[The role of the vascular surgeon in improvement of organization of dialysis help]. / Rol' angiokhirurga v uluchshenii organizatsii dializnoi pomoshchi.

Analysed herein are one-year results of formation of arteriovenous fistulas in 109 patients with end-stage chronic renal failure, as well as therapeutic decision-making after angiosurgical counselling of 144 patients presenting with 'problem' permanent vascular accesses. The counselling and formation of arteriovenous fistulas were carried out in conditions of interdepartmental collaboration between outpatient centres dealing with haemodialysis and vascular surgeons specialized in ultrasound mapping of peripheral vessels and performing different variants of arteriovenous fistulas. The angiosurgical care was as close to the patient as possible. Of the 109 operated patients, primary arteriovenous fistulas were made in 46 (42.2%) cases, secondary AVF - in 27 (24.8%) cases, and reconstruction of AVF - in 36 (33.0%) cases. Of the 144 patients with 'problem' permanent vascular assesses, correction of arteriovenous fistulas turned out impossible in 13 (9.1%). In the remaining 131 (90.9%) patients there was a possibility of different variants of open reconstruction of arteriovenous fistulas or performing angioplasty. Active policy of vascular surgeons in interdepartmental collaboration with nephrologists made it possible to bridge over the difficulties of patients routing which resulted in reduction of the terms of formation of arteriovenous fistulas by 2 months. Preventive arteriovenous fistulas were carried out in 17.4% of cases of primary permanent vascular assesses. During a year after formation of permanent vascular accesses, the number of patients with vascular catheters in ambulatory centres decreased from 22 to 17%. These positive changes in organization of the dialysis treatment made it possible to reduce the risks of infectious complications, to obtain adequate blood flow characteristics for haemodialysis procedures, as well as to decrease financial expenses and labour costs for AVF care.

[Criteria for selection of patients for radiofrequency ablation of major venous trunks in varicose disease, short- and long-term outcomes].

OBJECTIVE: to investigate criteria for selection of patients for radiofrequency ablation (RFA), as well as to assess the immediate and remote outcomes of comprehensive minimally invasive treatment of patients presenting with class C2-C6 chronic venous disease (CVD). MATERIAL AND METHODS: we performed a total of 604 interventions in 512 patients (554 on the superior vena cava (diameter from 3 to 26 mm), 45 on the inferior vena cava (diameter from 3 to 14 mm), 5 on the anterior accessory veins (4-8 mm in diameter) The varicose veins were removed by means of compression sclerotherapy. The interventions were performed using tumescent anaesthesia in out-patient conditions. The check-up ultrasonographic duplex scanning was carried out within 1-5 days after RFA, then after 6, 12, 24, 36 and 48 months. RESULTS: All major veins except two were found to be occluded immediately after the interventions. A complication was observed in one case (0.2%). The remote results were assessed on 514 lower limbs. In all, except two, major trunks of the subjected to RFA saphenous veins were occluded. Recurrent varicose veins were observed on 82 (13.9%) lower limbs. Using two ports was required in tortuosity of the SVC and with thrombophlebitis of the SVC in the anamesis. A small diameter of the vein may currently not be considered as a limiting factor. Of the 11 patients with a varicose node above the saphenofemoral junction, one patient was found to have a floating thrombus in it which required crossectomy. RFA demonstrated advantages as compared with crossectomy and stripping in obese patients, while in acute ascending superficial thrombophlebitis in a series of cases it made it possible to refuse the traditional surgical operations. In class C6 CVD conservative therapy was carried out parallel to correction of venous haemodynamics which made it possible to reduce the term of epithelisation of the trophic ulcer. Removal of the deep vertical veno-venous reflux by means of RFA in all cases resulted in SVC occlusion. CONCLUSION: Planning of RFA requires a thorough clinical and ultrasonographic assessment, ideally an ultrasonographic examination should be performed by the operating surgeon. Technical obstacles in the majority of cases may be overcome. RFA is a method of choice in obese patients with a deep vertical veno-venous reflux. Early application thereof in class C6 CVD reduces the term of epithelisation of trophic ulcers. 99.7% of cases showed occlusion of the vein immediately after the intervention and 99.6% of cases within the term of up to 48 months.