[Long-term outcomes of aortofemoral reconstructions in patients with type 2 diabetes mellitus].

Studied herein are long-term outcomes of aortofemoral reconstructions in a total of 469 patients presenting with atherosclerosis. Of these, 201 (42.8%) patients were diagnosed as suffered from type 2 diabetes mellitus (DM). By the time of the survey, the age of the patients in this group averaged 64.7 +/- 1.2 years. The remaining 268 (57.2%) patients (mean age 62.5 +/- 1.7 years) turned out to be non-diabetic. Surgical interventions performed on the background of pronounced limb ischaemia (50% of the patients had critical ischaemia) had made it possible to save the limb affected and for a long time to increase the distance of pain-free walk in 85.9% of diabetic patients and in 93.1% of non-diabetic subjects. Nine years after the vascular reconstruction of the aortoiliac zone, the indices of the cumulative patency of the bypass grafts (72% for diabetic patients and 81% for non-diabetics) and the limb-salvage rate (78.9% for those with DM and 88.5% for those without DM) remained sufficiently high. The cumulative survival rate amongst the diabetic patients after 3 and 6 years was significantly lower (74.0% and 58.0%, respectively) as compared with that in the non-diabetic patients (93.0% and 72.0%), P < 0.01, whereas by the 9-year period of follow-up it turned out to be similarly low in the both groups of patients (amounting to 26.0% and 29.0%, respectively). In diabetic patients, the mortality rate was significantly higher, with deaths occurring earlier, than in those from the comparison group (43.1% at 56.0 +/- 2.4 months and 28.9% at 62.4 +/- 1.9 months, respectively). The underlying causes of death regardless of the presence of diabetes mellitus chiefly comprised cardiac complications which in diabetic patients were observed significantly more often and occurring at earlier terms (52.9% at 49.5 +/- 1.7 months and 31.1% at 62.1 +/- 1.5 months, respectively, P = 0.04). Hence, despite the presence of DM, aortofemoral reconstructions in the majority of cases (up to 80%) make it possible to reliably and for a long time prevent the development of critical ischaemia and to save the lower limbs.

[Analysis of quality of ambulatory follow-up of patients with type 2 diabetes mellitus after reconstructive operations on the aortoiliac segment].

The article is dedicated to assessment of quality of ambulatory management of patients suffering from type 2 diabetes mellitus in remote terms following reconstructive operations on the aortoiliac segment. The aspects investigated included the frequency of the of patients' visiting the district polyclinic, as well as frequency and quality of planned examinations and conservative treatment. Presented herein are the results of questioning and comprehensive examination of fifty-six patients suffering from type 2 diabetes mellitus (mean age 62.3 +/- 1. 7years) performed averagely 61.9 +/- 2.1 months after surgical treatment. Fifty percent of these patients appeared to have prior to the operation had critical ischaemia of the lower extremities. By the time of the check up examination, 62.5% of these preserved stage 1 or 2A ischaemia and 37.5% had stage 2B ischaemia, which on the whole was indicative of a long-term positive outcome of surgical interventions in this severely ill cohort of patients. During this time period, in 23 (41.1%) patients with baseline critical ischaemia it turned out possible to avoid limb amputation, and 62.5% were found to have considerably increased the distance of pain-free walking (stage 1 or 2A). Together with it, the obtained findings suggested virtually total lack of adequate angiological care for the postoperative patients at the ambulatory-polyclinic level. First of all, there are neither correctly organized dispensary follow up of patients nor continuity between the clinical hospital and the polyclinic. Analysing the check-up clinical evidence showed that 83.9% of patients required correction of blood glucose level, 96.4% that of lipid profile, and 73.2% that of the haemocoagulation system. Twenty-five (44.6%) patients required stagewise reconstructions due to an atherosclerotic lesion of the previously intact arteries of the lower limbs (21), prosthesis-leg thrombosis (1) and anastomotic restenosis (3). Hence, the clinical effect of a clinical intervention in diabetic patients is apparently evident. Correct and adequate organization of therapeutic and preventive care at the ambulatory and polyclinic level may substantially improve the remote results of vascular operations in this cohort of patients.

[Femoro-popliteal bypass above popliteal fossa with PTFE graft: which graft diameter is better?].

The paper presents the results of 80 femoro-popliteal bypasses above popliteal fossa for patients with lower limb atherosclerotic lesions that were fulfilled with the use of polytetrafluoroethylene (PTFE) graft in the Department of Vascular Surgery, AV Vishnevsky Institute of Surgery, from February 1992 till December 2005. 50% of patients had lower limb ischemia grade IIb, 13.7% - grade III and 36.3% - grade IV. Distal circulation was good in 41.2%, satisfactory - in 48.5% and unsatisfactory - in 10.3% of patients. The technique of surgical reconstruction was conventional. In 50% of cases the diameter of PTFE grafts was 8 mm, in another 50% - 6 mm. A statistically significant difference in bypass patency was revealed between prostheses with different diameter in late postoperative period. For the 8-mm grafts the patency rate was 93%, 64% and 51% in 12, 30 and 60 months, respectively, while for the 6-mm grafts the same rate was 62%, 44% and 31%, respectively (p=0.004).

[Femoropopliteal bypass above the knee-joint fissure by means of a vascular prosthesis made of PTFE: choosing an appropriate diameter of the prosthesis].

Presented herein are the outcomes of a total of 80 operations of femoropopliteal grafting above the knee-joint fissure, carried out using a vascular prosthesis made of polytetrafluoroethylene (PTFE) in patients diagnosed with atherosclerotic lesions of the arteries of the lower extremities over the period between February 1995 and December 2005 at the Department of Vascular Surgery of the A. V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences. Fifty percent of the patients were operated on for grade II B ischemia, while 13.7% of the patients suffered from grade III ischaemia of the lower limb, and 29 (36.3%) subjects were found to have grade IV ischaemia. The condition of the distal bed was considered <> in 41.2% of the patients, being defined as <> in 48.5%, and as "poor" in 10.3%. The operative intervention was carried out according to the conventionally accepted technique. 50% of the reconstructions were performed using the prosthesis 8 mm in diameter, and 50% - using that measuring 6 mm in diameter. A statistically significant impact of the diameter of the prosthesis used on the patency of the graft in the remote postoperative period was revealed: with the prosthesis 8-mm in diameter, the patency after 12, 30 and 60 months amounted to 93%, 64% and 51%, respectively, while with the transplant measuring 6 mm in diameter, these indices at the above-mentioned time intervals did not exceed 62%, 44% and 31%, respectively (P=0.004).

[Surgical treatment of recurrent renovascular hypertension]. / Khirurgicheskoe lechenie retsidiva vazorenal'noi gipertenzii.

The article analyzes the results of surgery for a recurrence of vasorenal hypertension developing as a result of an impaired major blood flow in the operated on renal artery. The main causes of the blood flow impairment in the immediate postoperational period included an expansion of indications for the primary reconstructive operation or technical drawbacks during the operation itself whilst in the long-term post-operational period the progression of the underlying disease was the principal culprit. Repeated operations on the renal arteries were performed in 19 patients, and in 28 patients surgery consisted of secondary nephrectomy. Good and satisfactory results after repeated reconstructive operations on the renal arteries were obtained in 73.3% of the cases. The operation of choice in repeated interventions is the autovenous prosthesis of the renal artery.