[Endovascular treatment of common iliac artery aneurisms]. / Rezul'taty endovaskulyarnogo lecheniya anevrizm obshchei podvzdoshnoi arterii.

OBJECTIVE: To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS: Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS: Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.

[Proximal fixation devices in endovascular repair of abdominal aortic aneyrysm with unfavourable proximal neck anatomy]. / Ustroistva proksimal'noi fiksatsii stent-grafta pri éndovaskuliarnom lechenii anevrizmy briushnogo otdela aorty s neblagopriiatnoi anatomiei proksimal'noi sheiki.

Abdominal aortic aneurysm is a common vascular disease requiring surgical treatment. Currently, endovascular aortic repair is a good alternative to open surgery. However, high incidence of unfavorable anatomical variants of the proximal landing zone limit the use of endovascular aortic repair in these patients. Additional techniques can increase applicability of endovascular procedure with optimal results. Two patients with unfavorable proximal neck anatomy undergoing endovascular aortic repair with anchor type of proximal fixation devices are reported in the article.

[Twelve months results of percutaneous coronary interventions in patients with ischemic heart disease combined with diabetes mellitus using sirolimus and everolimus covered stents].

We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.

[Coronary stenting in patients with ischemic heart disease with multivessel involvement of coronary vascular bed and low Syntax score].

MATERIAL AND METHODS: We followed 619 patients with ischemic heart disease (IHD) and multivessel involvement of coronary arteries: 317 patients subjected to coronary artery bypass grafting (CABG, group 1) and 302 patients subjected to multivessel percutaneous coronary intervention (PCI, group 2) with implantation of drug eluting stents. Both groups had comparable clinical characteristics. During hospitalization we registered deaths and unfavorable cardiological and cerebrovascular events. In remote period after revascularization we assessed survival, angina recurrences and related repeat revascularizations, and rate of severe cardiovascular complications (composite of deaths, acute myocardial infarctions [AMI], stroke, and repeat myocardial revascularizations). RESULTS: During hospitalization there were no significant differences between groups by parameters studied: death rate was 1.7 and 0.9%, that of AMI 2.6 and 1.9%, of stroke 0.9% and 0, of composite of death, AMI, and stroke 5.1 and 1.9% (p = 0.37) in groups 1 and 2, respectively. Survival in remote period was 90.2 (group 1) and 92.7% (group 2). Comparison of Kaplan-Meier survival curves also revealed no significant differences between groups. Angina recurrence/repeat revascularization took place in 54 (17.0%) and in 64 (21.2%) patients in groups 1 and 2, respectively (p = 0.128). Repeat revascularization was carried out in 32 of 54 patients (59.3%) in group 1 and in 58 Of 64 patients (90.6%) in group 2. Rate of severe unfavorable events during whole period of follow up was 33.1% in group 1 and 30.5% in group 2 (p > 0.05). CONCLUSION: In IHD patients with multivessel coronary artery involvement and low Syntax Score immediate and long term (5 year) results of stenting with drug eluting stents are not inferior to results of CABG.

Effects of LDL lipids on activity of group IIA secretory phospholipase A2.

Effects of phosphatidylcholine, oxidized phosphatidylcholine, sphyngomyelin, cholesterol, and cholesterol esters incorporated in LDL on activity of group IIA secretory phospholipase A2 from human cardiac myxoma were studied. Liposomes containing radioisotope-labeled phosphatidylethanolamine served as the substrate for group IIA secretory phospholipase A2. Oxidized phosphatidylcholine significantly stimulated activity of group IIA secretory phospholipase A2, while phosphatidylcholine in the same concentrations did not modify enzyme activity. Sphyngomyelin incorporated in LDL inhibited group IIA secretory phospholipase A2 activity. Cholesterol and cholesterol esters virtually did not modify enzyme activity. The results indicate that LDL phospholipids and their oxidized forms can be involved in regulation of group IIA secretory phospholipase A2. Study of the mechanisms regulating the proinflammatory group IIA secretory phospholipase A2 can promote the development of new approaches to the diagnosis and treatment of inflammatory processes.

[The effect of LDL on the activity of proinflammatory secretory phospholipase A2 (IIA) depends on the degree of their oxidation].

Phospholipase A2 group IIA which is secreted in inflammation [secPLA2(IIA)] does not always exhibit catalytic activity, although being present in patients' serum. The mechanisms regulating the enzyme activity in peripheral blood have not been studied in sufficient detail. In this study we examined the effects of native and oxidized LDL with varied degree of oxidation on secPLA2(IIA) from human heart myxoma. The degree of LDL oxidation was evaluated from the amount of conjugated dienes and lysophosphatidylcholine. Liposomes containing radio-labelled phosphatidylcholine were used as a substrate in the secPLA2(IIA) activity assay. Native LDL isolated from serum of healthy subjects inhibited secPLA2(IIA) in a dose-dependent manner. Minimally and moderately oxidized LDL in which < 40 % phosphatidylcholine was hydrolysed to lysophosphatidylcholine activated secPL2(IIA). Strongly oxidized LDL in which > 40 % phosphatidylcholine was hydrolysed to lysophosphatidylcholine inhibited the enzyme. Thus, our findings indicate that the characteristics of circulating lipoproteins are changed by their oxidation. Minimal and moderate oxidation of LDL results in activation of secPLA2(IIA), while strong oxidation causes inhibition of the enzyme. Since inflammation leads to an increase in secPLA2(IIA) secretion and LDL oxidation, the results obtained can be used for the diagnostics of inflammatory processes and provide more insight into molecular mechanisms underlying the development of atherosclerosis.

[Effect of atorvastatin therapy on the level of secretory phospholipase A2 group IIA and on the modification of low density lipoproteins in patients with ischemic heart disease].

We studied effect of atorvastatin on secretory phospholipase A2 group IIA (sPLA2-IIA) in blood serum of patients with ischemic heart disease (IHD), lipid composition of low density lipoproteins (LDL) and process of modification of LDL induced by sPLA2-IIA in 20 patients taking 20 mg/day of atorvastatin for 3 months. In patients with initially high level of sPLA2-IIA ( > 8 mcg/l) its concentration significantly decreased. Amount of total cholesterol, triglyceride, lecithin, and lysolecithin remained unchanged, however in equimolar relations there occurred decrease of amount of total cholesterol and increase of cholesterol esters. At incubation of LDL, extracted from patient s plasma before initiation of the study, with human sPLA2-IIA from cardiac myxoma, 3.5 nmol of lysolecithin per 1 mg of LDL protein was formed while at incubation of LDL of same patients, extracted after 3 months of atorvastatin administration, amount of lysolecithin was 1.54 nmol/mg LDL protein. Thus atorvastatin therapy causes lowering of sPLA2-IIA in patients with initially high blood level of the enzyme and to a great extent precludes sPLA2-IIA induced LDL modification.

Effect of serum from cardiovascular patients on catalytic activity of secretory phospholipase A2 (IIA).

Incubation of patients' serum catalytically active by type IIA secretory phospholipase A2 (SP-IIA) with serum containing the enzyme in a high concentration but exhibiting no catalytic activity in 1:1 volume ratio led to a significant inhibition of SP-IIA catalytic activity. donor and patient sera with low levels of SP-IIA had no effect on the serum with SP-IIA activity under these conditions. However, the increase in the content of patients' serum with a low level of SP-IIA in the incubation mixture to 1:2 (v/v) and of donor serum to 1:3 (v/v) also led to blockade of SP-IIA catalytic activity. These results indicate that human serum contains an SP-IIA inhibitor and its concentration decreases significantly in sera with SP-IIA activity.

[Serum level of secretory phospholipase A2 (sPLA2) as a predictor of restenosis after coronary angioplasty]. / Uroven' sekretornoi fosfolipazy A2 v syvorotke krovi kak prediktor restenoza posle koronarnoi angioplastiki.

AIM: To elucidate whether secretory phospholipase A2 (sPLA2) level in the blood and catalytic activity are significant predictors of restenosis after coronary angioplasty (CAP). MATERIAL AND METHODS: Samples of venous blood were obtained from 24 patients before CAP and 1, 3, 6 days and 6 months after it. sPLA2 was measured with enzyme immunoassay, catalytic activity--using aqueous emulsion of 14C-labelled phosphatidylcholine. Control coronarography was performed in all the examinees 6 months after CAP. RESULTS: Restenosis was detected in 13 patients. In the serum of their blood sPLA2 rose significantly after CAP and persisted for 6 days after it. If restenosis was not registered, this rise was insignificant and disappeared by day 6 after CAP. Catalytic activity of sPLA2 on day 6 after CAP was significantly higher in patients who later developed restenosis. CONCLUSION: Elevated concentrations of sPLA2 in blood serum of patients after CAP may predict restenosis. Moreover, sPLA2 may not only mark inflammation but directly participate in development of restenosis.