[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.

[Postoperative ventral hernia in patients, who undergone the liver transplantation operation].

The development of postoperative ventral hernia was observed in 8 patients from 114, who undergone the liver transplantation operation. The patients were followed in terms up to 14.5 years. The authors consider the indications and features of surgical treatment of such postoperative hernias.

[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.

[Role of intrventional radiology in pre- and postoperative periods of liver transplantation].

The purpose of this study was to prove the use of interventional radiological procedures before and after liver transplantation (LT). Between 1998 and 2009 years, 54 LT were performed in 52 patients. 18 patients received 19 interventional radiological treatments including 11 preoperative (trans-catheter oily chemoembolization of hepatocellular carcinoma, n=3; transjugular intrahepatic portosystemic shunting, n=8) and 8 postoperative (drainage or stenting of biliary strictures, n=4; balloon dilatation and/or stenting of inferior vena cava or cava-caval anastomosis, n=3; splenic artery embolization in sleal syndrome, n=1). It is concluded that before LT, trans-catheter embolization delays the growth of hepatoma and prolongs time for donor liver waiting. Transjugular portosystemic shunt decreases the risk of fatal variceal bleeding. Post-LT complications such as vascular or biliary strictures and steal syndrome can be also effectively corrected by methods of interventional radiology.

[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.

[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.