DIFFERENCES IN ECG CHARACTERISTICS AND CO-MORBIDITIES AMONG PATIENTS WHO UNDERWENT ELECTIVE SURGICAL REPAIR.

The aim of the study was to assess differences in ECG features and prevalence of comorbidies between two groups of patiens: with Abdominal Aortic Aneurism (AAA) and Aorto-Iliac Occlusive Desieses-Lerish Syndrome (LS). Data was collected for all consecutive adult patients who underwent elective surgical repair of AAA (fusiform aneurysm) or LS at "The Center of Vascular and Heart Diseases" (Tbilisi, Georgia) between 2010 and 2014. We studied a prevalence of Arterial Hypertension (AHT); Diabetes mellitus (DM); Renal Failure (RF),Peripheral Artery Disease (PAD), Coronary Artery Disease (CAD) and rate of coronary revascularization in these patients; We also, investigate some of the electrocariographic characteristics: Corrected QT interval(QTC),QT dispersion(QTD). The majority of patients were mail (92% in both groups). Prevalence rate of CAD didn't differ significantly between groups with LS and AAA (37% and 39%P=0.7000 respectively). Rate of revascularization was (7% and 6% P=0.577 respectively). Prevalence rate of DM was higher in patients with LS compared with AAA (27%and 8%P=0.0000 respectively); PAD was more prevalent in LS group (98% and 48% P=0.0000 respectively). RF was less prevalent in patients with LS as compared with AAA (51% and 64%P=0.0200). Prevalence rate of AHT was significantly low in LS than in AAA (49% and 65%P=0.0000 respectively). A prevalence rate of increased QTd (>0.07ms) was high in LS group but the difference between these two groups was not statistically significant (16% and 9% P=0.1563 respectively). Absolute number of prolonged QTd was high in LS group in comparison with AAA and this difference was statistically significant (0.04±0.026 and 0.02±0.028 P=0.0092 respectively).QTC remained in normal range in both groups. Rates of CAD and coronary revascularization did not differ between patients with AAA and LS. The high incidence of DM and PAD was found in patients with LS as well as high HR and prolonged QTd. Prevalence Rate of AHT, RF was higher in patients with AAA as compared with LS group. These findings indicates: a)Different composition of risk factors in two groups. However, both groups of patients are at increased risk of development of coronary events and this circumstance may be considered as a predictor of worse prognosis. b) High incidence of renal failure in AAA group may contribute a progression of renal dysfunction in this patients during /after surgery.c) A prolonged QTd was high in LS group which may contribute heightened risk of fatal arrhythmias in this patients. Further studies are needed for evaluation a prevalence rate of prolonged QTd in the large population.

Transradial unprotected left main coronary artery stenting in an octogenarian with severe angina and Leriche syndrome.

Coronary artery disease in octogenarians is often diffuse and difficult to manage due to concomitant peripheral vascular disease. The authors describe a case in which an unprotected left main coronary artery was successfully treated by transradial stenting in a patient with severe angina and Leriche syndrome.

Coronary artery disease incidence between type II diabetic and non-diabetic patients with Leriche syndrome.

BACKGROUND: Coronary artery disease (CAD) is the major determinant of preoperative morbidity and mortality for patients requiring major vascular surgery. The management of CAD in these patients is controversial. AIMS: The incidence and severity of CAD in diabetic and non-diabetic patients with Leriche syndrome was explored. SETTINGS AND DESIGN: 107 patients with Leriche syndrome were selected as major vascular occlusion and grouped according to their diabetic Status. Sex, age, dyslipidemia, obesity, hypertension, clinic cardiac status, coronary angiographic lesions and coronary revascularisation procedures were noted. MATERIAL & METHODS: Patients' demographics, intra-operative and per-operative data were recorded and compared. In every patient with Leriche syndrome scheduled for elective vascular reconstruction coronary angiography was performed. Lesions were evaluated for the percentages of stenosis. Preliminary coronary bypass or percutaneous coronary intervention was recommended for those found to have advanced or severe CAD. Results of revascularisation procedures were compared. STATISTICAL ANALYSIS USED: Chi-square or Fisher exact chi-square test is used for conditional variables. Independent samples was analysed by using t-test. Kruskal-Wallis variance test was used if the variances are not homogeneous according to the Levene test. RESULTS: No difference was found in both groups except family history and obesity. Coronary angiographic investigation indicates that 59% of DIAB group and 38% of NONDIAB group patients have advanced or severe CAD which has a high probability for myocardial revascularization. Overall revascularisation rate is 37.8% in DIAB group and 45.7% in NONDIAB group (p=0,641). Preoperative mortality was found 2.7% in diabetics and 4.2% in non-diabetics (p=0.342). CONCLUSIONS: Leriche syndrome with diabetes mellitus is more likely to have advanced coronary disease than those without diabetes mellitus. Coronary angiography and subsequent revascularisation should be performed only in those patients who require major vascular surgery.

[Repeated operations after reconstructive interventions on the aortofemoral segment]. / Povtornye operatsii posle rekonstruktivnykh vmeshatel'stv v aortobedrennom segmente.

At the department of vascular surgery of the Novgorod regional hospital 455 reconstructive operations for atherosclerotic occlusions in the aorto-femoral segment were performed at the period from 1984 to 1991. Specific complications requiring reconstructive reoperations took place in 92 patients (20.2%), 21 patients (4.6%) having earlier specific complications and 71 patients (15.6%)--late ones. Causes of the appearance of the specific complications are analyzed, the methods of treatment of such patients are recommended. Lethality after reoperations for late complications made up 9.8%, amputation of the extremity was performed in 14.1% of the patients. The positive result of the reoperations with a regress of ischemia and the preserved function of the extremity was noted in 76.1% of the patients.

[The prognosis of the efficacy of revascularization of the penile corpora cavernosa in the surgical treatment of Leriche's syndrome]. / Prognozirovanie éffektivnosti revaskuliarizatsii kavernoznykh tel polovogo chlena pri khirurgicheskom lechenii sindroma Lerisha.

The authors have developed a procedure for predicting the efficiency of penal spongy body revascularization in surgical management. Thirteen qualitative parameters, such as duration of sexual dysfunction, libido, having a sexual intercourse partner, degree of intermittent claudication, duration of lower extremity diseases, penal erection angle after drug test and ultrasound Doppler echography with drug test, were evaluated in 36 patients with Leriche's syndrome and erectile dysfunction. The qualitative parameters obtained were converted to quantitative discrete characteristics. The set of characteristics was used to predict the postoperative parameter--the value characterizing the sexual function by using the well-known methods of regression analysis on a PS/XI personal computer by the multiple regression programme in the Statgraphics program package. The high accuracy of prediction of the value characterizing the sexual function by this method makes it possible to substantiate the expediency of penal spongy body revascularization and opens up new ways for improving its outcomes.