[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.

[Diagnosis and treatment of peripheral arterial aneurysms in lower limbs].

Authors analyzed a five years experience of the diagnosis and treatment of peripheral arterial aneurysms in the Center of vascular surgery of the multidisciplinary military hospital. Authors give the assessment of different diagnostic instrumental methods and demonstrate results of surgical treatment. The possibility and effectiveness of endovascular-traumatic method of surgical correction of this pathology of lower limb arteries are given.

[Treatment of rupture of abdominal aortic aneurism in multi-field military hospital].

For the last 5 years in the center of vascular surgery of Vishnevskiy 3rd Central Military Clinical Hospital 218 patients with abdominal aortic aneurism were treated, 96 planned surgical operations for abdominal aortic aneurism (post-operative mortality 3.1%) were performed. 11 patients underwent urgent surgical operation because of rupture of abdominal aortic aneurism. 1 of 11 patients died at the stage of laparotomy, the second patient died after clipping of ruptured aneurysm. In other 9 cases surgical operation was performed successfully. But 2 of 9 patients died in a few hours after surgery. In summary, 4 of 11 patients underwent surgical operation for rupture of abdominal aortic aneurism survived. The postoperative mortality was 63.6%. Authors gave an example of successful treatment of patient with rupture of abdominal aortic aneurism. It was concluded that successful treatment of rupture of abdominal aortic aneurism is possible only in case of well-run integration of different treatment and diagnostic departments. CT angiography is crucial for instrumental diagnostics of rupture of abdominal aortic aneurism. Successful surgical operation is impossible without organized blood supply service, refusion and donor blood. Artificial lung ventilation, extracorporal detoxication and adequate pharmacological supply help to avoid severe complications during the postoperative period, even in patients with associated pathology.

[Diagnosis and treatment of complications after femoral artery paracentesis].

The authors show that the prophylaxis of local complications after femoral artery cannulation consists of proper technique of puncture, careful site selection for puncture, usage of closure devices and external compression. The authors also underline that it is necessary to pay special attention to patients receiving anticoagulant or antiaggregant therapy. Despite the rarity, occurrence of inguinal canal hematoma after the X-ray contrast angiography and X-ray endovascular surgery is a serious complication that can prolong recovery. For a complete recovery after femoral artery paracentesis it is necessary to provide a bed regime, to apply a compression band and to monitor a medical state during the first day.

[Treatment of vascular implants' infections in aortic position].

Nowadays the infection of a vascular implants in abdominal aorta is the heaviest and terrible complication in vascular surgery. Frequency of suppuration of vascular implants in aortic position is from 1 up to 3,5%, with lethality from 21 up to 80%. Average age is 61,4 +/- 4,3 years. In 6 cases, bifurcated system was infected, in other 3--linear. From methods of tool diagnostics the certain value has fistulography. Visualization of an artificial limb at the given research is pathognomonic its attribute infection. The Most significant, exhaustive method in our supervision was a computer tomography with bolus contrast.

[Successful treatment of aneurysm of iliac artery in old patient with widespread atherosclerosis of aorta].

Disclosure of aneurysm of abdominal aorta indicates severity and prevalence of atherosclerotic process which means high probability of combined occlusive affections in other arterial circulations. Authors treated the patient with aneurysm of iliac artery with widespread atherosclerosis of aorta taking into account the abovementioned facts. Right stage surgical tactics assured success.

[Use of tourniquets in limb combat injuries].

The garrot is one of the most well-known means by stemming of an exterior flow of blood of injured limbs. The article presents analyze of frequency, of indicated values and faults during the using of garrot in modern conditions of the combat in the Northern Caucasus (1994-2002). On the base of 104 wounds of great vessels, the authors make a conclusion about the necessity of using of the garrot only in the cases of absolute indications, when the other method of hemostasia, more simple and secure, is impossible.

[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.

[Extraanatomic reconstruction of the right renal artery].

This paper reviews two clinical cases of a rare type of extraanatomic revascularization of the right kidney by means of establishing a renogastroduodenal arterial anastomosis. The clinical cases presented herein demonstrate an adequacy of the given extraanatomic reconstruction of the renal artery. The indications for such operation are compelled and should be determined strictly individually in terms of each concrete case.

[Treatment of gunshot wounds of the veins in the first echelon of specialized surgical care]. / Lechenie ognestrel'nykh ranenii ven v pervom éshelone spetsializirovannoi khirurgicheskoi pomoshchi.

Results of first specialized aid to 26 wounded with injuries of the major veins are analyzed. Rate and nature of injuries of various major veins are regarded. Complete rupture of the vessel and its destruction with dehiscence of different length were seen in more than half of the cases (57.7%). In this case repair of venous vessel patency required various plastic methods. In lateral or incomplete transverse rupture it was possible to put lateral or circular vascular suture. Ligature of injured venous vessel was performed in half of the cases. Based on anatomic features of venous circulation in the extremities, immediate and long-term results of the treatment, 2 groups of injuries were identified: 1st - ligature of the veins did not lead to disorders of venous circulation and function of the extremity in the nearest and long-term period after surgery; 2nd - ligature of the vessel was dangerous due to serious disorders of venous circulation in the nearest period after surgery and might lead to disorders of extremity function and disability. In gunshot wounds of the major veins good results may be achieved in early reconstructive surgeries with individual approach allowing for general condition of the wounded and nature of vessel injury.

[Vasaprostan in everyday practice of vascular surgery department]. / Vazaprostan v povsednevnoi praktike otdeleniia sosudistoi khirurgii.

The paper analyses vazaprostan administration to 88 patients with lower limb arteriosclerosis obliterans. Effectiveness of the drug is assessed in concordance with initial grade of ischemia.

[Roentgenendovascular arrest of bleeding in iatrogenic injury to the subclavian artery]. / Rentgenoéndovaskuliarnaia ostanovka krovotecheniia pri iatrogennom povrezhdenii podkliuchichnoi arterii.

The authors present a clinical case report concerned with the arrest of continuous external bleeding from the subclavian artery due to its iatrogenic injury at transluminal endoprosthetics by stent graft. In patient Zh. aged 23 years, the subclavian artery was injured when an attempt was made to piece a subclavian venous catheter. Under conditions of remarkable coagulopathy because of prolonged mechanical jaundice, the patient developed a major hematoma of the right neck and the right chest. To handle continuous bleeding, a JOSTEHT-GRAFT (7.0 in D, 28 mm in length) was implanted into subclavian artery defect. The bleeding was handled and the patency of the great artery was maintained. The roentgenendovascular procedure allowed to avoid a technically difficult traumatic surgical intervention under conditions of pronounced anemia and coagulopathy.

[Lumbar sympathectomy in atherosclerosis obliterance of lower limb arteries and age of the patients]. / Poiasnichnaia simpatéktomiia pri obliteriruiushchem ateroskleroze arterii nizhnikh konechnostei i vozrast patsientov.

In the elderly and old patients with atherosclerosis of lower limb arteries, ultrasonic dopplerography assisted study of hemodynamics in foot with use of Valsalva and corinfar tests was carried out. It is revealed that these patients retain high reaction to sympathetic influences. The obtained data were the base for use of lumbar sympathectomy in 419 patients over 65 years as an independent method of surgical treatment and in combination with reconstructive operations on major arteries. Good results were obtained in 70.1% operated patients, satisfactory results--in 22.7%. There were no significant differences in the results of lumbar sympathectomy between this age group and younger patients.