[Management of thrombotic occlusions of femoropopliteal bypass grafts treated by a combined method].

Presented in the article are two clinical case reports concerning remote results of successful surgical management of thrombotic occlusions of femoropopliteal bypass grafts treated by a combined method. The first stage of surgical treatment in both cases in the roentgen-equipped operation room consisted in open thrombectomy of the shunt, with the second stage being endovascular recanalization - in the first case balloon angioplasty of the proximal and distal anastomosis and in the second case - balloon angioplasty and stenting of the distal anastomosis, distal arterial bed.

[Comparative characteristics of the open and endovascular methods of treatment for carotid artery stenoses].

The article is dedicated to the problem concerning treatment for stenoses of the extracranial portions of carotid arteries. From March 2004 to November 2009 at the Department of Vascular Surgery No 2 of the N. A. Semashko Central Clinical Hospital No 2 we treated a total of 364 patients presenting with stenotic lesions of the extracranial portion of the carotid arteries. Of these, 176 patients underwent revascularization of the carotid basin: 120 patients endured open carotid endarterectomy (CEAE), 56 patients sustained carotid angioplasty and stenting (CAS), with a total of 128 CEAE and 67 CAS interventions performed. The following conclusion was made: with high skill of surgeons and broad experience in carrying out revascularization of the carotid basin, the CEAE and CAS procedures possess comparable efficacy and safety with CEAE possessing reliable advantage in terms of the parameters of the patient's quality of life.

[Treatment of occlusive vascular diseases of the lower extremities using the method of autologous transfusion of UV-irradiated blood]. / Lechenie obliteriruiushchikh zabolevanii sosudov nizhnikh konechnostei metodom autotransfuzii UF-obluchennoi krovi.

Knott's autotransfusion of UV-irradiated blood was performed in 163 inoperable patients, including 141 patients with obliterating atherosclerosis and 22 patients with endarteritis. Good clinical effect was produced that was particularly apparent in patients with obliterating atherosclerosis. Assessment of the effects of autotransfusion of US-irradiated blood on microcirculation, peripheral circulation, hemostasis and humoral immunity in the two samples confirmed the method's efficiency.

[Reconstructive operations in surgical treatment of vasorenal hypertension]. / Rekonstruktivnye operatsii pri khirurgicheskom lechenii vazorenal'noi gipertonii

The experience of 313 reconstructive operations performed in 289 patients with renovascular hypertension is analysed. The importance of choosing the surgical procedure with due regard of the etiology and extent of the pathological process is emphasized. The most effective and frequently employed reconstructive procedures consisted in the author's original technique of transaortic endarterectomy (232 operations), resection of the renal artery with reimplantation of the ostium into the aorta (19 operations), renal artery resection with an end-to-end anastomosis (23 operations). In cases of bilateral lesions of the renal arteries two-stage procedures are recommended, spaced 3-4 months apart. Reconstructive interventions on the single renal artery are described.

[Features of renal dynamics among patients with vasorenal hypertension according to rheographic findings]. / Osobennosti pochechnoi gemodinamiki u bol'nykh s vazorenal'noi gipertenziei po dannym reografii.

Preoperative and late postoperative rheonephrographic findings in 23 patients with vasorenal hypertension are reported. Renal rheography was supplemented with a controlled hypotension test. Diagnostic and predictive value of renal rheography and the controlled hypotension test is explained. Indirect evidence of the irreversible nature of renal angiosclerotic changes on the side of occlusive lesion was demonstrated in patients with poor surgical results and a relatively intact contralateral kidney.

[Importance of morphologic examination of the kidneys of patients with vasorenal hypertension for predicting the results of surgical treatment]. / Znachenie morfologicheskogo issledovaniia pochek bol'nykh vazorenal'noi gipertenziei dlia prognoza rezul'tatov khirurgicheskogo lecheniia.

Light-optical, electron microscopic and morphometric studies of biopsy material from kidneys of 24 patients with vasorenal hypertension were performed. It was determined that sclerosis of the arteries and arterioles on the side of the lesion was more marked, than in the contralateral kidney. At a later stage of the disease (more than 3 yr.) there were occasional signs of increased renin-synthesizing activity of the juxtaglomerular apparatus (JGA) with its simultaneous decrease at the stenotic side. JGA activation in the contralateral kidney can be one of the mechanisms supporting hyperrenin arterial hypertension and can prevent the decrease of the blood pressure after surgery. Studying of the biopsy material with the estimation of the sclerosis degree of the arterial tree vessels, as well as JGA activity, is important for prognosing the results of surgical treatment of vasorenal hypertension.

[Relation of the effectiveness of surgical treatment of vasorenal hypertension and morphologic changes of the kidneys]. / Zavisimost' éffektivnosti khirurgicheskogo lecheniia vazorenal'noi gipertenzii ot morfologicheskikh izmenenii pochek.

Renal puncture and incision biopsy specimens were investigated, using light and electron microscopic techniques, in 34 patients with vasorenal hypertension. The magnitude of the hypotensive effect of reconstructive surgery on renal arteries is shown to be largely dependent on the severity of arteriolosclerosis in the ischemized kidney rather than the contralateral one. Quantitative assessment of the severity of renal arteriolar sclerosis has established a critical vascular index (the ratio of arteriolar wall thickness to lumen diameter) above which the probability of reconstructive surgery producing a hypotensive effect becomes rather low.

[Potential use of mathematical methods for predicting the surgical treatment results in renovascular hypertension]. / O vozmozhnosti ispol'zovaniia matematicheskikh metodov dlia prognozirovaniia rezul'tatov khirurgicheskogo lecheniia bol'nykh vazorenal'noi gipertoniei.

The duration of the case history was determined in 16 patients with vasorenal hypertension caused by unilateral lesion of the renal arteries, as well as renal activity in peripheral and reno-venous blood, Tmax and T1/2 according to the findings of renography, and blood flow in the renal artery before and after reconstruction according to the results of intraoperative flow measurement. The set of characteristics obtained was used in prognosing the parameters of arterial pressure (AP) in the postoperative period by means of regression analysis. The relative root-mean-square error in prognosing systolic AP was 15% and diastolic AP 20%. Nomograms for determining AP parameters according to the combination of characteristics were elaborated.

[Complex clinical and morphofunctional study of vasorenal hypertension]. / Kompleksnoe kliniko-morfofunktsional'noe issledovanie u bol'nykh vazorenal'noi gipertoniei.

Hemodynamics, elastic characteristics of the greater arteries and blood renin activity were studied at the different stages of the disease in 23 patients with renovascular hypertension, caused by unilateral stenosis of the renal arteries. In 14 cases electron microscopy of the bioptic specimens of the impaired kidney was performed. It was shown that the peripheral plasma renin activity plays the leading role in the pathogenesis of arterial hypertension in the disease duration up to 3 years. The irreversible changes of the renal juxtaglomerular apparatus and the depression of their renin synthesizing function occur with progressing hypertension, and the secondary pressor mechanisms and factors prevail in the pathogenesis of hypertension. The loss of the arterial elastic properties as well as the depression of the renal hypotensive function may be one of the factors determining the failure of surgery at the late stages of the disease.

[The clinical aspects of using Vazaprostan in patients with atherosclerotic involvement of the vessels of the extremities]. / Klinicheskie aspekty primeneniia vazaprostana u bol'nykh s ateroskleroticheskim porazheniem sosudov konechnostei.

A study was made of the clinical efficacy of vasaprostane and its influence on peripheral hemodynamics, microcirculation and hemostasis. The results of the studies made it possible to ascertain that the drug is highly effective, which enables the abatement of the ischemic syndrome to be attained. Vasaprostane was found to improve regional hemodynamics and microcirculation. In addition, it corrected hemostatic disorders.

[Diagnosis and microsurgical correction of impotence of vascular origin]. / Diagnostika i mikrokhirurgicheskaia korrektsiia vaskulogennoi impotentsii.

The authors worked out an original complex of instrumental methods for the diagnosis of impotence of vascular origin, which includes ultrasonic Dopplerography of the genital arteries, radionuclide examination of hemodynamics of the penis, and radiocontrast phalloarteriography with the use of intracavernous pharmacological load. The results of the study make it possible to increase essentially the efficacy of microsurgical correction of impotence of vascular origin through objective indications for operative treatment on the basis of the suggested diagnostic methods, improvement of the techniques of revascularization of the cavernous bodies, and pathogenetically substantiated tactics of postoperative rehabilitation of patients.

[Prognostication of the degree of the hypotensive effect of revascularization of both kidneys in patients with renovascular hypertension]. / Prognozirovanie stepeni gipotenzivnogo éffekta revaskuliarizatsii obeikh pochek u bol'nykh s vazorenal'noi gipertenziei.

A method for prognosticating the degree of a hypotensive effect of revascularization of both kidneys was developed on a group of 22 patients with vasorenal hypertension caused by bilateral affections of the renal arteries. It was based on mathematical treatment by the method of multidimensional regressive analysis of some parameters of preoperative examination of the patient and allowed the postoperative arterial pressure value to be calculated in mm Hg.

[Mathematical modeling of the degree of nephroarteriolosclerosis in vasorenal hypertension]. / Matematicheskoe modelirovanie vyrazhennosti nefroarteriolo- skleroza pri vazorena'lnoi gipertenzii.

Comparison of the findings of clinical, instrumental, and laboratory examination of patients with vasorenal hypertension with the results of morphological analysis of renal bioptic material showed that multivariate regression analysis of the parameters of examination of the patients provides for authentic calculation of the quantitative index of nephroarteriolosclerosis--the vascular index of the afferent arterioles of the renal glomeruli. The calculated values of the vascular index for both kidneys are criteria for choosing the method of operative intervention in vasorenal hypertension.

[Administration of prostaglandin E1 in the treatment of patients with chronic lower limbs critical ischemia with concomitant ischemic heat disease]. / Lechenie bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei s primeneniem prostaglandina E1 na fone soputstvuiushchei ishemicheskoi bolezni serdtsa.

Drug treatment of chronic lower limbs critical ischemia (CLLCI) remains an important problem, particularly in patients with concomitant ischemic heart disease treated with prostaglandins E1 (PGE1). Experience in treatment of these patients with alprostadil is presented. Symptoms of a high risk of coronary events are demonstrated, prophylactic measures are proposed.

[Comparative assessment of the results of open carotid endarterectomy and carotid aftery stenting]. / Sravnitel'naia otsenka rezul'tatov otkrytoi karotidnoi éndarteréktomii i stentirovaniia sonnykh arterii.

A comparative study of 48 carotid stent grafting and 23 open carotid endarterectomies was carried out. Patients of both groups were comparable by cerebrovascular insufficiency degree and concomitant diseases. General rate of complications after carotid stent grafting (CSG) was 5.1%. There was a small ischemic stroke with right-sided hemiparesis and aphasia in one patient during CSG. Complete regress of the neurological symptoms was seen on the 5th day. In the nearest postoperative period after CSG there was a big ischemic stroke in the territory of MCA in one patient. Rate of complications after open carotid endarterectomy (OCEAE) was 8.7% Transient ischemic attacks were seen in 2 patients in early postoperative period. Paresis of the IX cranial nerves was in one patient. In long-term postoperative period after CSG 2 patients died due to cardiac causes. One patient died 18 months after OCEAE due to ischemic stroke. In long-term period after OCEAE restenosis of the internal carotid artery was seen in 4.5% cases, while there were no restenosis after CSG. It is concluded that CSG is an effective method of treatment of carotid stenosis with lower lethality and postoperative complications rate compared with OCEAE. Indications for CSG are symptomatic stenosis of ICA (>60%), asymptomatic stenosis of ICA(>70%), two-sided lesions of the carotid arteries, carotid stenosis with lesions of other brachiocephalic arteries, insufficiency of Willis circle.

[Role of the lungs in the regulation of the generation of active oxygen forms by leukocytes under normal and pathological conditions]. / O roli legkikh v reguliatsii generatsii aktivnykh form kisloroda leikotsitoami v norme i patologii.

Studies conducted in the clinic (in patients with cardiac diseases) and experiments (performed on intact dogs) by means of the hemiluminescent method and the nitroblue tetrazolium test showed that the lungs, in distinction to other organs (heart and others), have a stimulating effect on the generation of active oxygen forms (AOF) by the leukocytes. In this way the lungs may probably play a double role in the organism: potentiate its defence (by intensifying the microbicidal activity of the phagocytes) and facilitate damage (by secretion of AOF by the phagocytes beyond them--into the tissues); the resultant effect depends on the balance of these two types of action. In carcinoma of the lung the stimulating effect of its involved lobe (part) on the leukocytes diminishes.