[Combined methods of treatment the congenital arterio-venous fistulas of peripheral vessels].

A 10-year experience and results of combined methods of surgical treatment of arterio-venous fistulas of peripheral vessels in 50 patients were analyzed. The patients were systematized on the basis of existing classifications, clinical manifestations of the disease, methods of invasive (ultrasound dopplerography and duplex scanning) and invasive (angiography) examinations. According to many authors no one of conventional methods of surgical treatment of arterio-venous fistulas which are used singly can be effective and must not be recommended as the most optimal. Stepwise employing of traditional operations and endovascular techniques are the main conditions for preventive measures of ischemic disorders in the limbs.

[Substantiation of surgical decision making in congenital lesions involving the inguinal major vessels n injection drug abusers].

The article is dedicated to surgical policy pursued in lesions involving femoral major vessels in the inguinal region, having developed due to long-term abuse of injection narcotic drugs. Analysed herein are the outcomes of surgical management of thirty-one patients presenting with a pulsating haematoma and inguinal pseudoaneurysms of post-injection aetiology. According to the authors' opinion, choosing the appropriate scope of the would-be operation is too complicated largely due to peculiarities of the pyo-necrotic process in this zone. Revealed and systematized characteristic of this category of risk factors that pose a real threat of severe consequences when any type of surgery. The authors recommend using only 2 categories of operations: ligation of damaged vessels in the groin area as an independent operation and ligation of vessels with the restoration of blood flow through lateral bypass autovein. Indications for their use, particularity of performing the ligated operations in the inguinal region was given.

[The combined strategy in treatment of lymphangiodysplasia].

The experience of treatment of a rare form of pathology of the lymphatic system was analyzed. The surgical tactics, depending on both the dimentions and the form of lymphangiodysplasia, were described. The absence of the pain sensitivity and large tumor size were the main reason of medical help seeking for the patients on the late stages of the disease. To minimize the volume of the intraoperative bleeding, the authors recommend skeletization of the magistral arteries or their embolisation as a preliminary step before the lesion's surgical excision. The method proved to be extremely effective in two patients with giant lymphagioma.

[Methods of operative interventions in postthrombotic disease of the crus].

Analysed herein are the findings of examination and outcomes of surgical management of 43 patients presenting with crural postthrombotic disease. Of these, eighteen patients were diagnosed as having stage II chronic venous insufficiency (CVI) and the remaining 25 had stage III CVI. All the patients had previously experienced acute thrombosis of deep crural veins. Eight patients had developed thrombosis during or in the immediate terms after typhoid fever, seven women in the postpartum period, and a further four women after endured operations on the organs of the abdominal cavity or small pelvis. Twelve patients had developed thrombosis after a blunt injury of the limb. In a further 12 cases, the causes of thrombosis coujinot be revealed or traced properly, thus having remained unknown. The disease duration varied form twelve months to nine years. Venous haemodynamics was studied by means of duplex scanning and phlebography, with the latter used if indicated. The prevailing role in making appropriate diagnosis was found to belong duplex scanning. Thirty-one patients were subjected to combined surgical procedures. Twelve subjects underwent single-stage operations. The main stage of the intervention in combined surgery consisted in resection of the anterior tibial vein and dissection of communicating veins of the medial surface of the crus according to the Savelyev-Konstantinova's technique; phlebectomy was performed on the crus only. The remote period was marked by a decrease in the CVI's severity, i.e., transition to a lesser-severity degree in eighteen patients (41.9 %), while in twenty-five cases (58.1 %) CVI remained at the baseline level. Totally, positive results were obtained in forty patients (93.0%). Three patients (7.0 %) initially presenting with grade C5-6 CVI and subjected to single-component operations were found to have poor outcomes. Surgical correction of the venous blood fl ow does by no means cure the patient but appears to result in persistent remission of the disease, with adequate rehabilitation after surgery leading to considerable regression of CVI.

[Successful surgical repair of aortic arch torsion and aneurysm].

Described herein is a rarely encountered in clinical practice case regarding surgical management of pathological tortuosity of the aortic arch with a simultaneously present aneurysm thereof. The defect was surgically corrected in the setting of extracorporeal circulation. The tortuous and aneurysmatic aortic arch was resected within the boundaries of the healthy tissues, duly followed by establishing an end-to-end anastomosis between the edges of the resected aorta.

[Reconstructive operations in unilateral occlusions of the iliac vein].

Analysed herein are the findings of the examination and outcomes of surgical management of 48 patients with unilateral occlusion of the iliac veins. Of these, grade I chronic venous insufficiency (CVI) was observed in 12 patients and grade II SVI in 28 subjects. Grade III CVI's with trophic ulcers were diagnosed in 8 patients. In a further eight patients, the primary cause of thrombosis had been catheterization of the femoral vein in childhood. Nine patients developed thrombophlebitis following the endured enteric fever, with four patients having developed it after an injury, four - after an operation on the abdominal cavity organs, and four - after delivery. In the rest 19 patients, we failed to reveal the cause of thrombophlebitis. The venous haemodynamics was studied by means of the following methods: Doppler ultrasonography, duplex scanning and phlebography. The latter was used by the indications, with the duplex scanning technique having proved to play the leading role. The patients with postthrombotic lesions of several segments appeared to have a severer degree of CVI. The venous circulation was more compensated in the well-developed suprapubic collateral network. The patients were subjected to two types of surgical interventions: the Palm-Esperon operation with and without the establishment of the AV fistula (26), and correction of the suprapubic collaterals (21). The indication for establishing the AV fistula was the difference of pressure in the femoral veins of not less than 50 mm Hg. The correction of the suprapubic collaterals was carried out in considerably varicose-dilated saphenous veins of the suprapubic area. Disseminated lesions of the deep veins and secondary alterations in the tibial veins were additionally managed and coped with by the appropriate correcting operations performed on the crus. Postoperative complications were observed in two (4.2%) patients: thrombosis of the femoral-iliac shunt and of the corrected suprapubic vein. Favourable outcomes were obtained in 46 (95.8%) patients.

[Successful surgical treatment of veritable internal carotid aneurysm due king-king].

In the report authors had shown the clinical observation (case) of surgical treatment of the patient with veritable lateral aneurysm of right internal carotid artery appeared due of its king-king.

[Surgical management of thromboses and aneurysms of the reconstructed vessels].

This paper analyses the results of reoperations in 52 patients with thromboses (n=42) and aneurysms (n=10) of the reconstructed vessels. The main causes of their development were progression of vascular disease and suppuration of a surgical wound. No relationship was established between complications and the type of suture materials. The diagnosis of the disease was made on the basis of the clinical data and duplex scanning. The operation of choice for thromboses of aortofemoral grafts was retrograde thrombectomy with reconstruction of the distal anastomosis, which was performed in 24 patients. Despite the controversial data on the possibility of thrombectomy from vein grafts the authors could accomplish it in 6 of 10 patients with thromboses of the femoro-popliteal vein bypasses. It is emphasized that the basic component of reoperations for occlusions of the femoro-popliteal segment lies in the formation of a tension-release arterio-venous fistula. In the postoperative period, rethrombosis of the reconstructed vessels occurred in 2 patients, arrosive bleeding in 3; limb amputation was performed in 3 patients, one of whom died from peritonitis.

[Surgeries on major vessels in removal of different tumors]. / Operatsii na magistral'nykh sosudakh pri udalenii opukholei razlichnoi lokalizatsii.

Experience in diagnosis and surgical treatment of 49 patients with tumors of different localization close to their major with main vessels is analyzed. Two variants of tumor - vessel interrelation were seen, patients with iatrogenic vascular lesions were included into a separate group. In 9 patients (group 1) only extravasal compression by the tumor was seen. Most of these tumors were benign. In 15 patients (group 2) reconstructive vascular surgeries were performed because of close interrelation with the tumor or tumor spread into the vessel. Most of these tumors were malignant. Iatrogenic lesions of arteries during surgeries were in 25 patients (group 3). It is demonstrated that duplex sonography permits to diagnose affection of vessels by tumors without invasive procedures. All the patients underwent vascular reconstruction simultaneously with tumor removing. Sceletization of vessels with their decompression was the surgery of choice in benign tumors. In malignant tumors it is recommended to remove the tumor with affected segment of vessel and repair of blood flow. Ligation of vessel may be justified in some cases.