[Surgical treatment of a patient with syphilitic aortitis]. / Khirurgicheskoe lechenie patsienta s sifiliticheskim aortitom.

Syphilitic aortitis is a rare disease caused by Treponema pallidum affecting the aorta and leading to inflammation. Syphilitic aortitis is one of the causes of aortic aneurysms. This article presents surgical treatment of a patient with syphilitic aortitis and thoracic aortic aneurysm. This clinical case confirms the difficulties of surgical treatment.

[Endovascular treatment of common iliac artery aneurisms]. / Rezul'taty endovaskulyarnogo lecheniya anevrizm obshchei podvzdoshnoi arterii.

OBJECTIVE: To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS: Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS: Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.

[Proximal fixation devices in endovascular repair of abdominal aortic aneyrysm with unfavourable proximal neck anatomy]. / Ustroistva proksimal'noi fiksatsii stent-grafta pri éndovaskuliarnom lechenii anevrizmy briushnogo otdela aorty s neblagopriiatnoi anatomiei proksimal'noi sheiki.

Abdominal aortic aneurysm is a common vascular disease requiring surgical treatment. Currently, endovascular aortic repair is a good alternative to open surgery. However, high incidence of unfavorable anatomical variants of the proximal landing zone limit the use of endovascular aortic repair in these patients. Additional techniques can increase applicability of endovascular procedure with optimal results. Two patients with unfavorable proximal neck anatomy undergoing endovascular aortic repair with anchor type of proximal fixation devices are reported in the article.

[Transarterial therapy for hepatocellular cancer].

AIM: To estimate treatment of patients with hepatocellular cancer after transarterial chemoembolization as independent curative method, "bridge" to liver transplantation and in the context of combined therapy. MATERIAL AND METHODS: We presented an experience of transarterial chemoembolization in treatment of 29 patients with hepatocellular cancer. Curative procedures were performed in the context of independent therapy, "bridge" to liver transplantation and combined treatment. It was performed 48 procedures in all. 44.9% of patients underwent one and two procedures, 10.2%--three performances. Mean interval between procedures was 76.2±116.2 days (range 8-139 days). RESULTS: Post-embolization syndrome including fervescence, nausea and pain was observed in 24.1% after 1st stage, in 50% and 33.3% after 2nd and 3rd stages respectively. Mean time of expectation of liver transplantation in bridge therapy group was 8.5±6.8 months (range 1-20 months). Median survival after transarterial chemoembolization in monotherapy group was 9 months.

Myocardial revascularization in CAD patients with left ventricular ejection fraction below 35%.

UNLABELLED: The aim of the present study was to compare the short- arid long-term clinical results in CAD patients with an initial LV ejection fraction below 35% after coronary stenting and coronary artery bypass grafting (CABG). METHODS AND RESULTS: the study accrued 94 CAD patients with an initial LV ejection fraction below 35%. As dependent on the revascularization techniques performed, the patients were distributed into two groups. The first group comprised patients after intracoronary stenting. The second group included patients who had undergone CABG. Both groups were comparable in terms of the basic clinical criteria. The short-term clinical success of intervention in CS and CABG groups accounted for 97.6% and 97.7% respectively (p>0.05). The hospital lethality was significantly higher in the CABG group than in the CS group and was quoted as 13.7% versus 2.3% (p<0.05). No significant differences in the clinical status were recorded among patients with the clinical success. In the long-term period, the three-year survival in the CS and CABG groups accounted for 73.2% and 79.1% respectively (p>0.05). The incidence of unfavourable clinical events (UCE) in the CABG group was recorded significantly less frequently than in the CS group and constituted 21.9% versus 39% (p<0.05). Complete "freedom" from angina and UCE in the CABG group was recorded significantly more often among CABG group patients versus the CS group: 79.1% versus 60.9% respectively (p<0.05). CONCLUSION: As regards the immediate clinical efficacy both methods of revascularization are not statistically different. However, CABG is associated with a significantly higher hospital lethality. In turn, in the long-term period with the three-year survival in the study groups being statistically comparable), the incidence of UCE is recorded significantly most frequently in the CS group.