[Clinical study of efficacy and safety of Aducil in patients with chronic lower limb ischaemia]. / Klinicheskoe issledovanie éffektivnosti i bezopasnosti Adutsila pri khronicheskoi ishemii nizhnikh konechnostei.

AIM: The study was aimed at assessing efficacy and safety of treatment with Aducil® (cilostazol) compared with Trental® 400 in patients with moderate-to-severe intermittent claudication due to peripheral atherosclerosis. PATIENTS AND METHODS: The study included a total of one hundred and forty-five 36-to-75-year-old patients. The participants were distributed into 2 groups according to the inclusion/exclusion criteria in a 2 to 1 proportion: patients in group 1 received Aducil® 100 mg BID, in group 2 - Trental® 400 TID for 12 weeks. 142 subjects completed the protocol. RESULTS: Analysis of the effectiveness of treatment according to the primary criterion showed a better effectiveness of Aducil® as compared with Trental® 400. Subjects who received Aducil® had a higher increase in the absolute maximum walking distance after 12 weeks of treatment as compared with those taking Trental® 400: 126±110 m versus 45±39 m, respectively (р<0.001). Subjects who received Aducil® had a statistically significant improvement in quality of life parameters such as physical and mental health components according to the SF-36 questionnaire after 12 weeks of treatment (р≤0.01). Subjects in Aducil® group had better quality of life with an increase from 34 to 40 points according to the physical component score, while patients in Trental® 400 group demonstrated minor positive changes (from 35 to 37 points); mean mental component score increased from 45 to 48 points in Aducil® group as compared with an increase from 45 to 47 points in Trental® 400 group. While self-reported physical health status was similar between the groups at baseline, subjects in Aducil® group reported better physical functioning after treatment (р=0.016). Two adverse events were registered in two subjects in Aducil® group. CONCLUSION: Analysis of the study endpoints demonstrated that Aducil® had better treatment effectiveness in patients with chronic lower limb ischemia stage IIB according to the classification of A.V. Pokrovsky-Fontaine as compared with Trental® 400, while the safety profile and drug tolerance were similar between the two.

[Extracranial aneurysms of carotid arteries in the practice of a vascular surgeon]. / Ékstrakranial'nye anevrizmy sonnykh arterii v praktike sosudistogo khirurga.

The present study was aimed at retrospectively analysing the results of examination and open surgical treatment of patients diagnosed with extracranial aneurysms of carotid arteries. PATIENTS AND METHODS: We analysed the results of examination and outcomes of surgical treatment in a total of 11 patients (6 men and 5 women) presenting with an aneurysm of the extracranial portion of the carotid artery and undergoing treatment at the Department of Vascular and CAD Surgery of the Moscow Regional Research Clinical Institute from 2005 to 2016. The mean age of the patients amounted to 56.5±13.9 years (ranging from 33 to 73 years). The diagnosis of an aneurysm was made based upon the findings of duplex scanning with colour mapping (DS+CM), four patients were additionally subjected to computed tomography (CT) and one to magnetic resonance tomography (MRT). 8 aneurysms turned out to be true aneurysms and 3 appeared to be pseudoaneurysms. 8 aneurysms were localized in the internal carotid artery (ICA) and 3 - in the common carotid artery (CCA). RESULTS: Eight cases were treated by resection of the aneurysm followed by prosthetic repair (5 with an autovenous graft and 3 with a synthetic graft), a further two cases were managed by resection of the aneurysm and an 'end-to-end' anastomosis made, and in one case a false aneurysm was removed, with the arterial defect sutured. The check-up examinations were carried out at 2 and 6 months of the postoperative period. Neither lethal outcomes nor acute cerebral circulation impairments (ACCIs) were registered within the time frame the follow up period. Two patients were found to suffer from cranial nerve injury having disappeared during follow-up. CONCLUSION: An open reconstructive operation is a safe and effective method of preventing complications of aneurysms of the extracranial portion of the carotid artery.

PREVENTION OF HEART FAILURE PATIENTS WITH DECREASED EJECTION FRACTION IN NON-CARDIAC SURGERY: LEVOSIMENDAN OR ANESTHETIC CARDIOPROTECTION?.

BACKGROUND: Chronic heart failure (CHF) significantly worsens the prognosis of surgical treatment in noncardiac surgery, doubling mortality in compared with patients with coronary artery disease. Modern anesthesiology has at least two methods that potentially can improve the results in noncardiac surgery: anesthetic cardioprotection and the prevention of CHF decompensation with levosimendan. THE AIM: to study the efficacy of anesthetic cardioprotection andpreoperative preparation with levosimendan for the prevention of CHF decompensation in patients with reduced left ventricular ejectionfraction in noncardiac surgery. ENDPOINTS: the primary endpoint of the trial is the need and the maximum dose of inotropic drugs in the perioperative period; secondary point: the length of stay in the ICU, composite outcome, the dynamics of SI, FI, the content ofNT-proBNP and TnT Materials and methods: A randomized study was performed in three groups of patients during reconstructive operations on infrarenal part of aorta: control (traditional methodfor prevention of decompensation of CHF were used) - 31 patients; the group with the anesthetic cardioprotectivei - 31 patients; the group with a preoperative preparing with levosimendan - 30 patients. RESULTS: The incidence of heart failure (estimated by need to use inotropic drugs - IS) was 83% of control group patients and 75% of the patients of the group "VIMA" (p = 0,65). The number ofpatients needing the use of dobutamine in LS-group was significantly below, 50% (p = 0,02 relative to control group and p = 0,08 compared to the group VIMA). IS in the control group was 8 [6, 9] µg xkg⁻¹ - xmin⁻¹ ; group VIMA 8 [3; 9] mg xkg ⁻¹ xmin⁻¹ , whereas in the LS group only 2 [0; 7] mg ⁻¹ xkg⁻¹ xmin⁻¹ . Differences between groups credible, given the Bonferroni correction (p = 0,0015). In our study, was not identified significant differences in 30-day mortality: in the control group it was 3,4%; in the group VIMA of 3,1%; in the group of LS - 0% (p > 0,017); however, a composite outcome (number of adverse events (heart attack+stroke+mortality) were slightly better in the LS group - 17%, against 34% in the control group (p = 0,043). CONCLUSION: Preoperative preparation with levosimendan in patients with reduced fraction left ventricle ejection when performing reconstructive operations on the descending aorta reduces the incidence of episodes of decompensation of heart failure compared with the control group to 39,8% (p < 0,05). The use of this technique improves the composite outcome of operations on the infrarenal aorta. The study has not shown the influence of anesthetic cardioprotection in terms of hospitalization and composite outcome of surgical treatment.