[Changes in deep femoral artery topography during open revascularization of the lower limbs]. / K voprosu ob izmenenii topografii ust'ya glubokoi arterii bedra pri otkrytykh revaskulyariziruyushchikh vmeshatel'stvakh.

OBJECTIVE: To study topographic changes of femoral triangle arteries during open revascularization of the lower limbs. MATERIAL AND METHODS: A retrospective study included 30 men aged 59.6±3 years with atherosclerotic femoropopliteal occlusion and chronic lower limb ischemia IIb-III stage according to the Pokrovsky-Fontaine classification. All patients underwent open reconstructive interventions. Ten patients underwent above-knee femoropopliteal replacement with a synthetic prosthesis, 10 patients - above-knee femoropopliteal bypass with a synthetic prosthesis, 7 patients - above-knee femoropopliteal bypass with autologous vein, 3 patients - below-knee femoropopliteal bypass with autologous vein. Control group consisted of 30 healthy mean aged 60±2 years. Ultrasound was carried out using the Esaote My Lab Alfa scanner (3-12 MHz linear transducer and 3-5 MHz convex transducer). RESULTS: In healthy volunteers, deep femoral artery always arose from common femoral artery under the angle ≤30° in all cases (20° - 93.3% of cases, 30° - 6.7% of cases). In patients with previous surgical treatment, angle of deep femoral artery varied from 35 to 80°. After femoropopliteal bypass grafting with autologous vein, angle of deep femoral artery varied from 35 to 45° (35° - 8 patients, 40° - 1 patient, 45° - 1 patient). After femoropopliteal bypass grafting with a synthetic prosthesis, angle of deep femoral artery increased up to 40-50° (40° - 2 patients, 50° - 8 patients). In case of previous femoropopliteal replacement with a synthetic prosthesis, angle of deep femoral artery increased up to 70-80° (70° - 7 patients, 75° - 2 patients, 80° - 1 patient). CONCLUSION: Normally, angle of deep femoral artery does not exceed 30°. Open reconstructive surgery on femoropopliteal arteries increases this value from 30° to 80°. Minimal changes are observed after femoropopliteal bypass grafting with autologous vein.

Apoptosis and Cell Proliferation Markers in Inflammatory-Fibroproliferative Diseases of the Vessel Wall (Review).

Apoptosis is the main feature of inflammatory-fibroproliferative disorders of the vessel wall. Studies in animal models have shown that smooth muscle cells (SMCs) cultured from endarterectomy specimens from the affected area proliferate more slowly and display higher apoptotic indices than SMCs derived from the normal vessel wall. Apoptotic cells were found in the destabilized atherosclerotic plaques, as well as in the samples with restenosis of the reconstruction area. Injury to the vessel wall causes two waves of apoptosis. The first wave is the rapid apoptosis in the media that occurs within a few hours after injury and leads to a marked reduction in the number of vascular wall cells. The second wave of apoptosis occurs much later (from several days to weeks) and is limited by the SMCs within the developing neointima. Up to 14% of the neointimal SMCs undergo apoptosis 20 days after balloon angioplasty. Ligation of the external carotid artery in a rabbit model led to a marked decrease in blood flow in the common carotid artery, which correlated with the increased apoptosis of endothelial cells and SMCs. Angioplasty-induced death of SMCs is regulated by a redox-sensitive signaling pathway, and topical administration of antioxidants can minimize vascular cell loss. On the whole, studies show that apoptosis is prevalent in vascular lesions, controlling the viability of both inflammatory and vascular cells, determining the cellular composition of the vessel wall. The main markers of apoptosis (Fas, Fas ligand, p53, Bcl-2, Bax) and cell proliferation (toll receptor) have been considered in the current review.

[Effect of an antioxidant on vascular wall cell apoptosis markers after reconstructive operations]. / Vliianie antioksidanta na markery apoptoza kletok sosudistoi stenki posle rekonstruktivnykh operatsii.

AIM: This study was aimed at determining Bcl-2 and Bax proteins expression before and after reconstructive-repairing operations in patients with atherosclerosis obliterans of lower extremities and at assessing the effect of an antioxidant (vitamin E at a dose of 100 mg once daily for 1 month after surgery) on the dynamics of changes of Bcl-2 and Bax proteins in the postoperative period. PATIENTS AND METHODS: The study included a total of 60 patients with stage III-IV lower limb atherosclerosis obliterans. All patients underwent reconstructive-repairing operations on the arteries of the aortofemoral segment. After surgery the patients were divided into two groups. Group A included 30 patients who during 1 month received additionally to basic therapy vitamin E at a daily dose of 100 mg. Group B was composed of 30 patients receiving basic therapy alone according to the National guidelines of managing patients with peripheral artery disease. All patients before, on POD 1, and 1 month after surgery were subjected to venous blood test aimed at determining Bcl-2 and Bax apoptosis proteins expression by means of enzyme-linked immunosorbent assay. RESULTS: In patients of groups A and B, the baseline level of Bcl-2 protein (4.75 and 4.2 ng/ml, respectively) was comparable with that in apparently healthy volunteers (5.3 ng/ml). The baseline levels of Bax protein in patients of the operated groups (26.9 and 26.0 ng/ml, respectively) were increased compared with the values in healthy volunteers (16.5 ng/ml). On POD 1 there was increased expression of Bax protein in Group A and B patients to 39.4 and 30.2 ng/ml, respectively. One month after surgery, Group B patients demonstrated a decrease in the Bcl-2 values below the baseline level - 1.1 ng/ml (p=0.003), with the Bax level continuing to increase - 36 ng/ml (p=0.004). In turn, Group A patients after 1 month were found to have increased levels of the Bcl-2 protein - 5.75 ng/ml, with the Bax level returning to the baseline values - 27.4 ng/ml. CONCLUSION: In stage III and IV lower limb obliterating atherosclerosis, the level of the Bax proapoptoric protein was higher than that in healthy volunteers. On POD 1, there occurred increased expression of the pro-apoptotic protein Bax and activation of apoptosis markers. On the background of using vitamin E at a dose of 100 mg once daily for 1 month, there was a decrease in level of the Bax propapoptotic protein (p=0.003) and an increase in level of the anti-apoptotic Bcl-2 protein level (p=0.0007).

Expression of Apoptotic Markers Bcl-2 and Bax in the Vascular Wall.

The aim of the study was to assess the levels of Всl-2 and Bax proteins in the vascular wall and their correlation with serum cholesterol in patients with stage III-IV atherosclerosis obliterans of lower limb arteries. Materials and Methods: The study included 32 patients with stage III-IV atherosclerosis obliterans of the lower limb. Samples of intraoperative material (all three layers of the vascular wall) including an atherosclerotic plaque (AP) were taken during primary open surgery on major leg arteries. As a control, we used samples of the arterial wall without visible signs of atherosclerosis. Based on AP ultrasonography, the patients were divided into two groups: with APs of mixed echogenicity and with hyperechoic (calcified) AP. The vascular samples were crushed and homogenized for further measurements of Всl-2 and Bax proteins; in a separate setup, cholesterol in blood serum was measured. Results: In patients without atherosclerotic changes, the level of the anti-apoptotic protein Bcl-2 in the arterial wall was 1.25 ng/mg, and that of the pro-apoptotic protein Bax - 4.7 ng/mg. In the case of APs of mixed echogenicity, the expression of Bcl-2 was 1.8 ng/mg (p=0.143) and that of Bax - 5.1 ng/mg (p=0.834), with no significant differences from AP-free vascular wall samples. In the arterial wall containing a heterogeneous calcified AP, the expression of Bcl-2 was 0.9 ng/mg (p=0.143), In contrast, the level of Bax was 6.8 ng/mg, which showed its significant increase as compared with the non-AP controls (p=0.02). In the cases with predominantly hyperechoic AP, the expression of Bcl-2 was significantly lower (p=0.036), and that of Bax - significantly higher (p=0.036) in comparison with AP of mixed echogenicity. In patients with hyperechoic AP, we found a negative correlation between the Bax and Bcl-2 values ( r=-0.315) and a positive correlation between the Bax expression and serum cholesterol (r=0.617). Conclusion: In arterial walls with hyperechoic (calcified) APs, the expression of anti-apoptotic protein Bcl-2 is reduced, and that of pro-apoptotic protein Bax is increased, which indicates the apoptosis activation in advanced atherosclerotic lesions. In patients with such APs, elevated cholesterol levels directly correlate with the increased expression of pro-apoptotic Bax protein (r=0.617).

[Clinical anatomy of deep femoral vessels in the area of femoral triangle]. / Klinicheskaia anatomiia glubokikh sosudov bedra oblasti bedrennogo treugol'nika.

AIM: The purpose of this study was to specify the anatomy of the deep femoral artery and deep femoral vein within the femoral triangle. MATERIAL AND METHODS: The study was based on the data of anatomical dissection of vessels in the area of the upper third of the femur (20 specimens ) and ultrasonographic duplex angioscanning of patients undergoing routine examination of the vascular system (40 patients, 50 lower extremities). Ultrasonography was performed using linear and convex transducers (frequency 3-13 and 3-5 MHz). RESULTS: In the majority of cases, the deep femoral artery originated from the common femoral artery: in 100% of cases in anatomical dissection and in 98% according to the findings of ultrasound duplex angioscanning. Two trunks of the deep femoral artery were revealed in 14% of cases. The findings of ultrasound duplex angioscanning and those of anatomical dissection demonstrated a high origin of the deep femoral artery in 8% and 10% of cases, respectively. In the majority of cases, the deep femoral artery originated from the posterior surface of the common femoral artery: in 46% of cases on ultrasound duplex angioscanning and in 60% of cases in anatomical dissection; along the posterior lateral surface: in 36% according to the data of ultrasound duplex angioscanning and in 40% on dissection. The origin of the deep femoral artery from the medial surface of the common femoral artery was encountered in 8% cases and in 6% of cases was associated with formation of an atypical saphenofemoral junction. One patient was found to have the origin of one of the trunks of the deep femoral artery from the anterior surface of the common femoral artery. Two trunks of the deep femoral vein were revealed in 84% of cases. The proximal trunk flowed into the femoral vein from the lateral surface immediately beneath the ostium of the deep femoral artery, and the distal trunk - 1-1.5 cm lower from the posterior medial side of the femoral vein. CONCLUSION: The knowledge of variant anatomy of deep femoral vessels is very important for decreasing the risk of iatrogenic lesions during surgical manipulations and false-negative results of diagnostic manipulations. If possible, it is always necessary to preoperatively assess variant anatomy of deep femoral vessels (real-time assessment of topography of vessels by means of ultrasound duplex angioscanning, preoperative marking of vessels).

[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[Recirculation syndrome in hemodialysis patients]. / Prichiny sindroma retsirkuliatsii pri programmnom gemodialize.

OBJECTIVE: To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS: There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS: In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION: Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.

[Promising methods of studying perfusion in patients with atherosclerosis of peripheral arteries]. / Perspektivnye metody issledovaniia perfuzii u patsientov s aterosklerozom perifericheskikh arterii.

Prevalence of atherosclerotic peripheral artery disease (PAD) has steadily been increasing all over the world, affecting approximately 10% of the population. PAD dramatically decreases the patients' quality of life and is accompanied by high risks of limb amputation and death. Reconstructive and restorative interventions make it possible to achieve the highest success in treatment of PAD. Their results largely depend on the state of the patient's peripheral bed. Currently, the periphery is objectively assessed by means of ultrasonographic duplex examination, digital subtraction angiography, roentgen computed tomographic angiography (CTA), and in a series of cases magnetic resonance tomographic angiography (MRA). Widely known are the scale of assessing peripheral vascular resistance, suggested by R. Rutherford and the Bollinger scoring system. All these methods study predominantly the major blood flow, only slightly touching the microcirculatory bed. Promising methods in this area are radionuclide methods - single-photon emission computed tomography (SPECT) and positron-emission tomography (PET). Used singly, they possess high sensitivity but low spatial resolution, therefore they are supplemented by CTA or MRA. It is supposed that the use of radionuclide methods would make it possible to accurately assess the state of an atherosclerotic plaque and angiogenesis in conditions of ischaemia. Yet another method of diagnosis of microperfusion is contrast-enhanced ultrasonography (CEUS). CEUS reveals deficit of perfusion of the gastrocnemius muscles of patients with PAD in accordance with severity of the disease and degree of the development of collaterals. It is also used for determining the results of therapy with agents improving microcirculation. The degree of blood supply to tissues may be evaluated with the help of perfusion computed tomography (PCT). The main area of its application is diagnosis of impairments of cerebral circulation. Under study is a possibility of using PCT in atherosclerosis of lower-limb arteries, as well as assessing the efficacy of the reconstructive and restorative procedures performed.

[Hemostatic changes in patients with peripheral artery disease before and after bypass surgery]. / Pokazateli gemostaza u patsientov s aterosklerozom perifericheskikh arterii pri rekonstruktivno-vosstanovitel'nykh operatsiiakh.

AIM: To assess intrinsic coagulation pathway factors activity and hemostatic markers of endothelial dysfunction in patients with peripheral artery disease (PAD) before and after lower extremity bypass surgery. MATERIAL AND METHODS: 80 patients with PAD Fontaine grade IIB-III were enrolled. 40 patients underwent open aorto-femoral-popliteal repair (group A) and 40 patients - medication (group B). Before and in 3 months after surgery peripheral venous blood samples were collected to assess the activity of factors VIII, IX, XI, von Willebrand factor (VWF), protein C (PrC), and metabolites of nitric oxide II (NO). RESULTS: Increased preoperative activity of VIII, IX, XI, and VWF factors compared with normal values was observed in group A. After 3 months there was an additional increase of VIII and VWF factors' activity. Activity of IX and XI factors remained increased on background of reduced level of NO metabolites. In group B increased activity of IX, XI, and VWF factors was revealed while levels of NO metabolites and PrC were normal. CONCLUSION: Thus, PAD is followed by prothrombotic state especially in patients after surgery. Surgical procedures are associated with more severe hypercoagulation.

[MicroRNAs as potential noninvasive markers in the diagnosis of urological malignancies].

Small non-coding RNAs (microRNAs) are involved in almost all biological mechanisms of carcinogenesis. Due to their stability in biological fluids microRNAs may serve a perspective biomarker for diagnosis and prognosis of oncological diseases. The review is dedicated to the analysis of microRNAs, as potential diagnostic markers of urological malignancies. Recent advances in the knowledge of miRNAs origin in body fluids, their stability and application as a potentially new class of biomarkers in medicine are summarized and discussed in the article.

[Mutational landscape of prostate tumors revealed by whole-exome sequencing].

The results of the whole-exome DNA sequencing of eight prostate adenocarcinoma patients are presented. DNA was isolated from the peripheral blood as well as healthy and tumor prostate tissue from each patient. Bioinformatics analysis was conducted and the most significant mutations in prostate cancer patients were revealed. The obtained data could be important for understanding of the molecular mechanisms of prostate cancer pathogenesis and facilitate development of new approaches for treatment of the disease.