[Comparative analysis of carotid-subclavian transposition and stenting in case of stenotic damage of subclavian artery].

So carotid-subclavian transposition and stenting are effective and safe methods of correction of occlusive subclavian artery disease. Angioplasty and stenting of the subclavian artery is particularly indicated in patients with high surgical risk. Patients at low risk of surgery is preferred execution carotid-subclavian transposition.

[Topographic-anatomic grounding cervical-distalvertebral reconstruction of V3 segment vertebral artery vertebral artery].

Using 10 block-mounts "brain-base of skull- cervical spine" there were detected morphometric peculiarities of vertebral artery on the level C(I)-C(II) of spines of vertebra and of premastoidal part of cervical artery. Were effectuated 20 distalvertebral reconstructions. Were precised stages and technique of realization.

[Surgical correction of cerebral blood flow steal syndrome by aortic branches stenosis].

Results of surgical treatment of 119 patients with cerebral/coronary blood flow steal syndrome were analyzed. Vertebro-subclavian steal syndrome was registered in 91.5%. 80 patients were treated with the use of endovascular methods, open procedure was performed in 62 cases. Physiological blood flow was successfully reconstructed in 95.8%. Postoperative lethality was 5,1% after open operations, there were no deaths among patients, treated endoscopically. Bypass thrombosis was registered in 3.4% of patients treated by traditional method; restenosis or occlusion occurred after 34.3% of endovascular operations. Endovascular operations should be a method of choice in treatment of patients with severe occlusion of branches of aorta and cerebro-vascular insufficiency. By impossibility of subclavian artery or brachiocephal trunk recanalization with the use of endovascular techniques, open procedure should be performed.

[Aneurysmal degeneration of the autovenous carotid-subclavian bypass: experience with the treatment, review of literature].

The authors describe an experience gained with successful surgical treatment of a 73-year-old patient with a genuine aneurysm of the autoveinous carotid-subclavian bypass, iwelve years ago the patient was operated on for stenosing atherosclerosis of the coronary and left subclavian arteries (SCA). Aneurysm emergence was consequent on the use of v.saphena magna as a bypass in the given <> and was not associated with appreciable circulatory disorders in the left upper limb. However, its further existence was conjugated with the risk of rupture and bleeding. Examination (duplex scanning, angiography) confirmed the diagnosis of aneurysm. Besides, critical stenosis of segment I of the left SCA and opening of the left internal carotid artery (ICA) were verified as well. The patient was operated on: the first stage involved angioplasty and stenting of segment I of the left SCA; the second stage involved carotid endarterectomy on the left, resection of bypass aneurysm together with its disengagement. On control angiography performed 11 months later the patency of the reconstructed arteries appeared satisfactory; stenosis was not recorded. The given case demonstrates a modern approach to the treatment of patients with coexistent vascular pathology (atherosclerotic stenosis plus aneurysm).

[Diagnosis and surgical treatment of aneurysms of the popliteal artery].

Nineteen patients with aneurysms of the popliteal artery have been operated. Indications and type of surgery were determined on the basis of the clinical picture, angiography and duplex scanning data. There were 19 surgeries: ligation of afferent and efferent vessels of aneurysm with auto-venous grafting (8), resection of aneurysm with auto-venous grafting (5), dissection of aneurysm with auto-venous grafting and coverage with duplication from aneurysmatic walls (3), endovascular grafting of aneurysm (2), ligation of afferent vessel of aneurysm (1). In early postoperative period after open surgical revascularizations thrombosis was seen in 4 (25%) patients. One patient died on day 20 after surgery due to decompensation of severe concomitant disease. The patient who has undergone ligation of afferent vessel without revascularization has discharged after compensation of acute ischemia.

[Roentgenendovascular stenting (stent-graft) of the external iliac artery for elimination of post-traumatic arteriovenous anastomosis].

Presented herein is a case report concerning successful treatment of the post-traumatic pathological anastomosis between the left external iliac artery and iliac vein using the stent-graft Jostent-graft. The anastomosis emerged after gunshot injury to the abdominal cavity.

[Extraanatomic reconstruction of the right renal artery].

This paper reviews two clinical cases of a rare type of extraanatomic revascularization of the right kidney by means of establishing a renogastroduodenal arterial anastomosis. The clinical cases presented herein demonstrate an adequacy of the given extraanatomic reconstruction of the renal artery. The indications for such operation are compelled and should be determined strictly individually in terms of each concrete case.

[A favorable outcome of surgical treatment of a patient with thrombosis of the renal veins and inferior vena cava].

Presented herein is a clinical case report of a patient with thrombosis of the inferior vena cava, renal veins, acute renal failure, and anuria. The patient was admitted to the hospital two days after thrombosis. Diuresis was reestablished after emergency operation (thrombectomy from the inferior vena cava and renal veins). In the postoperative period, the clinical manifestations of renal failure and inferior vena cava syndrome regressed slowly. After 6 months of the control follow up the manifestations of renal failure disappeared; insignificant edema of the lower limbs was well preserved.

[Surgical treatment of occlusive and stenosing lesions of brachiocephalic arteries]. / Khirurgicheskoe lechenie bol'nykh s okkliuziruiushchimi i stenoziruiushchimi porazheniiami brakhiotsefal'nykh arterii.

The results of surgical treatment of patients with occlusive and stenosing lesions of brachiocephalic arteries implemented at Burdenko's Research Institute of Neurosurgery of the Russian Academy of Medical Sciences (RAMS) during 1999-2002 are described. A total of 164 operations were made in 128 patients. Different diagnostic methods and indications for various types of reconstructive and revascularization surgeries are under discussion. A variety of the carotid endarterectomy techniques and the conditions needed for their implementation (microsurgical equipment and intraoperative multi-modality neuromonitoring) are defined. Finally, the main complications and the methods of their prevention, correction and treatment are also described.

[Early thrombotic complications after femoro-popliteal segment surgery]. / Rannie tromboticheskie oslozhneniia posle operativnykh vmeshatel'stv na bedrenno-podkolennom segmente.

The work analyses the causes of early postoperative thromboses which occurred after reconstructive operations on the femoro-popliteal segment in 293 patients. Early postoperative thromboses are a frequent complication in reconstructive operations on the vessels and develop in 27% of cases mostly in the first days after the operation. The most frequent causes of early thromboses were deficient distal arterial blood circulation, technical and tactical errors of the intervention, and insufficiently corrected postoperative therapy. It is pointed out that combination of reconstructive operations on the main vessels with lumbar gangliectomy has a favorable effect on the results of treatment and prevention of early thromboses. The use of microsurgical techniques reduces the probability of the development of early postoperative thromboses. In the absence of an effect of repeated operative interventions, in increase of ischemia and intoxication the limb must be amputated before gangrene develops.

[The combined treatment of patients with atherosclerosis of the distal arterial bed of the lower extremities]. / Kompleksnoe lechenie bol'nykh s aterosklerozom distal'nogo arterial'nogo rusla nizhnikh konechnostei.

The authors summarize the experience of treatment of 178 patients with distal type of obliterated atherosclerosis of arteries of lower limbs. The 2nd stage of this malady was diagnosed in 91 (51.1%) patients; the 3rd stage--in 50 (28.1%); the 4th stage--in 37 (20.8%). 79 (44.4%) patients have received only conservative method of treatment, in 66 (37.1%) patients this method was accompanied by lumbar sympathectomy. Reconstructive operations with connection of one of the shin arteries to bloodstream were conducted in 33 (18.5%) patients. With the aim of improvement of distal artery channel visualization it is necessary to apply the digital subtraction angiography with the help of non-ionic roentgen-contrast preparations after the advanced application of spasmolytics.

[Lumbar sympathectomy in patients with arteriosclerosis obliterans of the lower extremities and diabetes mellitus]. / Poiasnichnaia simpatéktomiia u bol'nykh s obliteriruiushchim aterosklerozom arterii nizhnikh konechnostei i sakharnym diabetom.

In 72 patients with obliterative atherosclerosis of the arteries of the lower extremities and diabetes mellitus, the lumbar sympathectomy was performed. A good result was noted in 35 of them, amputation of the extremity was performed in 8 patients. Lumbar sympathectomy is indicated to the patients in initial stages of the disease.