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

According to the data of various statistical studies, 76% of patients with occlusion of the aortoiliac arterial bed are found to have lesions of the femoropopliteal segment. Surgical treatment of patients presenting with multi-layered atherosclerotic lesions still remains one of the most complicated problems of vascular surgery, since adequate revascularization of lower limbs requires correction of the inflow and outflow pathways. In the early postoperative period in patients with lower limb ischemia with multilevel lesions, as well as while performing conventional open reconstructions on the aortoiliac segment, the complication rates still remain high. Presented in the article are the results of a single-center randomized study comparing a hybrid procedure and aortofemoral bypass grafting for lesions of iliac arteries and the common femoral artery. All patients were enrolled into the study according to inclusion and exclusion criteria. The duration of follow up amounted to 24 months. The obtained findings demonstrated safety of the hybrid procedure in the early postoperative period, as well as a shorter length of hospital stay. High efficacy of hybrid operative interventions: clinical improvement in 92-98% of cases with low incidence of postoperative complications make promising the development of this direction of reconstructive vascular surgery in this cohort of patients as compared with aortofemoral bypass grafting. Our study was aimed at revising the guidelines on endovascular treatment of TASC II type C/D lesions of the aortoiliac segment, as well as implementing hybrid techniques in treatment of this cohort of patients.

Objective: The aim of the study was to assess efficacy of a new method of cyanoacrylate obliteration of veins, analyzing immediate and remote results.

Patients and methods: The primary endpoints were the pain intensity during surgery (as assessed by the visual analogue scale), occlusion of the vein and severity of the venous disease according to the Venous Clinical Severity Score at various terms. The results were analyzed during the first 10 days after manipulation and then after 1, 3, 6, 12 and 24 months. This study included 37 patients who from October 2018 underwent cyanoacrylate obliteration of veins according to a new technique on a total of 44 lower extremities.

Results: We performed 41 manipulations on the great saphenous vein (93.2%) and 3 on the small saphenous vein (6.8%). The diameter of the target vein ranged from 0.3 to 1.0 cm (mean 0.63 cm), with the length varying from 10 to 50 cm (mean 30.9 cm). We used from 0.2 to 1.6 ml (mean 0.76 ml) of glue composition 'Sulfacrylate'. The average pain level was 1.6 (minimum - 1, maximum 4) according to the visual analogue scale. In the early postoperative period, there were no serious complications. The most frequent complication of the early period was cyanoacrylate phlebitis having appeared on POD 3-4. During the first 10 days, complete occlusion was observed in 100 % of cases. The occlusion rate at 1 month, 3 months, 6 months, 12 months and 24 months amounted to 93.2%, 86%, 90.2% and 84.6%, respectively, with no clinical relapses observed.

Conclusion: The technique of vacuum-assisted glue obliteration of veins using Russian-made glue composition 'Sulfacrylate' proved safe and effective. Further studies are warranted for accumulation of experience and follow up of remote results.