[Features of pathological changes of fibro-cartilaginous tissue knee in patients with Baker cyst.]

Objective: Using magnetic resonance imaging (MRI) to evaluate the characteristics of pathological changes of fibro-cartilage of the knee in patients with Baker cyst, to assess the compliance of degrees of damage stages of osteoarthritis on a scale of Kellgren­Lawrence (K­L), and compare the results with the data of other researchers. Material and Methods: This study included patients (38­82 years) with a cyst Baker accidentally detected during ultrasound veins of the lower extremities. The subjects underwent a single knee MRI. MRI was made in three dimensions using 3D gradient-echo protocol. Independent radiologist evaluated the presence and severity of chondral defect osteophytosis, damage to the menisci and ligaments, intraosseous edema and subchondral cysts. The osteoarthritis stage of the knee were identified by X-ray performed in a standing position in the standard two projections, with K­L scale. Results: In this study, the results of a survey of 20 people, whose average age was 57.2 years. According to the radiological scale of K­L two patients were assigned to the stage 0 degree, 5 people to stage 1, 2, 4 each, and 3 ­ to stage 3. Synovitis of various severity was detected in 85% of the studies. Nineteen visualized the patellar cartilage damage, the condyles of the femur and tibia are most commonly affects the joint area. Among the most commonly injured ligament anterior cruciate ligament was determined ­ 9 (45%) patients in the same amount of detected intramedullary edema condyles femur and tibia. Eighteen subjects had at least one anomaly meniscus detectable by MRI, while in 11 (55%) persons were deviations, at least two or more regions of the knee examined. Conclusions: Our results suggest that not all visualized on MRI degenerative damage to intra fibro-cartilaginous tissue correlate positively with the stages of osteoarthritis of the knee, identified by standard radiographs and may not significantly affect the onset and progression of synovial cyst of the popliteal region.

[Retrojugular access to carotid arteries].

The issue aimed the comparative analysis of the classical and rarely used retrojugular access to carotid arteries on the example of 151 eversion endarterectomies. Of them, 56 operations were performed with the use of retrojugular and 95 with classical access. The retrojugular access demonstrated reliable benefits considering the postoperative period. The rate of tongue numbness and agility was smaller in the retrojugular group (1.7 vs 12%), as well as round mouth muscle paresis (1.7 vs 10%). There were no cases of dysphagia and hoarseness in the group of retrojugular access.

[Surgical treatment of pathological kinking of the internal carotid artery].

The study was aimed at improving surgical policy in management of patients presenting with pathological tortuosity of the internal carotid artery. The study comprised a total of 105 patients with pathological kinking of the internal carotid artery undergoing a total of 117 reconstructive operations. In order to determine the indications for the operation the patients were subjected to triplex scanning, transcranial Dopplerography and monitoring of blood flow in the median cerebral artery, contrast-enhanced computed tomography or magnetic resonance tomography. Depending upon the degree of intimal proliferation in the area of the maximal bend («septal tortuosity¼), the patients were divided into two groups: group I - pathological kinking of the internal carotid artery without intimal proliferation - 75 patients, Group II - pathological kinking with intimal proliferation - 30 patients. The indications for the operation were determined depending upon the degree of cerebrovascular insufficiency, haemodynamical significance of pathological tortuosity, the presence of intimal proliferation in the zone of the maximal bend - «septal tortuosity¼. An operation of choice for Group I patients was resection of the internal carotid artery with redressation and reimplantation into the own bed, and all Group II patients underwent resection of the area of kinking of the internal carotid artery with an end-to-end anastomosis in order to remove the septal portion. Immediately after the operation 85% of patients were found to have their cardiovascular insufficiency symptoms relieved and all patients showed improved haemodynamic parameters (p<0.01). Neither postoperative strokes nor lethal outcomes were registered.

A Specialized device designed for eversion carotid endarterectomy.

Carotid endarterectomy (CEAE) is currently considered to be one of the most efficient methods of treatment for chronic cerebrovascular insufficiency and prevention of recurrent acute impairments of cerebral blood supply. Methodically, the manipulation concerned is in the majority of cases carried out by one of two most commonly employed techniques, i. e., classical CEAE from the longitudinal arteriotomy with plasty with a synthetic patch, and the so-called eversion CEAE implying removal of an atherosclerotic plaque (ASP) by means of eversion of the internal carotid artery (ICA). Many Russian and foreign authors point out indisputable advantages of eversion CEAE, consisting in a shorter duration of ICA clamping, no need to use synthetic materials, preservation of the anatomical geometry of the bifurcation of the common carotid artery (CCA), a lower incidence rate of restenoses in the remote period. Along with it, eversion CEAE also possesses certain disadvantages consisting in namely complicated revision of the distal intima of the ICA (the zone wherein the ASP is tapering), the necessity of traction by the ASP, which may might lead to its premature detachment, impossibility of ICA eversion distal to the endarterectomy zone and repeat eversion of the already endarterectomised portion of the ICA. Hence, eversion carotid endarterectomy still remains the area of skilled and experienced vascular surgeons, thus giving prerequisites for further levelling its technical disadvantages shortcomings, which was the objective of the present study. The authors describe herein a new specially designed surgical device intended to facilitate the operation of eversion carotid endarterectomy, as well as the technique of application thereof. Based on a comparative example comprising a total of eighty-six eversion carotid endarterectomic procedures performed both with and without the new device, we demonstrated efficiency of using the proposed technique.

[Subclavian-femoral bypass grafting in treatment of lower-limb critical ischaemia in an elderly patient with an inoperable thoracoabdominal aortic aneurysm].

The authors describe herein a variant of successful palliative treatment of a 73-year-old male patient suffering from an inoperable thoracoabdominal aortic aneurysm accompanied by coronary artery disease, painless myocardial ischaemia, pathological tortuosity of the left internal carotid artery, type 2 diabetes mellitus, and chronic renal insufficiency. The patient was admitted to the Department of Vascular Surgery presenting with critical ischaemia of his left lower limb, complaining of numbness and gnawing pain both at rest and while walking a distance of up to 10-15 metres, demonstrating portions of skin ischaemia up to 2 cm long on the anterior surface of the femoral upper third, clinical signs of a thoracoabdominal aortic aneurysm, the presence of a pulsating formation in the projection of the infrarenal portion of the abdominal aorta measuring 5x6 cm. The diagnosis was made based on the findings of instrumental examination, ultrasonography, multispiral computed tomographic angiography, and coronarography, having confirmed the following: a thoracoabdominal aortic aneurysm, occlusion of the left common artery and anterior iliac artery, coronary artery disease, painless myocardial ischaemia, pathological kinking of the left internal carotid artery, chronic renal insufficiency, and type 2 diabetes mellitus. The first stage of the operation to perform consisted of mammary- coronary bypass grafting of the anterior interventricular artery from the left anterior lateral thoracotomy. Despite certain improvement in the condition of the coronary bed, the patient remained inoperable due to the presence of pronounced multipleorgan pathology and a high risk of lethal complications. Given these circumstances, the second stage of the intervention consisted in performing a palliative operation of subclavian-femoral bypass grafting on the left with a reinforced polytetrafluoroethylene stent graft.

Peculiarities of glomus-sparing eversion carotid endarterectomy.

Described in the article are technical peculiarities of performing eversion carotid endarterectomy with the preservation of the structure of the carotid glomus. Atherosclerosis of the carotid artery bifurcation appears to influence the onset and course of arterial hypertension. An important role therein is played by barorefl ex and glomus dysfunction. The operation of carotid endarterectomy decreases the background arterial pressure but in a series of cases, with destroyed structures of the carotid glomus, induces alterations in the pattern of arterial hypertension with the development of hyper- and hypotensive crises. The authors have worked out an operation of glomus-sparing eversion carotid endarterectomy, combining advantages of the eversion technique and prevention of glomus dysfunction. The outcomes of 25 operations demonstrated a positive antihypertensive eff ect of the new technique, with no systemic haemodynamic impairments observed in the patients after surgery.

[The effect of carotid endarterectomy on cognitive disturbances in patients with atherosclerotic stenosis of carotid arteries].

Clinical and neuropsychological features of non-dementia cognitive disturbances were studied in 102 patients with atherosclerotic carotid stenosis. Cognitive disturbances were assessed after the carotid endarterectomy (CEAE). Mild cognitive impairment was found in 37 (36,3%) of patients, moderate cognitive impairment was diagnosed in 36 (35,3%)patients. Moderate cognitive impairment was found more often in patients with symptomatic carotid stenosis with structural brain changes confirmed by neuroimaging data and with instable atherosclerotic plaques with the predomination of hypodensity component. It allows to suggest that both the reduction of perfusion and arterio-arterial microemboli may cause cognitive dysfunction in patients with atherosclerotic carotid stenosis. The data on the positive effect of CEAE on cognitive functions have been obtained. The positive changes were more distinct in patients with asymptomatic course of carotid stenosis. However CEAE may have a negative effect on cognitive functions in patients with moderate cognitive impairment of dysmnestic character and symptomatic carotid stenosis.

[Gigantic aneurysm resulting from pathological kinking of the internal carotid artery].

Described in the article is a case report of successful surgical management of a 50-year-old male patient presenting with a gigantic aneurysm of the right internal carotid artery, pathological tortuosity of the right and left internal carotid arteries, successfully treated by resection of the aneurysm of the right internal carotid artery with autovenous prosthetic repair of the right internal carotid artery.