RESUMEN
BACKGROUND: Patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) have a poor prognosis. The phase III KESTREL study evaluated the efficacy of durvalumab [programmed death-ligand 1 (PD-L1) antibody] with or without tremelimumab [cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antibody], versus the EXTREME regimen in patients with R/M HNSCC. PATIENTS AND METHODS: Patients with HNSCC who had not received prior systemic treatment for R/M disease were randomized (2 : 1 : 1) to receive durvalumab 1500 mg every 4 weeks (Q4W) plus tremelimumab 75 mg Q4W (up to four doses), durvalumab monotherapy 1500 mg Q4W, or the EXTREME regimen (platinum, 5-fluorouracil, and cetuximab) until disease progression. Durvalumab efficacy, with or without tremelimumab, versus the EXTREME regimen in patients with PD-L1-high tumors and in all randomized patients was assessed. Safety was also assessed. RESULTS: Durvalumab and durvalumab plus tremelimumab were not superior to EXTREME for overall survival (OS) in patients with PD-L1-high expression [median, 10.9 and 11.2 versus 10.9 months, respectively; hazard ratio (HR) = 0.96; 95% confidence interval (CI) 0.69-1.32; P = 0.787 and HR = 1.05; 95% CI 0.80-1.39, respectively]. Durvalumab and durvalumab plus tremelimumab prolonged duration of response versus EXTREME (49.3% and 48.1% versus 9.8% of patients remaining in response at 12 months), correlating with long-term OS for responding patients; however, median progression-free survival was longer with EXTREME (2.8 and 2.8 versus 5.4 months). Exploratory analyses suggested that subsequent immunotherapy use by 24.3% of patients in the EXTREME regimen arm contributed to the similar OS outcomes between arms. Grade 3/4 treatment-related adverse events (TRAEs) for durvalumab, durvalumab plus tremelimumab, and EXTREME were 8.9%, 19.1%, and 53.1%, respectively. CONCLUSIONS: In patients with PD-L1-high expression, OS was comparable between durvalumab and the EXTREME regimen. Durvalumab alone, and with tremelimumab, demonstrated durable responses and reduced TRAEs versus the EXTREME regimen in R/M HNSCC.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Humanos , Carcinoma de Células Escamosas de Cabeza y Cuello/etiología , Antígeno B7-H1 , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Recurrencia Local de Neoplasia , Neoplasias de Cabeza y Cuello/etiologíaRESUMEN
OBJECTIVE: To study distraction hinged motion arthroplasty of the ankle joint in combined treatment of osteoarthritis in terminal stages. MATERIAL AND METHODS: Ankle distraction hinged motion arthroplasty in the Ilizarov frame was performed in 10 patients with terminal post-traumatic osteoarthritis (mean age 54±6.2 years). Surgical technique and design of the Ilizarov frame, as well as additional reconstructive interventions are described. RESULTS: Preoperative VAS score of pain syndrome was 7±2.3 cm, after 2 postoperative weeks - 1±0.5 cm, 4 weeks - 0.5±0.5 cm, 9 weeks or before dismantling - 0±0.5 cm. Arthroscopic debridement of anterior part of the ankle joint was carried out in 6 cases, posterior part - 1 case, anchor reconstruction of lateral ligamentous complex (InternalBrace technique) - 1 case, anchor reconstruction of medial ligamentous complex - 2 cases. Restoration of anterior portion of syndesmosis was performed in 1 case. Pin site infections occurred in 2 cases. In one case, there was a breakdown of the wire fixator holding the pin passed through the talus in 5 weeks after surgery. CONCLUSION: Preliminary results allow us to characterize the proposed design of the Ilizarov frame layout and surgical technique as relatively simple and promising for postponing radical surgery on the ankle joint.
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Tobillo , Osteoartritis , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Artroplastia/métodosRESUMEN
Despite advances in the development of endovascular techniques of revascularization of renal arteries, in certain clinical cases still remains the need to perform extra-anatomic renal bypass grafting. To such instances belong complicated atherosclerotic aortic lesions, technical difficulties occurring during open revascularization of the aorta and its branches, as well as aneurysms of the juxtarenal portion of the abdominal aorta. Presented herein is a clinical case concerning a patient subjected to non-standard restoration of blood flow in the right renal artery after thromboendarterectomy from the juxtarenal aorta, performed from the left-sided extraperitoneal phrenolumbotomic approach and complicated by secondary dissection of the intima in the right renal artery.
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Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Prótesis Vascular , Disección , Endarterectomía , Humanos , Arteria Renal/diagnóstico por imagen , Arteria Renal/cirugíaRESUMEN
AIM: The study was aimed at assessing efficacy and safety of endovascular treatment of abdominal aortic aneurysms based on 11-year experience with implantation of stent grafts. PATIENTS AND METHODS: We retrospectively analysed outcomes of treatment of 242 patients with abdominal aortic aneurysm during the period from 2008 to 2019. Of these, 210 (86.78%) were males, mean age 69.32±7.36 years. Diagnosis was made using colour duplex scanning and contrast-enhanced multislice spiral computed tomography, with implanting the following stent grafts: Ella - 44, Ovation Prime - 33, Anaconda - 13, Endurand - 77, Aortix - 2, Zenith - 33, Seal - 39, with one endoprosthesis placement failed. Assessing safety of the operation, we took into consideration lethality due to aortic rupture/thrombosis. Efficacy was taken to mean technical success of the operation (implantation of all components of the endograft without switch to open surgery), the number of reoperations. RESULTS: Technical success of the operation was achieved in 98.35% of cases. In 1 case due to pronounced arterial calcification for technical reasons we failed to position the stent graft and in another case - the contralateral leg of the Ella prosthesis. The early postoperative period revealed: type A1 endoleak - 3.7%, type IB - 4.13%, type IIA - 6.6%, type IIB - 4.54%, type III - 0.83%, type IV - 0.83%. Repeat operations were performed in 20 (8.2%) patients within 30 days after the intervention and in 32 (13.22%) in the remote period. In the early postoperative period two conversions were performed: 1) iliorenal bypass grafting for restoration of blood flow through the renal artery occluded by endoprosthesis wall; 2) evacuation of retroperitoneal haematoma due to rupture of the common femoral artery. Lethality during the whole period of follow up amounted to 32 (13.22%) cases. Of these, due to aortic complications 4.54% (n=11) and due to accompanying pathology 8.67% (n=21). A direct correlation was revealed between the aortic diameter and duration of the operation which in turn increases the risk of complications requiring re-operation or resulting in a lethal outcome (RR - 1; 95% CD 1- 1; p=0.026). CONCLUSION: Our experience showed high safety and efficacy of stent graft implantation in treatment of patients with abdominal aortic aneurysms and high surgical risk.
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Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Resultado del TratamientoRESUMEN
BACKGROUND: Cell therapy was proposed as a procedure of indirect revascularization for patients with critical ischaemia of lower extremities for whom endovascular and surgical revascularization is impossible. We present herein a review of the state of the art of studies in the field of cell therapy of this cohort of patients. BASIC PROVISIONS: Cell therapy has proved safe, however, the results of studies of efficacy are relatively ambiguous and unconvincing. The number of patients in separately taken clinical trials is minimal. The reviewed studies differed not only by heterogeneity of the cell types used but by the routes of administration of cells (cells were delivered either intramuscularly (predominantly) or intraarterially) and the duration of follow up (time of assessment and duration of follow up varied from 1 month to 2 years). One of the problems became the lack of the routine study of the angiogenic potential of stem cells prior to their clinical application. It is known that the angiogenic activity of multipotent cells of apparently healthy patients may differ from that of patients suffering from atherosclerosis, chronic renal failure, diabetes. CONCLUSIONS: It is supposed that treatment with stem cells or precursor cells is more efficient as compared to protein or gene therapy not only owing to direct vasculogenic properties but a paracrine action through excretion of proangiogenic biologically active substances. More studies with larger cohorts are necessary to provide stronger safety and efficacy data on cell therapy. Besides, a promising trend in the field of cellular approaches is modulation of regenerative capability of stem cells, which may help overcome difficulties in understanding the place of cell therapy in therapeutic angiogenesis.
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Isquemia/terapia , Extremidad Inferior , Tratamiento Basado en Trasplante de Células y Tejidos , Terapia Genética , Humanos , Células MadreRESUMEN
Carotid endarterectomy is the main operation carried out for prevention of ischaemic stroke in haemodynamically significant stenoses of the bifurcation of the common carotid artery. Despite the literature data demonstrating some advantages of eversion carotid endarterectomy over the classical technique there arises a series of complicated, as yet unsolved problems. This concerns the control of the distal portion of an atherosclerotic plaque in prolonged lesions of the internal carotid artery, the absence of a temporary bypass graft, necessity of prosthetic repair of the internal carotid artery in detachment of the distal border of the plaque. We suggested a new technique of carotid endarterectomy making it possible to widen visual removal of atheromatous masses from the internal carotid artery, to improve the control of the distal portion of the plaque in a prolonged lesion of the internal carotid artery. We carried out a comparative assessment of efficacy and safety of the new method of carotid endarterectomy versus the classical variant in a randomized study. The proposed technique of carotid endarterectomy turned out to be compatible by safety and demonstrated similar results with the classical carotid endarterectomy by the number of ischaemic strokes, transitory ischaemic attacks, and myocardial infarctions in the early and remote postoperative periods. When comparing the groups by efficiency, the primary efficacy endpoint, including cases of restenosis >50% according to the findings of ultrasonographic examination of the brachiocephalic arteries, all cases of ischaemic events (acute impairments of cerebral circulation, transitory ischaemic attacks), as well as the presence of the clinical picture of cranial nerve paresis demonstrated a significant advantage of the new technique versus the comparison group at the expense of a lower incidence of restenoses in the area of the operation during the whole period of follow up. In the group of autoarterial remodelling, the composite endpoint of outcomes occurred in 6 patients (6.1%) and in the group with the classic carotid endarterectomy - in 19 (19.6%) patients, p=0.005.
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Isquemia Encefálica , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Accidente Cerebrovascular , Arteria Carótida Común , Constricción Patológica , Humanos , Resultado del TratamientoRESUMEN
AIM: The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system. PATIENTS AND METHODS: Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta. RESULTS: Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed. CONCLUSION: From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.
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Arteriopatías Oclusivas , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/cirugía , Humanos , Arteria Ilíaca/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del TratamientoRESUMEN
We studied the influence of vascular prostheses made of polytetrafluoroethylene and polyethylene terephthalate on the proliferation, migration, and NO production by bone marrow mesenchymal stem cells, human endothelial progenitor cells, and EA.hy926 endothelial cells, colonization of the prosthesis surface by endothelial and mesenchymal cells was also analyzed. Synthetic prostheses have a negative effect on cell proliferation and migration, while surface treatment with proteins (fibronectin or gelatin) promotes colonization of the prostheses with cells.
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Endotelio Vascular/efectos de los fármacos , Células Madre Mesenquimatosas/efectos de los fármacos , Tereftalatos Polietilenos/farmacología , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Células Cultivadas , Humanos , Politetrafluoroetileno/farmacologíaRESUMEN
AIM: The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS: The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS: The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION: Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.
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Estenosis Carotídea/cirugía , Stents , Implantación de Prótesis Vascular , Estenosis Carotídea/diagnóstico por imagen , Humanos , Resultado del TratamientoRESUMEN
Currently, there is great clinical demand for synthetic tissue-engineered cardiovascular prostheses with good long-term patency. Polyurethanes belong to the class of polymers with excellent bio- and hemocompatibility. They are known to possess good mechanical properties, but are prone to processes of degradation in conditions of functioning in living organisms. Attempts at solving this problem have resulted in the development of various new subclasses of polyurethanes such as thermoplastic polyether polyurethanes, polyurethanes with a silicone segment, polycarbonate polyurethanes and nanocomposite polyurethanes. This was accompanied and followed by offering a series of new technologies of production of implantable medical devices such as vascular grafts, heart valves and others. In the presented review, we discuss biological and mechanical properties of modern subclasses of polyurethanes, as well as modern methods of manufacturing implantable medical devices made of polyurethanes, especially small-diameter vascular prostheses.
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Prótesis Vascular/tendencias , Procedimientos Quirúrgicos Cardiovasculares/instrumentación , Prótesis Valvulares Cardíacas/tendencias , Poliuretanos , Materiales Biocompatibles/clasificación , Materiales Biocompatibles/farmacología , Procedimientos Quirúrgicos Cardiovasculares/tendencias , Humanos , Poliuretanos/clasificación , Poliuretanos/farmacologíaRESUMEN
Using stents for endovascular restoration of blood flow made a revolution in vascular surgery, however, despite numerous variants of stents presented on the pharmacological market, there are no stents which would completely solve the problem of restenosis in the area of stent placement. In order to decrease growth of the neointima of the stented portions of vessels, stents coated with cytostatic and cytotoxic agents were worked out. To optimize the rate of drug release it was suggested to apply them in a mixture with biodegradable or biostable polymers. Placement of drug-eluting stents in a combination with dual antiplatelet therapy made it possible to decrease frequency of restenosis and reocclusion of the restored vascular lumen in patients, however it did not solve the problem of the development of thromboses and neointimal hyperplasia in the remote postoperative period. The article provides an overview of various modifications of vascular stents, clinical studies of stents of various manufacturers, as well as modern developments in manufacturing polymer/drug coatings and methods of applying them onto the stent. This is followed by analyzing the contribution of coatings to clinical efficacy of stents and prospects of increasing efficacy of vascular stents.
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Stents , Enfermedades Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares/instrumentación , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/prevención & control , Humanos , Diseño de Prótesis , Stents/efectos adversos , Stents/clasificación , Stents/normas , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Described herein is a clinical case report regarding successful endovascular treatment of a patient presenting with an abdominal aortic aneurysm combined with occlusion of one of the iliac arteries. Cases concerning elimination of such pathology appear to be reported only sporadically in the available literature. The patient underwent reconstructive repair in two stages. The first stage comprised recanalization with stenting of the occluded iliac artery on the right and implantation of the Zenith stent graft. The findings of intraoperative check angiography showed no evidence of endoleak, with the preserved patency of both the stent graft and iliac arteries on the right. The second stage consisted of balloon angioplasty of stenosis of the external iliac artery on the left. The results of the follow-up examination at 3 years showed that the iliac arteries on both sides and the aortic endograft were free from significant stenoses, with no evidence of endoleaks.
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Aneurisma de la Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular , Endofuga/prevención & control , Procedimientos Endovasculares/métodos , Stents , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/fisiopatología , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
The study was undertaken to evaluate the efficacy and safety of endovascular interventions in the treatment of stenoses and occlusions of the brachiocephalic trunk (BCT). Described in the article are the results of retrospectively analysing the efficacy of endovascular interventions performed in a total of forty-five patients presenting with lesions of the BCT. Depending on the type of the BCT lesion, the patients were divided into 2 groups: Group One consisted of 28 patients diagnosed with stenoses of the BCT and Group Two included 17 patients found to have occlusions of the BCT. The outcomes of the interventions were assessed with due regard for the findings obtained by angiography, ultrasonographic duplex scanning of the brachiocephalic vessels, as well as by the examination of the patient's neurological status. The remote results were evaluated at follow-up terms ranging from 6 months to 4 years. No ischaemic strokes, myocardial infarctions, nor lethal outcomes were observed during 30 days after the intervention. In the early postoperative period, there occurred 1 (3.6%) case of transitory ischaemic attack in Group One, with also 1 (5.9%) case thereof encountered in Group Two. Within the time frame of the follow-up period (48 months), recurrent occlusion of the stented segment of the BCT was registered in 2 (7.1%) patients from Group One and in 1 (5.8%) patient from Group Two (p=0.87). The primary patency rate at 4 years in Group One and Group Two patients amounted to 86.8 and 88.3%, respectively (p=0.84). A conclusion thus drawn was as follows: endovascular intervention for stenoses and occlusions of the BCT is an effective and safe method of preventing acute cerebral circulation impairments in the vertebrobasilar basin.
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Arteriopatías Oclusivas , Tronco Braquiocefálico , Procedimientos Endovasculares , Insuficiencia Vertebrobasilar , Anciano , Angiografía/métodos , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/cirugía , Tronco Braquiocefálico/diagnóstico por imagen , Tronco Braquiocefálico/patología , Circulación Cerebrovascular , Constricción Patológica , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Estudios Retrospectivos , Siberia , Stents , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex/métodos , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/prevención & controlRESUMEN
AIM: To evaluate long-term outcomes of spinal neurostimulation (SNS) in patients with critical lower limb ischemia (CLI). MATERIAL AND METHODS: Long-term outcomes of SNS were assessed in 52 CLI patients. Changes of clinical status were considered by using of Rutherford R.B. et al. scale. Before and in 12 months after SNS percutaneous oxygen partial pressure (TO2, mm Hg) was measured at the affected lower limb at rest and in orthostatic test. Ankle-brachial index (ABI) was also determined. RESULTS: SNS improved clinical status in most cases through following effects: 1) reduced pain syndrome and increased motor activity; 2) skin ulcers healing due to increased TO2 and improved functional state of microcirculation. No augmentation of TO2 during orthostatic test at TO2 <10 mm Hg was associated with negative clinical dynamics after SNS (OR 3.2, CI 2.2-54.1, p=0.002). Coronary artery disease with supra-aortic vessels lesion was associated with reduced ABI after SNS (OR 2.1, CI 1.4-3.8, p=0.001).
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Isquemia , Enfermedad Arterial Periférica , Índice Tobillo Braquial , Humanos , Isquemia/terapia , Extremidad Inferior , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
OBJECTIVE: The study was aimed at comparing the outcomes of loop endarterectomy (LE) and endovascular revascularization (ER) with stenting in occlusive lesions (TASC II type D) of the superficial femoral artery (SFA), as well as revealing predictors of restenosis/reocclusion. PATIENTS AND METHODS: Between May 2011 and December 2016, a total of 234 patients presetting with occlusions of the SFA (TASC II type D lesions) were operated on. Of these, 117 patients underwent ER with SFA stenting and 117 patients were subjected to loop endarterectomy from the SFA. The obtained findings were analysed with the help of statistical methods using the Statistica 10 software package (StatSoft, USA). The level of deviation of the null hypothesis of no between-group differences was assumed at p<0.05. RESULTS: Technical success in the ER group amounted to 94% (110 of 117 patients) and in the LE group to 90% (105 of 117 patients). The length of postoperative hospital stay in the ER group was 4 days and in the LE group - 7.5 days (p<0.05). There were significantly more complications in the LE group as compared with ER group (p=0.04). No significant difference was revealed for the number of reocclusions/restenosis between groups - 9 (8.1%) cases in the ER group vs 10 (9.1%) cases in the LE group (p=0.83). CONCLUSION: Loop endarterectomy is a safe, effective and feasible procedure in TASC II type D lesions of the SFA, being not inferior by patency to endovascular treatment during 12 months of follow up; however, it is associated with a high risk for the development of local complications and increased number of postoperative bed-days.
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Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular , Endarterectomía , Arteria Femoral , Oclusión de Injerto Vascular , Extremidad Inferior/irrigación sanguínea , Stents , Anciano , Arteriopatías Oclusivas/diagnóstico , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Endarterectomía/efectos adversos , Endarterectomía/métodos , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Oclusión de Injerto Vascular/diagnóstico , Oclusión de Injerto Vascular/etiología , Humanos , Recuperación del Miembro/métodos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
BACKGROUND: Endothelial and smooth muscle cells are considered promising resources for regenerative medicine and cell replacement therapy. It has been shown that both types of cells are heterogeneous depending on the type of vessels and organs in which they are located. Therefore, isolation of endothelial and smooth muscle cells from tissues relevant to the area of research is necessary for the adequate study of specific pathologies. However, sources of specialized human endothelial and smooth muscle cells are limited, and the search for new sources is still relevant. The main goal of our study is to demonstrate that functional endothelial and smooth muscle cells can be obtained from an available source-post-surgically discarded cardiac tissue from the right atrial appendage and right ventricular myocardium. METHODS: Heterogeneous primary cell cultures were enzymatically isolated from cardiac explants and then grown in specific endothelial and smooth muscle growth media on collagen IV-coated surfaces. The population of endothelial cells was further enriched by immunomagnetic sorting for CD31, and the culture thus obtained was characterized by immunocytochemistry, ultrastructural analysis and in vitro functional tests. The angiogenic potency of the cells was examined by injecting them, along with Matrigel, into immunodeficient mice. Cells were also seeded on characterized polycaprolactone/chitosan membranes with subsequent analysis of cell proliferation and function. RESULTS: Endothelial cells isolated from cardiac explants expressed CD31, VE-cadherin and VEGFR2 and showed typical properties, namely, cytoplasmic Weibel-Palade bodies, metabolism of acetylated low-density lipoproteins, formation of capillary-like structures in Matrigel, and production of extracellular matrix and angiogenic cytokines. Isolated smooth muscle cells expressed extracellular matrix components as well as α-actin and myosin heavy chain. Vascular cells derived from cardiac explants demonstrated the ability to stimulate angiogenesis in vivo. Endothelial cells proliferated most effectively on membranes made of polycaprolactone and chitosan blended in a 25:75 ratio, neutralized by a mixture of alkaline and ethanol. Endothelial and smooth muscle cells retained their functional properties when seeded on the blended membranes. CONCLUSIONS: We established endothelial and smooth muscle cell cultures from human right atrial appendage and right ventricle post-operative explants. The isolated cells revealed angiogenic potential and may be a promising source of patient-specific cells for regenerative medicine.
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Prótesis Vascular , Células Endoteliales/citología , Miocardio/citología , Miocitos del Músculo Liso/citología , Neovascularización Fisiológica , Diseño de Prótesis , Animales , Diferenciación Celular , Proliferación Celular/efectos de los fármacos , Separación Celular , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Quitosano/farmacología , Células Endoteliales/efectos de los fármacos , Células Endoteliales/metabolismo , Células Endoteliales/ultraestructura , Humanos , Ratones SCID , Miocitos del Músculo Liso/efectos de los fármacos , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/ultraestructura , Neovascularización Fisiológica/efectos de los fármacos , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Poliésteres/farmacología , Cuerpos de Weibel-Palade/metabolismoRESUMEN
Presented herein is a literature review aimed at investigating the appropriateness and possibility of using nicergoline (sermion) for treatment of patients suffering from diabetes mellitus. The analysis includes the most clinically significant results of scientific studies. The material to be reviewed was retrieved using the following key words: 'nicergoline', 'sermion', and 'diabetes mellitus' (with their respective Russian equivalents) in such databases as Medline, PubMed, ScienceDirect, PMC, Cochrane, as well as archives of both Russian and foreign journals, guidelines (clinical guidelines on rendering medical care for patients with diabetes mellitus, selected lectures on endocrinology). A broad spectrum of action and no significant side effects have made it possible to use this drug in various pathological conditions. At the same time, because of limited experience of using nicergoline for vascular diseases and an insufficient number of the carried out studies the precise role of this therapeutic agent in clinical practice has not yet been conclusively defined. Special attention is given to the analysis of efficacy of nicergoline in atherosclerosis and diabetes mellitus.
Asunto(s)
Complicaciones de la Diabetes/tratamiento farmacológico , Nicergolina/farmacología , Ergolinas/farmacología , Humanos , Resultado del TratamientoRESUMEN
Presented herein are the results of treating a total of 110 patients with acute massive pulmonary thromboembolism. The patients included in the study were divided into 2 groups depending on the degree of severity of pulmonary hypertension. All patients underwent interventional treatment, i.e., endovascular mechanical fragmentation with local thrombolysis. Both short- and long-term outcomes were then analysed. Performing local thrombolysis made it possible to achieve regression of clinical manifestations of acute respiratory insufficiency in more than 98% of patients. Stabilization of the clinical condition in the early postoperative period was accompanied by improvement of haemodynamics of the right heart in the remote terms of follow up after the intervention. There were 2 (1.8%) lethal outcomes resulting from progression of acute cardiovascular insufficiency. Clinically significant haemorrhage was observed in 1 (0.8%) case and was successfully arrested by conservative therapy. It was shown that local thrombolysis contributed not only to improving perfusion of the lesser circulation, a reduction of pressure in pulmonary arteries and the right heart, but also to a decrease or normalization of the linear dimensions of the right auricle and right ventricle, as well as prevented the formation of chronic postembolic pulmonary hypertension in more than 90% of patients. It was also demonstrated that while performing this type of treatment, the initial level of pulmonary hypertension did not influence either the prognosis or the outcome of the disease.
Asunto(s)
Hipertensión Pulmonar , Embolia Pulmonar , Terapia Trombolítica , Adulto , Anciano , Ecocardiografía/métodos , Femenino , Hemodinámica , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/prevención & control , Masculino , Persona de Mediana Edad , Pronóstico , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Estudios Retrospectivos , Siberia , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Disfunción Ventricular Derecha/diagnóstico , Disfunción Ventricular Derecha/etiologíaRESUMEN
The article deals with a case report regarding successful surgical management of late type IB endoleak caused by dislocation of the leg of the stent graft, occurring three years after endoprosthetic repair of an aneurysm of the aortic infrarenal portion with the COOK stent graft, aneurysmectomy with prosthetic repair of the right common femoral artery using the linear vascular graft Intergard 8Ч20. The patient underwent surgical treatment: endoprosthetic repair of the iliac branch ZSLE-24-90-90 ZT of the Zenith Spiral AAA stent graft. The findings of the check-up angiography and ultrasonographic examination revealed no evidence of endoleak, with the stent graft's patency preserved. The early postoperative period was marked with moderate manifestations of asthenic syndrome. The patient was discharged in a satisfactory condition. Cases concerning removal of similar complication in the remote period following endoprosthetic repair of the aorta are mentioned sporadically in the available literature.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular/efectos adversos , Endofuga , Procedimientos Endovasculares/métodos , Stents/efectos adversos , Anciano , Angiografía/métodos , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Endofuga/diagnóstico , Endofuga/etiología , Endofuga/fisiopatología , Endofuga/cirugía , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/cirugía , Masculino , Reoperación/métodos , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
The article deals with a case report regarding successful surgical management of a patient presenting with an anatomically complicated aneurysm of the aortic infrarenal portion and iliac arteries. The first stage consisted in performing implantation of the Ovation Prime stent graft into the abdominal aorta. One month later, the second stage carried out for residual type IB endoleak consisted in implantation of the iliac components of the stent graft into the external iliac arteries on the right and the left. The postoperative period turned out uneventful. The findings of the check ultrasonographic examination showed no evidence of endoleak, with the stent graft's patency preserved. The patient was discharged in a satisfactory condition. The check multispiral computed tomography performed 30 days after the operation also demonstrated complete isolation of the aneurysm of the aorta and iliac arteries from blood flow, with the graft's being patent. The presented herein clinical case report is of sporadic occurrence and is of practical importance for extending the indications for aortic endoprosthetic repair.