Y configuration of the internal thoracic arteries in myocardial revascularization.

This paper describes the short-term results of surgical myocardial revascularization in 35 patients. Y configuration from one or two internal thoracic arteries was applied for bypass grafting of the left coronary artery. In 4 patients with truncal stenosis of the left coronary artery (LCA) or proximal stenoses of the anterior interventricular artery (AIVA) and circumflex artery, the length of the left internal thoracic artery (LITA) appeared adequate for creation of Y bypass and revascularization of the entire LCA pool. In most cases (28), Y bypass was formed from both ITA, which made it possible to revascularise more distant arteries of the posterolateral wall of the left ventricle. Analysis of bypass-graphies performed in 10 patients after 7 months on the average has demonstrated that occlusion (2) and stenosis of one of the branches (2) of Y bypass were most probably caused by underestimation of the degree of stenosis of the target coronary arteries.

[The results of direct myocardial revascularization in patients with various forms of coronary heart disease].

The authors analyzed the results of aortocoronary bypass surgery in correlation with the condition of the shunts and the native blood vessels. According to this analysis, 92.9% of the shunts were passable within 7.2 +/- 0.8 months of the surgery. Twelve shunts (four arterial and eight venous ones) had been occluded by the time of the control examination. Another ten shunts (five arterial and five venous ones) had hemodynamically significant stenoses. Concurrent blood flow was revealed in eight patients. According to comparative analysis, in cases of arterial shunting a good condition of the shunts was found in 95.6% of cases, while in patients with venous shunts the shunts were in a good condition in 88.1% of cases. Depending on the type of connection, the passability was satisfactory in 91.2% of straight shunts, in 94.5% of sequential shunts, and in 71.4% of Y-shaped ones. Analysis of changes in the native coronary arteries revealed progression of atherosclerosis in the bypassed arteries proximally to the site of anastomosis in 27 (25.5%) patients. An increase in the degree of stenosis distally of the site of anastomosis was found in 8 (7.5%) of patients; in another 7 (6.6%) patients similar changes were revealed in non-bypassed arteries. The surgery led to the disappearance of anginous manifestations and a negative result of a physical load test in most patients.

[A clinical case of successful combination of endovascular and surgical correction of multifocal atherosclerotic signs in an elderly patient]. / Sochetanie éndovaskuliarnoi i khirurgicheskoi korrektsii proiavlenii mul'tifokal'nogo ateroskleroza u patsientki pozhilogo vozrasta.

Combination of the methods of interventional cardioangiology with current techniques of vascular surgery allows a considerable broadening of the potential for the treatment of different signs of multifocal atherosclerosis in "high risk" patients. For instance, a 70-year-old patient (height 152 cm, weight 32 kg; initial concentration of serum creatinine 174 mumol/l) with the clinical evidence of progressing angina pectoris and critical ischemia of the lower extremities underwent angioplasty (the first stage) using a transradial access and stenting of the critically narrowed circumflex branch of the left coronary artery and angioplasty of the proximal segment of the right coronary artery. Good angiographic and clinical results were obtained. This provided a possibility of accomplishing aortofemoral bifurcation bypass grafting. So, the staged combined treatment made it possible to eliminate the life- threatening signs of multifocal atherosclerosis and to improve disease prognosis in an elderly patient classified with a group of inoperable subjects.