[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.

[Surgical treatment of total thrombosis of an abdominal aortic endograft]. / Khirurgicheskoe lechenie total'nogo tromboza éndoproteza briushnoi aorty.

Described in the article is a clinical case report regarding successful surgical treatment of total thrombosis of a stent graft in a high-risk surgical patient, having previously undergone endovascular repair of an abdominal aortic aneurysm by means of a unilateral stent graft with suprarenal fixation of its crown and femorofemoral crossover bypass grafting. 5 months after the operation, the patient began complaining of rest pain in his right leg and trophic ulcers of the foot. The findings of MSCT angiography revealed total thrombosis of the stent graft, to be later on followed by operative intervention, i. e. resection of an infrarenal abdominal aortic aneurysm with the removal of the stent graft, aortofemoral bifurcation prosthetic repair and graft-renal prosthetic repair on the left. The postoperative period was complicated by a transitory ischaemic attack. On POD 29, the patient was discharged in a satisfactory condition. 8 months later, the findings of the control MSCT angiography revealed thrombosis of the graft of the left renal artery, with the left kidney secondarily shrunken. However, the clinical biochemistry data showed no evidence of renal failure, thus suggesting that renal function was compensated exclusively at the expense of the right kidney.

[Hybrid surgical treatment of a multilevel lesion of lower-limb arteries]. / Gibridnoe khirurgicheskoe lechenie mnogourovnevogo porazheniia arterii nizhnikh konechnostei.

The study was aimed at assessing immediate postoperative and remote results of hybrid surgical treatment of patients with a multilevel lesion of lower-limb arteries. Described herein is the authors' experience with simultaneous hybrid surgical management of 48 patients, including 43 subjects with a multilevel lesion of arteries of the lower extremities. There were 40 men and 8 women, with the average age amounting to 65.8±7.9 years. Of these, 30 patients suffered from stage II-b chronic arterial insufficiency (CAI), 11 had stage III CAI and 7 had stage IV CAI according to A.V. Pokrovsky classification. While planning the hybrid operation on the arteries of lower limbs we assessed the type of the lesion to the aortofemoral and femoropopliteal segments according to TASC II. All patients were subdivided into 3 groups, depending on the type of hybrid operations: Group I (n=17) - aortofemoral segment, Group II (n=5) - femoropopliteal segment, and Group III (n=26) reconstruction of both above-mentioned segments. The technical success amounted to 93.7% in revascularization of all types of lesions of the arteries of lower limbs with the use of hybrid vascular reconstructions. The mean duration of the operation was 231.8±90.7 min, including that of the open stage amounting to 126.4±72.8 min and that of the endovascular stage to 105.4±62.9 min. In the immediate postoperative period there were 2 complications requiring repeat reconstructive operation. The ankle-brachial index (ABI) after the intervention increased from 0.43±0.17 to 0.85±0.12. The duration of follow-up averaged 23.4±15.1 months (range 1.9-45.2 mos). Primary patency at 6 months was 94%, at 12 months 94%, at 24 months - 85% and at 36 months - 79% in all groups studied. Four patients during the follow-up period were subjected to amputation. The limb salvage rates were as follows: during 36 months in all patients - 91.6%, in those with stage II-b CAI - 93.3% and in those with critical lower-limb ischaemia - 88.8%. The overall survival rate was 95.8%. The use of a hybrid method in treatment of a multilevel lesion of lower-limb arteries with revascularization of the aortofemoral and femoropopliteal segments proved efficient both in the immediate and remote periods.

[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 efficacy of antithrombotic therapy after total obliteration-reversing therapy in atherosclerotic arterial occlusion of the lower extremities]. / Effektivnost' antitromboticheskoi terapii posle total'noi dezobliterapii pri ateroskleroticheskoi okkliuzii arterii nizhnikh konechnostei.

The operation of total desobliteration of the arteries (TDA) is a modification of semi-open eversive endarterectomy (EAE). Under study was frequency of thromboses of the desobliteration area, its correlation with postoperative changes of the state of hemorheology and hemocoagulation and the antithrombotic treatment of 150 patients who were operated upon for total desobliteration of the iliofemoral-popliteal segment. The patients were divided into 2 groups which had no substantial difference. At the postoperative period patients of the 1st group (79) were treated with Ticlid ("Sanofi" France) in dosage of 500 mg/day. Treatment of 71 patients of the second group included a combination of two medicines (A + D): aspirin--1000 mg/day and dipiridamol--150 mg/day. A comparative analysis of frequency of the development of cardio-vascular complications at the remote period has shown that in the first group of patients the frequency of development of acute myocardial infarction and acute disturbance of cerebral blood circulation was two times less than in the second group of patients. It is to be noted that in case of the developed in time occlusion in the operation area, the extremity was saved in the Ticlid group in 62% of cases (7 amputations per 18 cases of reocclusion) while in the (A + D) group the extremity was saved in 29% (17 amputations per 24 cases of thrombosis). Thus, the investigation of long-term results of TDA in combination with postoperative antithrombotic therapy of patients with atherosclerotic occlusions of the iliofemoral-popliteal segment arteries has shown high effectiveness of Ticlid. As compared with traditional methods of treatment with aspirin and dipiridamol treatment with Ticlid allowed the cases of restenosis and reocclusions to become more than two times less often.