[Eduard Nikitich Vantsian: to the 100th anniversary of the birth]. / Eduard Nikitich Vantsyan: 101 god so dnya rozhdeniya.

One hundred and one years ago Eduard Nikitich Vantsyan (1921-1989), an outstanding Soviet surgeon, B.V. Petrovsky's pupil, Doctor of Medicine, Professor, Corresponding Member of the USSR Academy of Medical Sciences, was born (Fig. 1). He was the author of more than 120 scientific works and 6 monographs devoted to the study of motor function and surgery of the esophagus, conservative treatment of its constrictions and cardiospasm, diseases of the operated esophagus. He had developed methods of total and segmental plasty of the esophagus, treatment of hernias of the esophageal aperture of the diaphragm and diverticula of the esophagus. He supervised 26 dissertations, including 12 doctoral theses. Eduard Nikitich is considered one of the founders of esophageal and diaphragm surgery.

[Treatment of recurrent traumatic sternomediastinitis after cardiac surgery]. / Lechenie retsidivnogo travmaticheskogo sternomediastenita posle kardiokhirurgicheskikh operatsii.

OBJECTIVE: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.

[Negative pressure wound therapy for deep sternal wound infections: microbiological characteristics and antibiotic resistance]. / Vliyanie vakuum-assistirovannoi povyazki na lechenie glubokoi infektsii grudiny: bakteriologicheskii analiz i antibiotikorezistentnost'.

OBJECTIVE: To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen. MATERIAL AND METHODS: There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week.Results. Mixed infection was observed in 38 (37.3%) patients. S.aureus was the most common pathogen (n=51, 50%), Gram negative bacteria were found in 36 (35.3%) patients. Negative pressure wound therapy ensured eradication of S.aureus within 3 weeks while dressings were associated with only 40% decrease of the incidence of positive analyses (p<0.05). Effectiveness of the method was not obtained for Gram negative bacteria. CONCLUSION: Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.

[Efficiency of minimally invasive methods in treatment of varicose veins].

It was analyzed the results of studies comparing an efficiency of minimally invasive methods in treatment of varicose veins of lower extremities. Based on presented data similar efficiency of minimally invasive methods and conventional surgical treatment was proved. The graph reflecting remote results was made.

[Surgical treatment of patients with chronic lower limb venous insufficiency and trophic disorders].

The experience in surgical treatment of 326 patients with IV-VI degree chronic lower limb venous insufficiency (CEAP) is analyzed. Correction of disorders of venous hemodynamics was performed with surgical methods and sclerotherapy. The best clinical and functional results in long-term period were achieved in patients undergone surgery in an early stage of the disease without deep veins valves insufficiency and external trophic disorders. Pathology of deep veins required correction of valves function. It is concluded that these patients require complex approach to the treatment.

[Evaluation of results of surgical treatment of obliterating thrombangiitis in patients living in the North Arctic]. / Otsenka rezul'tatov khirurgicheskogo lecheniia obliteriruiushchego trombangiita u bol'nykh, prozhivaiushchikh v usloviiakh Krainego Severa.

Immediate and long-term results of surgical treatment of patients with obliterating thrombangiitis in patients living in Arctic North are analyzed. It is revealed that course of disease depends on length of patient's stay in Arctic North. These patients were younger, demonstrated more intensive progression of disease and more distal type of arterial lesion. Surgical treatment permitted to save 75.9% extremities in patients living in Arctic North with thrombangiitis and critical ischemia during 5 years after surgery that is worse than in patients living in Moscow region -- control group (86.1%). In long-term period more stable positive result was achieved after indirect revascularisation (save of extremity 78.3%).

[Organization of treating patients with major vessel injuries at stages of evacuation]. / Organizatsiia lecheniia postradavshikh s raneniiami magistral'nykh sosudov na étapakh évakuatsii.

The experience in treatment of 236 patients with primary injuries of major vessels is presented. A pressure dressing and tense surgical pack of the wound were used in a prehospital treatment. Use of a hemostatic tourniquet (37.3%) led to increased ischemia of injured extremity tissues. Maximal shortening of evacuation time is another important factor. Time to qualified surgical care was 3.2 +/- 0.4 hrs from injury moment, specialized--5.5 +/- 0.7 hrs. Shock was seen in 94.9% wounded. It is necessary to begin anti-shock treatment immediately after injury. Surgery was started only after shock compensation. If shock was caused by continued bleeding, surgery was started at the same time with anti-shock treatment (5.7%). Temporary shunt was used in field conditions in 35.9% wounded. In 11 (19.7%) cases endoprosthesis of original construction (two-lumen tube with microirrigator) was used. If this device was used there were no cases of arterial or venous thrombosis at the stage of specialized treatment. Since using of temporary endoprosthesis leads to delay of evacuation for specialized care it was performed only in cases of gangrene's threat when arrest of bleeding could not be performed with other methods.

Surgical treatment of patients with renovascular hypertension secondary to aneurysmal lesions of the renal arteries.

The paper analyzes the results of examination and surgical treatment of 71 patients with renal artery (RA) aneurysms which constituted 3% among all the subjects treated and examined at the Russian Scientific Centre of Surgery, Russian Academy of Medical Sciences (RSCS RAMS). Fibromuscular dysplasia caused RA aneurysm most frequently (60%). Contrast radioangiography was the basic modality used in the diagnosis of RA aneurysms. While making decision as to whether the surgical treatment is feasible, preference was given to reconstructions on the renal arteries in order to reduce systemic arterial pressure and to maintain renal function. Resection of the aneurysmal renal artery was resorted to most frequently, followed by establishment of an end-to-end anastomosis (38.2%). Lateral resection of RA aneurysm was employed only in the event of its eccentric bulging and when its diameter did not exceed 15-20 mm (22.1 %). There were no lethal outcomes. The positive results could be obtained in 93.6% of patients. In the long-term postoperative period, the stable positive results were recorded in 60.9% of patients with a history of reconstructions on the renal arteries for their aneurysmal lesion.

[Reconstructive surgeries on deep femoral artery in chronic critical limb ischemia]. / Rekonstruktivnye operatsii na glubokoi arterii bedra pri khronicheskoi kriticheskoi ishemii konechnostei.

Possibilities of revascularisation of the lower extremity through the deep femoral artery in elderly and aged patients with chronic critical limb ischemia were evaluated. Forty-nine patients with high surgical risk were studied. Safety of the extremity, decrease of ischemia degree and level of amputation were the main problems in surgical treatment. Deep-femoral-popliteal index was very important. If this index was less 0.3 surgeries on deep femoral artery were effective. If index was 0.3-0.5 results of surgery were questionable. Index more than 0.5 is the factor of unsuccessful revascularisation through the deep femoral artery.

[Surgical policy in patients with diffuse arterial lesion of lower extremities]. / Taktika khirurgicheskogo lecheniia bol'nykh s diffuznym porazheniem arterii nizhnikh konechnostei.

In spite of the achievements of contemporary surgery the rate of unfavoutable outcomes of reconstructive operations is keeping on to be high. Early postoperative complications because of inadequate choice of method for surgical treatment mount to 25%. Classification of the lesions of arteries of lower limbs is developed with due regards to functional and angiographic data. Simultaneous stenotic total lesions of the aorta, iliac, femoral, popliteal and tibial arteries lesions were considered as diffuse ones. The kind of surgical intervention is such lesions was determined according to functional reserve of collateral blood flow of the lower extremity. In such cases reconstructions only of aorto-iliac segment or multilevel reconstruction is possible (two-stage or one-stage reconstruction). The operation of choice was one-stage reconstruction.

[Complex approach to diagnosis and surgical treatment of patients with abdominal aortic aneurysm (classification)]. / Kompleksnyi podkhod k diagnostike i khirurgicheskomu lecheniiu bol'nykh anevrizmami briushnogo otdela aorty (klassifikatsiia).

The problem of management of abdominal aortic aneurysm (AAA) is becoming urgent due to growing AAA incidence. Most often concomitant disease in them is coronary artery disease (CAD) which itself is a risk factor for life. The study was performed in 249 patients, who underwent. Surgery for AAA in RAMS Research Center for Surgery in 1975-1997. 142 (57%) of them had associated CAD. The use of complex approach to the diagnosis in this category of patients has made in possible last years to increase detection of CAD by more than 75%. In surgical management the principle of dominant in lesion of one of these regions was used. In critical conditions of both regions one stage regions was used. In critical conductions of both regions one stage reconstruction was performed. This technique is well developed now. The proposed classification helps to assess completely concomitant diseases in patients with AA and to determine policy of surgical treatment individual for each patients.

[Surgical treatment of patients with chronic critical ischemia of legs, caused by atherosclerosis]. / Khirurgicheskoe lechenie bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskoi etiologii.

208 patients with primary chronic critical ischemia of lower extremities (CCILE) were operated on from 1988 to 1995. The criteria of CCILE were the following: ischemia of an extremity in rest with specific ischemic pain for more than 2 weeks; existence of ulcernecrotic changes in distal parts of the extremity; brachiommalleous index (BMI) less than 0.35; malleous systolic pressure less than 50 mm Hg. Functional condition of the patients corresponded to class 3A, B and 4. The share of patients with CCILE among patients with lower extremities arterial lesions was 35%. In 150 (72%) of them there were lesions of aorto-illo-femoral-tibio-popliteal segment; in 58 (28%)-damage of a femoral-popliteal-tibial segment. The number of patients with trophic changes appear in early stage. 154 reconstructive operations have been performed in patients with multiple arterial lesions higher and lower of the Poupart's ligament, and only one primary amputation and sympathectomy. In 63 (42%) of the patients the "two-floor" reconstruction has been performed. In 142 (92%) of the cases positive results have been achieved. In 78.5% cases the grafts were competent a year after the surgery and the extremities were saved in 88% of the patients. 60 reconstructive operations, 3 primary amputations and 1 sympathectomy have been performed in patients with the lesions, located lower than Poupart's ligament. In 58 (96%) of the patients positive results were achieved. One year after surgery the grafts patency was 63.5%, and extremities were saved in 79% of the patients. The immediate and long-term follow-up results of femoral-politeal and femoral-tibial grafting did not differ significantly. Long-term follow-up results were better in case of less duration of CCILE before surgery. Adequate revascularisation of the extremity is an optimal method of treatment of patients with CCILE.

[Reconstructive surgeries on abdominal aorta and leg's arteries in combination with coronary and brachiocephalic vascular atherosclerosis]. / Vosstanovitel'nye operatsii na briushnoí aorte i arteriiakh nizhnikh konechnosteí pri sochetanii ikh ateroskleroticheskikh porazhenií s aterosklerozom koronarnykh i brakhiotsefal'nykh sosudov.

The paper presents the 10-year outcomes of treatment of 260 patients with combined vascular atherosclerotic lesions of the heart, brain, and lower extremities. Pandopplerography of peripheral vessels, ECG, EchoCG revealed combined lesions to the major vascular basin in 12% of all the patients with atherosclerosis. The lower extremity vascular basin was surgically corrected in 134 patients. Both one-stage operations making up 19% of all interventions and providing evidence for their high efficiency and multistage or isolated reparative operation on the abdominal aorta and leg arteries. The total mortality was 7.5% when the lower extremity vascular basin was corrected in three-region lesions; amputations were performed in 3% of patients.

[35 years of experience in reconstructive operations in surgery of vasorenal hypertension]. / 35-letnií opyt rekonstruktivnykh operatsií pri khirurgicheskom lechenii bol'nykh vazorenal'noí gipertenzieí.

Reconstructive surgery was performed in 1148 patients with renal hypertension in the period from 1961 to 1996. Extracorporeal microsurgical correction with subsequent kidney autotransplantation was used in case of the lesions of the renal arteries branches. In 161 (14%) of the patients the result was unsatisfactory. The reasons of unsatisfactory results were the following: uncorrected stenosis of the contralateral renal artery (43%), nephrosclerosis of the contralateral kidney (26%), unknown reasons (31%). The long-term results have been followed up in 769 (67%) of the patients in the period for 135 +/- 4 months after the surgery. In 546 (71%) of the patients positive results persisted. The average time of symptomatic recurrence was 74 +/- 6 months after the surgery. Restenosis was the reason of recurrence in 61 (57%) of the patients. Based on these results the following recommendations are postulated: in atherosclerosis--the transaortic endarterectomy from the opening of the renal artery; in fibromuscular displasia--renal artery resection with end-to-end anastomosis; in nonspecific aorcic arteritis--bypass operations.

[Autologous vein bypass surgery in situ for reconstructive surgery of blood vessels of the leg]. / Autovenoznoe shuntirovanie po metodike in situ v rekonstruktivnoi khirurgii sosudov nizhnikh konechnostei

The paper analyzes the authors' own experience with femorodistal bypass surgery in situ in patients with lower extremity vascular occlusive lesions. The patent distal bed and the intact superficial saphena are obligatory conditions for these operations. The paper details the surgical procedure, criteria for adequate blood flow recovery, the spectrum and incidence of complications in the immediate postoperative period. The beginning of the paper presents a brief review of the data available in the literature, which shows the present status of this worldwide problem.

[Current problems of reconstructive surgery in patients with lesions of the visceral branches of the abdominal aorta]. / Aktual'nye voprosy rekonstruktivnoi khirurgii u bol'nykh s porazheniem vistseral'nykh vetvei briushnoi aorty.

This work is devoted to a current topic of vascular surgery, treatment of patients with such severe ailments as vasorenal hypertension and chronic abdominal ischemia. These diseases are secondary to the affections of the visceral branches of the abdominal aorta. The possibilities for their complete cure by means of reconstructive surgery are discussed. Results of surgery are analysed in 830 patients with affection of the visceral branches of the abdominal aorta, in whom reconstructive operations were performed: in 774 patients on the renal arteries and in 56 patients on unpaired visceral branches. Specific reconstructive operations are discussed in terms of their etiology and clinical manifestations. The immediate and long-term postoperative results were studied in these patients with the follow-up period lasting to 25 years. The necessity to assign such categories of patients to reconstructive surgery is demonstrated.