[Endovascular interventions in patients with glass iii infrainguinal arterial disease: 2-year results]. / Endovaskulyarnye interventsii u patsientov s infraingvinal'nymi porazheniyami GLASS III stepeni: rezul'taty dvukhletnego nablyudeniya.

OBJECTIVE: To evaluate the results of endovascular surgery in patients with chronic limb-threatening ischemia (CLTI) with infrainguinal arterial disease GLASS III. MATERIAL AND METHODS: Treatment outcomes were analyzed for the period 2017-2018. Inclusion criteria were age over 18 years, CLTI, extended (>20 cm) stenosis de novo and occlusion of femoropopliteal segment (FPS) combined with occlusive lesion of tibial arteries. We analyzed 147 patients divided into 2 groups depending on stenting strategy. FPS-1-TA included 53 patients who underwent angioplasty (± stenting) of femoropopliteal arteries and lower leg arteries resulted at least one patent tibial artery. FPS-2-TA enrolled 94 patients who underwent angioplasty of femoropopliteal arteries and lower leg arteries resulted ≥2 patent tibial arteries. Mean age was 71.0±9.8 years. There were 75 men. Demographics and clinical characteristics of patients were similar. RESULTS: Technical success rate was 100%. Mean length of stenting was 203 ± 99 mm. Occlusion of all 3 leg arteries correlated with high incidence of femoropopliteal stenting. In the FPS-1-TA group, stents were implanted in 39 patients, in the FPS-2-TA group - in 71 patients (73.6% and 75.5%, respectively, p=0.8). Braided nitinol stents were used for stenting of the lower third of superficial femoral artery and p1-p3 segments. Mean follow-up period was 22.6±1.1 months. Two-year results were not age-specific in our study. Kaplan-Meier overall survival, freedom from amputation and amputation-free survival for the entire sample were 79.6%, 81.0%, and 66.7%, respectively. We compared these values in both groups using Mantel-Cox log-rank test and obtained significant differences (67.9% vs 86.2%, p=0.004; 64.2% vs 90%, p<0.0001; 47.2% vs 77.7%, p<0.0001, respectively). CONCLUSION: Our results are comparable with literature data regarding freedom from amputation and amputation-free survival. We obtained significant differences in overall survival and freedom from amputation depending on endovascular strategy for tibial arteries. Correction of distal vessels with recanalization of at least two tibial arteries is advisable for endovascular treatment of diffuse complex lesions.

[Endovascular revascularisation in patients with necrotic wounds and extended infrainguinal arterial disease]. / Endovaskulyarnaya revaskulyarizatsiya u patsientov s gnoino-nekroticheskimi ranami nizhnikh konechnostei s infraingvinal'nym protyazhennym porazheniem arterial'nogo rusla.

OBJECTIVE: To report own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. MATERIAL AND METHODS: We have analyzed literature data and own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. RESULTS: Endovascular strategy is preferable in a certain subgroup of patients with extended infrainguinal lesions. CONCLUSION: Considering own data, we assumed the need for routine correction of outflow pathways (simultaneous angioplasty of at least 2 tibial arteries). Primary results are encouraging, but further research is required.

[Revascularisation in patients with failed previous arterial reconstructions]. / Metody revaskuliarizatsii u patsientov s narusheniem prokhodimosti ranee vypolnennykh arterial'nykh rekonstruktsii.

Redo arterial reconstructions are followed by advanced surgical risk or impossible in some cases. Active introduction of endovascular surgery complements the capabilities of conventional surgical approach. It is presented case report of restoration of patency of synthetic femoral-popliteal shunt with previous occlusion for a long time. The technique of recanalization and stenting of allograft is described. Immediate results are favorable but further research is needed.

[Remote results of endovascular atherectomy with the SilverHawk device].

The authors studied the remote results of 27 endovascular catheter atherectomies performed in 25 patients. All patients had lesions of arteries of the femoropopliteal segment according to the TASC II classification. The duration of follow up varied from 6 to 34 months. Endovascular catheter atherectomy was carried out by means of the SilverHawk EV3 system with protection of the distal bed from embolism using Spider EV3. Our findings prove that catheter atherectomy with the SilverHawk system is most efficient it treatment of short stenotic lesions, lesions localizing in the zone of increased dynamic activity, multi-level lesions of arteries of the femoropopliteal segment, as well as short lesions in patients suffering from diabetes mellitus.

[Microscopic investigation of vessel wall after endovascular catheter atherectomy].

Endovascular target catheter atherectomy (ETCA) - method of artery patency allowing to obtain occlusion substrate. Given the high destructive effect of atherectome's elements on tissue the objective was determination possibility of histological and electron microscopic investigation of this substrate after atherectomy. The research included 8 patients who underwent ETCA of legs arteries. It was observed substrate removal from broken stent in 1 case. 2 of 8 patients had diabetes. Obtained substrate was available for histological and electron microscopic investigation. Atherosclerosis was confirmed in all cases. It was not observed substrate significant morphological changes in patients with presence or absence of diabetes. Microscopic investigation of substrate from broken stent shows pronounced development of granulation tissue that was regarded as special form of reparative regeneration. Finding internal elastic membrane during microscopic investigation in some cases proves radical intervention. The authors consider that microscopic investigation of substrate after ETCA may be used for diagnosis verification, thorough analysis of morphological changes in lesion area and radicalism of atherectomy.

[Experience with transradial approach in roentgenoendovascular interventions on coronary arteries].

OBJECTIVE: To assess efficacy of the transradial approach and to evaluate possibility of its wide application for coronary interventions as an alternative to the transfemoral access. MATERIAL AND METHODS: A total of 317 percutaneous coronary interventions were performed in 312 patients presenting with coronary artery disease. Percutaneous coronary interventions (PCI) performed through the radial artery (RA) were made using the instruments manufactured by the Terumo Corporation. RESULTS: The right-sided radial approach (RA) was used to perform 172 (54.25%) diagnostic and 42 (13.25%) therapeutic coronary interventions. In 18.30% (n=58) of cases we failed to perform PCI through the RA due to various reasons. Compression haemostasis on the right radial artery in 100% of cases was performed using the device for compression of the puncture site TR Band (Terumo, Japan). Complications related to the approach occurred in 1.25% of cases: thrombosis of the radial artery with no evidence of ischaemia of the hand (n=1), haematoma of soft tissues of the forearm (n=1), haematoma of soft tissues of the shoulder (n=2). A dramatic decrease in the duration of PCI was achieved at the expense of using the RA, hydrophilic guide wire and introducer, universal catheter Tiger and Ikari guide catheters (Terumo, Japan). CONCLUSION: The radial approach makes it possible to perform coronary interventions rapidly, conveniently for both the patient and the roentgenosurgeon. The use of specialized tools makes it possible to perform an atraumatic and mild arterial access, decreasing the rate of haemorrhagic complications, providing rapidity, safety, and full control over PCI.