[FUNCTIONAL STATE OF PERIPHERAL VESSELS OF THE LOWER EXTREMITIES AND INTRAOSSEOUS PRESSURE IN PATIENTS, SUFFERING OBLITERATING ATHEROSCLEROSIS ON BACKGROUND OF DIABETES MELLITUS].

Results of examination of 46 patients, suffering obliterating atherosclerosis of the lower extremities arteries solely or in combination with diabetes mellitus (DM), were analyzed. The malleolar pressure index (MPI), regional systolic pressure (RSP), velocity of the volume blood flow (VVBF), rheographic index (RI), using test with nitroglycerine, postocclusion venous pressure (POVP) and intaosseous pressure (IOP) in tibiae were studied. The RI reduction, parallel to the arterial ischemia progression, was established. The test indices with nitroglycerine in patients with obliterating atherosclerosis have reduced step by step. With coexistent DM the efficacy of nitroglycerine was practically absent. POVP is upgraded in patients of all the groups and it have lowered step by step in a laying position of the patient, and while transition into standing position--it have upgraded progressively with a progress of arterial ischemia. IOP have upgraded significantly in isolated obliterating atherosclerosis in ischemia stage 3a and have lowered--in stage 3b. In coexistent DM IOP is upgraded in ischemia stage 3b also.

[SURGICAL ANATOMY OF THE TRIBUTARIES OF INFERIOR VENA CAVA].

The results of the anatomical study of the inferior vena cava (IVC) and its tributaries on 27 fresh cadavers were analysed. It was established that in past hepatic part of IVC fall from 7 to 23 veins. The diameter of the main hepatic veins on average 12.3 mm, and back ­ 4.8 mm. In 63% of cases between the main and back hepatic veins have a free box of length 10 ­ 18 mm. Lumbar vein 2 ­ 8 pairs of branches in 92.6% of cases merge and flow into the IVC by one trunk, often closer to her left hemi circle. The diameter of the joint lumbar vein average 5.2 mm. Upper joint lumbar vein falls into the IVC at a distance of 13 ­ 23 mm from the confluence of the right renal vein. Back hepatic and joint lumbar vein may be a source of intraoperative bleeding, that is difficult to control. Identified anatomical features tributaries of IVC below the diaphragm should be borne in mind when removing blood clots from the IVC.

[PROPHYLAXIS OF THROMBOEMBOLIC COMPLICATIONS IN TRANSFASCIAL THROMBOSIS OF THE LOWER EXTREMITIES].

Results of examination and treatment of 339 patients, suffering an acute varicothrombophlebitis, complicated by transfascial thrombosis, were analyzed. Indications for surgical prophylaxis of pulmonary thromboembolism in transfascial thrombosis in a system of vena cava inferior were studied. After the operation in all the patients, while presence of transfascial thrombosis, not taking into account the operation radicalism, the treatment was prescribed, similar to that for the deep veins thrombosis. In the deep veins thrombosis, combined with superficial varicothrombophlebitis , an access for excision of a small subcutaneous vein of lower extremity must be differentiated, depending on spreading of thrombotic occlusion and localization of the calf veins inflowing place. Introduction of active surgical tactic in presence of floating thrombus in the ankle­popliteal venous segment secures conduction of effective prophylaxis of pulmonary thromboembolism

[THE CHOICE OF SURGICAL TREATMENT METHOD FOR THE DEEP VEINS THROMBOSIS IN SYSTEM OF VENA CAVA INFERIOR].

There were analyzed the results of examination and treatment of 455 patients, suffering deep veins thrombosis in a system of vena cava inferior, of whom 175 (38.5%) were operated on. Inclusion of ultrasound duplex scanning, roentgencontrast phlebography, multispiral computer tomography with intravenous contrasting, radionuclide phleboscintigraphy into complex of clinic-instrumental examination of the patients gives possibility to estimate the disorders of the main trunk and collateral venous blood flow in the deep veins thrombosis, as well as to substantiate indications and choice of the operative treatment method.

[Immediate complications of endovascular interventions in chronic ischemia of the lower extremity tissues].

The results of examination and treatment of 66 patients, suffering occlusion-stenotic affection of the lower extremities arteries, to whom transcutaneous transluminal balloon angioplasty was performed, are adduced. Immediate postoperative complications after endovascular interventions have occurred in 4 (6.1%) patients. The immediate complications, causes of their occurrence, methods of treatment, ways of prophylaxis were analyzed. In 50% of patients, suffering complications of endovascular interventions in immediate postoperative period, it is possible to eliminate them, using simple prophylactic measures.

[Treatment policy in critical lower limb ischaemia in patients with pronounced concomitant pathology].

The authors analyse the results of examination and treatment of 25 patients presenting with occlusive and stenotic lesions of lower-limb arteries accompanied by pronounced concomitant pathology and undergoing minimally invasive endovascular interventions. Comprehensive clinical and instrumental methods of examination (ultrasound duplex scanning, roentgen contrast angiography, multispiral computed tomography with intravenous contrasting) made it possible to work out an algorithm of surgical policy. Patency after endovascular transcutaneous balloon angioplasty and/or stenting by the end of the third year of follow up amounted to 64%, with a limb salvage rate of 68% (17 patients).

[Surgical treatment and prophylaxis of pulmonary thromboembolism for renal cancer with presence of the implantation clots of the inferior vena cava].

Surgical treatment of 91 patients, suffering the renal cell cancer (RCC), complicated by tumoral thrombosis of inferior vena cava, was analyzed. In accordance to the Mayo clinic classification, there in the patients the tumoral thrombus spreading was revealed, depending on tumoral affection of a kidney (right-sided/left-sided): level 0--in 39 (31/8); level I--in 20 (6/14); level II--in 17(12/5); level III--in 11 (11/0); level IV--in 4 (3/1). Incomplete apparatus cavaplication was performed in 32 patients. There was proved, that incomplete apparatus cavaplication constitutes an effective method of surgical prophylaxis of pulmonary thromboembolism in patients, suffering RCC.

[Treatment of venous trophic ulcers, using echoscleroobliteration of perforant veins].

In 36 patients, suffering trophic ulcers on a chronic venous insufficiency background in a decompensated stage (C6 in accordance to CEAP), echoscleroobliteration of perforant veins, using a "foam-form" method in accordance to Tessari, was performed. In 29 patients postrombophlebitic syndrome in incomplete recanalization stage was diagnosed, in 7 recurrence of varicose disease of the lower extremities. In all the patients during echoscleroobliteration there was possible to obliterate the insufficient perforant veins, in 3 patients two perforant veins were obliterated in each of them. In a one week a pathological blood flow along perforant veins, in accordance to data of ultrasound duplex scanning, was absent. This effect lasted during 6 mo in 29 (80.6%) patients. In 25 (69.4%) patients a trophic ulcers healing was achieved in 1 - 3 mo. In a one year in 30 (83.3%) patients a stable obliteration was noted, in 3 (8.3%) - partial recanalization, in 3 (8.3%) - complete recanalization of perforant veins.

[Endovascular interventions for critical ischemia of the lower extremities].

There were analyzed the results of examination and treatment of 12 patients, suffering critical ischemia of the lower extremities tissues in the occlusion-stenotic affection of the femoro-popliteo-tibial segment vessels, to whom miniinvasive endovascular interventions were done. Complex clinico-instrumental examination of the patients (ultrasound duplex scanning, roentgenocontrast angiography, multispiral CT with intravenous contrasting) have permitted to substantiate the indications for conduction of endovascular interventions for critical ischemia of the lower extremities. The zone of reconstruction passability was confirmed after performance of endovascular transcutaneous balloon angioplasty in the follow-up terms up to 1 year in 9 (75%) patients, the lower extremities were saved in 10 (83.3%).

[Radical nephrectomy and thrombectomy in patients with renal cell cancer complicated by tumoral thrombosis of the renal vein and vena cava inferior].

Surgical treatment was conducted in 81 patients, suffering renocellular cancer (RCC), complicated by a renal vein and vena cava inferior thrombosis. According to the Mayo clinic classification, the level of a tumoral thrombus spread was established: the 0 level--in 37 patients, the level I--in 19, the level II--in 17, the level III --in 6, and the level IV--in 2. There were substantiated the optimal surgical accesses and technique of radical nephrectomy and thrombectomy for RCC, complicated by a renal vein and vena cava inferior thrombosis. It is recommended to apply transabdominal accesses: the extended median laparotomic, bilateral subcostal of a "Chevron" or "Mercedes" type. There was shown, that the access choice depends on the level of the tumoral thrombus localization.

[The reasons and frequency of early reocclusion origin in vessels of femoro-popliteal-tibial segment].

Main reasons and frequency of early postoperative thrombotic complications were analyzed. The frequency of early postoperative thrombosis in vessels of femoro-popliteal-tibial segment composed 19.1%. The most frequency of early reocclusion observed after the femoro-tibial reconstructive operations (in 32.4% patients), the least--after femoro-popliteal grafting at above knee level (in 14.1%). The main reason for early reocclusion is an inadequate estimation of distal arteries damage.

[Classification of arterial reocclusion of the femoro-popliteo-tibial segment for the choice of the reconstruction method].

The literature data, concerning the issues of terminology and classification of occlusion and reocclusion of the femoro-popliteo-tibial segment arteries were analyzed. Basing on analysis of the results of clinico-instrumental investigations performed, classification of the femoro-popliteo-tibial segment arteries reocclusion was proposed, which it is expedient to apply while making choice of the rereconstruction method.

[Changes in the central hemodynamics in the surgical treatment of abdominal aorta aneurysm]. / Zminy tsentral'noï hemodynamiky pry khirurhichnomu likuvanni anevryzmy cherevnoï chastyny aorty.

The algorythm of examination and treatment of patients with an abdominal aorta aneurysm was proposed.

[The ultrasonographic confirmation of the role of external carotid artery in blood supply of ischemic lesion in the big cerebral hemisphere]. / Dopplerohrafichne pidtverdzhennia znachenia zovnishn'o]i sonnoï arteriï v krovopostachanni ishemizovannoï pivkuli velykoho mozku.

Using intraoperative monitoring of the blood flow linear speed in a. cerebralis media while total a. carotis interna occlusion in 10 patients the authors have concluded, that the degree of blood flow compensation in a. cerebralis media depends not only on collateral compensation possibilities by the contralateral side and rate of it inclusion, but largely-on a. carotis externa possibility on the lesion side.