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

Mid-aortic syndrome is a condition characterized by obstructive lesions of the thoracoabdominal aorta, occurring in approximately 0.5-2% of cases. This report presents the long-term outcomes of a clinical case involving transcatheter treatment of mid-aortic syndrome in a child. At an early age, the patient underwent recanalization of an occluded thoracoabdominal segment, followed by staged balloon angioplasty and implantation of an Advanta V12 OTW 9×59 mm stent-graft (Getinge Group, Sweden). After the initial procedure, the patient was followed up over a 3-year period. During a routine hospitalization, an increase in the peak pressure gradient between the upper and lower extremities up to 30 mmHg was noted, along with a stenosis of the mid-portion of the stent-graft to 3.3 mm in diameter. Due to the evolving clinical presentation, a decision was made to perform repeat endovascular intervention. A Visi-Pro stent (Medtronic Corp., USA), 9×17 mm in size was implanted at the site of maximum stenosis followed by sequential balloon angioplasty. Control angiography revealed moderate residual stenosis with a luminal diameter of 7.5 mm and a peak gradient of 10 mmHg. Antiplatelet therapy (acetylsalicylic acid) and antihypertensive therapy (enalapril) were prescribed. The patient was discharged in satisfactory condition on postoperative day 5. Transcatheter techniques do not always achieve complete elimination of the stenotic area and require close follow-up due to the risk of neointimal hyperplasia. Nevertheless, the endovascular approach to palliative correction of mid-aortic syndrome allows the child to reach an optimal age for definitive surgical repair while reducing the need for repeated open procedures.

Sclerotherapy firmly holds a leading position in the treatment of malformations, as it is effective, minimally invasive, and in many cases, can be performed on an outpatient basis under local anesthesia. The advantages of sclerotherapy include minimizing risks and postoperative complications, creating optimal conditions for sclerosing agent-induced regression of pathological venous conglomerates, a short and uneventful postoperative period, and last but not least enabling outpatient treatment. The improved quality of life resulting from the reduction or elimination of pain and the restoration of functional activity of the maxillofacial region positively impacts the patients' overall somatic and aesthetic state, as well as their mental health.

The article presents a clinical observation of successful treatment of a patient with post-thrombotic occlusion of the subclavian artery and critical ischemia of the left upper limb. According to computed tomography angiography, extravasal compression of segment 2 of the subclavian artery by an additional cervical rib was detected. Decompression of the subclavian artery with resection of the additional cervical rib, thrombectomy, and angiography were urgently performed via the left supraclavicular approach. Blood flow to the limb was restored, and no additional endovascular procedures were required. Regression of the clinical picture of critical ischemia was noted in the postoperative period.

The article presents a clinical observation of successful multi-stage surgical treatment of a patient with severe cardiac insufficiency aggravated by long-standing posttraumatic arteriovenous fistula of the brachial artery. Additionally, during the examination, the patient was found to have significant stenotic lesions of both carotid arteries. This combination of pathological factors in one patient required a multidisciplinary discussion of surgical treatment tactics and has not been described in the literature before.

Background: One of the main success factors in the treatment of patients with acute mesenteric ischemia is the timely diagnosis and the earliest possible start of treatment. The aim is to evaluate the diagnostic accuracy and specificity of computed tomography (CT) with intravenous contrast and X-ray contrast angiography in the diagnosis of acute mesenteric circulatory disorders.

Material and methods: The work was carried out on the basis of two multidisciplinary hospitals of the third level, which include departments of general surgery and cardiovascular surgery. The study included 93 patients with suspected acute abdominal ischemia. CT angiography was performed in 68 of them, X-ray contrast angiography was performed in 14 of them, X-ray CT preceded endovascular intervention in 8 patients, and acute mesenteric ischemia was detected only intraoperatively after laparotomy in 28 patients after preliminary X-ray contrast examination.

Results: The sensitivity of CT angiography was 72.6%, and the specificity was 80.2%. Due to the accuracy and the possibility of detailed visualization of the distal parts of the mesenteric bed, the sensitivity of endovascular interventions was 94.6%, and the specificity was 100%.

Conclusion: The use of X-ray contrast angiography is preferable in patients in stable condition with suspected acute mesenteric ischemia, regardless of the severity of changes in the intestinal wall. CT angiography is an accessible and non-invasive research method, it is the primary diagnostic method in patients in order to identify complications of acute mesenteric ischemia, as well as the only method applicable in the absence of endovascular diagnostic methods in the clinic.

Background: Carotid endarterectomy (CEA) is an established method for stroke prevention in patients with significant carotid bifurcation stenosis. The carotid body (CB), a peripheral chemoreceptor located at the bifurcation, participates in the regulation of respiration and blood pressure. Whether the CB should be preserved during CEA remains a matter of debate, particularly in patients with atherosclerosis and resistant hypertension.

Objective: To study morphological and histological changes of the CB in patients with significant carotid artery stenosis and resistant arterial hypertension undergoing CEA.

Materials and methods: Thirty-four CBs were excised during unilateral CEA in patients with >70% internal carotid artery stenosis and resistant hypertension. Histological, immunohistochemical, and morphometric analyses were performed to quantify stromal, vascular, neural, and parenchymal components.

Results: The mean CB section area was 31.941 µm . The median number of lobules was 4. The ratio of functional parenchyma (lobules) to connective tissue was 1:2.08. Functional tissue accounted for ~30% of the CB area, whereas connective tissue comprised up to 62%. Morphological examination revealed lobular deformation, intralobular fibrosis, and vascular wall sclerosis. Despite preservation of lobule number, their size and structure showed marked involutional remodeling.

Conclusion: In patients with advanced carotid atherosclerosis and resistant hypertension, the CB exhibits profound involutional changes characterized by connective tissue expansion and loss of functional parenchyma. These findings suggest that CB preservation during unilateral CEA may be unwarranted, as its physiological role appears to be largely abrogated under chronic hypoxia.

Introduction: Endovascular thermal ablation techniques, such as endovascular laser or radiofrequency ablation (RFA), have become the standard of care for treating varicose veins. However, some patients may experience unpleasant sensations, such as a 'tourniquet' or 'string', in the area where the subcutaneous artery is obliterated. One way to reduce these adverse events is through the use of topical treatments, such as sodium heparin gel (1000 IU) and a combined preparation containing escin, heparin, and essential phospholipids. The aim of this study was to evaluate the clinical symptoms, frequency, and severity of the 'string' sensation in patients with varicose veins who underwent large saphenous vein ablation (LSVA), and to assess whether sodium heparin (1000 UI) or the combined preparation could alleviate these symptoms.

Material and methods: An open, randomized, prospective cohort study was conducted on 180 female patients aged 18-72 years (mean age 41.2±7.5 years) diagnosed with varicose veins of the lower extremities. The patients were divided into three groups: Group 1 underwent IVF without any additional conservative therapy; Group 2 received topical heparin (1000 IU) applied twice daily for two weeks after endovenous thermal ablation (EPR); and Group 3 received a topical medication containing escin, heparin, and essential phospholipids applied twice daily after EPO for two weeks.

Results: In the initial class of chronic venous disease, grade 3 according to the CEAR classification, a decrease in edema was recorded at the end of treatment in group 1 in 72.7% of cases, in group 2 - in 76.9% of cases and in group 3 - 91.7%, respectively. The differences between groups 3 (patients receiving a combination topical agent) and the other two were statistically significant (p<0.05). For grade 4 chronic venous diseases, a reduction in dermatitis symptoms was noted in group 3 in 83.3% patients compared to 50% and 57.1%, respectively, for groups 1 and 2. A decrease in induration of tissue was observed in 66.7% of patients in group three compared to 40%, in both group 1 and group 2. Healed ulcerative defects were noted in 60% of group 3 patients versus 33% and 25% in groups 1 and 2, respectively. Using a combination of topical agents, the number of 'string' symptoms decreased from 50.6% to 93.5%.

Conclusion: The symptom of 'string' after acute renal failure may occur 2 months after surgery in about 3-4% of patients on average. The use of topical agents containing a combination of venoactive drugs (escin), heparin, and essential phospholipids can help reduce the severity of this symptom.

Background: The frequency of injury of the limb major arteries in the era of continuous improvement of firearm types has a pronounced upward trend. There is an increase in the severity of injuries due to changes of damaging agents against the background of the growing number of armed conflicts in the world. Limb injuries occupy a leading position in the structure of war wounds and account for 46 to 74%. The formation of peripheral aneurysms and arteriovenous fistulas (AVFs) is an outcome of vascular trauma in 48.9-68.7% of cases. The lower extremities appear to be the most frequent localization of traumatic arteriovenous fistulas - 17%.

Objective: The aim of our study was to evaluate hemodynamic significance of blood flow disorders at local and systemic levels and related clinical manifestations in patients with verified gunshot traumatic limb arteriovenous fistulas depending on localization.

Patients and methods: The study included a total of 102 patients with injuries of the main vessels of the extremities complicated by the formation of traumatic AVFs. All patients with verified traumatic arteriovenous fistulas of the limb, in addition to standard methods of AVF visualization underwent echocardiography in the preoperative period in order to assess the negative influence on the central hemodynamics in the form of right heart overload, to evaluate the presence of pulmonary hypertension. Echocardiography was also performed in the early postoperative period (1-3 days) to assess hemodynamic changes after disconnection of the AVF.

Results: Negative effects on local hemodynamics were instrumentally verified in 100% of cases by ultrasound assessment, as well as by the findings of X-ray contrast methods, with clinical manifestations of limb AVF noted only in 57% of cases. Surgical disconnection of the AVF was followed by statistically significant (p<0.05) changes in the length and volume of the right atrium, pulmonary artery systolic pressure, mean pulmonary artery pressure and right ventricular outflow tract diameter.

Conclusion: Traumatic AVFs of the extremities within a period of up to one year from the moment of formation have a negative effect on central hemodynamics when localized on the upper limb only in the region of the axillary artery, when localized on the lower limb - only in the region of the common femoral artery. Traumatic AVFs located more distally have no effect on central hemodynamics during 1 year.

Background: Retrograde aortic dissection of type A is the most dangerous and difficult-to-predict complication of thoracic aortic arthroplasty. In this complication, without timely surgical treatment, mortality in the first 48 hours may exceed 40%. The aim is to present the results of surgical treatment of patients with type A retrograde aortic dissection after thoracic aortic stenting.

Material and methods: From 2014 to 2024, 7 patients underwent open aortic arch replacement for type A retrograde aortic dissection after thoracic aortic arthroplasty. 3 patients underwent surgery in the early period, and 4 in the long-term period after stenting.

Results: There was no hospital mortality. In the early and late postoperative periods, neurological complications, the development of multiple organ failure, and malperfusion of internal organs were not noted. In the long-term follow-up period, 4 years after surgery, 1 patient died (aorto-unassociated mortality).

Conclusion: Emergency open surgery is the method of choice for type A retrograde aortic dissection after aortic arthroplasty. This approach leads to good early and long-term results. All patients with distal aortic dissection require lifelong monitoring for timely diagnosis of possible complications.