[Biological aspects and clinical application of bone-marrow stem cells in critical lower limb ischaemia]. / Biologicheskie aspekty i klinicheskoe primenenie stvolovykh kletok pri kriticheskoi ishemii nizhnikh konechnostei.

Critical lower-limb ischaemia (CLLI) is associated with high risk of limb loss and a lethal outcome, as well as with decreased quality of life. The underlying cause of the disease is imbalance between blood supply of ischaemized tissues and their metabolic demands. Restoration of adequate perfusion with the help of standard medicamentous therapy or operative treatment is often inefficient or impossible. Cell therapy (CT) is a novel strategy making it possible to stimulate the growth of the microvascular bed and the mechanisms of molecular-cellular repair. One of the most promising trends is the use of bone marrow stem cells (BMSCs). Sufficient evidence concerning safety and relative efficacy of CT has by now been accumulated. The existing differences in the results of studies are related to numerous peculiarities of both CT itself and methods of its application. The present review is dedicated to contemporary notions of the biology of BMSCs, assessment of safety of CT and the results of its application in treatment of CLLI.

[Possibilities of hybrid surgery in treatment of thoracoabdominal aneurysms].

The authors present a clinical case report and review of literature concerning treatment of extremely complicated pathology - thoracoabdominal aortic aneurysm, also reflecting the most difficult problems and complications of classical surgical treatment. A successful clinical example showed advantages of a new, less invasive approach, i.e., hybrid surgery. Based on analysing literature sources, the authors describe controversial points of carrying out a hybrid operation and its results. Accumulating experience in and improving technology of the hybrid operation would make it possible to further improve therapeutic outcomes.

[Own experience endovascular prosthetic repair of abdominal aortic aneurysms].

Endovascular prosthetic repair has increasingly been used over the last several decades. This type of intervention is indicated for patients running a high surgical and anaesthesiological risk of an open surgical procedure. The experience gained in endovascular prosthetic repair of abdominal aortic aneurysms makes it possible to extend the indications for its practical application. The authors describe herein their experience gained in a total of 20 procedures of endovascular prosthetic repair of abdominal aortic aneurysms using the Gore Excluder endograft device in patients running a high risk of an open surgical intervention. There were neither short -nor long-term lethal outcomes. Three patients after endovascular prosthetic repair were found to have type 1 endoleak and two appeared to have type 2 endoleak. Type 1 endoleaks were coped with intraoperationally. Dynamic follow-up (at 1, 6, 12 months after surgery) of patients including computed tomography showed no complications whatsoever (i. e., no endoleaks, endograft migration, nor increase in the aneurysm's diameter). After endografting of abdominal aortic aneurysms there were neither cardiac nor respiratory complications in the immediate postoperative period. Hence, endografting of an abdominal aortic aneurysm is a method of choice for high-risk patients.

[Simultaneous reconstruction of visceral aortic branches and renal arteries].

The paper presents a case report of simultaneous reconstruction of visceral aortic branches and renal arteries. The case is interesting because of special operative particularities, that occurred in 54-year-old patient who received previously radiotherapy for abdominal lymphogranulomatosis. Follow-up investigation 4 years after vascular intervention has shown that the patient remained in a satisfactory condition. The paper includes brief literature review concerning the strategy of reconstructive volume choice for this disease.

Successful percutaneous endovascular treatment of a ruptured femoral aneurysm.

Popliteal and femoral aneurysms account for about 70% of the incidence of peripheral aneurysms. Only 4% of aneurysms run their course with the clinical evidence of rupture. The ruptured aneurysm is dangerous because of a potential limb loss as well as due to the threat of lethal outcome in patients at a high surgical risk. Presented herein is a successful experience (first in this country) gained with the treatment of a ruptured femoral aneurysm by means of endoprosthetics using a new stent graft with PTFB coating in a patient at a high risk for traditional surgical treatment.

Combined operations for multilevel lesions of the aortoiliac and femoropopliteal segments.

This paper describes the results of the treatment of 53 patients with combined arterial lesions of the iliofemoral and femoro-popliteal segments. Altogether 56 primary one-step operations were performed. The initial success was achieved in 53 (94.6%) cases. The long-term results were followed up in 43 (81.1%) patients, in the long-term period, repeated endovascular interventions were accomplished in 6 (1.8%) patients with re-stenoses of the iliac arteries. The best long-term results were obtained in the groups of patients who had undergone balloon angioplasty and stenting of the iliac arteries.

Results of primary reconstructions in patients with lesion of the tibial arteries.

An analysis was made of 146 primary reconstructions performed in 141 patients with occlusion of the arteries of the femoropopliteal segment and leg. At the hospital stage an improvement of the clinical status was attained after primary operations in 98% of cases. The five-year cumulative bypass patency after operations.accounted for 43.5% while the limbs could be saved in 91.5% of cases. The results obtained in patients with stage 2B chronic arterial ischemia (according to the A.V.Pokrovsky classification, 1979) coincided with the results of bypass grafts of the popliteal artery (the 5-year patency was 56.9% with the limbs saved in - 81.2% of cases), whereas the results of in situ vein bypass were marked by a significantly better cumulative patency in the long-term period.

[Clinical course of restenosis after carotid endarterectomy]. / Klinicheskoe techenie restenozov posle karotidnoi éndarteriéktomii.

Angiologic and neurologic examinations, ultrasonic dopplerography were performed in 89 patients after operation of carotid endarterectomy. Period of observation was 6-182 months after operation (61 months on the average). Positive clinical effect (absence of disorders of cerebral circulation-DCC) was achieved in 91% of cases. The frequency of both repeated transitory ischemic attacks and the strokes was 9%, the best frequency being in patients with initially asymptomatic course. It was found that the degree of restenosis directly correlated with frequency of neurologic symptom development: there were no repeated DCC in normal state of the operated artery. Meanwhile DCC frequency was less than 4% in cases with the degree of restenosis less than 60% and was equal to 15.8% in more than 60% restenosis. DCC were more frequently found in occlusion of internal carotid artery. Rather favourable course of restenosis of carotid artery was also conditioned by low content of the plaques dangerous in terms of embolism. Progression of atherosclerotic damages in other parts of extracranial arteries promoted clinical manifestation of cerebral ischemia. Moreover, negative neurologic dynamics developed in 7% of the patients with restenosis less than 60%, and in 13.8% of cases with restenosis more than 60%. The conclusion was made about efficiency of carotid endarterectomy in patients with atherosclerotic damages of carotid arteries. For prevention of repeated DCC it is recommended both to perform conservative therapy after the operation and to examine dynamically the patients using ultrasonic dopplerography beginning 6 months after the operation.