[Radiologically-guided dilatation in arterial stenosis of transplanted kidney]. / Rentgenovaskuliarnaia dilatatsiia pri stenoze arterii transplantirovannoi pochki.

Stenosis of the artery of a transplanted kidney is a grave complication of the posttransplanation period. Two method are applied for correction of the disease: reconstructive operation and radiologically-guided endovascular dilatation (RED). The primary method of choice is RED of the stenosis. We applied it in 20 patients. The result of the operation in the early postdilatation period was good in 15 (75%) patients, satisfactory in 2 (10%) patients. In 3 cases the method of RED of the stenosis failed because of technical complications. Restenosis occurred in 8 (47%) patients in the late-term periods after correction. Attempts to repeat RED were successful in 5 patients.

[Reparation of the vascular wall after laser recanalization of the artery (characteristics of changes in the vascular wall at a late period after laser recanalization)]. / Reparatsiia sosudistoi stenki lazernoi rekanalizatsii arterii (kharakteristika izmenenii v stenke sosuda v otdalennye sroki posle lazernoi rekanalizatsii).

Chronic experimental studies were carried out on 9 mongrel dogs. To study the reparation processes in the arterial wall after laser intervention, arteries of different anatomic zones were irradiated with laser: descending and abdominal aorta, iliac, femoral and axillary arteries. To make a laser trauma, two types of laser catheters were used: a) with the light guide with diameter of 400 and 600 microns; and b) with a quartz tip at the end. The laser light source was a laser of Cu vapors, and ND; YAG laser. Laser energy was transmitted in the form of individual impulses with the duration of 2-5 sec, and power of 8-10 watt. Histological studies of the preparations of the irradiated arterial wall were performed at periods: 1-3-7-16-28 days, and 2-8 months. Characteristic signs of the vascular wall reparations are given. The analysis of the experimental results showed that by the 28-th day after laser trauma, on the site of laser irradiation a connective tissue scar was formed substituting the defect in the vascular wall and covered from the lumen side with a thin continuous layer of endothelium without any signs of inflammatory infiltration. The development of intimal hyperplasia is not excluded, as well as of inflammatory reaction with the following thrombotic occlusion of the artery lumen. The study results can be used in clinical practice in order to determine the optimum tactics and performance of laser recanalization of the artery, as well as the treatment after the laser intervention.

[Transcutaneous transcatheter use of laser recanalization of coronary arteries in patients with ischemic heart disease]. / Chrezkozhnoe chrezkateternoe primenenie lazernoi rekanalizatsii koronarnykh arterii u bol'nykh ishimicheskoi bolezn'iu serdtsa.

The paper discusses the potential possibility and effectiveness of X-ray endovascular laser recanalization (ELR) of the coronary arteries in order to treat coronary atherosclerosis in patients with coronary heart disease. The intervention was performed in 4 patients (into the anterior interventricular artery in 3 and into the right coronary artery in 1). In 3 of 4 cases, X-ray ELR proved to be successful, in one case the intervention failed due to technological reasons. Recanalization of a completely occluded segment of the coronary artery with a residual stenosis of no more than 40% was observed in two cases. Laser recanalization of profound local coronary stenosis was made in the mid-third of the vessel in one case. It can be stated that X-ray ELR of the coronary artery may extend the scope of X-ray surgical therapeutical tools of the treatment of coronary atherosclerosis. At the same time, accumulation of clinical experience and further improvement of laser and laser catheter engineering are essential in defining the value and possible scope for the application of this method.

[Radiologically-guided vascular prosthesis after laser recanalization of occlusive lesions of the blood vessels of the lower limbs]. / Rentgenoéndovaskuliarnoe protezirovanie posle lazernoi rekanalizatsii okkliuziruiushchikh porazhenii sosudov nizhnikh konechnostei.

The article deals with the first clinical experience in radiologically-guided prosthetics after laser recanalization of occluded vessels of the lower limbs in 20 patients. The method was introduced into clinical practice after applying separately the methods of radiologically-guided endovascular prosthetics and laser recanalization with subsequent dilatation and experimental substantiation on dogs with artificially created chronic occlusions of the femoral artery. The first results are promising, although the true place of the method in sparing treatment of vessels will be ascertained after rich clinical experience is accumulated and the late-term results studied.

[Radioendovascular prosthesis of renal arteries in patients with renovascular hypertension]. / Rentgenoéndovaskuliarnoe protezirovanie pochechnykh arterii u bol'nykh vasorenal'noi gipertenziei.

A high percentage of restenoses after roentgenovascular dilatation of the renal arteries laid the basis of a search for new therapeutic methods for these patients. Experiments on implantation of nitinol spiral endoprostheses showed their ability for long-term permeability of renal arteries, not causing their thrombosis and intimal spreading, destruction of formed elements of the blood, change in plasma proteins. Morphological investigations have shown rapid formation (during 14 days) of connective tissue neointima, covered on the side of the blood flow with the true vascular endothelium (ensuring a nonadhesive surface and laminar blood flow), around the coils of an endoprosthesis. This method after its experimental development started to be used in clinical practice. The authors reported the first experience in the clinical use of this method (12 patients with vasorenal hypertension). A 15-month follow-up revealed a stable antihypertensive effect in all patients.

[Radiologic endovascular prosthesis of the renal arteries in patients with renovascular hypertension]. / Rentgenoéndovaskuliarnoe protezirovanie pochechnykh arterii u bolnykh vazorenalnoi gipertenziei.

A high percentage of restenoses after roentgenovascular dilatation of the renal arteries laid the basis of a search for new therapeutic methods for these patients. Experiments on implantation of nitinol spiral endoprostheses showed their ability for long-term permeability of renal arteries, not causing their thrombosis and intimal spreading, destruction of formed elements of the blood, change in plasma proteins. Morphological investigations have shown rapid formation (during 14 days) of connective tissue neointima, covered on the side of the blood flow with the true vascular endothelium (ensuring a nonadhesive surface and laminar blood flow), around the coils of an endoprosthesis. This method after its experimental development started to be used in clinical practice. The authors reported the first experience in the clinical use of this method (12 patients with vasorenal hypertension). A 15-month follow-up revealed a stable antihypertensive effect in all patients.

[Multiple renal arteries and renovascular hypertension]. / Mnozhestvennye pochechnye arterii i vazorenal'naia gipertenziia.

The presence of multiple renal arteries (MRA) as a congenital developmental anomaly encountered in 13% angiographic examinations is not the cause of vasorenal hypertension. Sustained hypertension develops in affection of one or several of the MRA. The authors analyse 55 patients with vasorenal hypertension in affection of one or more of the MRA. Interventions on the MRA restored their blood flow in 91.0% of patients. Positive results with reduction of hypertension were produced in 85.4% of patients. Complications--restenosis, thromboses--occurred in 12.7% of cases. One patient died from acute renal failure which had developed in thrombosis of the renal arteries. Patients with affection of one or several of MRA of various etiology may be cured successfully by organ-preserving reconstructive operations. Nephrectomy should be resorted to only in intraorganic affection of the renal vessels or in total loss of kidney function.