[Degenerative alterations of the afferent artery in long-functioning arteriovenous fistula]. / Degenerativnye izmeneniia privodiashchei arterii pri dlitel'no funktsioniruiushchem arteriovenoznom svishche.

Discussed in the article is the literature data on the background, causes, and mechanisms of the development of degenerative aneurysmatic transformation of the afferent artery in a long-functioning arteriovenous fistula. This is followed by presenting two own clinical case reports concerning the development of pronounced dilatation of arteries during 13 and 25 years of the existence of posttraumatic arteriovenous anastomoses, with a detailed description of the variants of surgical treatment of these patients.

[Deliberations on lumbar sympathectomy: years and practice on the occasion of the 90th anniversary of using the method in Russia]. / Razmyshleniia o poiasnichnoi simpatéktomii: gody i praktika. K 90-letiiu primeneniia metoda v Rossii.

The article deals with the literature data on history of and modern attitude to lumbar sympathectomy in treatment for occlusive lesions of lower-limb peripheral arteries. This is followed by analysing the experience of 1,764 operations both independent and those combined with vascular reconstructions over more than a 45-year period. A conclusion is drawn that lumbar sympathectomy remains an operation associated with minimal traumaticity and a low complication rate, thus for long years improving the quality of life and destiny of patients.

[Postoperative wound complications in cardiosurgery].

Presented in the article are the results of examination and treatment of 65 patients with infectious wound complications of the sternotomic injury after open heart surgery. The main risk factors for their development in our patients were as follows: obesity, chronic obstructive pulmonary disease, diabetes mellitus, severe heart failure, prolonged operation, sternal instability. The leading pathogenic microorganisms were Gram positive staphylococci. Treatment varied from prolonged antibiotic therapy with surgical debridement of the wound to subtotal resection of the sternum with various plastic reconstructive interventions. The scope of treatment was determined by the type and severity of infectious wound complications. Due to lack of standardized approaches in diagnosis, treatment and prevention this problem remains to be of current importance.

[Contribution of military surgeons participants of the great patriotic war to solving the problem of rendering medical care to the wounded with lesions of blood vessels].

review in the article are opinions and experience of outstanding academic military surgeons, participants of the Great Patriotic war: Burdenko N N., Kupriyanov P.A., Akhutin M.N., Banaitis A.I., Elansky N.N, Petrovsky B.V., and others. The methods they worked out and practically implemented made it possible to substantially improve the outcomes of gunshot wounds and vascular lesions.

[Surgical treatment of chronic abdominal ischemia].

The study includes data of 139 patients with chronic abdominal ischemia, due to hemodynamically significant occlusion of impaired visceral aortic branches. The diagnosis was confirmed by aortography, computed tomoangiography and duplex color angioscanning. Immediate and long-term results of 49 reconstructive and conditionally reconstructive operations, 11 transcutaneous endovascular angioplasty, as well as postoperative complications, were analyzed.

[The diagnostics and treatment of the postoperative mediastinitis].

Treatment results of 48 patients with mediastinitis after the open cardiac surgery were analyzed. The main mediastinitis risk factors were: the chronic obstructive lung desease, diabetes mekkitus, severe cardiac insufficiency, prolonged operation, the use of artificial blood circulation and sterna instsbility. Major infective agents of mediastinitis were the Gram-positive cocci. The treatment options varied from the prolonged antibiotic therapy to plastic reconstructive surgery, which were determined by the severity of mediastinitis.

[Touches to the portrait of Professor A.A. Bocharov].

110 years since the birth of a famous scientist, Professor Lieutenant General Medical Service Arcadiy Alekseevich Bocharov (23.09.1901-2707.1970). In 1961 he was deputy chief surgeon of the Department of Defense and the chief surgeon of the Central Hospital n. a. P.V. Mandryka. In 1967 A.A. Bocharov became chief surgeon of the Central Military Clinical Hospital n.a. A.A. Vishnevsky. He owns more than 80 scientific publications section of multi-volume work "The experience of Soviet medicine in the Great Patriotic War of 1941-1945".

[Role of vascular surgery by experience of the Great Patriotic War (1941-45) (To the 65th anniversary of the Victory in the Great Patriotic War)].

During the Great Patriotic War, military medicine gained a wide and versatile experience in organization of rendering medical care for and treatment of millions of the wounded in exceptionally complicated circumstances. The most important mission encountered by the medical service, i. e., salvation and treatment of soldiers was accomplished with honour: more than 72.3% of the wounded and 90.6% of diseased soldiers and officers were returned to the ranks by the Russian medical profession. Soviet surgeons contributed significantly to solving problems of field surgery as a whole and vascular surgery in particular.

[Delivery of the surgical services to the wounded with injuries of major vessels].

According to consolidated data the frequency of injuries of blood vessels during the Great Patriotic war 1941-1945 was 2.3-4.9%. In the first and the second period of the war the temporary hemostasia on the battlefield was delivered via surgical tubing, tamponade or compressing bandage; the final--via deligation of the arteries in the wound or overlap of hemostatic clamp or the amputation was performed. In the process of delivering of the knowledgeable medical assistance garrot was removed, traumatonesis was performed and the final hemostasia was performed via vasoligation in the wound or along it, than transfused. In some hospitals were organized special units for patients with injuries of vessels. In the third period of the war the main method of primary and secondary hemostasia was vasoligation in the wound or along it. The vessel suture was performed rarer than in the first and the second period. The methods of treatment and prophylaxis of complication of vessel's injury were examined.

[Diagnosis and surgical methods of managing patients with chronic abdominal ischaemia].

Presented herein are the findings of examination of sixty-two patients with clinical manifestations of chronic abdominal ischaemia predominantly induced by stenosis of the celiac trunk. The authors carried out a comparative analysis of efficacy of instrumental methods of diagnosis of chronic abdominal ischaemia syndrome, having also investigated the lesions of the visceral branches by the findings of angiography. Also presented herein are the outcomes of various methods of surgical correction: 47 reconstructive and conditionally reconstructive operations, 10 transcutaneous endovascular angioplasties, also considering complications of the immediate postoperative period as well as short- and long-term outcomes of surgical treatment.

[Organization of scientific-methodological work in Central Military Clinical Hospital named after A.A. Vishnevskii].

There was congested a wide experience of organization and management of scientific work in the 3rd CMCH by Vishnevsky A.A. for a term of more than 40 years. This experience is subjected to generalization, analyze for the purpose of determination of it's priority orientations of improvement. Scientific-methods work in hospital is rated as a complex of measures, organisationaly-planed and coordinated by purpose and reinforcement of scientific schools of the 3rd CMCH by Vishnevsky A.A., as a basis of effective delivery of specialized medical aid. The vector of scientific researches is directed, generally, to solving questions of military and field medicine.

[Contribution of Russian surgeons-participants of the First World War in development of vascular surgery].

During the First World War wounds of vessels took 0,3-1,5% of all wounds, and lethality - 10-22%. Experience of vascular treatment, get by military-field surgeons during this war, was great. They have demonstrated advantage of vascular seam of bandage of vessels in conditions of their damages. Russian surgeons-participants of the First World War have formed the base, on which russian vascular surgery was advancing not only during wars, but also during peace-time.

[Cardiovascular surgery in a hospital].

The problem of effectuating of a specialized aid to the patients with damages of vessels, enlargement of the patients with cardio- and vessel-diseases, a high lethality and invalidization formed a need for organization of specialized units. The first staff unit of vessel-surgery in the Armed Forces was created in 1968 in CMCH of Vishnevsky A.A. Since 1981 hospital became the main base of preparing vessel-surgeons. The author showed the role of prime specialists in elaborating and development of a new direction in treatment of the patients with cardio- and vessel-damages.

[Rendering surgical care for the wounded presenting with injuries to limb vessels].

The proffered paper provides the information about rendering surgical care for the wounded presenting with vascular injuries inflicted and sustained during wars Russia was engaged in, to be followed by a detailed description of the haemorrhage-arresting methods and techniques used in N. I. Pirogov's time, during World War I, the Great Patriotic War, as well as in local military conflicts and combat operations. Also depicted herein is the role surgeons of Russia have played in the development of vascular surgery, and, finally, due coverage is given to the statistical data concerning the methods of rendering care for those having suffered firearm wounds and injuries involving vascular lesions.

[Diagnosis and surgical treatment of aneurysms of the popliteal artery].

Nineteen patients with aneurysms of the popliteal artery have been operated. Indications and type of surgery were determined on the basis of the clinical picture, angiography and duplex scanning data. There were 19 surgeries: ligation of afferent and efferent vessels of aneurysm with auto-venous grafting (8), resection of aneurysm with auto-venous grafting (5), dissection of aneurysm with auto-venous grafting and coverage with duplication from aneurysmatic walls (3), endovascular grafting of aneurysm (2), ligation of afferent vessel of aneurysm (1). In early postoperative period after open surgical revascularizations thrombosis was seen in 4 (25%) patients. One patient died on day 20 after surgery due to decompensation of severe concomitant disease. The patient who has undergone ligation of afferent vessel without revascularization has discharged after compensation of acute ischemia.

[Roentgenendovascular stenting (stent-graft) of the external iliac artery for elimination of post-traumatic arteriovenous anastomosis].

Presented herein is a case report concerning successful treatment of the post-traumatic pathological anastomosis between the left external iliac artery and iliac vein using the stent-graft Jostent-graft. The anastomosis emerged after gunshot injury to the abdominal cavity.

[Lumbar sympathectomy in treatment of obliterating diseases of lower limbs: state of the art]. / Primenenie poiasnichnoi simpatéktomii v lechenii obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei -- sovremennyi vzgliad na problemu.

The article deals with analysing examination and surgical treatment of 80 patients with predominant lesions to the distal arterial bed of the lower extremities, who were operated on at the RRSC from 1996 to 2003 with various degree on the background of chronic obliterating diseases of lower limbs arteries. All the patients were subdivided into two groups according to the outcomes of the epidural block: Group I -- with positive outcomes consisted of 36 (45 %) patients, and Group II -- with a negative outcome -- included 44 (55 %) patients. The patients from the both groups underwent the following operations: lumbar sympathectomy combined with direct and indirect methods of revascularisation, as well as lumbar sympathectomy as an independent therapeutic method. To solve the problem concerning feasibility of either done, or concomitant lumbar sympathectomy, we devised assessment of microcirculation state (alterations in volumetric blood flow indices in epidural block in relation to the indices at rest, as well as in the immediate or remote postoperative period) and peripheral haemocirculation (dynamics of the onkle brachial index values on the background of epidural block test, nitroglycerine test in relation to the ARI at rest both in the short-, and long-term postoperative period) by data of scintigraphy and dopplerography of the lower limbs.