[Hybrid interventions for acute thrombosis after reconstructive operations on lower-limb arteries]. / Gibridnye operatsii pri ostrykh trombozakh posle rekonstruktivnykh operatsii na arteriiakh.

BACKGROUND: A steadily growing number of primary lower extremity arterial reconstructions is inevitably followed by the need to perform repeat interventions. Shunt reocclusion may become a cause of return of ischaemia to the initial level, may significantly increase the degree of limb-threatening chronic ischaemia, as well as lead to the development of an acute condition requiring urgent corrective measures to be taken. A reoperation currently continues to remain the standard of treatment. Despite advances in modern resuscitation, the postoperative mortality rate in such patients reaches 20%. AIM: This study was aimed at assessing feasibility of hybrid technologies in acute thrombosis after reconstructive operations on lower-limb arteries. PATIENTS AND METHODS: We retrospectively analysed the results of treatment of 66 consecutive patients urgently admitted to the City Clinical Hospital named after S.S. Yudin from 2015 to 2020 with acute lower limb ischaemia caused by acute occlusion of the zone of primary vascular reconstructions previously performed at other medical facilities. Depending on the method of surgical treatment, the patients were divided into two groups. The Study group included 20 patients subjected to open surgical interventions followed by angiographic control and using one or other type of X-ray-endovascular treatment. Endovascular interventions were performed for more than 70% stenoses in the major arteries and zone of the previously performed operation. The Comparison group comprised 46 patients treated without endovascular technologies. They were subjected to thrombectomy from the vascular construction with/without reconstructive-restorative operations. RESULTS: Seventeen (85%) of the 20 Study group patients were operated on in a stagewise manner, with the first stage consisting of an open intervention - thrombectomy and reconstruction followed by angiographic control and roentgenendovascular treatment. The remaining three (15%) patients underwent simultaneous interventions. In the postoperative period, limb amputations were performed in ten (22%) Comparison group patients and in one (5%) Study group patient (p=0.049). There were three (7%) lethal outcomes in the Comparison group, with none in the Study group. CONCLUSION: A combination of open and endovascular interventions in patients with shunt occlusion after vascular reconstructions makes it possible to reveal the cause of shunt occlusion, as well as to remove multilevel lesions, minimizing surgical wound and contributing to reducing the amputation rate.

[Reperfusion syndrome: state of the art]. / Reperfuzionnyi sindrom. Sovremennoe sostoianie problemy.

Reperfusion syndrome is a complex series of clinical manifestations resulting from restoration of blood flow to previously ischaemic tissues. It is accompanied by damage to cells, tissues and organs at various levels, followed by the development of multiple organ failure. This review deals with the main pathophysiological mechanisms of the development of reperfusion syndrome in lesions of cardiac, cerebral and lower-limb vessels. Oxidative stress is considered to be the most important marker of ischaemia-reperfusion injury irrespective of the type of tissues affected. Presented herein are the data on contemporary possibilities of influencing various stages and components of the development of reperfusion injury by means of drug therapy, demonstrating that due to the importance of oxidative stress as a key link of reperfusion injury, antioxidant therapy should be the main component of prevention and treatment of reperfusion injury.

[Revascularisation in patients with failed previous arterial reconstructions]. / Metody revaskuliarizatsii u patsientov s narusheniem prokhodimosti ranee vypolnennykh arterial'nykh rekonstruktsii.

Redo arterial reconstructions are followed by advanced surgical risk or impossible in some cases. Active introduction of endovascular surgery complements the capabilities of conventional surgical approach. It is presented case report of restoration of patency of synthetic femoral-popliteal shunt with previous occlusion for a long time. The technique of recanalization and stenting of allograft is described. Immediate results are favorable but further research is needed.

[Objective assessment of the degree of ischaemia and efficacy of treatment in chronic arterial insufficiency of lower limbs]. / Ob''ektivnaia otsenka stepeni ishemii i éffektivnosti lecheniia pri khronicheskoi arterial'noi nedostatochnosti nizhnikh konechnostei.

Presented in the review is the data concerning contemporary criteria for assessing the degree of chronic lower limb ischaemia and quality of the treatment performed. Problems regarding objectivization of the degree of an ischaemic lesion of an extremity and assessment of quality of conservative treatment still remain unresolved. Currently, in the world practice along with instrumental methods (assessment of the ankle-brachial index) subjective criteria are mainly employed: assessment of pain-free walking distance or maximum distance walked. In order to work out appropriate regiments of conservative treatment and compare efficacy of various drugs for treatment of chronic lower limb ischaemia and, in particular, intermittent claudication, it is necessary to use objective criteria. Detailed consideration is hence given to the possibilities of using morphological, biochemical and histological criteria such as determination of vascular endothelial growth factor A (VEGF-A) in peripheral blood and determination of apoptosis markers (BNIP3) and hypoxia-inducible factor (HIF-1) in a biopsy sample of the gastrocnemius muscle of the ischaemized extremity.

[Assessment of endothelial dysfunction for prevention of complications in patients with lesions of peripheral arteries]. / Otsenka éndotelial'noi disfunktsii v profilaktike oslozhnenii u bol'nykh s porazheniem perifericheskikh arterii.

BACKGROUND: Severity of endothelial dysfunction and impairments of the vasomotor function of arteries correlate with the degree of the development of atherosclerosis and the risk of cardiovascular complications. To date, poorly studied still remains the problem concerning alteration of the regulatory function of the endothelium in patients diagnosed with pronounced atherosclerotic lesions of peripheral arteries, as well as the impact of a surgical intervention on indices of endothelial dysfunction. PATIENTS AND METHODS: Presented in the article are the results of preoperative study of the endothelial function by means of peripheral arterial tonometry (PAT) using the Endo PATTM 2000 device (Itamar Medical Ltd.) in a total of 74 patients undergoing surgical treatment at the Institute of Surgery named after A.V. Vishnevsky. The male-to-female ratio in the studied group was 1:2.52, with the patients' average age amounting to 67Ѓ}8 years. Of the 74 patients, 21 were subjected to a repeat examination performed at terms varying from 2 to 23 months postoperatively. Of these, 17 (80.95%) patients took statins. Fourteen (66.7%) patients had endured an operative intervention on carotid arteries and seven (33.3%) had been operated on for lesions of lower-limb arteries. RESULTS: The statistical analysis of the obtained findings revealed no significant differences of the indices of the endothelial function in the studied group between the genders, depending on age, smoking or taking statins. Neither were there statistically significant differences in the reactive hyperaemia index (RHI) amongst the patients with the involvement of one or several arterial basins. We did not reveal a direct relationship or regularity of the effect of a surgical intervention on the RHI values in the operated patients. This might be explained by the fact that the method of PAT to a greater degree assesses the state of the microvascular bed rather than that of large arteries.

[59-th International Congress of the European Society of Cardiovascular Surgeons (Izmir, Turkey, 15-18th April, 2010)].

This article is the review of the 59-th International Congress which had taken part in Izmir, Turkey at 15-18th April of 2010 year. There had been discussed important problems of cardiovascular surgery, especially endovascular treatment of the aortic diseases.

[Endovascular separation of the arterio-arterial anastomosis between the circumflex branch of the left coronary artery and bronchial artery].

Presented in the article is a case report concerning successful dissociation of an arterio-arterial anastomosis between the circumflex branch of the left coronary artery and bronchial artery using a stent graft in a 72-year-old patient.

Remote results after prosthetic repair of the internal carotid artery for atherosclerotic lesions.

Presented herein is the authors' experience gained in employing a method of prosthetic repair of the internal carotid artery in patients suffering from atherosclerotic stenosis. Special attention is paid to intraoperative factors having led to arterial prosthetic reconstruction. Also analysed are the remote results of treatment in 81 of 97 operated patients. The mean duration of follow-up amounted to 28 +/- 3 months. All the patients in the remote period were subjected to colour duplex scanning of the reconstructed tone and that of the contralateral internal carotid artery (ICA), immediately followed by assessing the neurological status. Two patients were found to have developed single transient ischaemic attacks, with their grafts remaining patent. A further three patients had developed thrombosis of the graft, with restenosis of the anastomosis zone being revealed in four patients more. All complications were symptom-free. The obtained findings showed that, taking into consideration the remote results and in certain indications, prosthetic repair of carotid arteries is an efficient method of treatment for atherosclerotic lesions of the ICA and in this relation is at least not inferior to the conventional techniques of carotid endarterectomy.

Carotid artery grafting for restenosis after carotid endarterectomy.

The paper analyzes outcomes of 12 internal carotid artery (ICA) graftings for repeat stenosis after carotid endarterectomy (CEA) in 11 patients. In 6 cases restenosis occurred after eversion CEA, in 5 - after conventional patch CEA, and in 1 case - after ICA patch angioplasty for post-CEA restenosis. Critical restenosis >75% in reconstruction area was an indication for surgical intervention. There was 1 case of graft thrombosis in early postoperative period with hemispherical stroke and lethal outcome. Eight patients were examined in late postoperative period. Mean follow-up was 34?+/-?8.44 months (from 16 to 48 months). No cerebrovascular disturbances in operated ICA feeding area were detected. In 6 patients graft patency was good, while 2 smoking patients with diabetes mellitus and hyperlipidemia demonstrated repeat restenosis of proximal anastomosis >70%.

Carotid artery dissection (literature review and a case report).

The paper presents a literature review on the internal carotid artery (ICA) dissection and an original case report. The dissected ICA segment was resected and grafted.

[The assessment of medical therapy effectiveness of patients with lower limb chronic venous insufficiency: the results of prospective study with Ginkor Fort].

The results of prospective study on combined agent Ginkor Fort are presented. The study included 60 patients with variceal disease and clinical picture of chronic venous insufficiency (CVI), II-IV CEAP class. Besides the registration of common and well known subjective signs (lower limb pain, heaviness and discomfort feelings, night palsies and paresthesia, edema), the main outcome measures included the results of digital photo-plethysmography (PPG). Initial assessment demonstrated the decrease of both venous return time (To) and muscular-venous pump capacity (Vo) with the increase of CEAP class; the trend of To appeared to be statistically significant (p=0.0318). The treatment resulted in the regression of main clinical complaints according to the 6-score analog scale. PPG showed the rise of to from 19.5+/-4.9 s to 20.5+/-3.7 s, though this trend was statistically insignificant (p>0.05). Vo elevated significantly from 3.69+/-2.4% to 4.04+/-2.3% (p<0.05), demonstrating the grown functional capacities of leg pump. PPG with To and Vo analysis can be used in combination with ultrasonic examination for the quantitative assessment of venous outflow disturbances and accordingly, of the CVI severity. This method can serve as an indicator of conservative treatment effectiveness. Combined agent Ginkor Fort is feasible for adjunctive therapy in complex treatment of patients with lower limb CVI symptoms.

[Ginkor Fort for management of lower limb chronic venous insufficiency]. / Ginkor Fort v lechenii bol'nykh s khronicheskoi venoznoi nedostatochnost'iu nizhnikh konechnostei.

Considering current knowledge on pathogenesis of lower limb chronic venous insufficiency, the authors substantiate the necessity of drug therapy in phlebological practice. The use of combined drug Ginkor Fort - representative of a new polyvalent venotonics - is described. The need of large-scale clinical trials with adequate objective control is stressed.

Soil phytoremediation from the breakdown products of the chemical warfare agent, yperite.

A plant-based bioremediation (phytoremediation) strategy has been developed and shown to be effective for the clean-up of soil contaminated by the breakdown products of the chemical warfare agent (CWA), yperite. The method involves exploiting the plant growth hormone, indole-3-acetic acid (IAA), to intensify the phytoremediation. For determination of the yperite breakdown products, gas chromatography is used. Soil and plant samples were analysed with a gas chromatograph fitted with an atomic emission detector. The method of standard-free determination was employed to identify sulphur-containing substances (SCSs). A series of soil tests was conducted, which showed that the level of SCSs decreased 4, 8, and more than 20-fold compared with that found in contaminated soil. This decrease was dependent upon the IAA concentrations used for plant treatment. The treated plants accumulated 2.7 to 2.9-fold larger amounts of the SCSs than did the untreated plants. Owing to its simplicity, environmental safety and inexpensiveness, the method can be recommended for the restoration of soil fertility in areas of storage and destruction of blister CWAs.