[Total laparoscopic retrieval of a cava filter: case series]. / Polnost'iu laparoskopicheskoe udalenie kava-fil'tra: seriia sluchaev.

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.

[First experience with total laparoscopic reconstructive operations in occlusive lesion of the aortoiliac arterial segment]. / Pervyi opyt total'nykh laparoskopicheskikh rekonstruktivnykh operatsii pri okkliuzionnom porazhenii aortopodvzdoshnogo arterial'nogo segmenta.

According to the TASC II and the Russian National Guidelines on management of patients with lower limb arterial diseases, in patients with type C and D lesions of the arterial bed performing aortofemoral bifurcation bypass grafting is preferable. Laparoscopic technique makes it possible to combine advantages of minimally invasive surgery with well-known remote results of open reconstructive operations on the aortoiliac segment. The study included a total of 54 patients undergoing treatment at the Cardiosurgical Department of Clinic No 1 of the Volgograd State Medical University over the period from January 2012 to September 2015. The examined patients were subdivided into two groups. Group One was composed of the initial 26 patients operated on during the period from January 2012 to April 2014. Group Two comprised the remaining 28 patients operated on during the period from April 2014 to September 2015. Safety of performing the intervention was determined by prediction of the postoperative lethality and complications rates by means of the V-POSSUM scale. The predicted lethality and complications rates for both groups amounted to 2.3 and 23.5%, respectively. We carried out a comparative analysis of intraoperative data such as duration of the operative intervention, duration of mobilization of the aortoiliac segment, time of aortic cross-clamping, volume of intraoperative blood loss, intraoperative complications rate, conversion in the open access. In the early postoperative period we analysed the level of lethality, complications rate and indices of postoperative rehabilitation of the patient. For demonstrativeness of the dynamics of alterations of intraoperative indices, as well as for plotting the 'learning curve' the moving average method was used. Analysing the obtained findings revealed that implementation of total laparoscopic aortofemoral reconstructive operations was not accompanied by either high lethality or great number of complications, not exceeding the predicted indices by the V-POSSUM scale. The average duration of the operation in Group I amounted to 346±18.3 min, and in Group II to 316±13.3 min, with the time of aortic cross-clamping averaging 80±10.3 and 61±4.2 min and the volume of blood loss 898±23.5 ml, respectively. As experience was gained in performing laparoscopic reconstructive operations in Group Two patients the 'learning curve' demonstrated a statistically significant decrease of these intraoperative values, as well as a decrease in the complication rate and parameters of the patient's state in the postoperative period. Due to absence of extensive laparotomic or retroperitoneal accesses, the early postoperative period was characterised by rapid restoration of the passage along the intestine, early activation of patients, short length of stay in the intensive care unit and hospital stay.

[Pathogenesis and prevention of secondary thromboses and thromboembolic complications in patients with endured lower limb deep vein thrombosis].

The study was aimed at revealing the role of thrombophilic states in the pathogenesis of deep vein thrombosis and determining efficacy of pathogenetic prevention of venous thromboembolic complications. The study included a total of 84 patients presenting with lower limb deep vein thrombosis. The patients were subdivided into two groups. The patients of the Study Group (n=44) were examined for thrombophilic states, revealing of which was followed by prescribing specific lifelong therapy aimed at correction of the alterations revealed. The Control Group patients (n=40) received a carefully selected therapeutic dose of warfarin (until the value of the International Normalized Ratio was within the therapeutic range from 2 to 3) and were given recommendations on taking this agent for 6 months followed by discontinuation. The Study Group patients demonstrated less relapses of deep vein thromboses as compared with the Control Group patients. The symptoms of chronic venous insufficiency in the Study Group were also less pronounced. These results are in accord with the findings of ultrasonographic duplex scanning in the remote period after endured thrombosis. A conclusion was drawn on the necessity of carrying out further studies aimed at altering the recommended therapeutic regimen for patients in the remote period after sustained deep vein thrombosis.

[Assessing the prognostic significance of morphometric parameters of vascular wall inflammation for remote results of reconstructive operations in the aortoiliac zone in patients with atherosclerosis obliterans].

The study was aimed at assessing the relationship between the activity (including the inflammatory one) of the atherosclerotic process in the zone ofarterial reconstruction in patients under-going surgery on the aortoiliac arterial segment and long-term thrombotic reocclusions. The study comprised a total offorty-nine patients, with the postoperative follow-up period amounting to 5 years. We carried out morphological studies of the aortic wall in the zone of the proximal anastomosis and the walls of the common femoral arteries in the zone of distal anastomoses. It was determined that the presence of morphometric sign of inflammation and atherosclerotic deformity in the preparations of the aortic and arterial walls was accompanied and followed by increased incidence of long-term thrombotic complications in the reconstruction zone with more pronounced progression of the thrombotic process in the arteries of the peripheral bed distal to the reconstruction site.

[Prognosis of complications after reconstructive surgeries on the aorto-iliac segment]. / Prognozirovanie oslozhnenii posle rekonstruktivnykh operatsii na aortopodvzdoshnom segmente.

Evaluation of efficacy of neuronet technologies for prognosis of specific complications after reconstructive surgeries on aorto-iliac segment was made. A learning sample consisted of 500 reconstructive surgeries, a test one - 161. High efficacy of analog neuron nets was revealed. Prognosis of early thrombosis, postoperative bleeding and also of lethal outcome demonstrated better results, mistake of prognosis was 3.7, 1.2 and 4.6%, respectively. Prognosis of infectious complications and long-term outcomes demonstrated worse results, mistake of prognosis was 7.0 and 10.5%, respectively.

Effect of Buerger's thromboangiitis activity on the outcomes of vascular reconstructions.

Altogether 39 patients suffering from thromboangiitis obliterans were under observation. The vasculitis activity score (VAS) developed by R.A. Luqmain et al. (1994) was used as a criterion for thromboangitis activity. The patients were distributed into 2 groups: the first group included patients in the period of remission and the second, group comprised patients in the period of exacerbation. The patients underwent different types of vascular reconstructions. On examination of hemostasis and hemorheology the second group patients demonstrated potentiation of platelet function, inhibition of antiaggregation activity of the arterial wall, the rise of aggregation activity of red blood cells, and inhibition of blood fibrinolytic activity. The tendency toward hypercoagulation and hyperaggregation revealed in the second group patients led to deterioration of the immediate outcomes of reconstructive operations. Thrombosis of the reconstructed area was recorded in 5 (26.31%) first group patients and in 7 (35%) second group patients. In the first group, the high limb amputation was accomplished in one (5.26%) patient whereas in the second group, amputation was performed in 6 (30%) cases. So, the VAS according to R. A. Luqmain et al. (1994) is a reliable predictor which allows to carry out the screening of patients with Buerger's thromboangiitis for vascular reconstructions. The presence of the clinical signs of vasculitis activity in Buerger's thromboangitis requires preliminary preliminary preparation aimed at the removal of inflammation and correction of hemorheologic and hemostatic disorders.

[Effects of the anticoagulation therapy regimen on frequency of early thrombohemorrhagic complications after operations on major arteries of lower extremities]. / Vliianie rezhima antikoaguliantnoi terapii na chastotu rannikh trombogemorragicheskikh oslozhnenii posle operatsii na magistral'nykh arteriiakh nizhnikh konechnostei.

The results of 295 reconstructive operations on the major vessels of lower extremities were analyzed. The patients were divided into 4 groups depending on the scheme of anticoagulation therapy in the postoperative period. Under investigation was the state of hemostasis and hemorheology. The frequency of thrombohemorrhagic complications was assessed. It was found that the regimen based on the administration of low molecular weight heparins during the nearest 5 days after the intervention was the most rational regimen of anticoagulation therapy after reconstructive operations on the major arteries of lower extremities.

[Aneurysms of the aorta and its visceral branches as a cause of gastrointestinal hemorrhage]. / Anevrizma aorty i ee vistseral'nykh vetvei kak prichina zheludochno-kishechnykh krovotechenii.

From 1993 till 1999 6 patients with aneurysmointestinal fistulas complicated by bleedings were operated. In 4 cases the aneurysmointestinal fistulas were primary, in 2 cases--secondary. Gastroduodenoscopy, ultrasonic examination of abdominal organs, retroperitoneal space and duplex scanning of main vessels were used. Correct diagnosis before operation was made in 5 patients. The following operations on the vessels were performed: suturing of defect of central anastomosis (1), aortobifemoral grafting (1), abdominal aorta grafting (2), suturing of aortal defect (1), resection of peripheral aneurysm (1). Thrombosis of prosthesis branch (1) and suppuration of prosthesis bed with arrhosive bleeding (2) were early postoperative complications. Immediate postoperative lethality was 33.3%. Long-term results are followed in 3 patients. There were no repeated signs of graft infection in remote period. Basic methods of clinical and instrumental examination including ultrasound permit to make correct diagnosis before operation. Active surgical policy saves the life in the majority of patients, but it is necessary to use carefully the synthetic grafts for arterial vessels repair.

[Prevention of early thrombotic complications after reconstructive operations in occlusions of the aorto-iliac segment]. / Profilaktika rannikh tromboticheskikh oslozhnenii posle rekonstruktivnykh operatsii pri okkliuziiakh aortopodvzdoshnogo segmenta.

108 patients with atherosclerosis of aorto-iliac segment have undergone various reconstructive operations on this segment. Depending on the treatment all the patients were divided in 2 groups (test group--54 patients, control group--54 patients). The patients of the control group received aspirin, rheopolyglucin and trental for correction of hemorheology and hemocoagulation disorders. In patients of the test group at the same time as this treatment, the indirect electrochemical blood oxidation by intravenous infusion of 0.03% sodium hypochlorite was applied. Regional hemodynamics, hemorheology and hemostasis indices were studied in all the patients. It was established that indirect electrochemical blood oxidation permits to significantly improve the hemorheology indices, to diminish thrombophilia phenomenon during the treatment and early postoperative period. It was noted that early thrombotic reocclusion and amputations rates were reduced in the test group.