[Surgical treatment of a huge paraganglioma of the right common carotid artery bifurcation]. / Khirurgicheskoe lechenie krupnoi paragangliomy bifurkatsii pravoi obshchei sonnoi arterii.

Described herein is a clinical case report regarding successful surgical treatment of a female patient presenting with a large paraganglioma of the right common carotid artery. On admission, the woman had complained of a mass in her neck, having significantly enlarged within the previous 6 months, with the appearance of dysphagia and moderate pain syndrome. The findings of multislice computed angiography and ultrasonographic duplex angioscanning of the brachiocephalic arteries helped to verify the location, size, and topography of the tumour. Taking into account the diagnosed secondary foci in the lungs, it was decided to first perform embolization of the artery supplying the tumour, which was followed by biopsy of tissue of the neoplasm. After histological verification and ruling out malignancy, successful radical resection of the paraganglioma was performed.

[Hybrid treatment of a patient with dissecting thoracoabdominal aortic aneurysm and single kidney]. / Gibridnye tekhnologii v lechenii patsienta s rassloivsheisia torakoabdominal'noi anevrizmoi aorty i edinstvennoi pochkoi.

Presented herein is a clinical case report regarding a repeat intervention for a type II dissecting thoracoabdominal aortic aneurysm treated by means of a hybrid technique in a 76-year-old male patient with a single kidney, having 9 years previously endured resection of an aneurysm of the infrarenal aortic portion. The first stage consisted in prosthetic repair of the thoracoabdominal aortic aneurysm by an oblique anastomosis, with the second stage (7 days thereafter) being endoprosthetic repair of the descending thoracic aorta. The findings of check-up computed tomography at 16 months postoperatively demonstrated no negative dynamics.

[Bypass grafting in patients with infected vascular grafts]. / Obkhodnoe shuntirovanie pri infitsirovanii sosudistogo proteza.

Analysed herein are the results of treating a total of 17 patients presenting with pathology of the aorta and lower-limb arteries, who from 2010 to 2018 required redo interventions due to infection of a previously implanted synthetic vascular graft. At admission, 3 patients were diagnosed as having an open infected wound, 11 were found to have a fistula, 2 had a false aneurysm in the area of the distal anastomosis of the branch of the bifurcation aortofemoral prosthesis, and 1 had thrombosis of the branch of the prosthesis with evidence of infection. As redo surgery, 4 patients underwent subclavian-femoral bypass grafting, 2 were subjected to crossover iliac-femoral bypass grafting, 8 to unilateral iliac-femoral bypass grafting, 3 to loop endarterectomy. In the majority of cases (14 of the 17) we used bypass grafting with creation of the tunnel through the muscular lacuna. Lethal outcomes were registered in 35% (n=6) of cases in the early postoperative period. Death was caused by acute renal failure in 6% (n=1), by acute mesenteric thrombosis in 12% (n=2), by gastrointestinal haemorrhage in 6% (n=1), and by multiple organ failure in 12% (n=2). Long-term mortality amounted to 33% (n=3) within 12 months. The main causes of death were increasing renal failure in 10% (n=1) and cardiovascular insufficiency on the background of heart diseases in 10% (n=1), as well as respiratory insufficiency in 10% (n=1). Reinfection in the remote period was diagnosed in 1 patient. A conclusion was drawn that bypass grafting is traumatic, however, it may be the only way to save the limb or patient's life in a complicated clinical situation. Using the superficial femoral vein as a shunt demonstrated good long-term results as to patency and resistance to surgical infection. Using a flap of the greater omentum, retroperitoneal fat, as well as wrapping of the prosthesis with a muscular flap ensured good tolerance of the zone of bypass grafting to reinfection.

[Open surgical treatment of aneurysms and dissection of the thoracic and thoracoabdominal aorta]. / Otkrytoe khirurgicheskoe lechenie anevrizm i rassloeniia grudnoi i torakoabdominal'noi aorty.

Presented herein is experience in treating a total of 56 patients with pathology of the arch, descending and thoracoabdominal aorta from 1997 to 2017. Of these, 6 (11%) patients were diagnosed with a Crawford type I-II thoracoabdominal aortic aneurysm (TAAA), 20 (35%) patients with Crawford type III-IV TAAA, 18 (32%) were diagnosed as having an aortic arch aneurysm (AAA) and descending thoracic aortic aneurysm (DTAA), 12 (22%) had DeBakey type I and IIIb aortic dissection. To protect the visceral organs and spinal cord from ischaemia in 28 (50%) cases we used a temporal bypass from a synthetic vascular graft with zero porosity and measuring from 15 to 20 cm in diameter. RESULTS: Mortality within 30 days amounted to 14.3% (n=8), that after 30 days amounted to 10.7% (n=6): in elective operations - 12% (n=5) and 5.4% (n=3), in emergency operations - 21% (n=3) and 21.4% (n=3), respectively. The total in-hospital mortality amounted to 25% (n=14), equalling 19% (n=8) and 43% (n=6) for elective and emergency operations, respectively. Mortality in using temporal bypass in elective operation amounted to 9.5% (n=2) during 30 days and that without using this method to 14.3% (n=3), after 30 days being 9.5% (n=2) and 4.7% (n=1), respectively. Mortality for emergency cases with a temporal shunt during 30 days was 28.6% (n=2), without - 14.3% (n=1), after 30 days - 28.6% (n=2), without - 14.3% (n=1). In type I-II TAAA mortality within 30 days was 16.6% (n=1), after 30 days - 50% (n=2); type III-IV TAAA - 10% (n=2) and 15% (n=1); DTAA - 22.2% (n=4) and 33.3% (n=2); aortic dissection - 8.3% (n=1) and 16.6% (n=1). Acute renal failure (ARF) occurred in 6 (10.7%) patients and was more often observed in the group without temporal shunting. Events of spinal cord ischaemia with the development of spinal stroke occurred in 6 (10.7%) cases. Five-year survival amounted to 61%. CONCLUSION: Temporal bypass in surgery of the thoracic and thoracoabdominal aorta may be used for prevention of ischaemia of visceral organs, kidneys and spinal cord in operations accompanied by cross-clamping of the descending thoracic aorta.

[Treatment of abdominal aortic aneurysms in patients older than 70 years of age].

The investigation has shown that patients with the diagnosed abdominal aortic aneurysms must be operated, the age being not considered a contraindication to surgical treatment. Five years survival of the patients after resection of the abdominal aortic aneurysm and its prosthesis does not depend on the age and is higher than 70%, while the expectant management leads to rupture of the aneurysm and death of 70% of the patients. A medical algorithm has been developed allowing reduction of lethality of elderly patients with abdominal aortic aneurysms and less frequency of complications.

[Semiclosed endarterectomy of the aorto-femoral segment by Vollmar loops]. / Poluzakrytaia éndarteréktomiia aortobedrennogo segmenta petliami Vollmar.

In 1996-1998 131 patients were observed who underwent semiclosed loop endarterectomy of the aorto-femoral segment by Vollmar loops. The control group consisted of 220 patients on whom the operations of uni- or bilateral aorto-femoral bypass with synthetic prostheses were made. The semiclosed loop endarterectomy was mainly fulfilled through the femoral access, the retroperitoneal access was used in 18.3% of the patients. Thus the time of operation was as short as (100 +/- 10.9) min. in mono- and (118.6 +/- 12.9) min. in bilateral reconstructions, and blood loss in typical cases was not more than (327 +/- 24.1) ml. The operation of semiclosed loop endarterectomy gave a high level of patency to the reconstructed aorto-femoral segment. The primary 5-year patency of the iliac arteries was 91.86%, the cumulative one--93.87%. Such parameters for shunting operations were lower: 75.4 and 81.63% respectively (p < 0.05).

[The surgical treatment of aneurysms of the abdominal aorta]. / Khirurgicheskoe lechenie anevrizm briushnoi aorty.

Based on an experience with treatment of 107 patients with aneurysms of the abdominal aorta subjected to planned or urgent operations the authors discuss the problems of the clinical course, diagnosis, indications for operative treatment, the technique of operative interventions and their results. In planned operations lethality was 4.1%, in ruptures of the aneurysm-64.2%. One year after the operations 90% of the patients were practically healthy, 5 years later they were 70%.

[Role of extra-intracarotid anastomosis in the surgical treatment of chronic cerebral ischemia]. / Mesto ékstra-intrakarotidnogo anastomoza v khirurgicheskom lechenii khronicheskoi tserebral'noi ishemii.

About 500 patients with ischemic brain lesions were studied. Out of them 201 patients underwent 230 operations: 140 extra-intracarotid bypass (EIB) and 90 various interventions on brachiocephalic branches. The study of cerebral hemodynamics by examining blood pressure in the central artery of the retina and middle cerebral artery during surgery, comparison of these findings with those of Doppler sonography and angiography made the authors conclude that EIB improves cerebral hemodynamics, and in some cases it is the only intervention able to improve the status of patients. In severe disseminated atherosclerosis with occlusion of one of the carotid arteries, EIB should follow other interventions on brachiocephalic branches. EIB was found to make the natural history of cerebral failure steady in 80.3%.