monitoring tool for compressive therapy effectiveness in patients with arterio-venous and venous forms of lower limb angiodysplasias. Compression stockings Relaxsan III class were shown to improve microcirculation in this patient population after 1 month wearing.

Carotid thromboses in the early postoperative period after carotid endarterectomy.

The paper analyzes 10 cases of internal carotid artery (ICA) thrombosis, which occurred after 635 carotid endarterectomies (CEA), carried out from January 1997 to July 2004. CEA procedures included 346 (54.5%) open CEAs with PTFE patch angioplasty and 289 (45.5%) eversion CEAs. Patients with thromboses in the reconstructed area (n=10) had the profiles of comorbidities and cerebrovascular insufficiency grade similar to the total CEA group (p>0.1). Differences concerned the higher rate of atrial fibrillation cases (10%), diabetes mellitus (30%) and contralateral ICA occlusions (20%) in the group of thromboses (p>0.1). Among these 10 patients, 5 underwent eversion CEA (1.44% of the total eversion CEA group) and 5 - open CEA with patch angioplasty (1.73%). In 8 patients thromboses manifested as local neurological symptoms in the area supplied by the operated carotid artery. One patient demonstrated the progression of general cerebral symptomatology, while in the tenth patient thrombosis was accompanied with cerebral coma. Urgent ultrasonography in 7 patients failed to detect a blood flow in ICA, that proved the diagnosis of ICA thrombosis; in 3 patients ultrasonography showed a mural thrombosis. Nine patients underwent reoperation in emergency, while for the tenth patient an intervention was contraindicated due to the thrombosis of middle cerebral artery, unstable clinical state (cerebral coma) and progression of neurological symptomatology. PTFE arterial graft was implantedin 7 reoperated patients with ICA thrombosis, thrombectomy from ICA was carried out in 1 patient and in another one patient a thrombectomy from reconstructed segment with PTFE patch angioplasty of the arteriotomy defect was fulfilled. In 3 reoperated patients a complete resolution of neurological symptoms was evident 24 hours after intervention, in 2 patients neurological symptomatology regressed over 2-4 weeks. In another 3 reoperated patients local neurological symptoms persisted; 1 patient demonstrated postoperative progression of neurological symptomatology and coma with fatal outcome. The last patient, for whom a reoperation was contraindicated, died due to aggravation of cerebral coma. Dynamic follow-up in early postoperative period after CEA, especially in the first 6 hours, as well as an urgent duplex scanning of the reconstructed area in case of neurological symptoms development, provides timely diagnosis of postoperative thrombosis and the success of reoperations. Adjustments to patient's cardiac status and appropriate intraoperative heparinization can decrease the risk of this complication. An urgent reoperation aimed at the restoration of carotid blood flow, immediately after the diagnosis of thrombosis (provided the absence of deep coma), promotes a complete or partial regression of neurological symptoms and helps to prevent a progression of cerebrovascular disturbances.

Comparative analysis of carotid endarterectomy late outcomes related to intervention modality.

The paper presents a comparative analysis of late outcomes after 105 carotid endarterectomies (CEA) performed in 89 patients from 1997 to 2003, including 95 patients (90.5%) operated for atherosclerotic stenosis of internal carotid artery (ICA) and 7 patients (6.6%)--for combined ICA stenosis and tortuosity. The severity distribution of cerebrovascular insufficiency (CVI) was the following: grade I--in 22.8%, grade II--in 12.4%, grade III--in 25.7% and grade IV--in 38.1% of patients. CEA methods included eversion endarterectomy in 50.4% cases and open (classic) surgical CEA with PTFE patch angioplasty in 49.6% cases. Mean follow-up period was 31.8 months for the eversion CEA group and 37 months--for the open CEA group (from 3 to 72 months). In 76.4% patients the duration of follow-up period exceeded 1 year. During the follow-up period all patients underwent clinical examination and color duplex scanning of reconstructed CA segment with assessment of diameter, vascular wall thickness and blood flow. TIA was registered in 1 patient from eversion CEA group and in 1 patient from open CEA group. Thus, in the long-term postoperative period 98% of patients were free from neurological complications. Hemodynamically significant restenoses developed in 8 cases (7.6%), including 4 patients from the eversion CEA group and 4 patients from the open CEA group. Myointimal hyperplasia (> 3 mm) accompanied by hemodynamical alterations occurred in 1 patient from the eversion CEA group and in 2 from the open CEA group. In the rest of cases restenoses were related to atherosclerotic plaque formation. In conclusion, the long-term outcomes indicate that CEA is effective in the prevention of cerebrovascular events regardless of carotid angioplasty strategy. The rate of late postoperative restenoses was similar for eversion and open CEAs. Both modalities can be promising for the surgical correction of CA stenoses.