[Outcomes of endoprosthetic repair of abdominal aortic aneurysm]. / Rezul'taty éndoprotezirovaniia anevrizmy briushnogo otdela aorty.

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.

[Robotic-assisted operations for pathology of the aortoiliac segment: own experience]. / Robot-assistirovannye operatsii pri patologii aorto-podvzdoshnogo segmenta: nash opyt.

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.

[Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions]. / Autoarterial'noe remodelirovanie bifurkatsii obshchei sonnoi arterii v lechenii stenoticheskikh porazhenii.

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.

[Comparing efficacy of recanalization with stenting of extended occlusions of superficial femoral artery and loop endarterectomy]. / Sravnenie éffektivnosti rekanalizatsii so stentirovaniem protiazhennykh okkliuzii poverkhnostnoi bedrennoi arterii i petlevoi éndarteréktomii.

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.

[Endovascular interventions for stenoses and occlusions of the brachiocephalic trunk]. / Éndovaskuliarnye vmeshatel'stva pri stenozakh i okkliuziiakh brakhiotsefal'nogo stvola.

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.

[Results of endovascular interventions in patients with occlusive stenotic lesions of arteries of the aortoiliac segment].

Presented herein are the results of endovascular interventions performed in a total of 220 patients with chronic ischaemia of lower limbs and occlusive and stenotic lesions of the aortoiliac arterial segment. Group One patients (n=155) underwent angioplasty with stenting (a total of 186 interventions performed) and Group Two patients (n=65) were subjected to recanalization of the occlusion zone with stenting (65 interventions). The remote results were assessed in all patients within the terms of up to 4 years. In Group One patients, restenosis of the stented segments within the mentioned terms of follow up was revealed in 11 (7.1%) cases, thrombosis - in 5 (3.2%) cases. In Group Two patients restenosis was detected in 3 (4.6%) cases and thrombosis of the stented segment in 6 (9.2%) cases. In the both groups, restenosis >50% or thrombosis of the stented segment developed significantly more often with the length of the stented segment exceeding 100 mm (p=0.01 in Group One and p=0.0077 in Group Two). Primary patency of the stented segments at 12 and 24 months after the intervention in Group One amounted to 97.5±1.5 and 92.3±3.3% and in Group Two 92.7±3.6 and 81.9±6.6%, respectively. A conclusion was made that endovascular interventions may be a method of choice in occlusive and stenotic lesions of the aortoiliac-segment arteries. Extended length of the lesion of iliac-segment arteries (more than 100 mm) deteriorates the rates of primary patency after stenting.