Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery最新文献

Presented herein is a clinical case concerning successful treatment of varicose veins of the lower extremities in a patient with moderate severe hemophilia A. The patient underwent endovenous laser ablation of the great saphenous vein. According to the recommendation of a hematologist, correction of hemophilia was performed by means of infusion of blood coagulation factor VIII. Delayed sclerotherapy of the dilated tributaries was managed. Good results were achieved with neither intra- nor postoperative complications. The duration of follow-up and ultrasonographic assessment amounted to 1 year.

According to the national guidelines for the diagnosis and treatment of diseases of the lower extremity arteries of 2019, extended occlusion of the aorto-submandibular segment on both sides is an indication for aorto-femoral bifurcation bypass surgery. The current level of development of vascular surgery and endovascular methods of surgical treatment allows the use of a minimally invasive hybrid approach in the treatment of such a group of patients. This clinical case describes a minimally invasive hybrid approach in the treatment of a patient with extended occlusion of the aorto-iliac segments on both sides, with hemodynamically significant damage to the common femoral arteries and the formation of critical ischemia of the left lower limb.

Objective: This study was aimed at improving the results of surgical treatment of patients with infected synthetic prostheses in the aortoiliac zone by replacing them with an autovenous graft using in situ technique.

Patients and methods: Analyzed herein are therapeutic outcomes in a total of 78 patients who underwent redo surgery for infection of aortofemoral bifurcation allografts over the period from 2001 to 2023. These patients were initially operated on for atherosclerotic occlusion of the terminal aorta and its branches (Leriche syndrome) or aneurysms of the infrarenal aorta. Prosthetic infection was observed both in the immediate and long-term postoperative periods. After confirmation of the diagnosis and preoperative preparation, all patients were re-operated in the scope of aortofemoral bifurcation autovenous prosthetic repair according to in situ technique. Femoral and internal jugular veins were used as autografts.

Results: In the immediate postoperative period, the following complications were encountered: acute renal failure (ARF), multiple organ system failure (MOSF), and arrosive bleeding. Thrombosis of one of the branches of the autovenous prosthesis developed in two (2.5%) patients, one (1.3%) of whom was subjected to high-level hip amputation. Arrosive bleeding was observed in five (6.4%) cases. Perioperative mortality amounted to 15.3% (12 patients). The remote results were evaluated in 62 patients during a 1-to-12-year follow-up period. Only one patient developed false aneurysms of distal anastomoses, which were operated on successfully. There was no long-term mortality.

Conclusion: Thus, the method of removing an infected synthetic bifurcation graft in the aortoiliac position with simultaneous autovenous redo prosthetic repair using femoral and internal jugular veins can be considered as a method of choice of surgical treatment in patients with suppuration of bifurcation prostheses. Editor's comment. The Editorial Council draws the reader' attention to the fact that this work is a continuation of a multi-year study of surgical treatment of patients with suppuration of a synthetic bifurcation prosthesis in the aortoiliac position, analyzing the results of operations performed using the same technique.

We evaluated multiple (use of both internal thoracic arteries) and single (use of one internal thoracic artery and the great saphenous vein) autoarterial bypass grafting in patients with an isolated lesion of the basin of the left coronary artery. In order to compare patients, we performed propensity score matching by the parameters having differences. Thus, the study consisted of two groups of patients: Group 1 (n=521) subjected to total myocardial revascularization using both internal thoracic arteries and Group 2 (n=521) undergoing shunting using one internal thoracic artery and the great saphenous vein. For differential diagnosis of relapse of angina pectoris in the remote period, coronary bypass angiography was performed in 169 patients. Occlusion of arterial shunts during a follow-up period of up to 13 years was revealed in 35 (14.3%) patients and that of venous shunts in 27 (30%) patients (log-rank = 0.043). With the help of a telephone survey or the data of repeat visits to the polyclinic, we assessed survival of patients after coronary bypass surgery. In the remote period, 56 (11%) Group 1 patients and 72 (14%) Group 2 patients died of cardiovascular pathology (log-rank = 0.045). Over the 13-year follow-up, acute cerebral circulation disorders were diagnosed in 31 (6%) and 35 (7%) cases in Group 1 and Group 2, respectively (log-rank = 0.456). The obtained findings suggest that multiple autoarterial bypass grafting ensures better results of coronary revascularization in the remote period of follow-up.

Currently, a patient with significant stenosis of the carotid bifurcation can be offered both open and endovascular reconstruction. Potential complications after an open operation on carotid arteries include myocardial infarction, ischemic or hemorrhagic stroke of the brain, transient disorders of cerebral circulation, postoperative hematomas with compression of cranial nerves or respiratory organs. One of the starting points in the development of these complications is a significant increase in arterial pressure in the early postoperative period. One of the techniques of performing an open operation aimed at preventing postoperative hypertension is sinus-sparing eversion carotid endarterectomy. A peculiarity of this procedure consists in changing the geometry of arteriotomy followed by cutting off the internal carotid artery. Thus, the sinocarotid zone remains intact. The use of such a modification makes it possible to achieve more manageable parameters of arterial hemodynamics, thereby preventing the development of persistent postoperative arterial hypertension and, accordingly, the complications described above.

Background: One of the main problems of hybrid interventions on lower extremity arteries with obliterating atherosclerosis is the decision-making as to the stages of manipulations within one operation.

Objective: This study aimed to improve the results of treating patients with lower limb critical ischemia by means of determining the sequence of stages of hybrid operations for lesions of the aortoiliac segment.

Patients and methods: Our study involved 226 patients who underwent hybrid surgery for critical lower limb ischemia at the Vascular Department of the City Clinical Hospital № 29 from 2018 to 2023. They were divided into 2 groups: Group 1 comprised 152 patients who underwent open intervention on femoral arteries as the first stage of a hybrid operation and Group 2 included 74 patients who underwent stenting of iliac vessels as the first stage. In order to retrospectively substantiate the sequence of stages of the hybrid operations, we used a mathematical model consisting in comparing the calculated total minimal diameter (d) of the lumens of the cross section of the femoral vessels, which would correspond to the clinical picture of critical limb ischemia, with the real one determined by means of CT angiography (dCT). The obtained data were statistically analyzed using the SPSS Statistics 17.0 software.

Results: In Group 1, the immediate success of arterial reconstruction was noted in 144 (94.7%) patients, with in most cases d>dCT and d=dCT, as assessed retrospectively. In Group 2, the success was achieved in 69 (92.6%) patients, with the retrospective analysis showing ddCT and d=dCT, more frequently encountered were those with relapse of critical ischemia, a history of a large number of re-operations, and amputations (p<0.0005). Group 1 patients with the ratio d

Conclusion: The proposed mathematical model for determining the phasing of a hybrid operation on lower-limb arteries is effective in drawing up a plan of surgical intervention. When d>dCT and d=dCT, it is more effective to perform the open stage first, and when d

A secondary aortoduodenal fistula is a rare, difficult-to-diagnose and often fatal complication in aortic surgery. We herein describe a clinical case concerning surgical treatment of a male patient presenting with an aortoduodenal fistula manifesting as relapsing gastrointestinal bleeding 7 years after abdominal aortic aneurysm repair. Comparing the findings of a comprehensive examination (endoscopic and roentgenological) with the clinical picture and anamnestic data made it possible to avoid mistakes at the diagnostic stage, as well as to choose an appropriate method of surgical treatment, i. e., performing repeat prosthetic repair of the aorta via a thoracoabdominal approach using a synthetic graft (silver-impregnated) with duodenal resection.

Even with the current pace of development of medicine, and cardiovascular surgery in particular, we regularly encounter untypical clinical situations when therapeutic decision-making poses a significant challenge. Presented herein is a clinical case concerning surgical treatment of a patient with an infrarenal aortic aneurysm and left pelvic kidney. The difficulty of the situation is that ischemia due to cross-clamping of the aorta may damage the kidney, with further transition to renal insufficiency. We proposed a modified methodology of the procedure, during which for the purpose of nephroprotection, the first stage consisted in prosthetic repair of the renal artery, to be only thereafter followed by aortic cross-clamping.

In early 2024, the updated ESVS guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries were published. A total of 160 recommendations were presented on the following topics: service standards, including surgical volume and training; epidemiology, diagnosis and screening; management of patients with small abdominal aortic aneurysms (AAA), including surveillance, cardiovascular risk reduction, and indications for treatment; elective AAA repair, including surgical risk assessment, open and endovascular surgery, as well as early complications; ruptured and symptomatic AAA, including perioperative management, such as permissive hypotension and use of aortic balloon occlusion, open and endovascular repair, as well as early complications; long-term results and follow-up after AAA surgery, including graft infection, endoleaks and subsequent procedures; management of complex AAA, including open and endovascular repair; treatment of iliac artery aneurysm, including indications for surgery; miscellaneous aortic problems, including mycotic, inflammatory and saccular aortic aneurysms. In addition, shared decision making is addressed, with supporting information for patients, and unresolved issues are discussed. Conclusion. The ESVS Clinical Practice Guidelines provide the most comprehensive, up-to-date, and unbiased advice to clinicians and patients on the management of AAA and iliac aneurysms. This article is an attempt to compare approaches to the treatment of patients with AAA under modern conditions in the Russian Federation to the concept proposed by the ESVS, with the aim of accelerating the development of domestic stent grafts.