[Immunocorrection in combined prevention of early postoperative complications in patients with systemic vasculitis].

The authors studied peculiarities of the immune status in angiosurgical patients with systemic vasculitis, as well as possibilities of immunodiagnosis and immunocorrection in prevention of early coagulopathic and reparative complications after angiosurgical interventions in this cohort of patients. A total of 172 angiosurgical patients presenting with systemic vasculitis were subdivided into two groups depending on the preoperative preparation methods used. In Group One (Study Group) comprising 81 patients preoperative preparation was carried out using immunosuppressive therapy with hormones and cytostatics according to the rheumatologist's indications. In Group Two (n=91) hormones and/or cytostatics were replaced by the proposed four-component immunocorrection including various combinations of correcting the lifestyle, use of antioxidative-activity immunomodulators, plasmapheresis and intravenous administration of immunoglobulins. It was determined that using this method of correction made it possible to achieve a good anti-inflammatory effect in angiosurgical patients with systemic vasculitis, thus avoiding negative aftermaths of immunosuppression. The developed method of immunocorrection makes it possible to decrease the rate of early postoperative coagulopathic and reparative complications in angiosurgical patients as compared to therapy with hormones and/or cytostatics.

Effect of immunocorrection on surgical outcomes in patients with autoimmune-aetiology vasculitis and vasculopathies.

The present study was undertaken to investigate and compare the outcomes of three options of preoperative preparation and postoperative management of patients presenting with autoimmune-aetiology vasculitis and vasculopathies, who had been subjected to angiosurgical interventions over a 7-year period. According to the aetiopathogenetic sign, the majority of the patients appeared to have thromboangiitis obliterans, non-specific aortoarteritis, primary and secondary vasculopathies. All the patients were age- and sex-matched and well comparable by the underlying disease, the level of lesions of the vascular bed, and the ischaemia burden. The study was performed retrospectively. A total of three options of preoperative preparation and management of the postoperative period were used: option one - treatment comprising plasmapheresis, immunoglobulins and biological immunomodulators; option two - using cytostatic agents and hormone therapy; and option three - consisting of conventional basic vascular therapy alone. The comparative analysis performed demonstrated a clear advantage of immunocorrection and efferent techniques of treating patients presenting with the pathology concerned. The use of the therapeutic-and-diagnostic algorithm we are suggesting herein would make it possible to avoid complications in the immediate postoperative period, to reduce the duration of the patients' hospital stay averagely by 10 days, and to prolong persistence of the obtained positive results by 11.5%.

Multiyear experience in endoscopic thoracic sympathectomy.

The results of endoscopic thoracic sympathectomy performed for 787 patients during a 30-year period are presented. Six hundred seventy three patients were operated on for upper limb arterial occlusion of distal and diffuse type, Raynaud's disease or syndrome, 7 patients - for causalgic pain in upper limbs and Sudeck's syndrome, 85 - for hyperhidrosis. Twelve patients underwent lower thoracic sympathectomy for painful chronic pancreatitis, 4 - total destruction of thoracic sympathetic trunk due to pernicious hypertension of unknown origin, and 6 - endoscopic thoracic sympathectomy for acute thrombosis of upper limb arteries with distal circulation impairment. Immediate positive effect of interventions was detected in all cases except for acute arterial thrombosis. One patient died postoperatively due to arrhythmia-related cardiac arrest. Postoperative complications - lung border damage and intercostal vascular hemorrhage - were detected in 0.2% of cases. Increased air effusion from pleural cavity and intercostal neuralgia were observed postoperatively in some cases but did not require any special management. Long-term outcomes were followed up for period of 5-10 years, 72.7% of monitored patients had stable positive outcomes. Our experience has demonstrated that endoscopic thoracic sympathectomy is a safe, minimally invasive and effective intervention for upper limb chronic arterial insufficiency of distal and diffuse type or for hyperhidrosis.

Endarterectomy and shunt: alternatives or in tandem?

There is no doubt about the efficacy of endarterectomy in the instance of localized occlusions of the arterial tree. The procedure was first developed in 1946 and has been widely used. However, in the case of extensive, non-localized atheromatus disease of the aorta-iliac and the femoral-popliteal-tibial segments in the leg, the majority of vascular surgeons prefer the application of shunts or prosthetics. Nevertheless, there are proponents of extensive obliteration of the endothelium in these regions. There is also the possibility of combining both techniques. In order to assess the outcomes of the latter technique, we reviewed 567 patients who were operated on for aorta-iliac and for femero-popliteo-tibial disease at Chelyabinsk Centre for Vascular Surgery in Russia from 1987 to 1991. Five hundred forty-one of these suffered from atherosclerosis. The other 26 patients had non-specific inflammation of arterial system. The age distribution was 32 to 78 years; there were 551 men and 16 women. Ischemia in the degree of III to IV (according to the scale established by Fontain) was present in 341 patients. Multi-site occlusions and associated multi-organ disease affected 213 patients. Atheromatous disease was determined by ultrasonography, load tests and angiography.

[Surgical tactics in occlusive lesions of the brachiocephalic and coronary arteries]. / Khirurgicheskaia taktika pri okkliuzionnykh porazheniiakh brakhiotsefal'nykh i koronarnykh arterii.

Surgical management of combined arterial occlusions is a difficult problem. Combined lesions of the coronary arteries and brachiocephalic trunk are marked by significant mutual aggravation. The authors examined 48 patients with this pathological condition in the last 4 years, 32 of them underwent restorative surgical interventions. The direct effect was positive in 87% of patients. Four patients died after the operation. Comparative evaluation of the late-term results was carried out by the actuarial method. The authors believe a stage-by-stage character of the intervention to be expedient, except for cases of one-stage critical ischemia carried out simultaneously in two arterial channels and the possibility of simultaneous reconstruction of the sternotomy approach.