[Remote results of open interventions in treatment of abdominal aortic aneurysms].

Analysed herein are the results of treating a total of 471 patients operated on at the Department of Surgical Treatment for Arterial Pathology of the Research Centre of Cardiovascular Surgery named after A. N. Bakulev under the Russian Academy of Medical Sciences for an aneurysm of the infrarenal portion of the abdominal aorta. Complicated forms of AAA were observed in 71 (15.1%) patients. Of these, 13 patients were admitted presenting with a clinical picture of aortic rupture, 56 patients with aortic wall tear (according to ultrasound and/or MSCH findings), and two patients had break of the inferior vena cava. The most frequently encountered accompanying diseases were as follows: CAD noted in 367 (78.2%) patients. Valvular heart defects were revealed in 68 (14.4%) patients. Atherosclerotic alterations of the ascending aorta were diagnosed in 97 (20.6%) patients, and an ascending aortic aneurysm in 14 (2.8%) patients. Operations on the heart were performed in 45 (19.1%) patients. Mitral valve plasty was carried out in 7 patients, and 11 patients had a history of prior interventions on the aortic root and ascending aorta (Bentall-De Bono operation in 3 patients, Carbol operation in 3 patients). 32 patients underwent reconstructive operations on coronary arteries. Transmyocardial laser revascularization of the myocardium was carried out in 4 patients. Endovascular interventions were performed in 32 (6.8%) patients (stenting or transluminal balloon angioplasty of coronary arteries). All patients underwent AAA resection with prosthetic repair. The mentioned operations were combined with the following simultaneous interventions: aortocoronary bypass grafting performed in 31 cases, carotid endarterectomy in 27 cases, and plasty of renal arteries was carried out in 48 patients. Complications in the immediate postoperative period were observed in 79 (16.8%) patients. Hospital mortality amounted to 11 (2.3%) patients. The cumulative survival rate after 1, 5 and 10 years after surgery amounted to 93%, 81% and 44%, respectively, in a complicated course amounting to 91%, 79% and 16%, respectively. The obtained findings of the study demonstrated that the results of the AAA resection should be regarded as fairly good. The main factors influencing the quality of life and surgical outcomes in abdominal aortic aneurysms are as follows: CAD, arterial hypertension, and chronic cerebrovascular diseases. In patients without accompanying diseases, the criteria of quality of life after surgery approximate to those in a healthy population.

[Limb revascularization through the deep femoral artery in atherosclerotic femoropopliteal occlusions]. / Revaskuliarizatsiia konechnosti cherez glubokuiu arteriiu bedra pri ateroskleroticheskikh bedrenno-podkolennykh okkliuziiakh.

The article analyses the results of examination and surgical treatment of 101 patients who were subjected to 105 reconstructive interventions on the deep femoral artery (DFA). Angiography showed affection of the orifice and beginning (up to 2 cm) of the DFA in 57.14% of cases, for a distance of 2-6 cm in 24.76%, and for a distance of more than 6 cm in 18.1% of cases. Arterial outflow was found to be excellent in 52.38%, good in 21.9%, satisfactory in 19.05%, and poor in 6.67% of cases. According to the findings of ultrasonic dopplerometry the changes of regional hemodynamics were most marked in III degree ischemia of the limb. Endarterectomy with the formation of a new communication between the superficial and deep femoral arteries was conducted in 14 cases, autovenous profundoplasty in 21, autoarterial profundoplasty in 35, autoarterial prosthetics of the DFA in 14, and autovenous DFA prosthetics in 21 cases. In 87.13% of patients the operation on the DFA was combined with lumbar sympathectomy. Choice of the method for DFA reconstruction on the basis of morphofunctional appraisal of the occlusive-stenotic process, the condition of collateral circulation and the outflow paths made it possible to achieve favorable results both in the immediate and late-term postoperative periods in more than 73% of cases.

[Surgical treatment of ischemic colitis in patients with abdominal aortic aneurysm]. / Sposob khirurgicheskogo lecheniia ishemicheskogo kolita pri anevrizme briushnoi aorty.

The authors suggest an original method for revascularization of the inferior mesenteric artery for the prevention and treatment of ischemic colopathy in operative treatment of abdominal aortic aneurysm. The essence of the method consists in shunting the blood flow from the channel of the celiac trunk by anastomosing the right gastroepiploic artery with the inferior mesenteric artery by the end-to-end techniques. Topographoanatomical studies of the right gastroepiploic and inferior mesenteric arteries were conducted on 22 cadavers for experimental substantiation of the suggested method. Besides that, selected angiograms of the celiac trunk and its branches were studied in 50 patients. The suggested method for revascularization of the inferior mesenteric artery in resection of aneurysm of the abdominal aorta with intraluminal prosthetics was applied in eight patients with good results.

[Reconstructive surgery of abdominal aortic aneurysm]. / Rekonstruktivnaia khirurgiia anevrizmy briushnoi chasti aorty.

The authors have developed the methods for performance of a reconstructive operation for abdominal aortic aneurysms which permit to avoid prolonged clamping of the abdominal aorta. On the basis of the results obtained, a conclusion of the high effectiveness of these methods has been drawn.

[Immediate results of reconstructive operations in arteriosclerosis obliterans of the iliac and femoral arteries]. / Neposredstvennye rezul'taty rekonstruktivnykh operatsii pri obliteriruiushchem ateroskleroze podvzdoshnykh i bedrennykh arterii.

The work generalizes the immediate results of restoration of the main and collateral blood flow in 240 patients with arteriosclerosis obliterans of the iliac and femoral arteries. The outcomes of surgical treatment were judged according to the clinical and ultrasonic evaluation of regional hemodynamics. The results were found to be good in 84 (35.0%), satisfactory in 104 (47.5%), and poor in 42 (17.5%) patients. The results of operations on the iliac and femoral arteries are shown separately, as well as the results of surgery in their combined lesions. Thromboses of the reconstructed arteries and prostheses were encountered in 10 (4.17%), hemorrhages in 8 (3.33%), wound infection in 16 (6.67%), and venous thromboses in 4 (2.5%) patients. For the prevention of thromboses of the deep veins the author claims dosed physical exercises on a constructed training apparatus to be advisable. Amputation of the extremity was carried out in 10 (4.17%) patients because surgical correction of the blood flow proved ineffective and specific complications occurred.

[Surgical tactics in obliterating atherosclerosis of the iliac and femoral arteries]. / Khirurgicheskaia taktika pri obliteriruiushchem ateroskleroze podvzdoshnykh i bedrennykh arterii.

The article discusses the indications for and the choice of the method of reconstructive operations in patients with arteriosclerosis obliterans of the iliac and femoral arteries. It is based on the analysis of the results of examination and surgical treatment of 240 patients. Radiocontrast angiography and ultrasonic dopplerometry were applied for morphofunctional characteristics of regional circulation. The study showed that the surgical tactics in this category of patients should be determined by the severity of ischemia of the extremity, the character, localization, and length of the arteriosclerotic process, the state of the inflow and outflow passages, the condition of collateral circulation in the internal iliac and deep femoral arteries, and the presence and severity of concomitant diseases. The developed differentiated approach made it possible to achieve positive results of treatment in the immediate postoperative period in 82.50% and in the late-term follow-up periods in 77.38% of patients.

[Selection of the approach to the surgical treatment of diseases of the abdominal aorta]. / Vybor dostupa pri khirurgicheskom lechenii zabolevanii briushnoi aorty.

The article discusses results of using in clinic different operative accesses in surgical treatment of occlusive-stenotic injuries and aneurysms of the abdominal aorta in 224 patients. Full medial laparotomy was used in 22 patients, extraperitoneal access--in 27 patients, extraperitoneal C. Rob access--in 122 patients, extended +thoraco-phreno-lumbotonic access--in 5 patients, the developed extraperitoneal access--in 48 patients. The advantages of the proposed method as compared with the pararectal method and C. Rob's one were experimentally confirmed. Choice of the operative access depending on the kind and spread of the pathological alterations in the abdominal aorta and the presence of complications were shown to be expedient.

[Intestinal complications after reconstructive operations on the abdominal aorta and their prevention]. / Kishechnye oslozhneniia posle rekonstruktivnykh operatsii na briushnoi chasti aorty i ikh profilaktika.

The results of treatment of 1229 patients with diseases of the abdominal aorta (AA) have been analysed. Two original methods for prevention of colonic ischemia in performance of a reconstructive operation on AA are suggested.

[Regional hemodynamics and its surgical correction in combined arteriosclerotic lesions of the iliac and femoral arteries]. / Regionarnaia gemodinamika i ee khirurgicheskaia korrektsiia pri kombinirovannykh ateroskleroticheskikh porazheniiakh podvzdoshnykh i bedrennykh arterii.

The authors analyse the regional hemodynamics and the results of surgical treatment of 81 patients with coexistent atherosclerotic affections of the iliac and femoral arteries. Radiocontrast angiography and ultrasonic dopplerometry were conducted by elaborated methods for morphofunctional characteristics of arterial circulation. Inclusion of the internal iliac and deep femoral arteries in the main blood flow was the principal method of surgical correction. A differentiated choice of the reconstructive operation allowed a positive result of treatment to be produced in 80.25% of patients in the immediate and in 76.31% of patients in the late-term postoperative periods.

[Ultrasonic evaluation of regional hemodynamics in arteriosclerosis obliterans of the iliac and femoral arteries]. / Ul'trazvukovaia otsenka regionarnoi gemodinamiki pri obliteriru- iushchem ateroskleroze podvzdoshnykh i bedrennykh arterii.

Regional hemodynamics was studied in 120 patients with atherosclerosis obliterans of the iliac and femoral arteries by ultrasonic Dopplerometry. Regional malleolar systolic pressure, malleolar-upper arm index, and regional systolic perfusion pressure deficit (RSPPD) were determined by an elaborated method. The authors analyse the values of regional hemodynamics according to the severity of the trophic disorders and type of the occlusive lesion of the iliac and femoral arteries. It was established that, being an integral characteristic, RSPPD allows the degree of limb ischemia to be characterized quantitatively most informatively with consideration for the condition of the central hemodynamics.

[Surgical tactics in aneurysm of the abdominal aorta]. / Khirurgicheskaia taktika pri anevrizme briushnoi chasti aorty.

The results of treatment of 164 patients with aneurysms of the abdominal aorta are summarized. Of these patients, 95 were operated on. Realization of the developed tactics of treatment permitted to reduce the incidence of postoperative complications 3.8-fold, and lethality--5.3-fold.