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

Transjugular Intrahepatic Portosystemic Shunting (TIPS) is a minimally invasive interventional radiology procedure that demonstrates high efficacy in reducing the portocaval pressure gradient. However, despite the effectiveness of this technique, clinical practice reveals cases of shunt dysfunction manifesting as stenosis or thrombosis due to various causes (leakage of thrombogenic bile into the stent lumen, intimal hyperplasia, prolapse of loose liver tissue, etc.). This may lead to recurrence of portal hypertension. In such cases, repeat endovascular intervention becomes both feasible and necessary to restore shunt patency. The article presents two clinical cases describing various endovascular techniques for correcting dysfunction of previously established portocaval shunts, aimed at reducing the portosystemic gradient.

False aneurysms of upper-limb arteries are rare pathological conditions in vascular surgery. They are typically caused by various injuries, more often iatrogenic, after endovascular interventions. These pseudoaneurysms can be complicated by ruptures, compression of nerves and nerve plexuses, as well as embolization of the distal arterial bed with the development of limb ischemia. In this article, we summarize the experience of surgical treatment of false aneurysms of upper-limb arteries and describe two clinical case reports of successful surgical management of giant pseudoaneurysms of the brachial and axillary arteries.

Objective: To evaluate the effectiveness of conservative therapy supplemented by administration of plasma-free autologous platelet lysate in treatment of patients with chronic critical lower-limb ischemia if it was impossible to perform a reconstructive operation.

Patients and methods: This study is a continuation of our previously initiated research in the field of therapeutic angiogenesis using plasma-free autologous platelet lysate. Analyzed herein are the results of treating a total of 96 patients with critical ischemia of the lower extremities. The patients were divided into two groups: Group I included 49 patients who received standard conservative therapy supplemented by administration of plasma-free autologous platelet lysate and Group II consisted of 47 patients who underwent standard conservative therapy. We assessed such alterations as relief of rest pain, limitation of the necrosis zone, and epithelization of trophic ulcers. Besides, we analyzed the findings of three-phase scintigraphy assessing changes of microcirculation accompanied by an increase in the radiopharmaceutical elimination index because namely this parameter is most sensitive in critical ischemia. The duration of the follow-up period was 12 months, with interim examinations carried out at 6 months.

Results: The groups had no statistically significant differences in the main clinical and demographic indicators (p>0.05). A decrease in trophic ulcers was noted in 32 (65.3%) Group I patients and in 23 (48.9%) Group II patients, p=0.031; rest pain relief was noted in 25 (51.0%) Group I patients and in 17 (36.2%) Group II patients, p=0.024. In a number of Group I patients, three-phase scintigraphy performed again at 12 months showed improvement in tissue blood flow and an increase in the radiopharmaceutical elimination index. The amputation rate was higher in Group II (4.1%) than in Group I (2.0%), p=0.031, with no lethal outcomes observed.

Conclusion: In inoperable patients with chronic critical ischemia of the lower extremities, complex conservative therapy supplemented by administration of plasma-free autologous platelet lysate demonstrated better results than standard therapy over a 12-month follow-up period.

Objective: To study perioperative results of minimally invasive direct coronary artery bypass grafting (MIDCAB) off-pump in treatment of patients with ischemic heart disease (IHD).

Patients and methods: Our retrospective single-center study included a total of 1366 patients operated on during the period from September 2012 to September 2024 at the Federal State Budgetary Institution 'Federal Center for High Medical Technologies' (Kaliningrad). All patients underwent coronary bypass grafting (CBG) of the anterior descending artery (ADA) according to the MISCAB technique. There were 1054 (77.1%) men and 312 (22.9%) women. The mean age of the patients amounted to 66.1±16.4 years. Prior to surgery, functional class II angina of effort was diagnosed in 422 (30.9%) patients and FC III angina in 811 (59.4%) patients. 865 (63.3%) patients had a history of myocardial infarction. Lesions of the brachiocephalic arteries were detected in 194 (14.2%) patients and lesions of the low-limb arteries in 188 (13.7%) patients. 701 (51.3%) patients underwent hybrid interventions and 14 (1%) were subjected to subclavian coronary artery bypass grafting. Risk stratification was assessed by the EuroSCORE scale, amounting to 2.2±1.1%. We analyzed such perioperative parameters as early mortality, postoperative complications, and the immediate results.

Results: All 1366 patients underwent CABG via left anterolateral thoracotomy off-pump (MIDCAB). Of these, in 701 patients CABG was performed as a stage of hybrid intervention. The average length of stay in intensive care unit and that of hospital stay amounted to 1.1 and 6.1 days, respectively. The early postoperative period in 17 (1.2%) patients was complicated by hemorrhage, requiring wound revision. 32 (2.3%) patients developed cardiac arrhythmia as atrial fibrillation relieved medicamentally. Surface suppuration of the postoperative wound occurred in 9 (0.7%) patients. The in-hospital mortality rate amounted to 0.7% (9 patients).

Conclusion: The MIDCAB technique is feasible 'on stream' and is associated with satisfactory immediate results in treatment of CAD patients of various age categories, with severe accompanying pathology, as well as in repeat patients. MIDCAB can be used in both an isolated lesion of the ADA and in a multi-vessel lesion as a stage of hybrid intervention. For further study of the technique, it is necessary to conduct prospective randomized trials and to examine long-term results.

Presented herein is a clinical case concerning endovascular surgical treatment of a male patient having developed a paraprosthetic pseudoaneurysm of the proximal anastomosis 2 years after previously performed aortofemoral bifurcation repair for an infrarenal abdominal aortic aneurysm. The preoperative preparation was followed by endovascular prosthetic repair of the false aneurysm of the proximal anastomosis in the juxtarenal portion of the aorta. The postoperative period was uneventful with no complications, and the patient was discharged in a satisfactory condition on POD 9. During the period of follow-up in the hospital and at the outpatient stage 20 months, he reported no complaints, leading an active lifestyle. The control contrast-enhanced multislice computed tomography at 12 months after stent graft implantation revealed that the pseudoaneurysm was excluded from the circulation, with the visceral arteries contrasted satisfactorily. This clinical case demonstrates a significant progress in relation to minimally invasive treatment of complications of open surgical interventions on the abdominal aorta.

Background: According to the periodical press of the 19th century, there were very few studies devoted to the history of the origin of vascular surgery (operations of venous suture, arterial suture and cardiorrhaphy) in Russia.

Objective: This study was aimed at determining the precedence of first operations of venous suture, arterial suture and heart suturing in Russia based on publications in the periodical press in the 19th century.

Materials and methods: Presented herein are reports of Russian surgeons regarding operations of vascular suture, arterial suture and cardiorrhaphy published in the periodical press in the 19th century. These publications were analyzed using historical, evolutionary-chronological and comparative methods.

Design: retrospective study.

Results and discussion: We performed a comparative content analysis of 3 articles by Russian surgeon I.F. Sabaneev published in the periodical press (journal 'Medical Review', 1890, 1894; journal 'Russian Surgical Archives', 1895). A conclusion was made that I.F. Sabaneev should be considered a pioneer of not only restorative vascular surgery in Russia (venous suture operation and the first arterial suture operation) but also one of the world leaders performing cardiorrhaphy in experiment (third in the world operation of heart suturing in a rabbit).

Conclusion: Owing to I.F. Sabaneev's works in vascular surgery in 1895 in Russia, the paradigm of inevitability of ligation of a diseased or injured vessel was replaced by a new paradigm, i. e., possibility and necessity of restoring the vessel's integrity with preservation of main blood flow. And namely the arterial suture operation became the last step on the way to cardiorrhaphy.

Objective: To develop a safe technique of visualizing the abdominal aorta during endovascular aortic aneurysm repair (EVAR) using an alternative contrast agent - medical carbon dioxide (CO2).

Patients and methods: In 2023-2024, a total of nine 58-to-74-year-old male patients underwent EVAR under the guidance of medical carbon dioxide (CO2). Six patients were preoperatively diagnosed as having chronic kidney disease (CKD).

Results: The technical success of EVAR using medical carbon dioxide (CO2) alone was achieved in 7 patients (77.8%). In 2 patients (22.3%), due to insufficient imaging, we were forced to use combined angiography (CO2 + iohexol). The average amount of injected carbon dioxide in the first group per patient was 350±50 cm3, with the average amount of injected iohexol in the second group of patients equaling 20±5 ml. None of the patients in both groups with CKD required hemodialysis or additional hydration therapy. The parameters of renal markers before and after carboxygraphy did not change.

Conclusion: Medical carbon dioxide (CO2) can be safely and effectively used as a contrast agent during EVAR in patients with CKD.

Objective: This study aimed to assess the remote results of endovascular radiofrequency denervation (ERD) of renal arteries in patients with resistant arterial hypertension (AH).

Patients and methods: The study lasted 10 years. At the first stage, from a total of 284 patients with resistant AH we selected 13 patients to undergo ERD of renal arteries. These were patients who had: 1) all possible 'surgical' causes of AH ruled out; 2) clearly defined AH resistant to 4-component therapy; 3) resistance of AH confirmed only by means of 24-hour ambulatory blood pressure monitoring (ABPM). ERD was carried out using a high-frequency generator. Ablation was achieved by a Symplicity catheter with energy power supply not exceeding 8 W. The remote results of ERD of renal arteries were assessed during a period of up to 120 months. Assessment criteria: a possibility of achieving the target level of BP and pressure decrease gradient in the postoperative period.

Results and discussion: Over a 5-year follow-up, we registered reliable persistence of decreased levels of the average 24-hour systolic BP (from 217.9±24.7 to 144±8.76 mm Hg, p<0.05) and diastolic BP (from 108.2±8.7 to 91.4±13.8 mm Hg, p<0.05), as well as the time index of elevated systolic BP (from 78.2±14.6 to 49.8±29.6%, p<0.05). During 10 years of follow-up, nine (70%) patients were found to have stage 1 AH and the target level of BP on the background of minimal doses of antihypertensive drugs, as confirmed by the findings of 24-hour ambulatory blood pressure monitoring. None of the operated patients during the follow-up period after ERD demonstrated episodes of progression of heart failure.

Conclusion: With strictly defined indications for endovascular radiofrequency denervation of renal arteries, this procedure is followed by a decrease in BP and stabilization of AH for up to 10 years of the postoperative period.

Objective: To comparatively analyze early results of surgical treatment of patients with aneurysms of the ascending aorta in normal and variant anatomy of the brachiocephalic trunk.

Patients and methods: Our retrospective study included a total of 259 patients operated on for ascending aortic aneurysms. Depending on the anatomy of the brachiocephalic trunk (BCT), the patients were divided into two groups. Group I consisted of 202 patients with normal anatomy of the BCT and Group II comprised 57 patients having variant anatomy of the BCT, with the BCT and left common carotid artery originating from the aorta in a solitary-ostium manner. We analyzed both intra- and postoperative data.

Results: The duration of artificial circulation and circulatory arrest with antegrade cerebral perfusion was comparable in patients of both groups. Analyzing the course of the postoperative period revealed 11 (5.4%) neurological events in Group I patients and 2 (3.5%) neurological events in Group II patients (p=0.542). Prolonged pulmonary ventilation was required in 14 (6.9%) Group I patients and in 1 (1.7%) Group II patient (p=0.142); resternotomy for hemorrhagic complications was required in 6 (2.9%) and 4 (7.01%) Group I and Group II patients, respectively (p=0.170). Hospital mortality in Group I amounted to 7 (3.4%) patients, with no lethality in Group II (p=0.152).

Conclusion: The anatomical structure of the brachiocephalic trunk is not a factor influencing the result of prosthetic repair of the ascending aorta ('hemiarch').

Therapeutic angiogenesis is a method of inducing neovascularization in ischemized tissues. The consensus of Russian experts presents the relevant information on the history and state of the art of using the method of therapeutic angiogenesis in vascular surgery, particularly the possibilities of gene engineering on the example of the only registered in the Russian Federation drug containing in its composition plasmid supercoiled deoxyribonucleic acid carrying the gene encoding vascular endothelial growth factor under control of promoter pCMV VEGF165. The current consensus determines the place of gene therapeutic angiogenesis in treatment of patients with occlusive lesions of lower-limb vessels from the position of evidence-based medicine.