[Open prosthetic repair of descending aortic aneurysm after its primary endoprosthetic repair]. / Otkrytaia operatsiia protezirovaniia anevrizmy niskhodiashchego otdela aorty posle ee pervichnogo éndoprotezirovaniia.

Presented in the article is a clinical case report regarding management of an 82-year-old female patient with late complications after staged treatment for an aneurysm of the descending and abdominal portions of the aorta, with the first stage consisting in endoprosthetic repair of the descending aortic portion and the second stage (after 4 months) in endoprosthetic repair of the abdominal aortic portion. Outpatient computed tomography performed 9 months after endoprosthetic repair of the abdominal aorta revealed an increase in aortic diameter over the distance between two stent grafts in the thoracic and abdominal aortic portions from 44 mm to 76 mm. In May 2019, a repeat operation was performed: resection of the aneurysm of the distal portion of the descending aorta on temporary subclavian-femoral and prosthesis-femoral shunts, with dissection of part of the thoracic stent graft, followed by formation of a proximal anastomosis between the endoprosthesis and a 30-mm linear Dacron prosthesis, and a distal anastomosis above the celiac trunk. The woman was discharged on POD 16. Follow-up computed tomography performed 8 months later demonstrated a type II endoleak from the inferior mesenteric artery and growth of the abdominal aortic aneurysm, thus requiring embolization of the ostium of the inferior mesenteric artery via the system of the superior mesenteric artery, with a good clinical effect and a decrease in the diameter of the aortic abdominal aneurysm.

[Open surgical treatment of aneurysms and dissection of the thoracic and thoracoabdominal aorta]. / Otkrytoe khirurgicheskoe lechenie anevrizm i rassloeniia grudnoi i torakoabdominal'noi aorty.

Presented herein is experience in treating a total of 56 patients with pathology of the arch, descending and thoracoabdominal aorta from 1997 to 2017. Of these, 6 (11%) patients were diagnosed with a Crawford type I-II thoracoabdominal aortic aneurysm (TAAA), 20 (35%) patients with Crawford type III-IV TAAA, 18 (32%) were diagnosed as having an aortic arch aneurysm (AAA) and descending thoracic aortic aneurysm (DTAA), 12 (22%) had DeBakey type I and IIIb aortic dissection. To protect the visceral organs and spinal cord from ischaemia in 28 (50%) cases we used a temporal bypass from a synthetic vascular graft with zero porosity and measuring from 15 to 20 cm in diameter. RESULTS: Mortality within 30 days amounted to 14.3% (n=8), that after 30 days amounted to 10.7% (n=6): in elective operations - 12% (n=5) and 5.4% (n=3), in emergency operations - 21% (n=3) and 21.4% (n=3), respectively. The total in-hospital mortality amounted to 25% (n=14), equalling 19% (n=8) and 43% (n=6) for elective and emergency operations, respectively. Mortality in using temporal bypass in elective operation amounted to 9.5% (n=2) during 30 days and that without using this method to 14.3% (n=3), after 30 days being 9.5% (n=2) and 4.7% (n=1), respectively. Mortality for emergency cases with a temporal shunt during 30 days was 28.6% (n=2), without - 14.3% (n=1), after 30 days - 28.6% (n=2), without - 14.3% (n=1). In type I-II TAAA mortality within 30 days was 16.6% (n=1), after 30 days - 50% (n=2); type III-IV TAAA - 10% (n=2) and 15% (n=1); DTAA - 22.2% (n=4) and 33.3% (n=2); aortic dissection - 8.3% (n=1) and 16.6% (n=1). Acute renal failure (ARF) occurred in 6 (10.7%) patients and was more often observed in the group without temporal shunting. Events of spinal cord ischaemia with the development of spinal stroke occurred in 6 (10.7%) cases. Five-year survival amounted to 61%. CONCLUSION: Temporal bypass in surgery of the thoracic and thoracoabdominal aorta may be used for prevention of ischaemia of visceral organs, kidneys and spinal cord in operations accompanied by cross-clamping of the descending thoracic aorta.

[Treatment of an aortic arch aneurysm ruptured into the lung]. / Lechenie razryva anevrizmy dugi aorty s proryvom v legkoe.

Described herein is a clinical case report concerning treatment of a 32-year-old female patient with rupture of an aneurysm of the arch and descending portion of the thoracic aorta, with the bleeding having penetrated the upper lobe of the left lung. The woman was admitted to the Department of Vascular Surgery of Municipal Multimodality Hospital No 2 of Saint Petersburg, presenting with a clinical pattern of aneurysmal rupture previously diagnosed by computed tomography performed at one of the local hospitals. Studying her case history revealed that, when a child, she had endured an operation for a defect of the interventricular septum and aortic coarctation with aortoplasty using a Dacron synthetic patch. On admission, she was treated as an emergency to immediately undergo temporal ascending-descending bypass grafting of the aorta and left common carotid artery without use of a heart-lung machine. After resection of the aneurysm of the arch and descending portion of the thoracic aorta and removal of the upper lobe of the left lung, a decision was made to leave the temporal shunt as permanent. In the early postoperative period the woman developed acute cerebral circulation impairment with minimal neurological deficit which was later on relieved. After 22 days, due to persisting atelectasis of the lower lobe of the left lung, the presence of an incompetent stump of the upper bronchus and air in the left pleural cavity, as well as high risk of infection of the vascular graft, we performed final bilateral pneumonectomy with omentopexy, i. e., suturing of the greater omentum to a portion of the thoracic graft. The woman was discharged on postoperative day 34 in a satisfactory condition. She then successfully gave birth to a child. She is currently presenting neither complaints nor evidence of respiratory insufficiency. The duration of follow up amounted to 8 years.

[Hybrid surgical treatment of a multilevel lesion of lower-limb arteries]. / Gibridnoe khirurgicheskoe lechenie mnogourovnevogo porazheniia arterii nizhnikh konechnostei.

The study was aimed at assessing immediate postoperative and remote results of hybrid surgical treatment of patients with a multilevel lesion of lower-limb arteries. Described herein is the authors' experience with simultaneous hybrid surgical management of 48 patients, including 43 subjects with a multilevel lesion of arteries of the lower extremities. There were 40 men and 8 women, with the average age amounting to 65.8±7.9 years. Of these, 30 patients suffered from stage II-b chronic arterial insufficiency (CAI), 11 had stage III CAI and 7 had stage IV CAI according to A.V. Pokrovsky classification. While planning the hybrid operation on the arteries of lower limbs we assessed the type of the lesion to the aortofemoral and femoropopliteal segments according to TASC II. All patients were subdivided into 3 groups, depending on the type of hybrid operations: Group I (n=17) - aortofemoral segment, Group II (n=5) - femoropopliteal segment, and Group III (n=26) reconstruction of both above-mentioned segments. The technical success amounted to 93.7% in revascularization of all types of lesions of the arteries of lower limbs with the use of hybrid vascular reconstructions. The mean duration of the operation was 231.8±90.7 min, including that of the open stage amounting to 126.4±72.8 min and that of the endovascular stage to 105.4±62.9 min. In the immediate postoperative period there were 2 complications requiring repeat reconstructive operation. The ankle-brachial index (ABI) after the intervention increased from 0.43±0.17 to 0.85±0.12. The duration of follow-up averaged 23.4±15.1 months (range 1.9-45.2 mos). Primary patency at 6 months was 94%, at 12 months 94%, at 24 months - 85% and at 36 months - 79% in all groups studied. Four patients during the follow-up period were subjected to amputation. The limb salvage rates were as follows: during 36 months in all patients - 91.6%, in those with stage II-b CAI - 93.3% and in those with critical lower-limb ischaemia - 88.8%. The overall survival rate was 95.8%. The use of a hybrid method in treatment of a multilevel lesion of lower-limb arteries with revascularization of the aortofemoral and femoropopliteal segments proved efficient both in the immediate and remote periods.

[Open surgical treatment of a giant renal cyst on the background of an arteriovenous fistula of the right renal artery]. / Otkrytoe khirurgicheskoe lechenie gigantskoi kisty pochki na fone arteriovenoznogo svishcha pravoi pochechnoi arterii.

Presented herein is a clinical case report concerning open surgical treatment of an arteriovenous fistula of the renal artery with a large venous aneurysm in the hilum of the right kidney and a giant cyst of the upper pole in a 28-year-old woman. The intraoperative findings revealed disunion of the arteriovenous fistula, followed by edge-to-edge suturing of the arterial defect. The venous aneurysm in the hilum of the right kidney was dissected and sutured by the edge-to-edge technique, with the additional varicose renal vein ligated. The postoperative period turned out to be uneventful with favourable convalescence and no complications. The check MSCT angiography performed 3 months later showed that the venous aneurysm was thrombosed, with no evidence of arterial blood ingress revealed. The excretory function of the kidney was preserved. Also discussed in the article are variants of diagnosis and treatment of an arteriovenous fistula of this localization and complications thereof.