[Functional rehabilitation of the myocardium after different kinds of direct revascularization of the myocardium in patients with occlusion lesion of the abdominal aorta and arteries of lower extremities].

The degree and terms of recovery of the functional state of the myocardium after direct revascularization of the myocardium under conditions of extracorporeal circulation and on the working heart were studied in 58 patients with occlusion lesion of the arteries of lower extremities. In 30 patients (1st group) coronary artery bypass grafting (CABG) was fulfilled under conditions of extracorporeal circulation, in 28 (2nd group) revascularization of the myocardium was fulfilled on the beating heart. In patients with occlusion lesion of the abdominal aorta and arteries of lower extremities and IHD of the III-IV functional class we followed the strategy of stage-by-stage interventions in the arterial basins. CABG is indicated at the first stage. The optimal method of direct revascularization of the myocardium was proved to be operation on the beating heart which had a number of advantages: lower risk of the development of postoperative complications, quicker restoration of the myocardium function and rehabilitation of the patients, shorter time for the 2nd stage of operation-revascularization of lower extremities.

[Tactics of surgical treatment of critical lower limbs ischemia and concomitant coronary heart disease class III-IV].

The possibility and use of prolonged epidural anesthesia in terms of preoperative care was studied in 78 patients. Patients with various stages of coronary arteries affection, central haemodynamics state and risk of reconstructive surgical treatment on lower limb arteries were marked out. Patient selection criteria for aortocoronary shunting or reconstructive operation on great lower limb vessels were worked out. It is proved, that prolonged epidural anesthesia allows not only to attain good analgesia but to minimize cardiac complications at reconstructive operations on abdominal aorta and its branches.

[Indications to the formation of arteriovenous fistulas in performing reconstructive operations in patients with atherosclerotic lesions of the main arteries of the femur and shin at the stage of critical ischemia].

Causes of early shunt thromboses were studied retrospectively in 35 patients with occlusion of the femoro-popliteal segment and critical ischemia, in whom the operation of distal femoro-tibial shunt with the autovein had been performed by the method in situ without an application of the arteio-venous fistula (AVF). Early thromboses of the shunts took place in 8 patients (22.9%). The main cause of the early thromboses of the femorotibial shunts was shown to be a critical occlusive-stenotic lesion of the main arteries of the shin and foot with dysfunction of the plantar arch as well as decompensation of the microcirculation system. Objective criteria of the formation of AVF were worked out. The application of the criteria in operative treatment of 25 patients allowed the number of early thromboses to be reduced to 4%.

[Choice of optimal surgical reconstruction at patients with critical limb ischemia due to infrainguinal atherosclerotic arterial occlusive disease].

One hundred and four patients with atherosclerotic lesion of femoro-popliteal segment and III-IV stage of ischemia underwent vascular surgical procedures. Results of these operations were analyzed depending on state of distal arterial bed. Autovenous femoro-popliteal bypass (FPB) with reversed autovein was performed at 49 (47.1%) patients, femoro-tibial bypass (FTB) with autovein in situ - at 55 (52.9%). Clinical and angiographic variants of favorable and unfavorable prognosis of FBP and FTB are described. It is demonstrated that severe lesion of outflow distal arteries is the main cause of bypasses thrombosis. Protective arteriovenous fistula in the region of FTB distal anastomosis improves significantly short-term results of operation.

[Auto-venous femoral-popliteal bypass in patients of different age groups]. / Autovenoznoe bedrenno-podkolennoe shuntirovanie u patsientov razlichnykh vozrastnykh grupp.

The results of autovenous femoro-popliteal shunting performed in 106 patients with infrainguinal atherosclerotic arterial occlusion were investigated. All the patients were divided into 3 groups: younger than 50, from 50 to 60 and older than 60 years of age. The most favorable results were registered in the group of patients aged from 50 to 60. In 3 years these results made up 52.2%, in 5 years--17.4%. The lowest indices of shunt functioning were noted in patients younger than 50, and 3 and 5 years later they were 38.5 and 7.7% respectively. In 70% of this age group patients there were injuries of the main crural arteries and significant changes in the phospholipid fraction level. The main cause of unsatisfactory results of shunting operations in the femoro-popliteal area is though to be the injuries of the main crural arteries and the progressing course of the atherosclerotic process.