[Role of perforating veins in occurrence of varicose disease and its recurrences after surgical interventions].

The blood horizontal reflux via insufficient perforating veins (PV) from the deep venous system into subcutaneous one is considered an important factor of formation of chronic venous insufficiency in varicose disease (VD) and its recurrences (VDR). The role of PV in a VD progressing and in a VDR postoperatively in 774 patients, operated on for primary VD and 243 - VDR, is discussed. While determining significance of the blood horizontal reflux and substantiation of necessity for the PV ligation there must be taken into account the data of the colour duplex scanning concerning their valve apparatus state and clinical estimation of the disease severity.

[Combined treatment of arteriovenous malformations of the head and neck].

An arteriovenous malformation (AVM) is a vascular developmental abnormality conditioned by impaired embryonic morphogenesis and characterized by the development of an abnormal connection between arteries and veins. More than 50% of the total number of patients suffering from this pathology are those having the pathological foci localizing in the area of the head and neck. At present, a combined method is both a generally accepted and the most radical one used for treatment for AVM. However, in the majority of cases, excision of the malformation leaves an extensive and complicated defect of tissues, whose direct closure leads to coarse cicatricious deformities. Over the period from 2004 to 2012, we followed up a total of 37 patients presenting with arteriovenous malformations of the head and neck. At admission the patients underwent preoperative examination including clinical tests, ultrasound duplex scanning, arteriography, MRT, and computed tomography. 24-72 hours prior to the operative intervention the patients were subjected to embolisation of the main vessels supplying the vascular malformation. Excision of the AVM was in 8 cases followed by primary closure of the postoperative wound, in 17 patients the defect was closed by transposition of the axial flaps, and 12 subjects underwent free transplantation of composite complexes of tissues. Relapse of the disease was revealed in 17 patients. In the majority of cases, relapses developed during the first year after the operative intervention (10 cases). The control of the disease's course was obtained in 20 patients. In 8 of the 12 patients with free transplantation of flaps we managed to obtain long-term control over the disease's course (more than 5 years). Hence, free microsurgical transplantation of compound complexes of tissues may be considered as a method of choice for closing the defect after excising an AVM in the area of the head and neck. Replacement of the defect with a well-vascularized tissue complex considerably improves regional haemodynamics, decreases tissue ischaemia, and is capable of providing longterm control over the disease's course.

[Early differential diagnostics of sialadenitis in the parotid salivary glands by ultrasonography methods].

Work is devoted diagnostics of sialozy in parotid salivary glands and early exposure of cancer at sialozy. For diagnostics we used are sonografy methods of research (ULTRASONIC + coloured dopplerografy) and sonoelastografy (SEG) methods. Marked uninvasiveness and high exactness of diagnostic methods at the disease of sialozys and cancer.

[Prophylaxis of thrombotic complications of reconstructive interventions for occlusion of the main arteries of femoral-popliteal segment].

Comparative evaluation of effectiveness of the usage of the Pentosan polysulfas SP 54 and low molecular heparins after reconstructive interventions by the patients with occlusion of the main arteries of femoral-popliteal segment for the prevention of postoperative thrombotic complications was held. The obtained results show the great hypocoagulation and hypocholesterol effect of Pentosan polysulfas SP 54, and the expediens its application in that patients.

[Perspectives of using popliteo-tibial shunting in distal portions of the lower extremities arteries lesions].

In the treatment of ischemic disorders in patients, suffering diabetes mellitus, the venous shunting toward a. pedis dorsalis and/or paramalleolar segment of a. tibialis posterior are aplied most frequently. Distal shunting was performed in 3 patients suffering critical ischemia of the lower extremities with possible alternative of amputation operation. The diameter and the state of internal vessel surface, the presence of its calcification, as well as the state of the blood inflow and outflow ways, had constituted the criterions of choice of certain segment of arteries for anastomosing. In the presence of several available vessels, the better surgical access to the artery and shorter way for shunting were taken into account. In 2 patients popliteoposterotibial shunting was performed, using autoven (1 observation) and the composed shunt (1 observation); and in one--distal anastomosis was formed with a. pedis dorsalis. In 2 mo after the operation the composed shunt thrombosis occurred. In patients, to whom autovenous shunting was performed, the regional hemodynamics indices were stable, the shunts are functioning.

[Noncomplicated varicose disease: morphological peculiarities, the ways of reflux spread].

The studying results of anatomical variants of the leg large subcutaneous vein (LLSV) and its tributaries structure are adduced, the possible ways of the blood reflux spread are determined. The authors present anatomical classification of varicose disease of the LLSV basin, the epidemiology data of the disease forms incidence are adduced.

[Retrospective analysis and modern concept of treatment of the limbs lymphoedema].

Lymphoedema--is a chronic disease, characterized by the volume enhancement of some part of body, more often--of the limbs, as a consequence of tissues oedema, caused by the lymphatic system transport and resorptive function disorder. Modern approaches to lymphoedema treatment foresees combination of conservative and surgical ones, for example, microsurgical, taking into account the oedema character, stage of the disease, the previous treatment efficacy.

[New technologies in diagnosis and surgical treatment of the abdominal aorta aneurysm].

Modern views about occurrence, pathogenesis, and methods of diagnosis and surgical treatment of abdominal aorta aneurysm are adduced. Application of new highly informative diagnostic methods, an adequate anesthesiological support, differentiated methods of surgical intervention have permitted to reach marked progress in the treatment of patients with abdominal aorta aneurysm.

[The choice of operative method for the arterial occlusion in the femoro-popliteo-tibial segment].

The results of surgical treatment of 198 patients suffering atherosclerotic occlusion of the femoro-popliteo-tibial segment arteries were analyzed, of them endarterectomy from superficial femoral artery was performed in 75 (37.9%) patients, femoro-popliteal shunting using autovena--in 93 (47%), synthetic prosthesis--in 17 (8.6%), in 4 (2%)--distal anastomosis was formatted with "hanged" segment of popliteal artery, revascularization of the limb via the deep femoral artery system was done in 9 (4.5%) patients. Good immediate result was noted in 86.4% patients, in 2 years and more--in 68.6%. Comparative analysis of methods of the femoro-popliteo-tibial segment arteries reconstruction had trusted, that more stable indices of hemodynamics were achieved after performance of autovenous shunting with formation of distal anastomosis via proximally than the knee joint fissure localisation.

[Clinical and ultrasonographic diagnosis of angiodysplasia].

Diagnosis and treatment of the inborn angiodysplasia constitutes the complex problem of vascular surgery. Of the multiple causes, conditioned by such the state of the issue, it is necessary to stress such as unsatisfactory knowledge of physician, the absence of strict diagnostic criterions, the attempts of the pathology elimination by specialists of various disciplines. The aim of the investigation was to determine the principal clinical and ultrasonographic criterions, permitting to reveal vascular malformation rapidly and objectively, to differentiate its type, the spreading, to characterize hemodynamical disorders.

[Varicose disease: classification and ultrasonic diagnosis]. / Varikoznaia bolezn'. Klassifikatsiia, ul'trazvukovaia diagnostika.

Results of clinical examination and ultrasonic investigation in 478 patients with varicosic disease (VD) of lower extremities are adduced. Basing on the data obtained the clinicoanatomic forms of VD were deliniated. The typical and nontypical forms diseases criterions of ultrasound diagnosis were determined. It was demonstrated that the choice of the surgical treatment tactics in patients with VD depends on its clinicoanatomic form, and the principal method of diagnosis is the color duplex scanning.

[Changes of regional hemodynamics and microcirculation in tissues of lower extremities in patients with obliterating atherosclerosis in stages I and II]. / Izmeneniia regionarnoi gemodinamiki i mikrotsirkuliatsii v tkaniakh nizhnikh konechnostei u bol'nykh s obliteriruiushchim aterosklerozom v I i II stepeni.

Basing on analysis of results of ultrasonic investigation and laser Doppler flowmetry, performed in 125 patients with obliterating atherosclerosis of lower extremities arteries in I-II stages, the criterions of the chronic arterial insufficiency severity diagnosis were determined. There was established, that in high functional reserve of microcirculation present it is expedient to recommend to the patients the conservative treatment, as well as physiotherapeutic and sanatorium health resort procedures.

[Standardization of the report on clinical effects of surgical treatment of patients with obliterating atherosclerosis of the lower extremities]. / Standartizatsiia otcheta o klinicheskom effekte operativnogo lecheniia bol'nykh s obliteriruiushchim aterosklerozom arterii nizhnikh konechnostei.

To achieve the objectivization of the operation results performance, to compare them, to conduct a dynamic control of the reconstructed arterial segments passability and the course of the disease as well, the estimation of treatment efficacy in patients with obliterating atherosclerosis of the lower extremities arteries must be standardized for some factors, considering the change in the patient state and locus morbi. The authors had performed the analysis of approaches to solve this problem and proposed the criterions of the operative treatment efficacy estimation in patients with intermittent claudication and critical ischemia of lower extremities.

[Current possibilities of the diagnosis and surgical treatment of acute thrombophlebitis and severe forms of varicose disease]. / Sovremennye vozmozhnosti diagnostiki i khirurgicheskogo lecheniia ostrogo tromboflebita i tiazhelykh form varikoznoi bolezni.

The data on examination and surgical treatment of 35 patients, suffering severe forms of varicose disease in stage of trophic disorders occurrence and with an acute thrombophlebitis are adduced. The concept of an active surgical help, including thromboembolic complications prophylaxis, depending on thrombophlebitis localization, correction of the venous hemodynamics disorders and the staged closure of trophic ulcer is substantiated. Introduction of the proposed tactics had permitted to achieve satisfactory outcomes, including the trophic ulcer healing and the trophic disorders regression in all the patients operated on.

[Surgical treatment of occluding lesion of the subclavian artery]. / Khirurgicheskoe lechenie okkliuziruiushchego porazheniia podkliuchichnoi arterii.

Results of cerebral hemodynamics investigation and operative treatment of 53 patients with the subclavial artery (SA) occlusion were presented. It was established that the course of the cerebral vascular disorders occurrence in patients with the SA proximal segment occlusion is the vertebro-subclavial robbing syndrome. The consider that the SA resection with her implantation to ipsilateral a. carotis communis (ACA) is operation of choice. The vessel prosthesis is indicated in presence of widespread affection. It is expedient to performed one-stage correction of blood flow in the vessels mentioned in patients with ipsilateral localization of the SA and ACA affection.

[Venous thromboembolic complications in abdominal and vascular surgery. The risk factors and measures of prophylaxis]. / Venoznye tromboémbolicheskie oslozhneniia v abdominal'noi i sosudistoi khirurgii. Faktory riska i mery profilaktiki.

There were analyzed 4675 histories of cases of patients, who were operated on for disease of the digestion organs (3349) and for obliterating atherosclerosis of abdominal aorta and peripheral arteries (1326). The risk factors of occurrence were established, the prophylaxis methods for venous thromboembolic complications (TEC) in postoperative period were elaborated. High efficacy of application of fraxiparine in the venous TEC prophylaxis in abdominal and vascular surgery was noted.