[Modern trends in development of surgical and endovascular treatment of patients with arterial pathology]. / Sovremennye tendentsii razvitiia khirurgicheskogo i éndovaskuliarnogo lecheniia bol'nykh s arterial'noi patologiei.

The last decade has seen distinct dynamics of the worldwide growth of the number of endovascular interventions and a decrease in the number of 'open' surgical operations for pathology of the aorta and peripheral arteries. The world trends of treatment of patients presenting with pathology of the aorta and peripheral arteries are indicative of a steadily growing amount of operations, most of which are performed in an endovascular manner. In the Russian Federation, the past decade has also witnessed a noticeable jump of the amounts of endovascular interventions. Thus, the number of operations from 2008 to 2017 increased from 15 094 to 37 109 (2.5-fold). Nevertheless, in Russia there is a significant lag in both the total amount and the ratio of the performed surgical and endovascular operations in patients with pathology of the aorta and peripheral arteries. The article analyses the world and Russian trends in the development of surgical and endovascular treatment of patients with pathology of the aorta and peripheral arteries.

[Results of endovascular treatment of obstructive lesions of veins of the iliofemoral segment]. / Rezul'taty éndovaskuliarnogo lecheniia obstruktivnykh porazhenii ven podvzdoshno-bedrennogo segmenta.

OBJECTIVE: The purpose of the study was to assess the immediate and remote results of endovascular treatment of obstructive lesions of the veins of the iliofemoral segment. PATIENTS AND METHODS: We performed balloon angioplasty and stenting for iliofemoral venous thrombosis in a total of 75 patients. Of these, 60 patients were subjected to stenting of post-thrombotic obstructions and 15 patients underwent stenting of non-thrombotic obstructive lesions of the iliac veins (for May-Thurner syndrome - in 11, for extravasal tumour-induced compression and cicatricial stenosis - in 4). Stenting was performed using self-expanding stents Wallstent (Boston Scientific, n=84) or S.M.A.R.T. (Cordis, Johnson & Johnson, n=16). The stent diameter varied from 12 to 18 mm depending on the venous segment to be stented. The average number of the implanted stents amounted to 1.3 per patient. Efficacy of endovascular intervention was evaluated by measuring the pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS). RESULTS: Technical success of endovascular intervention amounted to 92%. Stent thrombosis in the immediate postoperative period occurred in 7 (9.3%) patients. Of these, three patients were subjected to catheter-directed thrombolysis with restoration of patency of the stented venous segment of the limb. Stent occlusion within 48 postoperative months was diagnosed in 4 cases. Two patients underwent successful repeat angioplasty and stenting. Stent restenosis of not less than 50% at 36 months of follow up was observed in 5 (16%) patients. Repeat stenting was performed in 1 case. Dynamic control of stent patency was carried out by means of ultrasonographic duplex scanning. Also performed were control multispiral computed tomography-phlebography and roentgen contrast-enhanced phlebography. Cumulative primary and secondary patency at 60 months in post-thrombotic lesions amounted to 72 and 81%, respectively, in non-thrombotic lesions to 85% (primary patency). The VCSS values demonstrated a significant decrease in manifestations of chronic venous insufficiency. The mean value of the composite parameter decreased from 14.2±4.2 to 7.5±2.6 (p<0.001), the malleolar circumference decreased from 272.3±6.7 to 250.6±6.1 mm (p<0.01). Permanent healing of trophic ulcers was noted in 5 (71%) patients. CONCLUSION: The method of endovascular angioplasty and stenting for obstructive lesions of the veins of the iliofemoral segment is a minimally invasive, safe, and highly effective therapeutic modality, which is confirmed by significant improvement of the limb's condition and good remote results of patency of the venous segments restored. Endovascular methods should be wider implemented into the clinical practice.

[Hybrid approach to treatment of a patient with a thoracoabdominal aortic aneurysm]. / Gibridnyi podkhod k lecheniiu patsienta s anevrizmoi torakoabdominal'nogo otdela aorty.

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.

[Assessment of endothelial dysfunction for prevention of complications in patients with lesions of peripheral arteries]. / Otsenka éndotelial'noi disfunktsii v profilaktike oslozhnenii u bol'nykh s porazheniem perifericheskikh arterii.

BACKGROUND: Severity of endothelial dysfunction and impairments of the vasomotor function of arteries correlate with the degree of the development of atherosclerosis and the risk of cardiovascular complications. To date, poorly studied still remains the problem concerning alteration of the regulatory function of the endothelium in patients diagnosed with pronounced atherosclerotic lesions of peripheral arteries, as well as the impact of a surgical intervention on indices of endothelial dysfunction. PATIENTS AND METHODS: Presented in the article are the results of preoperative study of the endothelial function by means of peripheral arterial tonometry (PAT) using the Endo PATTM 2000 device (Itamar Medical Ltd.) in a total of 74 patients undergoing surgical treatment at the Institute of Surgery named after A.V. Vishnevsky. The male-to-female ratio in the studied group was 1:2.52, with the patients' average age amounting to 67Ѓ}8 years. Of the 74 patients, 21 were subjected to a repeat examination performed at terms varying from 2 to 23 months postoperatively. Of these, 17 (80.95%) patients took statins. Fourteen (66.7%) patients had endured an operative intervention on carotid arteries and seven (33.3%) had been operated on for lesions of lower-limb arteries. RESULTS: The statistical analysis of the obtained findings revealed no significant differences of the indices of the endothelial function in the studied group between the genders, depending on age, smoking or taking statins. Neither were there statistically significant differences in the reactive hyperaemia index (RHI) amongst the patients with the involvement of one or several arterial basins. We did not reveal a direct relationship or regularity of the effect of a surgical intervention on the RHI values in the operated patients. This might be explained by the fact that the method of PAT to a greater degree assesses the state of the microvascular bed rather than that of large arteries.

[Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment]. / Ispol'zovanie tekhniki ex vivo u patsienta s arteriovenoznoi mal'formatsiei pochek pri oslozhnenii éndovaskuliarnogo lecheniia.

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.

[Open thrombectomy in acute iliofemoral venous thrombosis]. / Otkrytaia trombéktomiia pri ostrom podvzdoshno-bedrennom venoznom tromboze.

AIM: The study was aimed at assessing efficacy of open thrombectomy in acute iliofemoral venous thrombosis. PATIENTS AND METHODS: From January 2012 to December 2016, a total of 37 patients underwent transfemoral thrombectomy for acute iliofemoral venous thrombosis. The Control Group consisted of 24 patients receiving standard anticoagulant therapy. Six patients were subjected to a hybrid operation consisting in thrombectomy supplemented with stenting of the residual compression stenosis of the left common iliac vein (CIV). The outcomes of the operations were controlled by means of duplex scanning. Clinical efficacy of the operations was evaluated with the help of the Venous Clinical Severity Score (VCSS) and CEAP classification. RESULTS: Patency of the iliofemoral segment at 6 months of follow up after thrombectomy was observed in 92% of patients. At the same time, in patients receiving anticoagulant therapy recanalization of the iliofemoral segment was observed in only 21% (5/24; χ2=31, p<0.01) of cases. Recanalization of the femoropopliteal segment 6 months after thrombectomy was noted to occur in 70% (23/33) of patients. The median of the composite index by the VCSS after 6 months decreased from 7 to 2 (p=0.002). The cumulative patency of the iliofemoral segment 36 months after surgery amounted to 86%. Clinical assessment of the remote results of thrombectomy according to the CEAP classification demonstrated that 90% (19/21) of patients were either free from or had weakly pronounced symptoms of post-thrombotic syndrome. CONCLUSION: Performing thrombectomy for iliofemoral thrombosis by selective indications using modern methods of restoring patency of deep veins significantly increases efficacy of treating patients presenting with this severe pathology and prevents the development of pronounced manifestations of post-thrombotic syndrome.

[First experience with hybrid operations for chronic obstruction of iliac-femoral segment veins in patients with post-thrombotic disease]. / Pervyi opyt gibridnykh operatsii pri khronicheskoi obstruktsii ven podvzdoshno-bedrennogo segmenta u patsientov s posttromboticheskoi bolezn'iu.

The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD). Hybrid operations [open endovenectomy from the common femoral vein (CFV) with creation of an arteriovenous fistula + stenting of iliac veins] were performed carried out in a total of eleven patients with PTD. Of these, there were 7 men and 4 women aged from 34 to 52 years (mean age - 42.8±7 years). All patients had severe-degree chronic venous insufficiency (CVI). The distribution of patients according to the CEAP classification was as follows: C4a - 2 patients, C4b - 4 patients, C5 - 4 subjects, C6 - 1 patient. The time having elapsed since a newly onset episode of acute iliac-femoral venous thrombosis varied from 2 to 12 years (averagely - 7.1±3.3 years). The degree of manifestation of PTD was determined by means of the Villalta-Pradoni scale before and 6 months after the operation. Instrumental methods of study included ultrasound duplex scanning (USDS), magnetic resonance and/or multispiral computed venography, and contrast-enhanced X-ray venography. The technical success of the procedure amounted to 91%. In one patient with occlusion of the common and external iliac veins we failed to perform recanalization and stenting. A further one patient developed in-stent and CFV thrombosis on the second postoperative day. An attempt of catheter thrombolysis turned out unsuccessful. There were no wound complications in the postoperative period. Neither was pulmonary artery thromboembolism registered. The dynamic control was carried out by means of USDS before discharge from hospital and at 1, 3 and 6 months after the intervention. The outcomes of hybrid operations after 6 months were followed up in five patients. Secondary patency rate of the stented iliac veins amounted to 100%. No relapses of trophic ulcers were observed. According to the Villalta-Prandoni scale the value of the median of the composite index decreased from 15 to 7 (p=0.012). The first experience with hybrid operations for obstructive lesions of veins of the iliac-femoral segment demonstrated their high efficacy and safety. Efficiency of the operation was confirmed by significant clinical improvement and good results of patency of the restored-repaired segments of veins.

[Experience with the ovations stent graft system for totally percutaneous endovascular repair of the infrarenal portion of the abdominal aorta].

Presented in the article are clinical cases of successful totally percutaneous endovascular repair of the infrarenal portion of the abdominal aorta using the Ovation Prime ultra-low profile stent graft in high-surgical-risk patients, yielding good immediate and short-term results, thus demonstrating new possibilities in endovascular treatment of aneurysms of the infrarenal portion of the abdominal aorta.

[Use of self-expandable stent grafts in aneurysms of internal carotid arteries].

Open surgical intervention is an operation of choice in lesions of coronary arteries. In some cases, however, performing reconstructive surgery is either impossible or associated with high risk of both intra- and postoperative complications. In such cases it is possible to perform an endovascular intervention, including endoprosthetic repair. The Russian and foreign literature contains either sporadic or small-in-number case reports concerning the use of stent grafts in carotid arteries aneurysms. The article describes cases of successful use of self-expandable stent grafts in three patients with a true aneurysm and pseudoaneurysms of internal carotid arteries.

[Analysis of remote results of eversion carotid endarterectomy].

Analysed herein are remote results of surgical management of patients presenting with atherosclerotic stenoses of carotid arteries by means of eversion carotid endarterectomy. Over the period from 2002 to 2007 specialists of the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health carried out a total of 393 eversion carotid endarterectomies in 356 patients. We assessed the remote results of 338 (86%) operations in 303 (85%) patients, analysing survival, freedom from stroke, patency of the reconstructed internal carotid artery and effects of risk factors on these indices. The average duration of follow-up amounted to 84 ± 31 months (max - 146 mos). A total of 242 (71.2%) patients survived. The cumulative 5-year survival rate amounted to 84%, with 10-year survival equalling 63%. Severity of the initial atherosclerotic lesion of the arterial bed, progression of atherosclerosis, and control over risk factors for atherosclerosis exerted a statistically significant influence on total survival. Acute disorders of cerebral circulation (of any localization) at a median follow-up of 81 ± 33 months (max - 146 mos) developed in 38 (12.1%) patients, of whom in 15 (4.8%) it terminated with a lethal outcome. Five-year cumulative freedom from stroke amounted to 92%, equalling 80% 10 years after. The risk factors which influenced the freedom from stroke included a history of acute impairments of cerebral circulation, restenoses of the reconstructed ipsilateral internal carotid artery (>70%), and diabetes mellitus. Amongst the examined by means of ultrasonography 164 patients, patency of the reconstructed ipsilateral internal carotid artery at an average follow-up of 75 ± 28 months (max - 135 mos) amounted to 95%. Haemodynamically significant restenoses (≥ 70%) were revealed in eight (5%) cases. Of these, three (2%) patients had narrowing of 70-89% and the remaining five (3%) patients had narrowing of ≥ 90% (including 2 occlusions of the reconstructed ipsilateral internal carotid artery). We revealed no risk factors influencing the development of restenosis of the reconstructed ipsilateral internal carotid artery after eversion carotid endarterectomy. The obtained findings give grounds to consider eversion carotid endarterectomy as a safe and reliable method for treatment of atherosclerotic lesions of carotid arteries and, consequently, for prevention of stroke. Control of risk factors may improve remote results of surgical treatment.

[Selected pages of history of vascular surgery in Russia (contribution of Russian surgeons to world vascular surgery)].

The article describes the most significant for Russian surgery personalities, facts, and events of the last 180years. An emphasis is placed upon those works, discoveries or operations made by Russians for the first timein the world's practice. To such we refer N.J. Pirogov's topographical anatomy of vessels (1837), N. V. Ekk's portocaval anastomosis (1877), A.A. Yanovsky's lateral arterial suture (1889), S.S. Bryukhonenko's artificial circulation unit (1923-1924), Yu. Yu. Voronoy's renal replantation onto femoral vessels (1933), V.P. Demikhov'stransplantation of vital organs (1946-1959), V.I. Kolesov's mammary-coronary anastomosis (1964),F.A. Serbinenko's endovascular neurosurgery ( 1979), E. I. Chasov's intracoronary thrombolysis by E.I. Chazov( 1974), endovascular prosthetic repair of the thoracic aorta by N.L. Volodos ( 1985) and a series of other facts.

[Restoration of valvular function of deep veins in lower-limb varicose disease].

The present work was based on analysing the results of a complex examination and surgical treatment of 16-to-78-year-old patients presenting with varicose disease during the period from 2006 to 2010. A total of 1,095 limbs were examined and operated on in 1,070 patients. Of these, 298 (29.6 %) were men, and 709 (70.4 %) women. The distribution of the patients according to the CEAP clinical classification was as follows: C1 - 3 patients, C2 - 215, C3 - 566, C4 - 203, C5 - 29, and C6 - 79 subjects. All patients underwent ultrasonic duplex scanning, with retrograde phlebography performed in 21 cases. 51.2% of patients were diagnosed as having pathological deep venous reflux. In the group of patients with valvular insufficiency of deep veins, a total of 93 operations aimed at correcting deep reflux were performed, including 12 interventions for congenital avalvulation of veins. The indications for restorative operations on the valvular apparatus of deep veins were determined in severe forms of chronic venous insufficiency combined with axial reflux along deep veins in cases of inefficiency of conventional methods of surgical and conservative treatment. The long-term outcomes of surgery were assessed after 18-48 months. The results were evaluated by means of clinical and instrumental methods of examination: the disease severity scale, patients quality of life questionnaire, ultrasonographic and roentgen contrast methods of examination, and legometry. The operations aimed at restoring the valvular function of the femoral veins turned out to be effective methods of correcting venous reflux and made it possible to restore the valvular function in 84% of cases. In the remote postoperative period valvular competence was observed in 74.6% of patients. Carrying out such operations significantly improve the course of the disease due to decreasing the malleolar volume (p<0.001), manifestations of symptoms of chronic venous insufficiency (p<0.001), and improving quality of life (p<0.001).

[Results of using composite bypass grafts with infragenicular distal anastomosis].

The authors share herein their experience with composite bypass grafts and PTFE synthetic prostheses used for treatment of obliterating diseases of the infrainguinal-segment arteries. The data of the study were based on the outcomes obtained in 92 patients. The authors assessed the condition of the outflow pathways and their effect on patency of composite bypass grafts in the immediate and remote postoperative periods, followed by comparative analysis of the short- and long-term therapeutic outcomes after using composite bypass grafts and PTFE synthetic prostheses in the infragenicular position for femoropopliteal and femorotibial reconstructions, also assessing the effect of the localization of the distal anastomosis on the immediate and remote therapeutic outcomes. Based on the obtained findings it was determined that the immediate results of patency depended upon the state of the outflow pathways and localization of the distal anastomosis. Thus, by the 1st, 3rd and 5th year of follow up patency of transplants in patients with the runoff score less than 7.0 amounted to 78.3, 21.7 and 4.3%, respectively. Analogous indices of patency in patients with the runoff score equalling or greater than 7.0 amounted to 60.7 and 3.6% for the 1st and 3rd year, respectively. The remote results of patency turned out to depend on the type of a vascular transplant and the state of the outflow pathways and did not depend on the localization of the distal anastomosis. Thus, the remote results of patency for the composite bypass graft for the 1st, 3rd and 5th year of follow up amounted to 74.5, 19.6 and 5.9%, respectively, versus 60.8 and 8.6% by the first and third year for the PTFE prosthesis. The limb salvage rate at the same terms for the composite bypass graft amounted to 94.1, 84.3 and 78.4% versus 73.9, 56.5 and 52.2% for the PTFE prosthesis.

[Conservative treatment of patients with intermittent claudication].

The article deals with the analysis of the results of randomized placebo-controlled studies of various therapeutic agents currently available in Russia, as well as the results of meta-analyses and Cochrane reviews of medicamentous treatment of patients with intermittent claudication. The results of these studies gave grounds to recommend the most efficient agents in the new edition of the "National Guidelines on management of patients with lower-limb arterial disease" (2013).

[Administration of the generic prostaglandin E1 VAP 20® in patients with lower limb critical ischaemia: a prospective study].

OBJECTIVE: The study was aimed at assessing efficacy and safety of administering the generic alprostadil VAP in patients presenting with lower limb critical ischaemia. MATERIAL AND METHODS: We carried out a prospective study including a total of 30 patients with lower limb critical ischaemia. The patients' mean age was 67.7±7.8 years, with men predominating - 60%. Trophic ulcers were observed in 40% of patients. The proximal level of the lesion was localized in the arteries below the inguinal ligament in 19 (63.3%) patients, in the aortofemoral segment - in 9 (30%) patients, and in the popliteal-crural-plantar segment - in 2 (6.6%) subjects. The average ankle-brachial index amounted to 0.49±0.4. The studied agent was used at a dose of 40 mcg once a day in patients with stage III ischaemia and a dose of 40 mcg twice daily in patients with stage IV ischaemia. The drug was administered for 14 days followed by a 14-day follow-up period. RESULTS: The pain syndrome score over the 14 days of treatment decreased twofold from 6.1±2.5 to 3.5±2.6 and within the subsequent 14 days it did not increase - 2.4±3.1 (p< 0.05). The number of patients in whom the pain syndrome decreased by 50% amounted to 19 (63.3%). The consumption of analgesic agents decreased from 60% (at the beginning of treatment) to 12 (40%) (14 days after treatment) and to 8 (26.6%) (at the end of the follow-up period). In patients with trophic ulcers, the average size of the ulcers during treatment decreased from 3.3±3.7 cm to 2.8±3.8 after 14 days, and at the end of the follow-up period the size of the ulcers amounted to 2.1±2.8 cm (p >0.05). The number of patients responding to treatment amounted to 22 (77.3%). The ABI during treatment did not change, being 0.49 ± 0.4 at the beginning of treatment, 0.53±0.4 after 14 days of treatment, and 0.47±0.3 at the end of the follow-up period. There were no amputations either during treatment or within the follow-up period. Only one lethal outcome occurred which was related to acute coronary insufficiency. The "response to treatment" was significantly influenced only by the level of the proximal lesion and age (p<0.05). CONCLUSION: VAP 20® demonstrated good efficacy and tolerability comparable to those of the original preparations.

[Does the method of carotid reconstruction influence the outcomes of the intervention?].

AIM: to carry out comparative assessment of the immediate outcomes of eversion carotid endarterectomy, classical carotid endarterectomy and prosthetic repair of the internal carotid artery in atherosclerotic-genesis stenoses thereof. MATERIAL AND METHODS: the study was based on a retrospective analysis of the immediate results of 630 isolated primary open interventions on the bifurcation of the common carotid artery in atherosclerosis, performed at the Department of Vascular Surgery of the A.V. Vishnevsky Institute of Surgery over the period from January 2008 to December 2010. The choice of the method of intervention was based on the indications developed worked out at our Department with due regard for the clinical and morphological peculiarities of the lesion of the carotid bifurcation. RESULTS: the incidence of performing eversion carotid endarterectomy (416; 66%) in the entire group was significantly higher than that of classical carotid endarterectomy (127; 20%) and that of prosthetic repair of the internal carotid artery (87; 14%) (p=0.000). Thrombosis of the reconstructed internal carotid artery developed significantly more often (p<0.05) after prosthetic repair (4.6%) and classical carotid endarterectomy (3.9%) as compared with the eversion technique (0.7%). Frequency of the development of homolateral stroke after prosthetic repair of the internal carotid artery (4.6%) was higher than after eversion carotid endarterectomy (1.2%) and classical carotid endarterectomy (2.36%), however, these differences were statistically significant only when compared with the group of the eversion technique (p=0.000). All techniques were accompanied by low mortality from stroke (the eversion technique - 0.24%, classical carotid endarterectomy (0%), prosthetic repair of the internal carotid artery - 1.15%), and the groups did not differ significantly by this parameter (p>0.05). CONCLUSION: the choice of the method of carotid endarterectomy should be determined by the character of lesions of the carotid bifurcation, anatomical interrelationships in the operation wound, and tolerance of the brain to clamping of carotid arteries. Eversion carotid endarterectomy, once possible to perform, is the most preferable method of reconstruction in atherosclerotic lesions of the carotid bifurcation.

Remote results of reconstructive operations in pathological deformity of the internal carotid artery.

OBJECTIVE: to study remote results of surgical treatment of patients presenting with a pathological deformity of the internal carotid artery. METHODS: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (ICA), who underwent a total of 166 reconstructive operations. RESULTS: 7% of patients were operated on at the asymptomatic stage, more than half (56%) of the patients were found to have transient (21%) or persistent neurological deficit (35%), 37% of patients had stage III cerebrovascular insufficiency. Twenty-five (15%) operations were performed for C- and S-shape tortuosity, ninety-seven (58%) procedures for kinking of the internal carotid artery, and forty-four (27%) interventions for coiling. The operation of choice was resection with redressation of the internal carotid artery and reimplantation into the old ostium (74%). Analysing the results of surgical treatment showed its high neurological efficiency in prevention of cerebral circulation impairments (93% of patients at terms up to 25 years had no such complications), as well as clinical efficacy (relief of cerebrovascular insufficiency symptoms in 91.1% of patients). The effect obtained appeared to preserve during 2 and 5 years in 96% and 92% of patients, respectively, and at terms up to 25 years in 83%. The 3-, 5- and up- to-25-year survival amounted to 95%, 92% and 75%, respectively. Restenosis of the internal carotid artery was significantly more often observed after prosthetic repair of the artery (p <0.05) as compared with other methods of reconstruction employed. Thromboses of the internal carotid artery were encountered with similar frequency (8%) only after prosthetic repair and resection of the internal carotid artery with an «end-to-end¼ anastomosis, which was significantly more often than in resection with redressation (p <0.05). Stroke incidence in the remote postoperative period amounted to 0.8% and the «stroke + stroke-related mortality¼ parameter equalled 1.6%. CONCLUSION: the remote results of surgical treatment for pathological deformity of the internal carotid artery are strongly suggestive of high efficacy of this method of prevention of impairments of cerebral circulation and treatment of cerebrovascular insufficiency in patients with the pathology concerned. The operation of choice in pathological deformity of the internal carotid artery is resection with redressation of the internal carotid artery and reimplantation into the original ostium.

[The place of vascular surgery in treatment of diabetic patients].

This article is dedicated to diagnostics, prevention and surgical treatment of vascular complications of diabetes mellitus, particularly prevention of ischemic strokes and treatment of critical ischemia of lower limbs. The main tendency in treatment of brachiocephalic artery lesions nowadays is a surgical intervention in the latent stage of the disease. X-ray endovascular surgical techniques are being increasingly used to treat lesions of lower limbs arteries. Limb preservation is impossible without cooperation of many specialists. It's essential to perform careful out-patient follow up of the patient after vascular reconstructive surgery.

[Long-term results of vascular surgery of Lerish syndrome in patients with type II diabetes Mellitus].

We analyzed long-term results of vascular surgery in 199 patients with diabetes and chronic limb ischemia. At the time of the study mean age of patients was 64.7+1.2 years. They all had severe course of disease. Results showed that in the majority of patients good clinical effect after aorto-femoral reconstructions persisted over a long period of time. Patency of aorto-femoral bypass and limb salvage rate after 9 years equaled 72 and 79%, respectively. This was associated with improved quality of life. Surgery for severe limb ischemia (50 % of patients had critical ischemia) helped to preserve the limb and achieve sustainable increase of pain-free walking distance in 85 % of patients. However 5-year survival rate was 75%. The leading cause of death was myocardial infarction. This was indicative of the lack of prevention of progression of coronary artery disease. Thus, despite the presence of diabetes aorto-femoral reconstructions in most patients reliably and continuously prevented development of critical ischemia and preserved lower limbs. Active prophylaxis of cardiac complications is necessary for improvement of long-term survival of patients after vascular reconstructive surgery.

[Penetrating atherosclerotic ulcers of the aorta].

Widespread use of various present-day visual methods of study has made it possible to increase the frequency of revealing penetrating atherosclerotic ulcers, known to be ulcerations of an atherosclerotic plaque thorough the intimal elastic lamina into the medial layer of the aortic wall. The review deals with the literature data regarding the clinical picture, pathogenesis, diagnosis, policy of management and treatment of complications of penetrating atherosclerotic ulcers. The problem concerning the choice between surgical and endovascular treatment of penetrating atherosclerotic ulcers has been elucidated insufficiently in the present-day literature.