[Choice of hybrid interventions for iliac-femoral arterial lesions]. / Vybor ob"ema gibridnogo vmeshatel'stva pri porazhenii arterii podvzdoshno-bedrennogo segmenta.

OBJECTIVE: To compare the short-term and long-term outcomes of hybrid interventions after various infrainguinal reconstructions (restoration of blood flow through superficial femoral artery and pulsatile blood flow through deep femoral artery) in patients with iliac-femoral arterial disease. MATERIAL AND METHODS: A retrospective analysis included patients after hybrid iliac-femoral interventions between 2014 and 2018. These interventions included stenting of iliac arteries and various open infrainguinal reconstructions. The first group (n=41) consisted of patients who underwent reconstruction of superficial femoral artery, the second group (n=88) - restoration of pulsatile blood flow in deep femoral artery. We analyzed the Rutherford score, perioperative complications, primary patency rates and limb salvage rates after 12 months in both groups. RESULTS: Significant improvement (Rutherford score +3) was achieved in 28 (70%) and 14 (15.9%) patients, respectively (p<0.05). There were no significant between-group differences in the number of postoperative complications. Surgery time was longer in the first group (median 160 and 130 min, respectively, p<0.05). However, intraoperative blood loss was similar. Primary patency rates after 12 months were 82.4% and 95.1%, respectively (p=0.054). Limb salvage rates after 12 months were 94.7% and 100%, respectively (p<0.05). CONCLUSION: This study highlights the potential advantages of restoring pulsatile blood flow through the deep femoral artery in hybrid interventions. Higher primary patency and limb salvage rates in the second group indicate better long-term outcomes after restoration of blood flow through the deep femoral artery. Further prospective studies are needed to confirm these results and determine the underlying mechanisms of differences.

[18F-fluorodeoxyglucose PET/CT in the diagnosis of vascular graft infection]. / Vozmozhnosti PET/KT S 18F-ftordezoksiglyukozoi v diagnostike infektsii sosudistykh protezov.

OBJECTIVE: To investigate diagnostic role of 18F-fluorodeoxyglucose PET/CT in patients with suspected vascular graft (VG) infection. MATERIAL AND METHODS: A prospective analysis included data of 30 PET/CT examinations for suspected infection of aortic VG (n=27) and bypass grafts (n=3) after surgical treatment (median 48 months). In 77% (23/30) of cases, the diagnosis was initially «possible¼ (n=11) or «rejected¼ (n=12) in accordance with common diagnostic criteria. All PET/CT results were verified by clinical, laboratory and intraoperative («=20) data. VG infection was confirmed in 18 patients and ruled out in 12 cases. RESULTS: PET/CT confirmed VG infection in 94% (17/18) and excluded in 50% (6/12) of cases. False PET/CT results were obtained in 23% (7/30) cases: false positive in 6 cases and false negative in 1 case. Thus, sensitivity, specificity and diagnostic accuracy of PET/CT were 94%, 50% and 77%, respectively; positive and negative predictive value - 74% and 86%. PET/CT results allowed correct reclassifying 33% (10/30) of cases. VG infection was confirmed in 73% (8/11) of patients with initially «possible¼ diagnosis and excluded in 17% (2/12) of patients with initially «rejected¼ infection. Moreover, whole body PET/CT revealed unknown inflammation foci outside VG in 73% (22/30) of cases. These data were applied to correct treatment approach in 80% (24/30) of cases. CONCLUSION: Our results showed high efficacy of 18F-fluorodeoxyglucose PET/CT in the diagnosis of VG infection. Despite low specificity, this technique has high sensitivity and accuracy that allowed reclassifying 33% of cases.

[Results of endovascular treatment of abdominal aortic aneurysms].

OBJECTIVE: Studying the results of endovascular prosthetic repair in patients with abdominal aortic aneurysms. MATERIAL AND METHODS: A retrospective study of 34 elderly and aged patients (mean age 67.4±1.24 years) with severe concomitant pathology and the risk of Euroscore averagely amounting to 13.16±0.19, subjected to endoprosthetic repair for the presence of AAA. RESULTS: In all 34 cases we obtained good immediate results of endoprosthetic repair of the infrarenal portion of the abdominal aorta: positioning of stent grafts was adequate, expansion complete, with no sign of endoleak. Hospital lethality rate was 0%. The intra- and postoperative periods were not accompanied by the development of neither cardiological nor neurological complications. Analysing by the McNemar criterion showed that there was a statistically significant trend towards elevation of leukocytosis and ESR after surgery (p=0.074), and for other indices the shifts were statistically insignificant or absent. Since no signs of an inflammatory process were revealed, in all cases the postoperative wounds healed with fist intension, the alterations in the blood formula were associated with resorption of thrombotic masses in the paraprosthesis space. CONCLUSION: In all cases, implantation of the stent graft resulted in achieving the main objective, i. e. adequate isolation of the aneurysmatic sac in AAA. Dynamic follow up did not reveal any cases of stent graft dislocation, aneurysm rupture, thrombosis of endograft branches, or type 1a leaks.