[Method of determining disease severity in women with pelvic varicose veins]. / Sposob opredeleniia tiazhesti zabolevaniia u patsientok s varikoznoi bolezn'iu taza.

BACKGROUND: Using assessment scales in clinical and research practice is one of fundamental reference methods of evaluation in human pathological states. Pelvic vein varicosity is an independent nosological entity within the framework of chronic vein diseases. Currently, the clinical methods of assessment in the aspect of a patient-oriented approach in this type of disease are largely understudied and still not duly defined. AIM: The study was aimed at analyzing clinical outcomes of surgical treatment in the form of resection of the ovarian vein in female patients with pelvic varicose veins, based on the developed specialized scale of clinical assessment of disease severity. PATIENTS AND METHODS: We carried out an open prospective study of efficacy of resection of the ovarian vein in 37 women with pelvic varicose veins. The main criterion for assessment was a clinical method of determining manifestations of the disease by means of the Pelvic Venous Clinical Severity Score. RESULTS: According to the Pelvic Venous Clinical Severity Score, improvement of the condition was observed in 36 (97.3%) operated female patients and 1 (2.7%) woman turned out to have negative dynamics. The median of the composite score of the severity scale decreased form 11.78±5.06 points to 5.22±3.19 (p<0.05). The total positive gradient of the score amounted to 6.57±3 .65 points. A significant decrease in manifestations of severity was observed for 9 of the 10 clinical descriptors of the disease. CONCLUSION: The use of the suggested scale in practical assessment of the results made it possible to prove high efficacy of resection of the ovarian vein in women with pelvic varicose veins in the form of decreased intensity of the disease's symptomatology. The VCSS is an easy-to-fill-in tool, taking up little time, ensuring no influence of the physician's personality on the answers, presenting quantitative expression of therapeutic results.

Diagnosis and surgical treatment of a persistent sciatic artery aneurysm. / Diagnostika i khirurgicheskoe lechenie anevrizmy atipichnoi sedalishchnoi arterii.

The persistent sciatic artery is situated superficially in the gluteal region wherein it can be traumatized in normal daily activities: during a prolonged sitting position or while attempting to sit down. This leads to an early atherosclerotic lesion of the sciatic artery, to the development of aneurysmatic dilatation, and damage to the arterial wall. The present article describes a 72-year-old female patient presenting with a persistent sciatic artery of the left leg and a PSA aneurysm which consequently resulted in critical ischaemia of her left lower limb. This abnormality was detected during an examination and the woman was subjected to the operation of internal iliac-posterior tibial bypass grafting using an autologous vein with ligation of the sciatic artery. The bypass graft has been functioning for 5 months, with no events of critical ischaemia.

[Antithrombotic therapy after venous stenting]. / Antitromboticheskaia terapiia posle venoznogo stentirovaniia.

Presented herein is a literature review considering the problems of using antithrombotic therapy after venous stenting. Described herein are the literature data according to which the authors give preference to anticoagulant therapy (low-molecular-weight heparins, vitamin K antagonists, direct oral anticoagulants). This is followed by considering the problems of duration of treatment depending on various clinical situations. According to the presented data, the problem of prescribing disaggregants in a combination with anticoagulants after stenting of veins remains disputable, finding however many supporters. Analysed in the article are the results of the first International Delphi Consensus dedicated to antithrombotic therapy after venous stenting. Participating in the study were 106 independent experts practicing stenting in 78 centres of 28 countries of the world. Nonthrombotic iliac vein lesions, having appeared as May-Thurner syndrome due to extravasal compression and residual obstruction after thrombolysis, as well as the presence of postthrombotic syndrome were the main 'scenarios' for our study. The study resulted in working out provisions considering the policy of antithrombotic therapy in various obstructive lesions of deep veins. According to the presented data, anticoagulant therapy is preferable during 6-12 months after stenting in nonthrombotic iliac vein lesions. Low-molecular-weight heparins appear to be a method of choice in treatment during the first 2-6 weeks. Life-long administration of anticoagulants is recommended after multiple deep vein thromboses. Discontinuation of anticoagulants after 6-12 months is indicated after venous stenting in one episode of deep vein thrombosis. No consensus was achieved regarding the role of prolonged disaggregant therapy. Underlined in the article is the importance of a meticulous individual approach to choosing optimal policy of antithrombotic therapy and determining therapeutic policy together with a haematologist.

[Stagewise treatment of a giant false paraanastomotic aneurysm of the abdominal aorta].

The article deals with a case report concerning successful stagewise treatment of a patient presenting with a giant false abdominal aortic paraanastomotic aneurysm having developed 2 months after an operation of linear prosthetic repair for a juxtarenal aneurysm with reimplantation of the left renal artery. The secondary operation was carried out 3 months after aortic reconstruction. The first stage consisted in performing endovascular prosthetic repair of the abdominal aortic paraanastomotic pseudoaneurysm by means of a bifurcated stent graft Endurant II (Medtronic), with the second stage being laparotomy with the removal of the retroperitoneal haematoma. The postoperative period turned out uneventful. The patient was discharged from hospital on the 8th day after the second operation. The patient was examined 2 months later, presenting no complaints and returning to his previous work. According to the findings of the check-up duplex scanning, the graft was patient, with no evidence of a paraanastomotic aneurysm. This is followed by discussion of the problems regarding the use of surgical and endovascular technologies in treatment of paraanastomotic aortic aneurysms.

[Endovascular repair of an abdominal aortic aneurysm in a patient with horseshoe kidney].

Presented herein is a case report concerning successful endovascular treatment of a patient with an infrarenal abdominal aortic aneurysm combined with a horseshoe kidney. The diagnosis was verified by multispiral computed tomography. The patient underwent of endovascular repair of the abdominal aorta with a stent-graft AORFIX (Lombard Medical). The postoperative period turned out uneventful, with no complications. The patient was examined 3 years after the intervention. The findings of control check-up computed tomography showed no signs of either stent graft dislocation or endoleak.