[Comparative analysis of in-hospital and long-term results of patients with acute dysfunction of coronary bypass grafts depending on treatment tactics]. / Sravnitel'nyi analiz gospital'nykh i otdalennykh rezul'tatov patsientov s ostroi disfunktsiei koronarnykh shuntov v zavisimosti ot taktiki lecheniya.

OBJECTIVE: Comparative analysis of in-hospital and long-term mortality of patients in whom acute dysfunction of coronary bypass grafts was detected in the early postoperative period depending on conservative or surgical tactics. MATERIAL AND METHODS: The study is a retrospective analysis of data from 8801 patients who underwent elective coronary artery bypass grafting (CABG) between 2011 and 2022 at the Federal Center for Cardiovascular Surgery (Russia, Chelyabinsk). Among them, 196 patients underwent emergency coronary artery bypass grafting due to suspected perioperative myocardial infarction in the early postoperative period. In 119 patients, dysfunction of coronary bypass grafts was detected, in 77 patients no pathological changes were found. The criteria for inclusion in the study were patients with dysfunction of coronary bypass grafts (n=119). The 1st group included patients who underwent conservative therapy (n=33), the 2nd group (n=86) included those who underwent repeated myocardial revascularization. The primary endpoint was hospital mortality, secondary endpoints were long-term mortality and adverse cardiovascular events (myocardial infarction, stroke, repeat myocardial revascularization). Patients were surveyed via telephone. RESULTS: In-hospital mortality in the group of surgical reintervention was 8.1%, in the group of conservative treatment - 9.1% (p=0.867). According to the results of multivariate analysis, predictors of hospital mortality in patients of both groups were extracorporeal membrane oxygenation (p=0.014), time of artificial circulation (p=0.031), duration of artificial ventilation (p=0.001), number of days in intensive care (p<0.001). When analyzing long-term mortality using the Kaplan-Meier method in group 1 and group 2, no statistically significant differences were found; in the group of conservative therapy - 85±9.6 [66.2-103.7] months versus 108.2±4.8 [98.8-117.6] months in the surgery group (log-rank p=0.06). When analyzing long-term mortality from cardiovascular causes and the occurrence of adverse cardiovascular events, statistically significant differences were determined: in the group of conservative therapy - 92.5±9.3 [74.2-110.7] months versus 117.8±3.3 [111.2-124.3] months in the surgical treatment group (log-rank p=0.007) and 78.1±9.2 [60-96.3] months versus 98.9±3.9 [91.3-106.5] months (log-rank p=0.008), respectively. CONCLUSION: In-hospital mortality was comparable between groups. Long-term mortality from cardiovascular causes and the number of adverse cardiovascular events were significantly higher in the conservative therapy group. With timely detection of acute dysfunction of coronary bypass grafts, an active surgical approach has an advantage over conservative tactics and can improve the long-term prognosis of patients.

[Direct myocardial revascularization after 6, 12 and 24 hours of acute coronary syndrome]. / Pryamaya revaskulyarizatsiya miokarda cherez 6, 12, 24 chasa pri ostrom koronarnom sindrome.

OBJECTIVE: To evaluate the results of direct myocardial revascularization within 72 hours after manifestation of acute coronary syndrome. MATERIAL AND METHODS: A retrospective study included 48 (0.47%) out of 10 193 patients with coronary artery disease who underwent coronary artery bypass grafting for the period 2011-2019. Study patients underwent urgent direct myocardial revascularization. SYNTAX Score >22 points was observed in all cases. All patients were divided into 3 groups depending on timing of surgery: 26 patients - within 6 hours after admission, 15 patients - within 6 - 24 hours, 7 patients - within 24-72 hours. RESULTS: Level of myocardial damage markers was similar after 1 and 2 days (p>0.05). In the 1st group, 1 (3.84%) patient died in hospital, 5 (19.2%) patients - within 1 year after surgery. In the 2nd group, these values were 1 (6.6%) and 0, respectively. There was no mortality in the 3rd group (p>0.05). Overall 5-year survival was 100%. CONCLUSION: Early active open revascularization is advisable in patients with ACS and clear indications for surgery.

[Peculiariities of diagnostic parameters in patients with acute myocardial lesion after coronary artery bypass grafting]. / Osobennosti diagnosticheskikh pokazatelei u patsientov s ostrym povrezhdeniem miokarda posle operatsii aortokoronarnogo shuntirovaniia.

Annually, up to 850 000 coronary aortic bypass graft operations are performed worldwide. Despite modern technical equipment ensuring a high level of safety of the procedure, currently important remains a problem related to intraoperative myocardial damage in using artificial circulation. Early detection and clinical assessment of myocardial ischaemia often present a difficult task. This article deals with clinical, instrumental and laboratory methods of diagnosis, aimed at verification of an intraoperative cardiac lesion associated with graft dysfunction in coronary artery bypass grafting. Isolated electrocardiographic and echocardiographic signs of myocardial ischaemia between the comparison groups did not differ significantly. Analysing the markers of myocardial lesions, statistically significant differences were obtained only after 48 hours which, from the point of view of saving viable myocardium, is an utterly long-term interval. Studying the findings of intraoperative flowmetry showed statistically significant dependence between velocity characteristics, pulse index of shunts and their patency on angiographic examination. Thus, only combination of diagnostic parameters makes it possible to detect myocardial damage related to shunt dysfunction. This enables early determination of indications for performing bypass angiography and selection of the required therapeutic policy. Timely coronary artery angiography makes it possible to reveal defects of shunts and to timely perform surgical correction, preventing myocardial infarction.

[Coronary artery bypass grafting in non-ST-segment elevation acute myocardial infarction]. / Koronarnoe shuntirovanie pri ostrom infarkte miokarda bez pod''ema segmenta ST.

AIM: The study was aimed at comparatively assessing the immediate results of coronary artery bypass grafting operations without artificial circulation performed in non-ST-segment elevation acute myocardial infarction and chronic ischaemic heart disease. PATIENTS AND METHODS: The main group with non-ST-segment elevation acute myocardial infarction enrolled a total of 101 patients undergoing coronary artery bypass grafting without artificial circulation. The patients' age varied from 47 to 87 years, median 66.0 years (60.0; 71.0). The indication for the operation was persistent myocardial ischaemia on the background of carried out therapy with impossibility of performing percutaneous coronary intervention due to anatomy of coronary arteries and peculiarities of their pathology. The comparison group of chronic ischaemic heart disease was composed of 108 patients undergoing elective coronary artery bypass grafting without artificial circulation. The patients' age varied from 40 to 92 years, median - 60.0 years (58.0; 68.0). The patients with acute myocardial infarction had a significantly greater (p<0.05) number of coronary arteries measuring in diameter 2.5 mm and more, with significant occlusive and stenotic lesions, as well as a higher total SYNTAX score. The patients undergoing elective surgery were found to have an initially higher (p<0.05) left ventricular ejection fraction. RESULTS: In the group of acute myocardial infarction the waiting times for coronary artery bypass grafting varied from 2 to 8 days, median of waiting - 4.0 days (4.0; 5.0). The lethality rate (p<0.05) in the group of acute myocardial infarction amounted to 3.0% (3 cases) and in the group of chronic ischaemic heart disease to 0.9% (1 case). Twenty-one (20.8%) operations were carried out within the first 72 hours, with eighty surgical interventions (79.2%) performed after 72 hours from the onset of the disease. All 3 (3.8%) lethal outcomes were observed after coronary artery bypass grafting procedures performed later than 72 hours from the onset of acute myocardial infarction (p>0.05). The total number of complications (p>0.05) amounted to 18 (17.8%) and 10 (9.3%) in the group of acute myocardial infarction and in the group of chronic ischaemic heart disease, respectively. CONCLUSION: The immediate results of delayed coronary artery bypass grafting procedures without artificial circulation for acute myocardial infarction and chronic ischaemic heart disease were statistically comparable (p>0.05) by the lethality and complication rates. Lethality in the group of non-ST-segment elevation acute myocardial infarction din not depend on the time of operation after the onset of the disease.

[New possibilities of antithrombotic therapy improving prognosis in patients with stenosing atherosclerosis of carotid arteries]. / Novye vozmozhnosti antitromboticheskoi terapii, uluchshaiushchie prognoz u patsientov so stenoziruiushchim aterosklerozom sonnykh arterii.

The purpose of the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial was to evaluate a regimen of a two-way impact on thrombus formation in patients presenting with ischaemic heart disease and peripheral artery diseases. The study included a total of 1,919 patients with stenosis of carotid arteries and 1,032 patients with a history of stroke. Many patients with disease of peripheral arteries (including carotid arteries) enrolled into the COMPASS trial appeared to have additional risk factors for stroke such as, for instance, current or former smoking, diabetes mellitus, or ischaemic heart disease. An additionally carried out analysis for strokes revealed that supplementing rivaroxaban at a dose of 2.5 mg twice daily to acetylsalicylic acid decreased the risk for the development of ischaemic stroke by 49% (p<0.001), without increasing the risk for haemorrhagic transformation on the background of combined therapy (HR=0.35; 95% CI: 0.13-0.99; p=0.04), whereas the risk for haemorrhagic strokes remained at a low level and did not differ between the groups (HR=1.49; 95% CI: 0.67-3.31; p=0.33). The composite risk for major ischaemic and haemorrhagic events was significantly lower in the group of combined therapy. Adding rivaroxaban to acetylsalicylic acid appeared to result in a decrease in the risk of all-cause mortality in patients with ischaemic heart disease and peripheral artery disease by 18%. Thus, the addition of rivaroxaban at a dose of 2.5 mg twice daily to acetylsalicylic acid made it possible to decrease the risks of both primary and secondary strokes, and hence may be considered in patients with significant stenoses of carotid arteries for primary prevention, whereas in patients with endured ischaemic stroke - for secondary prevention, as well as after open endovascular reconstructive operations on carotid arteries.

[Possibilities of using the Colibri system for endovenous laser ablation]. / Vozmozhnosti primeneniia sistemy Colibri pri éndovenoznoi lazernoi obliteratsii.

AIM: The purpose of the study was to assess efficacy of endovenous laser ablation of major saphenous veins by means of the Mediola single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)'. PATIENTS AND METHODS: This non-comparative prospective study included 430 consecutive patients who underwent a total of 511 endovenous laser ablation procedures from January 2018 to March 2019. The great saphenous vein was subjected to obliteration in 343 (67.1%) cases, the anterior accessory saphenous vein - in 94 (18.4%) cases, and the small saphenous vein - in 74 (14.5%) cases. There were 170 (39.5%) men and 260 (60.5%) women, with a mean age of 52±12.8 years. RESULTS: The next day after the intervention the patients revisited the clinic for control examination, with the obtained findings demonstrating that occlusion of the target vein had been achieved in all 511 (100%) cases. At 2 months, we examined 411 (95.6%) people with a total of 484 (94.7%) treated veins. After 6 months, 399 (92.8%) people with 472 (92.4%) veins were examined. Recanalization with pathological reflux during the entire follow-up period was registered in 6 (1.3%) cases. Hence, the long-term rate of obliteration amounted to 98.7%. CONCLUSIONS: 1) endovenous laser ablation of major saphenous veins by means of the Mediola laser unit with wavelength of 1470 nm and single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)' made it possible to achieve obliteration of the target vein in 98.7% of cases at 6 months of follow up; 2) within the mentioned terms, the need for repeat intervention could appear in 1.1% of cases; 3) the Colibri system provides a possibility of decreasing the final cost of radial light guides for endovenous laser ablation by 30-50%.

[Possibilities of endovenous laser obliteration of subcutaneous veins with tumescence by cold saline solution]. / Vozmozhnosti éndovenoznoi lazernoi obliteratsii podkozhnykh ven s tumestsentsiei okhlazhdennym fiziologicheskim rastvorom.

AIM: The purpose of the present study was to assess the possibility of carrying out endovenous laser obliteration (EVLO) with radial light guides on a laser device operating at a wavelength of 1470 nm, using for tumescence only cold normal saline solution without additional sedation or narcosis in patients with allergy to local anaesthetics. PATIENTS AND METHODS: Our prospective non-comparative single-centre study consecutively included 37 patients who from November 2014 to June 2019 underwent a total of 41 isolated EVLO procedures without simultaneous miniphlebectomy or sclerotherapy of tributaries. Given the previous history of allergy to amide-group local anaesthetics and/or multiple allergic reactions to other agents, these patients received as anaesthesia and tumescence exclusively normal saline solution cooled to a temperature of +3-6ºC, without addition of local anaesthetics or any other therapeutic agents, with neither sedation nor narcosis. RESULTS: The great saphenous vein was subjected to coagulation in 33 (80.5%) cases, the anterior accessory saphenous vein in 5 (12.2%), and the small saphenous vein in 3 (7.3%) cases. The median of the mean diameter of the veins at 3 cm from the saphenofemoral or saphenopopliteal junction amounted to 10 mm (1st quartile 8.2; 3rd quartile 11). The median of the mean length of the coagulated vein - 45 cm (1st quartile 22; 3rd quartile 51), the median of the average amount of the administered normal saline solution - 300 ml (1st quartile 200; 3rd quartile 450), the median of the average amount of normal saline per 1 centimetre of the venous length - 8.7 ml (1st quartile 7.5; 3rd quartile 10). All patients without exception tolerated the intervention. The process of laser obliteration was not discontinued due to pronounced perioperative pain syndrome in any case. All patients after the procedure answered the question 'Would you repeat a similar intervention if the need arises?' in the affirmative. All the 41 (100 %) veins subjected to coagulation were obliterated at early terms of follow up, with no ultrasonographic evidence of recanalization. CONCLUSION: The obtained findings suggest a possibility of performing EVLO in patients with an allergy-burdened history in relation to local anaesthetics using for tumescence exclusively normal saline solution chilled to a temperature of +3-6ºC, with no additional sedation or narcosis. Such an approach makes it possible, on the one hand, not to change the organization of outpatient phlebological care and on the other hand to refuse from involving anaesthesiological support. Besides, it is absolutely safe in relation to the risk for the development of allergic reactions.

[Diosmin-containing phlebotropic drugs in varicose eczema]. / Diosminsoderzhashchie flebotropnye lekarstvennye preparaty pri varikoznoi ékzeme.

AIM: The purpose of the study was to examine the effect of diosmine-based phlebotropic drugs on dynamics of regress of varicose eczema in patients with chronic venous diseases, to compare their objective complaints and subjective symptoms before and after treatment, to determine the time of improvement. PATIENTS AND METHODS: The study enrolled a total of 80 patients presenting with chronic venous diseases complicated by varicose eczema (CEAP class C4A). The patients of the Study Group received combined treatment: elastic compression of lower extremities, phlebotropic agents (diosmin 450 mg + hesperidin 50 mg, 'Venarus' (manufactured by the Limited Liability Company 'Obolenskoe', Russia) and a dermatologist's prescribed topical treatment. The patients of the Comparison Group received similar treatment with the exception of phlebotropic drugs, however taking penoxiphylline at a daily dose of 1200 mg. RESULTS: The obtained findings demonstrated a decrease in pain intensity, lowered exudation, achievement of complete remission and reduced area of eczema with statistically significant differences in the groups. CONCLUSION: Modern phlebotropic drugs based on diosmin proved to be effective agents in comprehensive treatment of chronic diseases of lower-limb veins and varicose eczema.

[Analysis of risk factors for lethal outcomes of ST-segment elevation acute myocardial infarction]. / Analiz faktorov riska letal'nykh iskhodov ostrogo infarkta miokarda s pod''emom segmenta ST.

The purpose of the study was to objectively assess lethal outcomes in patients with the final diagnosis of 'ST-segment elevation acute myocardial infarction' (STEAMI) in order to reveal the circumstances and peculiarities of an unfavourable outcome. The work was performed on the basis of the medical records over 2014-2016, retrospectively analysing cases of STEAMI: a total of 131 lethal outcomes regardless of reperfusion therapy and 1,004 patients having survived after percutaneous coronary intervention (PCI). The data statistically significantly (p<0.05) distinguishing lethal outcomes were as follows: prevalence of female patients - 59.5%; transmural myocardial lesion - 90.1%; recurrent myocardial infarction - 32.1%; a history of functional class I-III angina of effort - 31.3%; a high average value of acute heart failure according to T. Killip classification - 2.4±0.2; cardiogenic shock - 30.6%; high frequency of previously endured acute cerebral circulatory impairments - 9.9%, a history of type 2 diabetes mellitus - 32.8% and degree I-III obesity - 35.1%. Amongst the deceased patients with AMI complicated by postinfarction cardiosclerosis and preexisting FC I-III angina of effort there was a low proportion of coronary angiography (CAG) (8.4%) and coronary operations (6.9%) previously performed. Also registered was a low frequency of reperfusion treatment (45.8%), which was associated with early mortality (within the first 2 hours of admission - 51.9%, within 3 to 24 hours - 16.8%). A decrease in efficacy of the interventions performed was influenced by syndromes of slow or absent blood flow (20.7% of PCI), as well as a multivessel haemodynamically significant lesion of three and more coronary arteries (56.2% of the CAGs performed). The obtained data concerning concomitant pathology and the condition are used to draw up a portrait of a patient jeopardised by a lethal outcome associated with AMI. These factors should be taken into consideration at the outpatient stage for a more active reperfusion policy aimed at preventing AMI.

[Venous thromboembolic complications in oncological patients: present-day possibilities of effective and safe anticoagulant therapy]. / Venoznye tromboémbolicheskie oslozhneniia u onkologicheskikh bol'nykh - sovremennye vozmozhnosti éffektivnoi i bezopasnoi antikoaguliantnoi terapii.

Cancer-associated thromboembolic complications in malignant neoplasms are commonly encountered. They deteriorate the course of the underlying disease and are frequent causes of death. The oncological patient is at high risk of not only thrombosis but haemorrhage during anticoagulant therapy. Recent randomized clinical trials have positively appreciated the possibilities of direct oral anticoagulants in treatment and prevention of thromboses in oncological patients. Analysing subgroups in these studies demonstrated that direct oral anticoagulants during long-term administration were at least as effective and safe as vitamin K antagonists. The most significant by the number of cases, duration of therapy, and methodology of analysis are the reports regarding rivaroxaban - an oral, direct factor Xa inhibitor. There are also findings obtained in a separate randomized study, confirming efficacy and safety of rivaroxaban in treatment of patients with cancer-associated venous thromboembolic complications as compared with therapy with low-molecular-weight heparins. Namely these results formed the basis for the guidelines of the International Society on Thrombosis and Hemostasis (SSC ISTH), according to which rivaroxaban may be regarded as an alternative to low-molecular-weight heparins in certain clinical situations.

[Stenting of calcified iliofemoral venous segment in post-thrombotic syndrome]. / Stentirovanie kal'tsinirovannogo iliofemoral'nogo venoznogo segmenta pri posttromboticheskom sindrome.

Stenting of the iliac veins in patients with post-thrombotic syndrome is an intervention associated with a low risk of complications, high primary and secondary patency rates, low incidence of restenosis, leading to a significant decrease in the severity of symptoms of chronic venous disease and a high rate of trophic ulcer healing, as compared with conservative therapy. Unlike subcutaneous veins, the formation of calcinates in deep veins after endured thrombosis is of considerably less frequent occurrence. Described in the article is a clinical case report concerning successful stenting of the iliofemoral venous segment in a female patient presenting with post-thrombotic syndrome, a trophic ulcer of the crus, and the presence of linear calcinosis in the lumen of the iliac veins and common femoral vein. This case report demonstrates the possibilities of contemporary endovenous techniques in treatment of this cohort of patients. Despite calcified segments, stenting was performed without technical obstacles and with a favourable clinical outcome. Such interventions may be regarded as justified and safe provided the operating surgeon has appropriate skill and experience.

[Damage to subcutaneous nerves in endovenous laser coagulation of the great saphenous vein]. / Povrezhdenie podkozhnykh nervov pri éndovenoznoi lazernoi koaguliatsii bol'shoi podkozhnoi veny.

The purpose of this study was to assess the incidence of the development of symptoms of damage to subcutaneous nerves after endovenous laser coagulation (EVLC) of the great saphenous vein (GSV), as well as to determine the effect of these symptoms on quality of life (QoL) of patients. Our retrospective study enrolled a total of 119 patients (mean age 50±13.9 years) subjected to 151 isolated EVLC of the GSV. The average volume of the injected anaesthetic per 1 cm of the vein's length amounted to 8.5±1.9 ml. Puncture of the GSV at the level of the thigh was performed in 37 (24.5%) cases, at the level of the crus in 114 (75.5%) cases. The intervention was performed at the power 5-10 W and linear density of energy approximately 70 J/cm. The median of the follow up period amounted to 264 days. The patients were interrogated by phone. The questionnaire included leading, understandable for patients questions about the presence of postoperative complaints characteristic of damage to subcutaneous nerves, as well as the question about the effect of these complaints on quality of life. The complaints characteristic of damage to subcutaneous nerves were reported for 61 (40.4%) operated limbs, with these symptoms decreasing quality of life only in 7 (4.6%) cases. All respondents noted gradual regression of the symptoms with time. The median of symptom relief amounted to 2 months. The analysis of interrelationship between the level of puncture by the thirds of the femur and crus and the damage of subcutaneous nerves demonstrated no statistically significant association (p=0.108), unlike the analysis by the femur/crus level, wherein the infragenicular puncture significantly increased the risk of traumatisation of subcutaneous nerves (p=0.022). No statistically significant differences by the frequency of damage to subcutaneous nerves depending on the power of energy were revealed (p=0.662). The obtained findings make it possible to recommend EVLC, including with puncture of the GSV below the knee, for patients with varicose veins in this basin.

[Algorithm of treatment policy for a femoral artery false aneurysm]. / Algoritm deistvii pri lozhnoi anevrizme bedrennykh arterii.

The purpose of the study was to elaborate an algorithm of treatment policy for post-puncture false aneurysms of the femoral artery (FAFA). The study was performed on the basis of the clinical material over 2014-2017 at the Regional Vascular Centre whose specialists have since 2017 been using the femoral arterial approach (FAA) only if the radial arteries are inaccessible for puncture or for inserting the endovascular tools and appliances. The obtained findings demonstrated that the number of coronary interventions performed with the use of the femoral arterial approach in patients presenting with acute coronary syndrome decreased from a total of 758 (100.0%) in 2014 to 166 (13.8%) in 2017. The frequency of FAFAs not subjected to surgical management and those subjected to surgical suturing by 2017 increased to 3.0 and 1.2%, respectively, with the same values for 2014 amounting to 1.8 and 0.4%, respectively. Taking into account the still existing necessity of using the femoral arterial approach in the patients, as a rule, belonging to the cohort of the so-called 'problem patients', the authors worked out an algorithm of therapeutic policy for FAFAs, which would make it possible to increase both efficiency and safety of the carried out endovascular interventions, as well as to determine the risks with their minimization in the postoperative period.

[Hybrid intervention for an atherosclerotic lesion of arteries of the iliofemoral segment]. / Gibridnoe vmeshatel'stvo pri ateroskleroticheskom porazhenii arterii podvzdoshno-bedrennogo segmenta.

The article describes a clinical case report regarding a successfully performed hybrid intervention in a patient presenting with critical ischaemia of a lower limb and an atherosclerotic lesion of arteries of the iliofemoral segment. Endovascular reconstruction in an isolated manner turned out to be impossible for both technical and anatomical reasons, whereas open reconstruction required two surgical accesses, an extended scope of the operation, and the use of a synthetic graft. Using a hybrid approach favourably contributed to adequate restoration of blood flow in the ischaemized limb, a decrease in the traumatic nature of the intervention, and also ensured angiographic control over the state of the operated arterial segment.

[Vein morphology after endovenous laser coagulation at different power and similar linear density of energy]. / Morfologiia ven posle éndovenoznoi lazernoi koaguliatsii pri raznoi moshchnosti i odinakovoi lineinoi plotnosti énergii.

The purpose of the study was to assess the depth of damage to the venous wall after endovenous laser coagulation (EVLC) at different power of the unit - 5, 7 and 10 W and similar linear density of energy (LDE) - approximately 70 J/cm. Our prospective comparative morphological study with blinding included a total of 30 patients subjected to EVLC of the great saphenous vein using the unit with a wavelength of 1,470 nm and radial light guides with automatic traction. The patients were divided into three groups, each comprising 10 patients. The unit's power (W) during EVLC and velocity of light guide traction (mm/s) in group one amounted to 5 and 0.7 (LDE - 71.4 J/cm), in group two to 7 and 1.0 (LDE - 70 J/cm) and in group tree to 10 and 1.5 (LDE - 66.7 J/cm), respectively. The coagulated veins were then procured from mini approaches and subjected to three sections made at a distance of 2 mm from each other. Specimens were stained with haematoxylin-eosin and picrofuxin according to the van Gieson technique. Then, in four places of each section (at 3, 6, 9 and 12 hours) we assessed the depth of the damage to the venous wall and calculated the average percentage of alteration - the ratio of the depth of the lesion to the venous wall thickness. The average depth of damage to the venous wall (µm) amounted in the first group to 122.9 ?m, in the second group to 182.9 µm, and in the third group to 267 µmm. The index of alteration (%) averagely amounted: in group one to 25.7, in group two to 37.9 and in group three (at a power of 10 W) to 55.5 (p=0.0001 when comparing each of the groups (the Kruskal-Wallis test)). Hence, despite an inconsiderable decrease of the LDE from the first to the third group, as power increased, the depth and percentage of damage to venous walls increased statistically significantly. It follows from the above-mentioned that: 1) an increase in power (from 5 to 10 W) of the unit during EVLC at comparable LDE (approximately 70 J/cm) leads to a deeper damage of the venous wall; 2) it is necessary to carry out a clinical study aimed at comparing different modes of coagulation, with the assessment of the frequency of recanalization and the level of pain syndrome.

[Efficacy of using rivaroxaban for treatment of heat-induced thrombosis after endovenous laser ablation]. / Effektivnost' primeneniya rivaroksabana dlya lecheniya termoindutsirovannykh trombozov posle endovenoznoi lazernoi koagulyatsii.

AIM: The study was aimed at assessing efficacy of using rivaroxaban for treatment of endothermal heat-induced thrombosis (EHIT) after endovenous laser ablation (EVLA) of saphenous veins. MATERIAL AND METHODS: Our prospective study included a total of 1,326 patients subjected to 1,514 EVLAs. In 1,091 (72.1%) cases the great saphenous vein (GSV) was ablated, in 124 (8.2%) cases the anterior accessory vein (AAV) was treated and in 299 (19.7%) cases the small saphenous vein (SSV) was treated. Heat-induced thrombosis developed in 21 (1.4%) cases: in 19 cases in the basin of the great saphenous vein and in 2 cases in the anterior accessory saphenous vein. No heat-induced thromboses in the basin of the small saphenous vein were observed. In 9 (0.6%) cases there was class 1 EHIT (according to the Kabnick classification), class 2 EHIT was noted in 10 (0.7%) cases and class 3 EHIT was observed in 2 (0.1%) cases. All patients with EHIT were given rivaroxaban: patients with class 1 EHIT received it at a single daily dose of 20 mg, patients with class 2 and 3 EHIT - at a dose of 15 mg twice daily. In one (4.8%) case the drug had to be discontinued on day two due to the development of dyspeptic events. All patients were found to have complete regression of the heat-induced thrombus within 6-25 days. No cases of clinical manifestations of pulmonary artery thromboembolism were observed. A conclusion was drawn that in clinical practice EHIT is an important and insufficiently studied problem. Rivaroxaban may be used as an oral agent for treatment of heat-induced thromboses after EVLA. Further studies are required to examine its efficacy and safety profile.

[Prevention of postpuncture iatrogenic pseudoaneurysms of femoral arteries after coronary interventions for myocardial infarction].

The study was aimed at analysing strategies of prevention of puncture-related complications in patients with myocardial infarction undergoing subjected to emergency coronary interventions by means of a femoral arterial access. We carried out a retrospective comparative analysis of two strategies aimed at preventing false aneurysms of femoral arteries: Group One (232 cases) - elective use of special devices for closure of puncture defects in patients with high risk of haemorrhage (previously performed thrombolytic therapy; exogenous obesity of the second-third degree, 2-3 degree arterial hypertension, use of 2b/3a blood platelet receptors inhibitors); Group Two (525) cases - conventional routine use of these technologies. Puncture defects were closed using by means of devices Cordis Exoseal and St.Jude Angio-Seal. The obtained results suggested advantage of the conventional approach: demonstrating a statistically significant (p < 0.05) decrease in the total incidence of false aneurysms of femoral arteries (from 5.2 to 1.9%) and the frequency of cases requiring surgical suturing of the defect in the femoral artery (from 1.7 to 0.2%). In the conditions of an intensive flow of emergency patients presenting with acute coronary pathology and requiring coronary interventions, devices for closing defects in the femoral arterial access make it possible to level puncture complications. Over the examined period of 2013-2014 there were performed more than 600 closures of defects of the femoral artery by means of the Cordis ExoSeal. These devices proved to be efficient, reliable, and very simple to use. A decrease in the incidence rate of puncture-related complications was also associated with rational prescription administration of drugs influencing positively various links of haemostasis.

[Association of renal function, telomere length and markers of chronic inflammation for patients without chronic kidney and cardiovascular diseases].

The retrospective analysis of 50 cases of acute myocardial infarction's treatment in patients older than 90 years old was held. Patients' age ranged from 90 to 101 years old. The average age was 92,1±0,7 years. 20 (40 %) patients have had reperfusion therapy: thrombolytic therapy - 2 (4 %), emergency coronary stenting - 18 (36%). The mortality rate was 26 %. Mortality in groups with/without reperfusion therapy was 20 % and 30 %, respectively. In the subgroup of coronary stenting, 4 patients died (the mortality rate was 22,2 %). The specialized medical care for patients over 90 years old with acute myocardial infarction associated with high mortality (26 %). It was proved statistically that the reduction (p < 0,05) of mortality is connected with coronary stenting. In cases with endovascular technical possibilities' presence, even with multivessel lesions, it is necessary to perform coronary stenting of the infarct/ischemia-responsible coronary artery. It is particularly important in cases complicated by acute heart failure.

[Clinical and surgical gender differences in patients older than 75 years who underwent emergency percutaneous coronary intervention in acute myocardial infarction].

There were 85 cases of endovascular treatment of acute myocardial infarct (AMI) in patients older than 75 years old in our investigation. The age of patients was from 75 to 96 years, the average age - 82,6±1,3 years. As for gender, all patients were divided into 2 groups: men - 37 (43,5 %) and female - 48 (56,5 %). The study was conducted in the following areas: determination of the baseline status of patients, analysis of technical aspects of diagnostic and medical percutaneous coronary interventions (PCI), as well as the comparison of results. RESULTS: apart from gender identities, the following results were obtained (p>0,05): high prevalence of cardiac diseases and basic somatic diseases; the acute cardiac failure (pulmonary edema, cardiogenic shock) was registered in 25,8 % of cases; the proportion of patients who were admitted 6 hours later from the onset of disease and who have had delayed reperfusion therapy, was 37,5 %; significant improvement of coronary blood flow in infarct-related coronary artery (TIMI classification), from an average index 1,4±0,2 before coronary stenting to 2,7±0,1 after interventions; endovascular operations were conducted in patients with multiple pathology of coronary arteries in the setting of extended occlusive lesions of infarct-related coronary artery; high efficiency of application of aspiration catheters for the removal of thrombotic masses in acute occlusion, as well as special devices for closing a puncture hole in the femoral arteries. Reduction of mortality in AMI patients over 75 years old of both sexes is associated with an increase in the proportion of emergency PCI. In both gender groups endovascular intervention was characterized by a clinically significant restoration of coronary circulation. Specific complications of PCI are rare, and it proves the safety of reperfusion therapy in the studied age group.

[An activity of forensic services during the Great Patriotic War: events, facts, people].

This article was prepared for the 70th anniversary of the victory in the Great Patriotic War of 1941-1945. Provides information about the historical aspects of the formation of a military forensics in the early years of the war, the creation in 1943 and in the subsequent operation of the war years forensics as an independent service in the system of military medicine.