[Use of endovascular drug-coated devices in lesions of femoropopliteoltibial arteries]. / Ispol'zovanie éndovaskuliarnykh ustroistv s lekarstvennym pokrytiem pri porazhenii arterii bedrenno-podkolenno-bertsovogo segmenta.

Endovascular intervention is one of the main methods of treatment in atherosclerotic lesions of the infrainguinal segment in patients with chronic lower limb ischaemia. Recent years have witnessed active use of drug-eluting techniques, significantly improving the long-term outcomes of peripheral reconstructions. This article is a review of publications on the results of using modern drug-eluting balloon catheters and stents in the femoropopliteoltibial position. The accumulated data will help solve the main problems of the classic balloon angioplasty, reducing the incidence of restenosis, improving primary patency, and decreasing the need for repeat interventions in the remote period of follow-up.

[Comparison of efficacy of rivaroxaban and warfarin after open operations on the infrainguinal segment]. / Sravnenie éffektivnosti rivaroksabana i varfarina posle otkrytykh operatsii na infraingvinal'nom segmente.

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.

[Results of hybrid loop endarterectomy from the superficial femoral artery with the MultiTASC]. / Rezul'taty gibridnoi petlevoi éndarteréktomii iz poverkhnostnoi bedrennoi arterii petlei MultiTASC.

The purpose of this study was to analyse the results of hybrid loop endarterectomy from the superficial femoral artery (SFA) in its occlusion, preformed in a total of forty-two patients. Of these, 27 patients had prior to the intervention been diagnosed with stage II B ischaemia and 15 patients had been diagnosed as having critical ischaemia. Technical success of the operation amounted to 88%, with the frequency of early thromboses equalling 2.7%. In the early postoperative period, one patient died of acute myocardial infarction. The 1-, 2- and 3-year remote cumulative primary patency rate amounted to 81, 74 and 74%, respectively. There were no amputations performed within the timeframe of the follow-up period. The technique of hybrid loop endarterectomy with the MultiTASC loop followed by stenting of the proximal portion of the popliteal artery in occlusion of the SFA and stenoses of the common femoral artery has proved to be a highly efficient intervention yielding good immediate and remote results.

[Outcomes of hybrid operations in multi storeyed lesions of arteries of the aortoiliac and femoropopliteal segments].

The work was aimed at analysing immediate and remote outcomes of hybrid operations in storey atherosclerotic lesions of the aortoiliac and femoropopliteal segments. Over the period from 1997 to 2012 hybrid operations were performed in a total of 224 patients presenting with multi-storeyed lesions of iliac and lower-limb arteries, classified as TASC A, B, C, and D. The operations were carried out at departments of vascular surgery of Clinical Hospital No 83 of the Federal Biomedical Agency of Russia and the Centre of Cardiovascular and Endovascular Surgery of Clinical Hospital No 119 of the Federal Biomedical Agency of Russia. All operations were simultaneous. The patients were subdivided into groups according to the character of intervention on iliac arteries: 1 - balloon angioplasty of iliac arteries, 2 - stenosing of iliac arteries, 3 - loop endarterectomy from iliac arteries followed by implantation of a covered stent into the zone of rupture of the intimal cylinder. In all cases the interventions of the arteries of the aortoiliac segment were combined with various open surgical reconstructions of the femoropopliteal segment. Technical success amounted to 99.1%. Interventional complications of the endovascular stage requiring conversion occurred in 2 cases. The immediate period complications influencing patency of the reconstructions performed were noted in 10 (4.5%) patients. Patency on the hospital stage with the deduction of cases of technical failures amounted to 98.6%. The remote results were followed up during 5 years in 76.5% of patients. Five-year primary assisted patency of the aortoiliac zone amounted to: in group 1 - 79.2%, in group 2 - 77.9%, and in group 3 - 89.4%. Five-year assisted patency of the femoropopliteal segment amounted to: for EAE of the common femoral artery - 98.2%, for profundoplasty - 100%, femoral proximal popliteal bypass grafting - 77.3%, femoral distal popliteal bypass grafting - 74.1%, femoral-tibial bypass grafting - 61.4%. There were no statistically significant differences in patency of the reconstructions of the femoropopliteal segment depending upon the type of intervention on the aortoiliac segment.

[A hybrid operation for chronic type III B aortic dissection].

Presented herein is a clinical care report of a successful hybrid reconstruction (i.e., an open operation and endovascular intervention) for a chronic type III B aortic aneurysm in the setting of the renal and lower-limb arteries malperfusion syndrome. Of obvious interest are the circumstances of the operation performed in a 36-year-old male patient who was subjected to a simultaneous reconstruction of the supra- and inter-renal portion of the aorta and endovascular treatment for lower-limb chronic ischaemia. A detailed description thereof is followed by a brief review of the literature related to appropriate decision-making regarding the scope of the reconstruction in the pathology involved.

[Colour duplex scanning in assessing efficacy of roentgeno-endovascular operations on lower-limb arteries].

The authors analysed efficacy of colour duplex scanning (CDS) in patients after roentgen- assisted endovascular interventions on lower-limb arteries. The study comprised 303 patients presenting with chronic obliterating diseases of lower extremities, who underwent a total of 456 endovascular interventions, including 375 stenting procedures. Efficacy of roentgen-assisted endovascular interventions was assessed l-to-3 days after surgery. We determined the main ultrasonographic criteria for successful balloon angioplasty, i. е., vessel's geometry restoration, haemodynamic alterations in the endovascular intervention site, the presence of residual stenosis less than 25%, accuracy of stent/stents' positioning, commensurability of the diameters of the stent and artery, exclusion of the aneurysm from blood flow. Also studied were ultrasonographic criteria for arterial complications following endovascular interventions, including thromboses of the zone of angioplasty the stent, the presence of less-than-25-percent stenosis, subintimal insertion of the stent, incomplete opening of the stent, incomplete capture of the stenosis area by the stent, and stent dislocation. CDS is an important method to assess evaluating efficacy of roentgen-assisted operations and the state of arteries after angioplasty.

[Simultaneous reconstruction of visceral aortic branches and renal arteries].

The paper presents a case report of simultaneous reconstruction of visceral aortic branches and renal arteries. The case is interesting because of special operative particularities, that occurred in 54-year-old patient who received previously radiotherapy for abdominal lymphogranulomatosis. Follow-up investigation 4 years after vascular intervention has shown that the patient remained in a satisfactory condition. The paper includes brief literature review concerning the strategy of reconstructive volume choice for this disease.

Combined operations for multilevel lesions of the aortoiliac and femoropopliteal segments.

This paper describes the results of the treatment of 53 patients with combined arterial lesions of the iliofemoral and femoro-popliteal segments. Altogether 56 primary one-step operations were performed. The initial success was achieved in 53 (94.6%) cases. The long-term results were followed up in 43 (81.1%) patients, in the long-term period, repeated endovascular interventions were accomplished in 6 (1.8%) patients with re-stenoses of the iliac arteries. The best long-term results were obtained in the groups of patients who had undergone balloon angioplasty and stenting of the iliac arteries.

[Surgical treatment of abdominal aortic aneurysm in a patient with a horseshoe kidney (a case report)]. / Khirurgicheskoe lechenie anevrizmy briushnoi aorty u bol'nogo s podkovoobraznoi pochkoi (klinicheskii sluchai)..

This paper describes a clinical case of the treatment of a patient with associated abdominal aortic aneurysm and a horseshoe kidney. Examination revealed type II blood supply of the horseshoe kidney according to Crawford. The operation was performed from thoraco-phreno-lumbotomy on the left. During operation, we ligated the accessory renal artery with a good retrograde blood flow, branching out just from the aneurysmal sac. Examination carried out in the early and long-term postoperative period did not discover renal malfunction as shown by laboratory and radionuclide research methods.

Results of primary reconstructions in patients with lesion of the tibial arteries.

An analysis was made of 146 primary reconstructions performed in 141 patients with occlusion of the arteries of the femoropopliteal segment and leg. At the hospital stage an improvement of the clinical status was attained after primary operations in 98% of cases. The five-year cumulative bypass patency after operations.accounted for 43.5% while the limbs could be saved in 91.5% of cases. The results obtained in patients with stage 2B chronic arterial ischemia (according to the A.V.Pokrovsky classification, 1979) coincided with the results of bypass grafts of the popliteal artery (the 5-year patency was 56.9% with the limbs saved in - 81.2% of cases), whereas the results of in situ vein bypass were marked by a significantly better cumulative patency in the long-term period.

[Surgical treatment of juxtarenal occlusion of the abdominal aorta]. / Khirurgicheskoe lechenie iukstarenal'noi okkliuzii briushnoi aorty.

Incidence, etiology and clinical course of chronic juxtarenal occlusion of the abdominal aorta have been studied. It was established that this type of lesion among other forms of occlusive disease of the aorto-ileal segment is encountered in 8.1% of patients. Inflammatory diseases of arteries prevailed as an etiologic factor. Diagnosis of this disease should be based on the use of complex up-to-date methods of examination. Roentgeno-contrast aortography in lateral position is of paramount importance in detection of upper level of thrombus spreading in the aorta. Original method of operative procedure used in 20 patients, has been developed with due regards for location of the occlusion, character of lesion of aortic walls and prophylaxis of intraoperative embolic complications. Restoration of blood flow in lower extremities without any intraoperative complications was obtained in all operated patients. In all suffering from symptomatic hypertension normalization of arterial pressure was obtained after the operation. Postoperative mortality rate made up 4.4%. The results obtained confirm high effectiveness of the above surgical treatment of patients with juxtarenal occlusion of the abdominal aorta.