[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.

[New aspects of the surgical treatment of aortic coarctation]. / Nekotorye novye aspekty khirurgicheskogo lecheniia koarktatsii aorty.

The article substantiates the urgency of the problem and shows the results of surgical treatment of coarctation of the aorta in 103 patients who were operated on in the recent 5 years. The operation of choice was resection of the coarctation with the formation of an end-to-end anastomosis (90.3% of operations). Establishment of the anastomosis by methods developed at the department makes it possible to achieve good results and avoid complications in the immediate and late-term postoperative periods. An anomalous arterial branch, a reduced branch of the 5th aortic arch called Abbott's artery, was ligated in 40% of cases. No fatal outcomes occurred in the last 5 years in surgical treatment of coarctation of the aorta.

[A new method of surgical treatment of recurrent aortic coarctation (aorto-aortic shunting from the ascending to the descending thoracic aorta)]. / Novyi metod khirurgicheskogo lecheniia rekoarktatsii aorty (aorto-aortal'noe shuntirovanie ot voskhodiashchei k niskhodiashchei grudnoi aorte).

The authors discuss the immediate results of 44 reconstructive operations performed for a second time on the descending thoracic aorta for complications of operative interventions conducted earlier for coarctation of the aorta. The high operative risk is connected with difficulties of rethoracotomy and the need to compress the thoracic aorta for a lengthy period of time. Operation for aorto-aortic shunting through right thoracotomy made it possible to avoid these difficulties. The immediate results of all 9 such operations were good.

[Surgical treatment of post-anastomosis aneurysm developed after reconstructive operations on the thoracic aorta]. / Khirurgicheskoe lechenie anevrizm anastomozov, voznikshikh posle rekonstruktivnykh operatsii na grudnoi aorte.

Twenty-three patients were examined and operated on for aneurysms of anastomoses which formed after reconstructive operations on the thoracic aorta for its coarctation (15), kinking of the arch of the aorta (4), traumatic aneurysms (2), nonspecific aortoarteritis (1) and dissecting aneurysm (1). The involved segment had to be repaired with a prosthesis in all operations carried out for the second time. In 30% of patients the course was complicated (aortopulmonary fistulas, false aneurysm with dissection of the descending thoracic aorta). Mortality was 57% in a complicated course and 6.3% in uncomplicated cases. The results of the operation were good in 18 patients.

[Dissecting aneurysms of the descending thoracic and abdominal aorta (current classification and surgical tactics)]. / Rasslaivaiushchie anevrizmy niskhodiashchei grudnoi i briushnoi aorty (sovremennaia klassifikatsiia i khirurgicheskaia taktika).

Results of clinical studies and surgical treatment of patients with dissecting aneurysms of the descending thoracic and abdominal aorta are discussed. A new modification of the clinicoanatomical classification of this aortic disease is proposed with the emphasis on the possibility of (1) retrograde extension of the pathological process into the aortic arch with primary intimal rupture in the descending thoracic segment, and (2) multifocal aortic lesion, a combination of dissecting aneurysm and true discrete aneurysm of the unaffected aortic portion. The possibility of performing various types of one-stage and stage-by-stage reconstruction of the descending aorta depending on the degree and extension of dissection is shown.