[Use of stents with bioactive coating in treatment of patients with lesions of the superficial femoral artery]. / Primenenie stentov s bioaktivnym pokrytiem v lechenii bol'nykh s porazheniem poverkhnostnoi bedrennoi arterii.

The authors analysed the immediate outcomes of implanting stents with bioactive coating in treatment of patients presenting with atherosclerotic lesions of the superficial femoral artery. Over the period from January 2014 to December 2015, endovascular interventions on the superficial femoral artery were carried out in a total of 18 patients (mean age 61.3±9.2 years). The implants inserted were stents with bioactive coating based on titanium oxinitride, measuring 6 to 8 mm in diameter and being from 50 to 200 mm long. Prior to operation and 7 days after implantation of the stent, the immunoenzymatic assay was used to determine the level of nitrogen nitric oxide (NO) in blood. The stents' patency was assessed by the findings of ultrasound duplex scanning performed at 30 days, and then 6 and 12 months after the intervention. There were no complications either during the operation or in the early postoperative period. An increase in the ankle-brachial index was observed in all patients: with the average value prior to treatment amounting to 0.4±0.3 and equalling 1.1±0.2 after stenting (p<0.0001). Normalization of the blood NO level was revealed (was noted to normalize): the mean value prior to operation amounted to 18.9±2.3 µmol/L and after operation to 28.9±4.1 µmol/L (p<0.05). Primary patency rate of the stents was 100% at 30 days, 94.5% (1 occlusion) at 6 months and 88.8% (1 restenosis and 1 occlusion) at 12 months. The patients with occlusion or restenosis were subjected to repeat endovascular interventions, with restoration of patency of the construction (with the construction's patency restored). By now all the 18 patients show preserved patency (currently patency was preserved) of lower-limb arteries, with no evidence of restenosis in the zones of operations. It was concluded that using stents with bioactive coating based on titanium oxinitride results in normalization of the level of NO in blood, which may contribute favourably to prolongation of the period of functioning of endovascular constructions. The first data concerning primary patency of stents of this type make it possible to count on betterment of the remote results of treatment of patients presenting with atherosclerotic lesions of the superficial femoral artery.

[Analysis of the association of polymorphic variants of SYP1A2, GSTT1,GSTM1, GSTP1, XRCC1, XRCC3, AR and VDR genes with predisposition to the development of prostate cancer].

One of the risk factors for the development of malignant tumors, including prostate cancer, is an individual genetic predisposition due to the various unfavorable polymorphic variants of normal genes. The aim of the study was to com- pare the frequency of different genotypes of polymorphic vari- ants of genes CYPJA2, GSTT, GSTM, GSTP1 (xenobiotics detoxification), XRCC1, XRCC3,(DNA repair) and VDR, AR (transcription factors) in patients with prostate cancer and in control group to determine their association with genetic pre- disposition to this disease. According to the results obtained the rs1544410 AA genotype (VDR gene) and the presence of less than 20 CAG repeats in the 1st exon (AR gene) are the risk factors for the development of prostate cancer. The het- erozygous genotype 722 CT (XRCC3 gene) demonstrated the protective effect.

[ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group.

[WAYS OF IMPROVEMENT OF LOOP ENDARTERECTOMY RESULTS FROM ILIAC-FEMORAL SEGMENT].

The article presents an analysis of treatment results of 91 patients with iliac-femoral segment artery occlusion at the period from 2008 to 2014. Patients were divided into 2 groups: main group (n=30) consisted of patients who undergoing a half-closed loop endarterectomy with following implantation of stent-grafts in this area and control group (n=61) had patients whom were performed routine half-closed loop endarterectomy. The II degree of ischemia of lower extremities was in 88 (96,7%) patients and III degree had 3 (3,3%) patients. The areas of abnormalities of intravascular pattern were detected in 100% of cases in intraoperative angiography. They were modified using stent-grafts. A primary vascular patency was 100% in the first group and it numbered 65% in the second group during 5 years. The intraoperative angiography control with stent-graft implantation to the area of endarterectomy allowed reliable improvement of treatment results.

[Characteristics of surgical approach using for patients with renal cell carcinoma, complicated by postcava tumor thrombosis].

The postcava tumor thrombosis had about 1/3 of patients with renal cell carcinoma at the initial examination. Reconstructive interventions were performed on the postcava for 38 patients (24 men, 14 women). The postcava thrombectomy was applied in 15 patients. The thrombectomy with postcava resection were carried out in 13 patients and plasty- in 6, prosthetics-in 4. An actuarial 3-year or 5-year survival rate of patients consisted of 59.4% and 42.2%. The performance of reconstructive interventions on postcava with its involvement was justified and provided satisfactory results in patients with renal cell carcinoma.

[An experience with 100 cadaveric transplantations of the liver in the Russian Research Center of Radiology and Surgical Technologies].

The authors made an analysis of their first 100 transplantations of cadaveric liver made at the period from 1998 through 2011. Postoperative complications and long-term results of transplantations at the period to 13 years are described. Cumulative survival up to 12 months was 91%, to 36 months--83%. Retransplantation of the liver was performed on 5 patients, 2 of them being successful.

[The value of intraoperative Doppler-flowmetry in assessment of blood flow after the hepatic artery reconstruction during the orthotopic liver transplantation].

The practical relevance of volumetric blood flow in the hepatic artery during orthotopic liver transplantation was determined. From May 2009 to January 2011 25 patients underwent orthotopic liver transplantation. Volumetric blood flow in the hepatic artery is routinely measured using a Doppler flow meter during the operation. In 15 cases out of 25 (60%) the blood flow rate immediately after the formation of arterial anastomosis was 150 ml/min (190 +/- 40 ml/min) and increased to adequate with repeated measurements. In 2 cases out of 25 (8%) the blood flow rate reduced in repeated measurements, but by the end of operation the blood flow to the hepatic artery was at the satisfactory level. Blood flow less than 150ml/min immediately after the formation of arterial anastomosis was found in 8 cases out of 25 (32%). The cause of inadequate blood flow was identified and corrected. There were no cases of hepatic artery thrombosis at the early postoperative period. The routine use of intraoperative blood flow measurements allows timely determination of insufficient arterial blood supply of the transplant and elimination of its causes.

[Direct results of endovascular prosthetics of aneurysms of the infrarenal part of the aorta in patients with a severe concomitant pathology].

From May 2007 to March 2009 under observation there were 58 patients aged from 52 to 79 years (mean age 68) with the diagnosis of abdominal aortic aneurysm (AAA). Selection of patients for endoprosthesis was performed by the data of spiral computed aortography. The endovascular exclusion ofAAA from blood flow was performed in 15 patients. All the patients had high risk of surgery because of multiple concomitant pathologies. In 14 (93%) patients bifurcational and in 1 patient aortofemoral unilateral prostheses of AAA were made with the application of femoro-femoral bypass. All implantations were technically successful without complications. Shorter time of operation, less intraoperative blood loss, shorter tine of staying in hospital and time of rehabilitation were found to be 1.5-3 times as compared with classical surgical intervention. Implantation of bifurcational stent-graph seems to be the method of choice in treatment of AAA patients with severe concomitant pathology.

[Results of the aortofemoral arterial reconstructions depending on hemodynamic conditions].

Reconstructive operations were made on AFS of 264 patients. The number of operated extremities with high peripheral resistance was almost 2 times less than with normal. When the operations on AFS were supplemented by operations of "outflow" the peripheral vascular resistance (PVR) in the arterial bed of the extremities was reliably rarer. The results of operations with high PVR are reliably worse. Operations of "outflow" considerably improve long-term results of AFS reconstructions.

[Results of femoro-popliteal arterial reconstructions depending on hemodynamic conditions].

The investigation included 205 patients. Reconstructive operations were fulfilled on major arteries of the femoro-popliteal segment (FPS) of lower extremities. An analysis of long-term results showed that the results of surgical treatment of lesions of FPS in obliterating atherosclerosis of the lower extremity vessels depended on the level of the peripheral vascular resistance in the lower extremity arteries, and the formation of the arteriovenous shunt in reconstructions of the FPS allowed considerable improvement of results of surgical treatment of patients with high peripheral vascular resistance.

[Methods of correcting hepatic arterial blood supply for subsequent implantation of the "port-catheter" infusion system].

The study was undertaken to investigate the feasibility of using surgical and roentgenoendovascular redistribution of the hepatic arterial blood flow for adequate implantation of the "port-catheter" infusion system. Between December 2001 and March 2008, we performed surgical (n = 25) or transcutaneous (n = 22) implantations of the infusion systems for carrying out regional chemotherapy in a total of forty-seven patients presenting with hepatic metastases of colorectal carcinoma. Anatomical variants of the hepatic arteries were observed in eleven cases. The blood stream was corrected by means of either transcatheter embolization (n = 7), ligation (n = 2), or transposition (n = 2) of the aberrant arteries. No complications were encountered. In all the cases, the "port-catheter" system was implanted successfully, with adequate hepatic perfusion achieved. Both transcatheter embolization and surgical reconstruction turned out to be efficient methods in correction of the blood flow in various anatomical structures of the hepatic arteries, thus favourably contributing to increased efficacy of regional chemotherapy.

[Modern diagnostic technologies in determination of the strategy of treatment of patients with obliterating atherosclerosis of the lower artery vessels].

The authors analyzed results of surgical treatment of 332 patients in whom 410 reconstructive operations were performed on the lower extremity arteries. During 12 months after operation on the aorto-femoral segment with high peripheral vascular resistance reocclusions were noted in 61% of the cases, with normal resistance--in 11.8%, after operation on the femoro-popliteal segment--in 77.1% and 28.3% respectively. According to the findings of computed tomography and magnetic resonance imaging, densitometry the indices were established allowing prognosis of high peripheral resistance in the lower extremity arteries at the preoperative stage. Such indices are considered to be indications to femoro-profundoplasty on the aortofemoral segments or arterio-venous fistula on the femoro-popliteal segment. Such effectively fulfilled interventions could reduce the frequency of reocclusions to 3.1% on the aorto-femoral segment and to 11.8% on the femoro-popliteal segment.

[The role of vascular reconstructions in the surgery of tumors of the hepatopancreatobiliary zone].

An analysis of results of 83 operations performed for tumors of the hepatopancreatobiliary zone included the period of 2006-2007. In 39 resections of the pancreas there were 16 (41.0%) cases when the operation was supplemented with a reconstruction of the major vessels. From 44 resections of the liver 10 (22.7%) interventions were made with resection of the major veins. No specific complications were noted associated with vascular reconstructions in the zones in question. Postoperative lethality after operations for malignant tumors of the hepatopancreatobiliary zone was 2.4%, after operations in the same zone supplemented with vascular reconstructions was 3.8%. The duration of postoperative hospital stay was practically the same of that of the patients operated for malignant tumors of the hepatopancreatobiliary zone without vascular reconstructions. One year survival of the patients operated for malignant tumors of the hepatopancreatobiliary zone without and with vascular reconstructions was commensurable. Reconstruction of the major vessels in operations for locally extensive tumors of the hepatopancreatobiliary zone allows more often using radical surgical interventions. Complete restoration of the patency of the major vessels in the zone of operations for tumor processes in the liver and pancreas alleviates the postoperative period, is not followed by more number of postoperative complications and lethality.

[A means for the hemodynamic correction of coronary insufficiency in the basin of the right coronary artery]. / Sposob gemodinamicheskoi korrektsii koronarnoi nedostatochnosti v basseine pravoi venechnoi arterii.

To synchronize the bloodstream along the shunt and the bloodflow along coronary channel hemodynamically protected aortocoronary shunt was elaborated and applied in 1 patient. The monocusp was formed, dipped in the aorta lumen by means of V-figurative cut in the ascending aorta wall. An aperture in the aorta wall, disposed behind the monocusp in direction of bloodstream, was closed with the autovena patch, in centre of which the section was made and the autovenous transplant was sewn along its edge.

[Anatomical types of coronary circulation and various lesions of the right coronary artery]. / Anatomicheskie tipy koronarnogo krovoobrashcheniia i varianty porazheniia pravoi venechnoi arterii.

The data on coronarography, conducted in clinic to 1249 patients in 1994-1996 yrs., and intraoperative data, obtained in the patients with a coronaris dextra (ACD) affection and its concurrent affection with a coronaris sinistra (ACS) operated on in clinic in 1974-1996 yrs., were analyzed. It was established that the frequency of severe affection of endothelium of ACD while the existence of the left coronary blood circulation (CBC) type 2.5 times as higher than that while the presence of its right or balanced kinds. The most frequent atherosclerosis occurrence in the proximal ACD portion creates the anatomical prerequisites for the broad application of surgical treatment methods of coronary insufficiency.