[Use of the "Multitask" device while performing endarterectomy from iliac arteries]. / Ispol'zovanie instrumenta «Multitasc¼ pri vypolnenii endarterektomii iz podvzdoshnykh arterii.

AIM: The study was aimed at assessing efficacy of using the "MultiTASK" device manufactured by the Le Maitre Company while performing extended endarterectomy from iliac arteries in patients presenting with multilevel atherosclerotic lesions of the arterial bed and chronic ischaemia of lower extremities. PATIENTS AND METHODS: We analysed the outcomes of surgical management of a total of 37 patients presenting with multilevel atherosclerotic lesions of the common and external iliac arteries and arteries below the inguinal ligament over the period from 2012 to 2015 at the Department of Emergency Vascular Surgery of the Scientific Research Institute of Emergency Ambulance Care named after N.V. Sklifosovsky. Twenty one (56.8%) patients presented with haemodynamically significant stenoses of the iliac artery. Eleven (29.7%) patients had occlusion of the external iliac artery and five (13.5%) patients presented with occlusion of the common iliac artery in the distal portion. In all cases there was a second block, i. e. occlusion of the superficial femoral artery. RESULTS: The primary patency rate of the external iliac artery after endarterectomy amounted to 100%. Immediate complications directly associated with endarterectomy from the external iliac artery were encountered in one (2.7%) case - during back traction of the loop there occurred perforation of the wall of the external iliac artery by a calcified plaque, thus requiring external-iliac-common-femoral prosthetic repair. Amputation was performed in two (5.4%) patients (in both cases due to thrombosis and the development of ischaemic gangrene owing to poor condition of the distal arterial bed). One (2.7%) patient died of acute myocardial infarction. CONCLUSION: Extended endarterectomy by means of the "MultiTASC" device turned out efficient, yielding good immediate outcomes in atherosclerotic lesions of femoral arteries both as an independent operation and when combined with reconstruction of arteries beneath the inguinal ligament.

[Experience in treating embologenic thromboses of deep veins of lower extremities].

The present work deals with analysing the outcomes of surgical management carried out in a total of five hundred and sixty-six patients diagnosed as having embologenic thrombosis of the lower-limb deep veins. Of these, 377patients received a cava filter implanted, with the remaining 189 patients being subjected to thrombectomy from the iliac and femoral veins. In nineteen patients, the operation was supplemented by establishing an arteriovenous fistula. The decision of whether or not to perform a surgical intervention in patients presenting with thrombosis of deep veins of the lower extremities was made based on the type and pattern of the thrombus concerned. First of all, such surgery was indicated primarily for those diagnosed with a floating, embolus-hazardous thrombus. Thrombectomy was carried out in the patients with a favourable prognosis of the underlying disease, if activation of the pathological process was possible. Cava filters were implanted to the patients diagnosed as having a recurrent embolism, with an unfavourable prognosis of the course of the underlying disease, as well as to those presenting with a severe concomitant pathology. Ultrasonography-guided control is obligatory at all stages of management.

[Clinical and ultrasound diagnostics of acute venous thrombosis].

The results of clinical and ultrasound diagnostics of acute venous lower limbs thrombosis in 206 patients are analyzed. The patients were divided in two groups; those in the first group (n=96) had a diagnosed pulmonary embolism, patients of the second (n=110) had no signs of it. 37 (18%) patients had an asymptomatic course of venous thrombosis, 25 (68%) of those were diagnosed with pulmonary embolism. 154 (74%) patients had floating thrombs, which resulted in pulmonary embolism in 53%. Clinical and ultrasound criteria of embologenic venous trombosis are developed. It allows prognose the pulmonary embolism development and optimize the treatment tactics.

[Radiation diagnosis of aortic aneurysmal ruptures with formation of anastomoses with the inferior cava and various organs].

The results of radiation diagnostic techniques were analyzed in 29 patients with aortic aneurysmal ruptures with formation of aortic anastomoses. The examination and treatment of 362 patients with abdominal aortic aneurysmal ruptures revealed that 23 (6.35%) patients had anastomoses (aortocaval (n = 15), aortoduodenal (n = 6), aortogastric (n = 1), and aortoureteral (n = 1)). Six patients were observed to have secondary aortointestinal anastomoses occurring after reconstructive vascular surgery. In one patient, abdominal aortic aneurysmal rupture first led to the formation of a primary aortoduodenal anastomosis and some time after surgery a secondary aortointestinal fistula emerged. One out of 113 patients with aortic dissecting aortic aneurysms had an aortopulmonary fistula. Ultrasonography, computed tomography, and angiography were performed in 27, 19, and 14 patients, respectively. Radiation diagnostic techniques revealed fistulas in 9 (31%) out of the 29 patients. The diagnosis of aortic anastomoses presents challenges.