[Preventive myocardial revascularization prior to abdominal aortic repair in patients without cardiac symptoms: long-term results]. / Profilakticheskaya revaskulyarizatsiya miokarda pered rezektsiei anevrizmy bryushnoi aorty u kardiologicheski asimptomnykh bol'nykh: otdalennye rezul'taty.

OBJECTIVE: To evaluate the long-term influence of preoperative invasive coronary screening and preventive myocardial revascularization on mortality and cardiac complications after open surgery for abdominal aortic aneurysms (AAA). MATERIAL AND METHODS: We present long-term outcomes after open surgery for AAA between 2011 and 2022. Patients without clinical or objective signs of coronary artery disease were included. In the 1st group, routine coronary angiography was performed before surgery. Prophylactic myocardial revascularization was performed in 12 cases. Long-term data on 45 patients were obtained. In the 2nd group, 53 patients underwent repair without invasive coronary screening, and data on 48 patients were obtained in this group. RESULTS: The median follow-up was 32 and 79 months, respectively. Kaplan-Meyer overall 48-month survival was 87.3% and 82.1%, respectively (p=0.278). In the first group, 2 patients developed angina pectoris in the same period. In the second group, we observed 2 cases of myocardial infarction and 3 cases of angina pectoris without infarction. Analysis of survival curves found no significant differences (p=0.165). CONCLUSION: In our study, invasive coronary screening and preventive myocardial revascularization in patients without clinical and objective signs of coronary artery did not improve 4-year long-term period after abdominal aortic repair. Perhaps, differences will appear after 4 years, and this requires further follow-up after coronary angiography. However, there is a tendency towards more common onsets of coronary artery disease that dictates the need for cardiac monitoring of such patients.

[Distal pancreatectomy with resection of the celiac trunk, right or left hepatic artery without arterial reconstruction (extended DP-CAR)]. / Distal'naya rezektsiya podzheludochnoi zhelezy s rezektsiei chrevnogo stvola vmeste s pravoi ili levoi pechenochnoi arteriei bez arterial'noi rekonstruktsii (rasshirennaya DP-CAR).

OBJECTIVE: To evaluate safety and postoperative outcomes of DP-CAR with resection of one of the lobar hepatic arteries without arterial reconstruction (extended DP-CAR). MATERIAL AND METHODS: Perioperative data and survival after 7 extended DP-CARs R0 were retrospectively analyzed. Arterial blood flow in the liver was assessed using intraoperative ultrasound and postoperative CT angiography. RESULTS: Among 40 DP-CARs, resection of left or right hepatic artery was performed in 7 cases of aberrant anatomy including 1 case of portal vein resection. Mortality and ischemic complications were not observed. The main source of blood supply to the «devascularized¼ liver lobe was interlobar communicating artery or the arcade of the lesser curvature of the stomach. Incidence of pancreatic fistula was 44%, mean blood loss - 230 (100-650) ml, surgery time - 259 (195-310) min, mean hospital-stay - 14 (9-26) days. Median survival of patients with pancreatic ductal adenocarcinoma was 25 months after combined treatment. Three patients died after 26, 28 and 77 months. Other patients are alive without progression for 109, 24, 23 and 12 months after therapy onset. CONCLUSION: Extended DP-CAR is advisable and safe procedure if reliable intraoperative control of liver and stomach blood supply is ensured.

[Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion]. / Diagnostika i lechenie raka golovki podzheludochnoi zhelezy, prorastaiushchego mezenteriko-portal'nyi segment ven.

AIM: To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer. MATERIAL AND METHODS: Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection. RESULTS: Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02). CONCLUSION: Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases.

[PAD prevalence in Russian Federation]. / Rasprostranennost' simptomnoi ishemii nizhnikh konechnostei v Rossiiskoi Federatsii.

BACKGROUND: Currently there is no data on peripheral arterial disease prevalence in Russia. AIM: To estimate prevalence of patients with symptomatic low limb ischemia (LLI) in Russian Federation on 2014. PATIENTS AND METHODS: «League for patient' protection¼ had sent questionnaires for all regional health departments asking to name prevalence of ICD-10 codes I70.2 (atherosclerosis of arteries of extremities) and I73.1 (thromboangiitis obliterans (Buerger)) on 2014. The figures were listed separately for ischemia I-IIa and III-IV (critical limb ischemia, CLI) (Pokrovsky, 1976). Also were mentioned major amputations and mortality. RESULTS: Total number of received questionnaires was 44, we've got information from all RF' federal regions with a population of appr. 71 million people. There were 174 125 cases of symptomatic LLI. Prevalence of symptomatic LLI among Russian population aged more than 40 years was 0.51%. Prevalence of intermittent claudication was 0.36% and of critical limb ischemia - 0.13%. Rate of major amputations was 6.9%. CONCLUSION: World PAD prevalence among people older than 25 years is 8.3%. The same figure in our study was only 0.5%. This is due to the fact that we considered only symptomatic LLI and only with codes I70.2 and I73.1. Prevalence of symptomatic patients among all PAD patients is 10-35%. So the real number of PAD patients in Russian might be 1.5-5%. We can conclude that PAD is still unrevealed in Russia. Another conclusion could be that the treatment results are less than satisfactory. Finally there is urgent necessity for special PAD register in RF.

[Epinephros metastasis of colorectal cancer complicated by tumor thrombosis of inferior vena cava].

Metastasis of colorectal cancer (CRC) in an adrenal gland develops in 1.8% of cases (in synchrony or in metachrony) for patients with liver metastatic lesion and aggravates for certain prognosis for long-term survival. There are no data concerning colorectal metastasis in an adrenal gland with tumor thrombosis of inferior vena cava (IVC) in world-wide literature. A patient, 57 years old, on 04.29.11 underwent palliative distal sigmoid colectomy in respect of CRC pT3N2M1 (metastatic lesion of liver right lobe). Process stabilization was noticed after 4 courses of polychemotherapy. On 07.28.11 she underwent right-sided hemihepatectomy. She underwent further 4 courses in accordance with the same scheme. On 12.06.13 case-control USI and multi-layer spiral CT of abdominal cavity detected mass lesion in the right adrenal gland, it was estimated as metastatic lesion with compression of inferior vena cava and thrombosis in its lumen at retroliver segment level. Right-sided adrenalectomy. Thrombectomy of IVC was carried out in the condition of total vascular isolation. Taking into account metastasis respectability in an adrenal gland and small extent of a tumor thrombus we suppose the described surgical practice to be justified. The problem of neoadjuvant chemotherapy prescription is still controversial.

[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.

[Randomized placebo-controlled studies of iloprost in treatment of lower limb critical ischaemia].

The article deals with the analysis of the treatment outcomes obtained in management of patients suffering from lower-limb critical ischaemia treated with iloprost, a stable analogue of the prostacyclin. The results of six randomized placebo-controlled trials and eleven trials of other drugs are described in this article. The meta-analysis of the iloprost studies confirmed the efficacy of the drug in decreasing the size of ulcers, pain relief, extremity amputation rate. Whereas the other examined drugs have not demonstrated such properties with rare exception.

[Aspirin versus oral anticoagulants following lower limb arterial reconstructions: what to choose?]. / Aspirin ili oral'nye antikoagulianty posle rekonstruktivnykh sosudistykh operatsii na arteriiakh nizhnikh kozechnostei: chto luchshe?

Graft thrombosis in long-term postoperative period after lower extremity arterial reconstructions often results in limb loss. In some studies prolonged antithrombotic therapy was demonstrated to improve long-term patency of vascular grafts. Nevertheless little consensus exists on the optimal antithrombotic agents. The paper reviews publications on the problem. Oral anticoagulants seem to be feasible for reconstructions with poor outflow. In such cases strict laboratory monitoring of blood coagulation system is mandatory to prevent hemorrhagic complications.