[Transradial approach in neuroendovascular procedures]. / Analiz primeneniya transradial'nogo vnutrisosudistogo dostupa v neirokhirurgicheskoi praktike.

OBJECTIVE: To evaluate safety and feasibility of transradial approach for neuroendovascular procedures and to familiarize neurosurgeons and neuroradiologists with the capabilities and limitations of this approach, as well as technical features influencing its effectiveness. MATERIAL AND METHODS: A retrospective analysis was performed in 270 patients who underwent transradial neuroendovascular procedures between January 2015 and December 2019. Diagnostic and surgical interventions were performed in 203 (75.2%) and 67 (24.8%) patients, respectively. The authors comprehensively describe catheterization technique and choosing the instrument for effective and safe transradial access. RESULTS: The right vertebral and both common carotid arteries were the most accessible for selective catheterization (100% of cases). The left common carotid artery was catheterized in all cases, the left internal carotid artery - only in 92% of cases. If catheterization of the left vertebral artery was necessary, we used the left-sided radial approach. Conversion to femoral approach was required in 2.6% of cases for the left internal carotid artery disease (n=7). Radial artery occlusion occurred in 3.7% of cases (n=10) and was asymptomatic in all cases. We present a video clip (https://youtu.be/3wZ6O8u-lpk) devoted to various surgical interventions through radial approach. CONCLUSION: Radial approach is safe and feasible and may be used for neuroendovascular procedures.

[Primary retrograde distal access for endovascular interventions in patients with lower limb ischemia]. / Pervichnyi retrogradnyi distal'nyi dostup pri endovaskulyarnykh vmeshatel'stvakh u patsientov s ishemiei nizhnikh konechnostei.

OBJECTIVE: To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia. MATERIAL AND METHODS: A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access. RESULTS: Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases. CONCLUSION: Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.

['Life-saving' interventions in subacute thrombosis of crural and plantar arteries]. / 'Zhiznespasaiushchie' interventsii pri podostrom tromboze arterii goleni i stopy.

The authors report a clinical case concerning successful endovascular treatment for subacute thrombosis of crural and plantar arteries in a patient with the only leg, substantiating therapeutic decision making with due regard for the duration of thrombosis and localization of the lesion of the arterial bed. Taking into consideration the statistical data on survival in case of performing major amputation in this cohort of patients, an 'aggressive' endovascular approach including three vascularizations made it possible not only to preserve the leg but also to save the patient's life.

[Assessment of functional state of microcirculatory bed of the foot in patients with lower limb critical ischaemia]. / Otsenka funktsional'nogo sostoianiia mikrotsirkuliatornogo rusla stopy u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.

[Remote results of endovascular revascularization in patients with lower limb critical ischaemia (LLCI) kept on chronic haemodialysis]. / Otdalennye rezul'taty éndovaskuliarnoi revaskuliarizatsii u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei, nakhodiashchikhsia na khronicheskom gemodialize.

The study was aimed at assessing remote results of endovascular treatment of patients presenting with lower limb critical ischaemia (LLCI) and kept on chronic haemodialysis. We retrospectively analysed the results of endovascular interventions in a total of 16 patients with ischaemic defects of the foot being on chronic haemodialysis, performed from 2001 to 2012 at the Department of Roentgenosurgical Methods of Diagnosis and Treatment of the St. Petersburg Scientific Research Institute for Emergency Ambulance Care named after I.I. Dzhanelidze. The patients' age varied from 39 to 75 years (mean 56.2±12.8 years). There were 11 (68.7%) men and 5 (31.3%) women. Ten patients (62.5%) suffered from diabetes mellitus. Of the ten diabetic patients, nine (56.2%) received insulin. A total of 21 endovascular interventions were performed on 16 extremities. The obtained findings were statistically processed by means of the Kaplan-Meier method. During follow up, LLCI relapses were observed in eleven (68.7%) patients, amputation of the femur was performed in eight (50%) patients, and five (31.2%) patients survived without major amputation. One year and two years after intervention, the probability of LLCI relapse absence amounted to 37.5 and 30%, respectively, that of major amputation - to 67.5 and 24.1%, survival without major amputation - to 50 and 17.9%, respectively. Patients with LLCI kept on chronic haemodialysis belong to a group of high risk of limb loss and a lethal outcome within 2 years after angioplasty.

[Angiographic characteristics of the lesion, influencing the choice to perform either direct or indirect endovascular revascularization for critical ischaemia of the lower limbs].

AIM: to determine which angiographic characteristics of a lesion of lower limb arteries are independent predictors of the possibility to re-establish the direct blood flow along the angiosomic (in relation to the trophic defect) artery. MATERIAL AND METHODS: we carried out a retrospective analysis of angiograms of 192 patients with degree IV peripheral arterial disease according to A.V. Pokrovky's classification, with restored free blood flow to the foot at least along one femoral artery by means of balloon angioplasty. All patients were subdivided into two groups: the group of direct revascularization (84 patients) and the group of indirect revascularization (108 patients). The compared groups reliably did not differ by the clinical characteristics and the stage of the trophic lesion (male gender, prevalence of diabetes mellitus and mean age amounted to: 45%, 73% and 71 years versus 39%, 77% and 69 years, respectively). However, in the group of direct revascularization more frequently were encountered lesions of the toes (75% vs 55%, p = 0.005), while in the group of indirect revascularization prevailing were lesions of the heel region (7% vs 29%, p=0.0002). RESULTS: the statistical analysis showed that independent predictors for a possibility of performing direct revascularization were as follows: total occlusion of the angiosomic artery on the foot (risk ratio (95% CI) = 0.10 (0.03-0.31), p =0.0001), blind (without stump) occlusion in the site of the origin of the angiosomic artery on the crus or foot (risk ratio (95% CI)=0.41 (0.19-0.90, p=0.03), and total occlusion of the trifurcation of the popliteal artery (risk ratio (95% CI) = 028 (0.09-0.81), p=0.02). CONCLUSION: in the presence of the above enumerated angiographic characteristics of the lesions of lower limb arteries it is appropriate to initially consider a possibility of performing indirect revascularization.

[Angiographic assessment of the incidence rate of atypical variants of the development of crural and plantar arteries].

OBJECTIVE: assessing the incidence rate of atypical anatomical variants of the development of the popliteal artery and plantar arteries according to the findings of digital subtraction angiography. MATERIAL: Retrospective analysis of angiograms of 2,456 lower limbs in 1,305 patients. The character of the arterial lesion and the quality of the angiograms allowed of evaluating the anatomy of the popliteal artery and plantar arteries on a total of 1,609 extremities (65%). RESULTS: The incidence of atypical ramification of the popliteal artery amounted to 9%. Altered blood supply of the foot was observed in 7.6% of cases. The total incidence rate of atypical anatomical variants in men and women did not differ significantly. In the presence of a typical anatomical variant on one extremity, the prevalence of atypical blood supply of the other limb amounted to 16.3%. In the presence of an atypical anatomical variant on one limb, the incidence of atypical blood supply of the other amounted to 42%. In case of atypical blood supply of the foot on one limb, the incidence rate of the same-type abnormality on the other equalled 48%. CONCLUSION: In a typical variant of blood supply of one extremity, the probability of typical blood supply of the other amounted to 83 .7%, in an atypical variant decreasing to 58%. In case of atypical blood supply of one foot, one should suppose an analogous anatomical variant on the other foot in half of the cases.

Comparative analysis of remote results of transluminal balloon angioplasty in treatment of lower limb critical ischaemia in groups of patients with and without diabetes mellitus.

All the hitherto conducted studies aimed at determining the efficacy of transluminal balloon angioplasty (TLBAP) in patients presenting with lower limb critical ischaemia (LLCI) have either dealt with the whole population of the patients involved, including a large proportion therein of patients with simultaneously present diabetes mellitus (DM), or solely investigated a group of patients suffering exclusively from diabetic foot syndrome. There has virtually been no information about non-diabetic patients, thus casting reasonable doubts upon feasibility of subjecting them to TLBAP, especially in the situation wherein there does exist a surgical alternative. In order to elucidate the problem concerned, we performed a comparative analysis of the incidence rate of freedom from LLCI relapses following TLBAP in diabetic versus non-diabetic patients. Based on the findings obtained from this analysis, a conclusion was made that the remote results of TLBAP were statistically not considered to be different in the groups of diabetic patients and non-diabetic subjects within the time frame of a 12-month follow up period. For the joint group, the cumulative probability of freedom from LLCI relapses during one year amounted to 65%, which is comparable with the outcomes of distal bypass grafting operations.

[Peripheral angioplasty in patients with lower limb critical ischaemia after operations of femoropopliteal bypass grafting].

The study was aimed at retrospectively assessing the outcomes of peripheral angioplasty (PAP) in patients presenting with lower limb critical ischaemia (LLCI) after previously endured operations off emoropopliteal bypass grafting (FPBG). The PAP procedure was carried out in a total of nine patients diagnosed with LLCI meeting the criteria of the Trans-Atlantic Inter-Society Consensus (TASC), in whom repeat bypass grafting was recognized impossible owing to the absence of either shunting-fit veins or arterial segments suitable for anastomosing. Of these, eight patients had a femoropoplietal bypass graft implanted previously, and the remaining patient had a femoral-anterior-tibial one. In four cases, the patency of the shunts was preserved but all the three tibial arteries were occluded. Five patients displayed total occlusion of the shunts. In 80% of cases, the PAP procedure was performed in C and D types of morphology of the arterial lesion according to the TASC criteria. The PAP procedure was technically successful in eight (89%) patients, making it possibly to re-establish blood supply to the foot along at least one tibial artery. No clinically significant complications following PAP in the treated patients were observed. The average duration of follow up amounted to 9 months. Technically successful PAP was accompanied by clinical success in all the cases. During the follow-up period, one patient died from myocardial infarction with no signs of LLCI. A relapse of LLCI was observed in one (12.5%) patient. The obtained findings suggest that in the treated patients with LLCI after FPBG and impossibility of performing repeat bypass grafting, PAP proved to be a safe and efficient method of revascularization.

[CASMSP (Complex Automated system of Mass Screening of the Population) as an information basis for the evaluation of health of the population]. / KASMON kak informatsionnaia baza dlia otsenki zdorov'ia naseleniia.

On the basis of the periodic medical check-up of 1385 adults carried out by means of the Computerized Automated System of Medical Aid to the Population there were calculated the integral indices, i.e., an index of deviation (ID) and a dip angle of ID, describing the health status of the population. Calculation alternatives are given along with the ID use for information supply on health status of the population according to the established aims. Simplicity of the calculation procedure and a sufficient degree of information content promote the application of the proposed indices to health care.