[Temporary hemostasis in the injuries of great vessels of different location].

Temporary hemostasis is one of the main points in emergency surgery of patients with trauma of major vessels. Folley catheters were used for temporary hemostasis in bleedings from stab-cut wounds with a narrow wound canal. The method of temporary clamping of the abdominal aorta above the visceral branches during profuse abdominal bleedings of unknown etiology is described in detail.

[Flap transverse sternotomy during operations on the vessels and organs of the upper mediastinum and the first cervical zone].

A surgical approach to vessels and organs of the upper mediastinum was grounded, developed and tested. An experimental study of flap transverse sternotomy was carried out in 20 cadavers. A wide approach with throwing of the presternum was the best for manipulations in proximal parts of the aortic branches. This approach was also less traumatic.

[Surgical management of vertebral artery injuries].

The authors describe problems of giving urgent surgical care to patients with wounds of the vertebral arteries in different areas of the neck and propose a simple and reliable method of hemostasis for wounds of the vertebral artery in the bony canal. An analysis of results of the surgical treatment of 16 patients with injured vertebral artery is presented.

[Bypass surgeries from remote vascular beds in the treatment of critical limb ischemia in elderly and old patients]. / Operatsii shuntirovaniia iz otdalennykh sosudistykh basseinov v lechenii kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

The problem of surgical treatment of elderly and old patients with critical limb ischemia and severe concomitant diseases is discussed. Surgical bypass from remote vascular beds is the only real possibility of effective care for such patients with the lowest risk. The results of treatment of 90 patients with critical limb ischemia were analyzed. The surgical technique is described in details. Modified methods of proximal anastomosis creation and technology of safe installation of graft into subcutaneous canal in subclavial-femoral bypass, surgical technique in femoral-femoral and ileo-femoral cross-over bypass are also described. Results demonstrate high efficacy of these surgeries and their lower risk. It is concluded that improved surgical technique permits to expand indications for surgery in elderly and old patients and to improve immediate and long-term results.

[Comparative assessment of different methods of treatment of chronic critical ischemia of lower extremities in elderly and senile patients]. / Sravnitel'naia otsenka razlichnykh sposobov lecheniia khronicheskoi kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of using different methods of treatment of chronic critical ischemia of lower extremities were analyzed in 267 elderly and senile patients. Ischemia of the lower extremities of the III degree was noted in 83% of the patients, the IV degree ischemia--in 17%. In 86 patients who underwent primary high amputation of the lower extremity 2 years survival was noted in 33.7%. In 89 patients treated conservatively during 12-14 days good and satisfactory results were obtained in 58.4%, amputations were made in 41.6%. The 2 years survival was 66.3%. In 92 patients primary reconstructive operations resulted in good and satisfactory outcomes in 75 (81.5%) out of them with the 2 years survival in 88.0%.

[Prevention of purulent complications after reconstructive vascular operations in elderly and aged patients]. / Profilaktika gnoinylh oslozhnenii posle rekonstruktivnykh operatsii na sosudakh u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of surgical treatment of 382 patients with III-IV stages critical limb ischemia and concomitant diseases were analyzed. The mean age of the patients was 67.7 years. All the patients underwent reconstructive operations on lower limbarteries. Three variants of antibiotic therapy were compared: 1) antibiotics were administered parenterally; 2) they were injected endolymphatically; and 3) they were used parenterally and endolymphatically. Combined antibiotic, i.e. a combination of parenteral and endolymphatic routes of administration was most effective.

[Surgical treatment of older patients with critical ischemia of the lower limps in occlussive disease of aorta and iliac arteries]. / Khirurgicheskoe lechenie bol'nykh starshikh vozrastnykh grupp s kriticheskoi ishemiei nizhnikh konechnostei pri okkliuzionnykh porazheniiakh aorty i podvzdoshnykh arterii.

17-year experience in surgical treatment of 302 elderly and old patients with occlusive disease of aorta and iliac arteries and critical limb ishaemia is analyzed. Different surgical policy depending on the type and length of atherosclerotic lesion and somatic state is offered. For persons in especially grave somatic state extraanatomical bypass operations (90 patients) were recommended, their technique was discussed in detail. Causes of postoperative complications were analyzed and prophylactic measures suggested. Prevention and treatment of infectious complications were considered.

[Injuries of cervical great vessels]. / Raneniia magistral'nykh sosudov shei.

Results of surgical treatment of 156 patients with cervical vessels injuries over 10-year period were analyzed. The majority of the wounds (82.7%) located in zone II of the neck. There were 143 (91.7%) stab-knife and 12 (7.7%) shotgun wounds. Combination of vascular traumas with injuries of deep cervical structures was in 16 (10%) patients. Detailed physical examination permits to avoid special device examinations before surgery in the majority of cases. When injuries of the esophagus or respiratory tract were suspected, the patients underwent diagnostic esophago- and bronchoscopy before and during surgery. Diagnostic and therapeutic policies in these kinds of injuries are systematized.

[Reconstructive surgery in injuries of major arteries and veins]. / Rekonstruktivnye operatsii pri raneniiakh magistral'nykh arterii i ven.

Retrospective analysis of surgical treatment for injuries of 408 major arteries and veins in 352 patients in the department of vascular surgery of N.V. Sklifossovsky Research Institute of Emergency Care from 1989 to 1996 is presented. Of 126 cases of prosthetic reconstructions in 72.2% autoveins were used, in 18.3%--synthetic prosthesis, and in 9.5% homologous arterial biologic prosthesis. Good results were obtained in 13.1% of patients, amputations were made in 4.8%. Lethality was 4.0%. Principles of treatment of combined injuries, prophylaxis of syndrome of inclusion and other complications are autlined.