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

Despite rapid development of vascular and endovascular surgery, the rate of amputation remains high even in developed countries. Major amputations are performed in 20-40% of patients with critical ischemia. In conditions of failure or impossibility of vascular reconstruction in the absence of a distal arterial bed, some teams of specialists use various methods of indirect revascularization. Based on the literature sources, the article provides a brief overview of such methods, assesses their applicability and effectiveness, substantiates the concept of free flap indirect revascularization of the limb in critical ischemia.

Objective: To assess efficacy of a method of modified open reconstruction of femoral and crural arteries in the absence of an autovein suitable for revascularization.

Patients and methods: The study included a total of 78 patients subjected to open arterial reconstruction. The duration of the postoperative follow-up amounted to 36 months and more. The patients were divided into 3 groups: Group 1 comprised 18 patients who underwent amodified operation including popliteal distal bypass grafting with an autovein and retrograde (or antegrade) semiclosed loop endarterectomy from the superficial femoral artery; Group 2 was composed of 29 patients subjected to classical femoropopliteal bypass grafting with a reversed great saphenous vein below the knee-joint fissure; and Group 3 consisted of 31 patients who endured X-ray endovascular reconstruction including balloon angioplasty with possible stenting of the superficial femoral artery and popliteal artery.

Results: Primary patency of the arterial bed at 1, 2 and 3 years of follow-up in Group 1 amounted to 80.9% (out of 21 patients), 75% (out of 20 patients) and 72.2% (out of 18 patients), respectively. Secondary patency after 3 years was 100%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 1 amounted to 90.4% (out of 21 patients), 85% (of 20 patients) and 88.8% (out of 18 patients), respectively. Primary patency at 1, 2 and 3 years of follow-up in Group 2 was 81.3% (out of 33 patients), 76.6% (out of 33 patients) and 68.9% (out of 29 patients), respectively. Secondary patency after 3 years amounted to 80%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 2 were 87.87% (out of 33 patients), 86.6% (out of 30 patients) and 86.2% (out of 18 patients), respectively. Primary patency of the arterial bed at 1, 2 and 3 years of follow-up in Group 3 amounted to 83.7% (out of 37 patients), 64.7% (out of 34 patients) and 48.3% (out of 31 patients), respectively. Secondary patency after 3 years was 90%. The limb salvage rates at 1, 2 and 3 years of follow-up in Group 3 amounted to 89.1% (out of 37 patients), 85.2% (out of 34patients) and 83.87% (out of 31 patients), respectively.

Conclusion: Performing modified open arterial reconstruction by means of the proposed method makes it possible to restore blood flow in the ischemized extremity with a long occlusive lesion of femoral and crural arteries. The remote results (36 months) are suggestive of efficacy of the developed technique.

Introduction: Currently, there is a significant arsenal of means for restoring blood flow in occlusive lesions of limb arteries. The great saphenous vein is recognized to be an optimal material. Traditionally during computed tomography angiography, we perform visualization of only the arterial bed, leaving the venous subcutaneous system unexamined. In our work, we demonstrated the use of volumetric 3D multislice spiral computed tomography (SCT) imaging as an objective and minimally time-consuming method of preoperative assessment of the great saphenous vein as a would-be conduit. It was shown that this method of diagnosis is of particular value in difficult situations such as formation of arteriovenous anastomoses while creating an access for hemodialysis, distal reconstructions of lower-limb arteries, repeat reconstructions of limb arteries.

Objective: To propose and substantiate the use of the method of volumetric 3D MSCT for verifying the state of lower-extremity subcutaneous veins in preliminary planning of the course of reconstruction of major arteries using limb saphenous veins.

Patients and methods: The standard SCT-angiography in the framework of a single study was supplemented by extended slice-by-slice visualization of soft tissues and examination of the subcutaneous venous network. Such an approach made it possible to preoperatively measure the diameter and length of the vein, to determine the dimensions and number of its tributaries. The obtained diagnostic information allows it to more reliably assess the possibility of using the great saphenous vein for reconstructive operation or reject it as a conduit. When planning in situ bypass, we applied this method of diagnosis to assess localization of large tributaries. This method was used in a total of 55 patients: 36 reconstructions on lower limbs, 4 - on upper limbs, 12 - in patients on hemodialysis and 3 - in reconstructions of visceral arteries.

Results: In all patients included into the study, the planning of the operation was adequate, comfortable and reliable.

Conclusion: The proposed method of visualizing subcutaneous veins based on layer-by-layer comparison of limb vessels turned out to be highly valuable from the point of view of precise planning of reconstructive operations using the great saphenous vein, especially in repeat reconstructions.

The incidence of aortic dissection varies from 3 to 10 cases per 100.000 people. According to the International Registry of Acute Aortic Dissection (IRAD), type B aortic dissection accounts for 33%. The mean age of these patients is 63 years, with two thirds of them being males. The past two decades have witnessed an increase in the use of thoracic endovascular aortic repair (TEVAR) and hybrid methods of treatment from 7 to 31%, with a decrease in the proportion of open operations from 17 to 8%. In the current guidelines of the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) as of 2024, TEVAR is considered a first-choice treatment procedure in patients with complications (class IB) in the acute phase and in high-risk patients (class IIa C) in the subacute phase. The main task of TEVAR is to close the proximal primary tear of the aortic intima, to exclude the false channel from blood flow, to initiate thrombosis of the false channel and dilatation of the true one. During TEVAR, there is a possibility of developing a specific complication, i. e., the formation of distal stent-graft induced new entry (dSINE). The mechanism of its development is multifactorial, with an important role given to fragility of the damaged aortic wall, rigidity of the stent graft, as well as the tendency of the graft to return to its original straight shape. The publications devoted to this subject in the literature are scarce. This complication occurs in 9.72-36.6% of patients. Mortality can reach 25%. Most authors make a choice in favor of repeat endovascular intervention. In this clinical case report, we describe surgical treatment of a 35-year-old male patient with acute type B aortic dissection after the development of dDINE within 1 month after emergency TEVAR. After TEVAR, the proximal fenestration was closed, with the development of thrombosis of the false lumen. However, the patient on the background of poorly controlled arterial hypertension developed a series of life-threatening complications. Performing an open operation on the thoracoabdominal aorta resulted in regression of spinal disorders and sustained clinical improvement.

Background: Arteriovenous malformations (AVMs) are the most aggressive type of vascular malformations. They are characterized by a progressive and relapsing course, as well as by a high number of clinically significant complications. Over the past two decades, endovascular treatment of AVMs has advanced rapidly, thanks to improvements in angiographic classification, treatment approaches, and embolization materials and tools. However, due to the rarity of the condition, large-scale studies reporting clinical outcomes of embolization for AVMs remain limited. Besides, the contemporary literature lacks uniformity in defining the outcomes that should be analyzed to evaluate treatment efficacy. For this reason, results from various clinical trials cannot be consolidated, complicating the development of evidence-based recommendations.

Objective: To analyze literature data and review recent studies describing treatment outcomes of peripheral AVMs.

Materials and methods: This study analyzed over 170 full-text English- and Russian-language publications from the past 10 years, sourced from PubMed, Google Scholar (English-language databases), eLibrary and the Russian Science Citation Index (RSCI, Russian-language databases). The publications cover various aspects of the management, diagnosis, and treatment of patients with peripheral AVMs.

Results: The currently available data on the definition, prevalence, and treatment of AVMs were systematized and presented herein. A structured table summarizing the findings of recent studies on endovascular treatment of peripheral AVMs is provided. This is followed by discussing the key trends and challenges in the research and management of this pathology.

Conclusion: Most of recent domestic and foreign publications on endovascular treatment of peripheral AVMs are case reports or case series. The high recurrence rates and need for multi-stage treatment underscore the importance of advancing embolization methods and technologies. International literature increasingly includes studies with larger patient cohorts, though most remain retrospective and single-center. Research focuses on outcomes of using various embolic agents and combining endovascular with surgical approaches. The universal use of transarterial, transvenous and percutaneous embolization methods or their combinations has proven its usefulness and effectiveness. Advanced surgical experience, technical tools and a wider range of embolic agents now allow previously impossible interventions to be performed, improving quality of life or achieving complete cure even in extensive, severe cases.

Objective: The purpose of the study was to compare safety and efficacy of endovascular treatment (EVT) and hybrid repair (HR) using 'Supera' stents in patients with combined lesions of the iliac arteries and common femoral artery.

Patients and methods: This pilot randomized study was registered on ClinicalTrials.gov (identifier: NCT03315884). The patients in the EVT group after recanalization and balloon angioplasty of the iliac arteries and common femoral artery underwent throughout stenting. The HR-group patients were subjected to recanalization and stenting of the iliac arteries in combination with endarterectomy from the common femoral artery and angioplasty with a xenopericardial patch. We compared short-term (30-day) and one-year results, including complications and patency rates.

Results: A total of 62 patients were randomized into two equal groups (31 EVT and 31 HR). The average length of the hospital stay in the EVT-group patients amounted to 3.9±1.2 days vs 7.9±2.7 days in the HR group, p=0.001. 30-day complication rates were 9.7% and 22.6% in the EVT and HR groups, respectively, p=0.17. Primary patency was 81% in the EVT group and 94% in the HR group, p=0.12. There were no statistically significant differences in secondary and primary assisted patency during 12 months, with no myocardial infarction, lethal outcomes, nor amputation.

Conclusion: The findings of this pilot randomized trial demonstrated safety and one-year efficacy of EVT in patients with tandem lesions of the iliac and common femoral arteries. The EVT-group patients showed a shorter length of hospital stay, a tendency toward a decrease in perioperative complications, and comparable to HR parameters of primary patency within 12 months.

Despite good results of using retrograde recanalization techniques (retrograde access, transcollateral technique) in a failed antegrade endovascular intervention, in some cases their use is impossible or associated with certain risks. Therefore, in rare instances it is feasible to use 'exotic' techniques. Presented herein is a clinical case report of successful use of antegrade pedal access in the situation of failed antegrade endovascular revascularization of the foot in a patient with chronic limb-threatening ischemia.

Background: Critical lower limb ischemia (CLLI) is an unfavorable prognostic factor in patients from the point of view of both limb loss and mortality. Endovascular operations for this pathology have gained wide acceptance. However, these operations are associated with administration of a liquid iodine-containing contrast agent (ICA) for visualization of arteries. Many such patients have accompanying pathology (chronic kidney disease, diabetes mellitus, etc.) and during angiography with a high dose of ICA there is a risk of developing contrast-induced nephropathy. That is why working with patients having many concomitant diseases and a high risk of nephropathy it is important to use 'gaseous' contrast media: carbon dioxide can be used as a contrast agent. Medical carbon dioxide does not possesses nephrotoxicity, causes no allergic reactions and is excreted naturally through the alveoli of pulmonary tissues. Using automatic injector Angiodroid for administration of carbon dioxide makes it possible to decrease the degree of patient's discomfort, because owing to smoothness of injections and pressure control the pain syndrome disappears almost completely.

Objective: To assess efficacy of using CO2-angiography in treatment of a patient with CLLI, diabetic foot syndrome and stage IV chronic kidney disease.

Patients and methods: Presented herein is a clinical case report of successful endovascular treatment of a male patient with CLLI, diabetic foot syndrome and stage IV chronic kidney disease using carboxyangiography.

Results and discussion: CO2-angiography exhibited good quality during endovascular balloon angioplasty in the patient with CLLI, diabetic foot syndrome and stage IV chronic kidney disease.

Background: High-flow arteriovenous malformations (AVMs) have long been considered by neuroradiologists as a target for embolization with adhesive embolizing materials based on N-butyl-cyanoacrylates (Glubran, Histoacryl).

Objective: The aim of this study was to evaluate the prospects of using adenosine triphosphate-induced cardioplegia during embolization of high-flow malformations or AVMs containing a hypertrophic shunt in the structure with non-adhesive embolizing materials.

Patients and methods: The study included 100 patients presenting with high-flow AVMs and operated on in 2018-2023. Of these, 83 patients had malformations corresponding to Spetzler-Martin grade III-V. The epileptic type of the course was dominant in 45% of patients, and among SM grade V AVMs, 10 patients out of 19 suffered hemorrhage. A total of 100 operations on embolization of high-flow malformations were performed. The key condition for the success of the operation was the provision by the anesthesiology team of prolonged (10-20 seconds) adenosine triphosphate-induced cardioplegia at the initial stage of AVM embolization. Not only the risk of embolizate migration directly through the high-flow shunt into the drainage veins and cerebral sinuses was minimized, but also the effect of 'hemodynamic calm' appeared, when non-adhesive embolizing material encountering no resistance filled the shunt and all compartments of the malformation as evenly and completely as possible. After that, with the heart rhythm restored, embolization was continued according to the operation plan.

Results: We operated on a total of 100 patients (58 men, 42 women, mean age 41.2 years), performing 100 procedures on the background of adenosine triphosphate-induced cardioplegia (1 mg/kg body weight). In 89 patients, we managed to attain complete asystole lasting from 5 to 35 seconds. In nine patients, we achieved pronounced bradycardia and arterial hypotension, in which the conditions of embolization of high-flow malformations practically corresponded to those on the background of complete asystole. No migration to cerebral veins and sinuses was noted. If necessary, adenosine triphosphate-induced cardioplegia was used more than one time. In 86 patients - once, in 11 patients - twice, in 2 patients - thrice and in 1 patient - four times. No events of tachyphylaxis, pronounced arrhythmia and cardiac dysfunction were observed during either surgery or 24-hour postoperative monitoring.

Conclusion: Adenosine triphosphate-induced cardioplegia is an effective, repeatable and safe technique allowing it to perform controlled embolization of high-flow arteriovenous malformations, requiring neither additional devices nor special skills, with no need to form a combination of various-viscosity embolizates to disconnect high-flow shunts.