[Clinical and ultrasonic predictors of postoperative complications after carotid endarterectomy].

For the period from 2007 to 2012 carotid endarterectomy was performed in 150 patients with cerebrovascular insufficiency I-IV degrees and atherosclerotic lesion of carotid arteries. Dynamic observation was performed by using of duplex scanning of brachiocephalic arteries, transcranial duplex scanning, multislice CT with contrast study of extracranial and intracranial arteries. Different degrees of vascular wall thickening of operated internal carotid artery including neo- and myointimal hyperplasia, restenosis and other complications were observed in 19 (12.6%) patients after carotid endarterectomy on background of cerebrovascular insufficiency progressing. It was revealed that transient ischemic attack or stroke, acute heart failure in early postoperative period, arterial hypertension with crisis course predominantly, diabetes mellitus 2 type, obesity, male sex, elderly age and smoking were clinical markers for complications after carotid endarterectomy. Ultrasonic markers of complications after carotid endarterectomy included terms of development and degree of vascular wall thickening in case of neointimal hyperplasia and restenosis, hyperperfusion syndrome and stroke, significant changes of blood flow velocity and indexes of peripheral vascular resistance.

[Surgical treatment of hemodynamically significant kinking of internal carotid arteries].

38 patients with different forms of vascular cerebral insufficiency, caused by kinking and atherosclerotic changes of internal carotid arteries were operated on. Various types of reconstructive operation on extracranial carotid arteries were performed. The color duplex ultrasound scanning and computed tomography proved to be highly informative noninvasive means for detecting carotid pathology in patients with vascular cerebral insufficiency. Reconstructive operations on internal carotid arteries can serve as prophylactic and treatment measure of chronic cerebral insufficiency. Authors propose the principle of "six types" of reconstructive operations which individualizes the surgical approach. Carotid surgery for asympomatic patients should be performed on strict indications.

[The risk factors and predictors of the clinically significant progression of atherosclerosis in patients with chronic lower extremity ischemia].

AIM: To define the risk factors and predictors of atherosclerosis progression leading to clinical worsening in patients with chronic lower extremity ischemia (CLEI). SUBJECTS AND METHODS: Two hundred and forty patients with lower extremity arterial (LEA) atherosclerosis were examined. All the patients underwent color duplex ultrasound scanning of the great arteries supplying blood to the brain and LEA. Later on an annual observation was made for 11 months to 11 years (mean 45.6 months). To evaluate the influence of various factors on the progression of LEA atherosclerosis, the authors estimated overall survival without progression of CLEI. RESULTS: The one-year overall CLEI progression-free survival was 93.5% (SE = 0.016); 5- and 7-year survival was 66.9% (SE = 0.040) and 53.7% (SE = 0.054), respectively. Over 5 years, a clinically significant progression of CLEI was noted in 32% of the smokers and in 8% of the non-smokers, also in 26% of the patients with grade 1 or 2 hypertensive disease (HD) and in 43% of those with grade 3 HD. The overall CLEI progression-free survival did not depend on the severity of type 2 diabetes mellitus (patients with the severe course were excluded from the analysis). LEA atherosclerosis showed a significantly rapider progression in patients with increased common carotid intima-media thickness (IMT) (p = 0.004). During 5 years, CLEI progression occurred in 18% of the patients with an IMT of < or = 1.0 mm and in 38% of those with an IMT of more than 1.0 mm, in 15% of the patients without hemodynamically significant stenosis (HDSS) of brachiocephalic arteries (BCA) and in 52% of those with HDSS of BCA, as well as in 20% of the patients without ischemic heart disease (IHD) and in 36% of those with symptoms of IHD. CONCLUSION: Smoking that increases the risk of CLEI progression by 2.1 times and severe hypertension are the most important factor influencing the progression of atherosclerosis. The IMT index is a universal predictor of progressive atherosclerosis. It may be presumed that there is a higher process development rate in the detection of HDSS of one of the arterial beds (LEA, BCA, and symptoms of IHD) at the first examination.

[Peculiarities of atherosclerotic damage of brachiocephalic arteries in patients with type 2 diabetes mellitus].

The state of vascular bed of brachiocephalic arteries was studied by the method of color duplex scanning in 250 patients (116 men and 134 women) with atherosclerosis of various vascular basins which in 62 of them took place at the background of type 2 diabetes mellitus (DM). Two hundred five patients had atherosclerosis of brachiocephalic arteries, 45 patients without atherosclerotic plaques in carotid arteries comprised control group. Mean age of patients was 65.3 +/- 7.6 years. A correlation was revealed between parameters of carotid artery stenosis and age of patients, level of arterial pressure, blood plasma concentration of total cholesterol. Degree of interrelation of these parameters was closer in patients with type 2 DM. Among patients with IHD with class I-III effort angina severity of carotid artery stenoses increased with elevation of functional class of angina. This dependence was most pronounced in patients with type 2 DM. Unstable and calcinated plaques were significantly more frequent in patients with type 2 DM than in patients without DM.

[Hypertensive crises: classification and current management]. / Gipertonicheskie krizy: klassifikatsiia i osobennosti lecheniia.

Data of current literature concerning with hypertensive emergencys and urgencies is presented. Hypertensive emergencys is a heterogeneous group of clinical states, caused or complicated by arterial hypertension, that require prompt blood pressure lowering to reduce morbidity and preserve life. The currently available choices for parenteral therapy of hypertensive emergencies and for oral therapy of hypertensive urgencies in selected groups of patients are extensively reviewed.