[Advantages of profundoplasty in patients with lower limb critical ischaemia in redo operations]. / Preimushchestva profundoplastiki u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei pri povtornykh operatsiiakh.

Our study was aimed at determining advantages of profundoplasty in patients with critical ischaemia of lower limbs in repeat arterial reconstructions. It included a total of 56 patients subjected to redo operations for thrombosis of a femoropopliteal bypass graft. Of these, 29 underwent profundoplasty (group I) and 27 repeat femoropopliteal bypass grafting (group II). Critical ischaemia was relieved in the early postoperative period in 28 (97%) and 24 (89%) patients of group I and II, respectively. The 3-year patency rate after profundoplasty amounted to 100% and after femoropopliteal bypass grafting to 47% (p<0.05). The lower-limb amputation rates over the 3-year period of follow up amounted to 3 (10%) and 11 (41%), p<0.05, respectively. Over the 3-year period of follow up, there was no statistically significant difference in the values of the ankle-brachial index (p>0.05).

[Significance of the deep femoral ertery in repeat reconstructions]. / Znachenie glubokoi arterii bedra pri povtornykh rekonstruktsiiakh.

Atherosclerosis obliterans is managed by various reconstructions of lower-limb arteries, but despite this, in the immediate and remote postoperative period there appears the necessity to carry out repeat reconstructions, which might be caused by shunt thrombosis, progression of atherosclerosis, etc. One of the methods of solving this problem is revascularization of lower-limb arteries through the deep femoral vein with plasty thereof. In occlusive lesions of the superficial femoral artery, the deep femoral artery plays the key role in blood supply of the entire extremity. The article deals with the principles of repeat surgical treatment of lower-limb arteries with the use of the deep femoral artery, also discussing the problems concerning the frequency of occurrence of thromboses in various positions, and the role of the deep femoral artery in blood supply of the lower extremity. The problem of efficacy of redo operations on lower-limb arteries using the deep femoral artery is still important. Despite the possibility of revascularization of lower extremities through the deep femoral vein, a high percentage of amputations remains. The terms of patency of the reconstructed deep femoral artery has proved to be several times longer than those of femoropopliteal and femorotibial shunts in the remote postoperative period. Besides, there are no clear-cut criteria for prognosis of efficacy of reconstructive interventions on the deep femoral artery in patients with multi-segment lesions of arteries of lower extremities after primary interventions, therefore, no common surgical policy exists. The use of the deep femoral artery in patients with ischaemia of lower extremities is explained by the minimally traumatic nature and confirmed efficacy after a series of previously performed multilevel operations, severe lesions of the distal bed, as well as in patients with severe concomitant diseases.

[Hybrid reconstructions in patients with lower limb chronic ischaemia and multilevel arterial lesions]. / Gibridnye rekonstruktsii u bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei i mnogourovnevym porazheniem arterii.

Presented herein is a review of the literature related to performing hybrid operations for multilevel lesions of the arteries of the lower limbs. This is accompanied and followed by analysing the data on variants of stagewise use of different methods of revascularization in hybrid interventions ("open" and endovascular) on the lower extremities, as well as complications, lethality rates, and remote results as compared with the parallel parameters obtained while performing non-hybrid operations.

[Treatment of patients with critical lower limb ischaemia: endovascular methods or reconstructive operations]. / Lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei: éndovaskuliarnye metody ili rekonstruktivnye operatsii.

Presented herein is a review of the literature related to endovascular methods of treatment of patients with critical lower limb ischaemia. This is followed by comparative assessment of the outcomes of endovascular and open surgical interventions. Also covered are problems concerning appropriate therapeutic decision making, taking into consideration peculiarities of lower limb ischaemia and the state at the expense of insufficiency of inflow/outflow.

[Outcomes of surgical revascularization in patients after stenting of lower-limb arteries].

The authors analysed immediate and remote results of primary "open" reconstructive operations and arterial reconstructions performed after previous stenting of lower-limb arteries. The study comprised a total of 93 patients presenting with lower-limb critical ischaemia. Group One consisted of 46 patients with localization of the lesion of lower-limb arteries above the inguinal ligament. Group Two was composed of 47 patients with localization of lower-limb arteries lesions below the inguinal ligament. Each group was subdivided into two subgroups: subgroups Ia and IIa included patients with previously endured stenting of arteries of the respective segment (23 and 22 patients, respectively), subgroups Ib and IIb included patients previously not subjected to either endovascular or surgical treatment (23 and 25 patients, respectively). All patients underwent "open" reconstructive vascular operations. The outcomes of intervention were assessed at the hospital stage, as well as at 6, 12 and 36 months of consecutive follow up. After 8 months of follow up patency of the shunts in all patients amounted to 100%, with the lower-limb salvage rate of 100%. After 1 year, despite differences between subgroups in each group, they were not statistically significant (p>0.05). After 3 years differences in shunts' patency and lower limb salvage rate in subgroups IIa and IIb were statistically significant (p<0.05). By the increment of the ankle-brachial index, the best result after 3 years was achieved in patients with primary arterial reconstruction (subgroups Ib and IIb) as compared to patients with previously endured endovascular interventions. The conclusion was drawn that shunts patency, limb salvage rate and increment of the ankle-brachial index in the remote period after performing primary arterial reconstructions below the Poupart's ligament were better than in patients with previously endured endovascular interventions.

[Surgical treatment of an aneurysm of the deep femoral artery].

We report herein a rare clinical case concerning an isolated deep aneurysm of the femoral artery with extravasal compression of the superficial femoral vein, complicated by venous insufficiency and oedema of the lower extremity. A 66-year-old female patient was admitted complaining of a pulsing formation on the left inguinal region, a feeling of puffiness and heaviness of the left lower extremity. The findings of the ultrasonographic Doppler scanning showed no signs of deep veins thrombosis, however, in the projection of the Skarpovsky's triangle of the left lower limb, there was an aneurysmatic dilatation of the deep femoral artery, arteriovenous malformation (?). In order to specify the diagnosis, we performed multispiral CT angiography revealing an isolated aneurysm of the deep femoral artery. Therefore, we carried out successful resection of the aneurysm with the end-to-side reimplantation of the unaltered distal portion of the deep femoral artery into the superficial femoral artery. Preoperative multispiral CT angiography is a valuable non-invasive diagnostic tool serving to evaluate not only an aneurysm itself but the distal arterial bed.

[Surgical treatment of patients with atherosclerotic occlusion of the aortoiliac segment combined with distal-bed lesions].

Analysed herein are the outcomes of surgical management of a total of 108 patients presenting with atherosclerotic alterations in the aortoiliac segment in a combination with distal-bed lesions. All patients were subdivided into 3 groups. Group One patients were subjected to surgical treatment consisting in isolated aortoiliac bypass grafting. The deep femoral artery according to the findings of the angiographic study appeared to be large and anastomosed with the popliteal artery. Group Two patients underwent simultaneously performed reconstructions on the aortofemoral segment in a combination with femoropopliteal bypass grafting above and below the knee-joint fissure. Reconstructions in Group Three patients were supplemented with indirect revascularizations of the extremities. The operations performed were represented by the following interventions: arterialization of the venous blood flow of the foot, lumbar sympathectomy, revascularizing osteotrephi nation, administration of gene-engineering complexes. The reconstructions in the aortofemoral segment in this group of patients were supplemented with indirect revascularization due to the presence of diffuse lesions of the distal-bed arteries. Analysing both immediate and remote outcomes of surgical management of these patients made it possible to compare its therapeutic efficacy in the represented groups.

[The results of surgical treatment of critical leg ischemia in dependence on wound microbial flora].

The results of treatment of 82 patients with critical lower limbs ischemia were analyzed. All patients had throphic ulcers and gangrene of one or few foot fingers. The study demonstrated the strong correlation between the type of wound microbial flora, distal vessel lesion extetion, type of the arterial reconstruction and limb 1-year survival results.

[Surgical mistakes in treatment of patients with lower limbs' critical ischemia].

The immediate and long-term results of the operative treatment of 473 patients with lower limbs' critical ischemia were analyzed. The ischemia was caused by vascular damage under the level of Pupart ligament. All patients overcame direct and indirect surgical revascularization procedures. The results of the reconstructive operations depended directly upon the transplant permeability both in early and long-term periods. Thus, the shunt thrombosis by femoral-popliteal bypass above the popliteal joint space was 7.5-10.7%, not depending on the operative technique. Whereas, the shunt thrombosis by femoral-popliteal bypass below the popliteal joint space was 8.5-37.0%, directly depending on the operative technique. The thrombosis frequency after femoral-tibial bypass was in between 28.3-100.0%. The comparative analysis proved obvious advantages of direct and combined revascularisations.

[Methods of treatment in patients with lower extremity arterial occlusive disease in presence of distal arterial lesion. (Part II)].

This report is based upon the data published in Russian and foreign reference sources and represents the analysis of methods of treatment in patients with lower extremity arterial occlusive disease in presence of distal arterial lesion.

[Effect of tactical errors on outcomes of surgical management of patients with lower limb critical ischaemia].

The review contains the analysis of the literature dedicated to the problem of surgical treatment of patients presenting with lower limb critical ischaemia, followed by consideration of errors and their effect on the outcomes of both direct and indirect revascularizing operations in lesions of the femoropoplietal-tibial segment.

[Anticoagulants in vascular surgery].

The paper reviews world wide publications on the use of anticoagulant therapy in vascular surgery. The authors analyze an adequate scope of heparin indications, efficiency of perioperative administration of unfractionated and low-molecular weight heparins, comparative efficiency of various heparin formulations, as well as the role of oral anticoagulants.

[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.

[Disorders of rheologic properties of blood and their correction in postthrombophlebitic syndrome]. / Narushenie reologicheskikh svoistv krovi i ikh korrektsiia pri posttromboflebiticheskom sindrome.

Pathogenetic mechanisms of disorders of rheologic properties of blood in postthrombophlebitic syndrome (PTPS) are analyzed. Thirty-six patients were examined and divided into 2 groups. In combined therapy of the study group (18 patients) pentoxyfillin tablets were included. In the control group derivatives of xantin were used. Good clinical effect of pentoxyfillin based on positive influence on rheologic properties of blood was demonstrated. In the study group significant reduction of edema was in 72,2% patients, of pains - in 83,3%. In the control group positive results were achieved only in 55,6% patients.

[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.