RESUMO
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.
Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The authors analyzed results of treatment of 127 patients. A new direction in the endovascular treatment of critical ischemia of the lower extremities is substantiated on the basis of a combination of methods of subintimal and intraluminal angioplasty. For the first time all the patients with critical ischemia of lower extremities, and having no irreversible changes of the extremity requiring amputation at the level of the low leg or femur, must be considered as good candidates for translumbar balloon angioplasty.
Assuntos
Angioplastia com Balão , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
The authors made an analysis of surgical methods of treatment of 63 patients and long-term results in the period from 1 to 6 years in 23 of them. The restoration of all the injured anatomical structures of the forearm and, in particular, the restoration (suture, autovenous plasty) of the major arteries and primary suture of the injured nerves are thought to be necessary for good results.
Assuntos
Traumatismos do Antebraço/cirurgia , Antebraço/irrigação sanguínea , Traumatismo Múltiplo/cirurgia , Lesões dos Tecidos Moles/cirurgia , Ferimentos Penetrantes/cirurgia , Adulto , Artérias/lesões , Artérias/cirurgia , Feminino , Seguimentos , Antebraço/inervação , Antebraço/cirurgia , Humanos , Masculino , Técnicas de Sutura , Fatores de Tempo , Resultado do TratamentoRESUMO
Under analysis are the factors of operative risk and results of operative interventions on distal segments of the arteries in elderly and senile patients with critical ischemia of lower extremities against the background of generalized atherosclerosis. Seventy-eight bypasses were fulfilled: ileo-femoral, femoro-popliteal, femoro-tibial, femoro-fibular. Pain at rest and gangrene of the foot and toes tissue were considered to he indications to bypasses. Among the risk factors smoking and arterial hypertension are particularly stressed. Postoperative lethality in patients of 80 years of age and older was 12.5%, among the patients from 70 to 80 years of age--7.7%. The active strategy is believed by the authors to be justified for revascularization of the extremity distal segments in critical ischemia and threatening amputation in the patients of 80 years of age and older.
Assuntos
Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Artéria Poplítea/cirurgia , Artérias da Tíbia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Estado Terminal , Feminino , Seguimentos , Humanos , MasculinoRESUMO
The outer surface of isolated metaphase chromosomes has been investigated by a method of thermally activated tritium labelling. We show that both chromosomal proteins and DNA are tritium-labelled. Fractionation of the chromosomal proteins reveals that scaffold proteins are the most labelled in condensed and EDTA-decondensed chromosomes. Exposition of some scaffold proteins on the outer surface of metaphase chromosomes is suggested.
Assuntos
Proteínas Cromossômicas não Histona/metabolismo , Cromossomos , Metáfase , Animais , Fibroblastos/metabolismo , Camundongos , Microscopia Eletrônica , TrítioAssuntos
Trifosfato de Adenosina/metabolismo , Caseínas/metabolismo , Imunoglobulina A Secretora/metabolismo , Leite Humano/fisiologia , Proteínas Quinases , Caseínas/isolamento & purificação , Cromatografia de Afinidade , Eletroforese em Gel de Poliacrilamida , Feminino , Humanos , Imunoglobulina A Secretora/isolamento & purificação , Leite Humano/imunologia , Peso Molecular , Fosforilação , GravidezAssuntos
Proteínas Cromossômicas não Histona/análise , Cromossomos/química , Membranas Intracelulares/química , Proteínas de Membrana/análise , Metáfase/fisiologia , Animais , Cromossomos/ultraestrutura , DNA/análise , Eletroforese em Gel de Poliacrilamida , Liofilização , Membranas Intracelulares/ultraestrutura , Camundongos , Microscopia Eletrônica , TrítioRESUMO
Experimental evidence on the interaction of liposomes of varying composition with canine serum components has shown that neutral liposomes and those positively and negatively charged bind actively to different serum proteins, among which albumin and heavy and light Ig G chains have been detected. A simple and informative approach to studying the liposome-protein interactions is suggested.