[Hybrid treatment of Kommerell diverticulum and giant aneurysm of intra-thoracic segment of aberrant left subclavian artery]. / Klinicheskii sluchai gibridnogo lecheniya divertikula Kommerelya i gigantskoi anevrizmy vnutrigrudnogo segmenta aberrantnoi levoi podklyuchichnoi arterii.

Kommerell's diverticulum causes compression of the esophagus, trachea and laryngeal nerve between the aberrant mouth of the left subclavian artery and ascending aorta. This leads to dysphagia or shortness of breath. We describe hybrid treatment of the right aortic arch with Kommerell's diverticulum and giant aneurysm of the aberrant left subclavian artery.

Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts.

The aim of the investigation was to study the factors influencing the radial stiffness of the thoracic aorta stent-grafts with the stent elements made of nitinol tubes by laser cutting and thermal shape setting. Materials and Methods: The work used stent elements made by different technologies by two different manufacturers from a nitinol tube with a wall thickness of 0.5 mm (E1) and 0.4 mm (E2), with a final diameter of 20 mm. Height of cells E1 - 15 mm, E2 - 12.5 mm. The stents were manually attached to a tubular woven non-crimped base (PTGO Sever, Russia) with a 6/0 suture, resulting in either single or continuous stitches. In the RLU124 radial force tester (Blockwise Engineering LLC, USA), each of the four stent-grafts, as well as their individual stent elements, were compressed by 10 mm from the initial diameter. The dependence of the radial forces on deformation under loading and unloading was graphically presented. The temperature and enthalpy of phase transitions of nitinols into the austenite (Af) and martensitic (Mf) phases were studied using differential scanning calorimetry (DSC-3; Mettler Toledo, USA). All indicators were compared with the characteristics of two commercial models - Cronus (China) and E-vita Open Plus (Germany). Results: Four prototypes of SibHybrid stent-grafts were tested; those differed in their stent elements, distances between them, and the type of sutures (single or continuous). The stent elements of the models studied differed in the values of Af, Mf, and the enthalpy of phase transitions of nitinols. The hardest stent was the E2 prototype. The fixation of stent elements to the woven fabric in the graft increased the radial force by 4.0-5.5 times. During compression by 50 and 20% of the original diameter, the SibHybrid models developed radial force 4.5-6.0 times greater compared with the E-vita Оpen Plus model. The radial force values of SibHybrid models were almost the same as for the Cronus and models at 20% compression. Using continuous twining round suturing increased the radial force by about 10 N; accordingly, SibHybrid E2 had the highest radial force because it was fixed by a continuous suture. The density of the stent elements fixed on the fabric did not affect the radial force of the stent-graft as a whole. Conclusion: In the manufacture of stent elements from nitinol tubes, the main factor determining the radial stiffness is the technology of nitinol shape setting. With the standard technology of thermal shape setting, radial force can be changed by varying the height of the structure cell element and the cross-sectional area of the cell bars, as well as the suturing technique.

[Djumbodis stent migration in a patient with aortic dissection]. / Migratsiia stenta Djumbodis u bol'nogo s rassloeniem aorty.

Treatment of patients presenting with type I aortic dissection is known to be a surgical challenge. The Djumbodis bare metal stent was developed to ease the burden of a reconstructive intervention on the aortic arch, to decrease the duration of the operation, and to minimize complications associated with artificial circulation. Currently, insufficiently explored remains the problem of complications occurring due to the technological fatigue of the metal and possible stent migration. Described herein is a clinical case report regarding migration of a Djumbodis stent, diagnosed 6 months after implantation for DeBakey type I acute aortic dissection. We revealed dislocation of the stent's distal portion with fenestration of the membrane of the true channel and perfusion of the false channel, as well as fractured fragments of the stent. The patient underwent repeat 'open' intervention.

[Hybrid procedures for aortic arch disease]. / Obzor gibridnykh vmeshatel'stv pri zabolevaniiakh dugi aorty.

Different surgical approaches for aortic arch disease were reviewed in the article. We have also compared various vascular prostheses for aortic replacement.

[Use of uncoated metal stents in surgery of aortic dissection]. / Primenenie nepokrytykh metallicheskikh stentov v khirurgii rassloeniia aorty.

Presented herein is a review of the literature concerning the use of uncoated metal stents in surgery of aortic dissection. A conclusion was drawn that the results of using the Djumbodis stent should not be directly extrapolated to the outcomes obtained in case of the E-XL stent which had mainly been used for hermetic sealing and for creation of optimal conditions for TEVAR. It is pointed out that the use of uncoated metal stents in aortic surgery is acceptable, however, it is required to solve a series of problems associated with elimination of certain shortcomings of the available devices. Also, it is necessary to work out clear-cut indications for using these stents.

[A case of treating a patient with a false aneurysm of the xenoconduit of the ascending aorta and pronounced cardiac insufficiency].

Described in the article is a clinical case of treating a previously operated patient presenting with a pseudoaneurysm of the xenoconduit of the ascending aortic portion, functioning Cabrol fistula and pronounced cardiac insufficiency, who was admitted to our institution in the state of decompensation. The obtained outcomes of treating this patient demonstrated a possibility of successfully using vascular grafts for establishing an anastomosis between the left coronary artery and ascending portion of the aorta in complicated conditions of a repeat intervention.