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

Presented herein is a clinical case report regarding endovascular thromboaspiration in acute upper limb ischemia having developed on the background of the novel coronavirus infection. A 66-year-old male patient had previously undergone in-hospital treatment for novel coronavirus pneumonia, to be discharged with clinical improvement. After discharge, the man by physician's recommendation continued taking rivaroxaban at a dose of 10 mg daily. Despite this, he developed acute thrombosis of the arteries of the forearm and hand. He was admitted to the City Clinical Hospital № 15 named after O.M. Filatov. The examination revealed a clinical picture corresponding to stage IIa acute upper limb ischemia. Anticoagulant and dual desaggregant therapy did not lead to regress of ischemia. The patient was subjected to thromboaspiration, with restoration of blood flow through upper limb arteries.

Objective: The aim of the study was to assess safety and reliability of using the MANTA closure device in endovascular treatment of patients with aortic aneurysms.

Patients and methods: The obtained results were retrospectively analysed based on the experience of treating 19 patients (from July 01, 2021 to November 31, 2021) for abdominal aortic aneurysms (n=14) and thoracic aortic pathology (n=5). All operations were performed at the Vascular and Endovascular Surgery Clinic, St. Katharine's Hospital, Frechen, Germany. In all cases, sheaths 9-14F were used for graft implantation. The primary endpoint of efficacy was technical success, with neither acute bleeding nor thromboembolic complications. In our study we used the MANTA closure device (Teleflex, Wayne, Pennsylvania), a novel device for closing percutaneous access to the femoral artery following the use of 10-20F (12-25F OD) devices or sheaths in endovascular catheterization procedures.

Results: Of the total number of patients, three had a dissection of the thoracic aorta, two penetrating aortic ulcer, in 14 cases aneurysm of the abdominal aorta. The mean age of the patients was 67±2.2 years. There were 16 males and 3 females. Of the 19 patients, bilateral access was used in 18 (37 inguinal approaches), in one case a monoiliac graft was implanted. The technical success of implantation of the MANTA closure device was 100%, with no conversion to open access to the femoral vessels. The findings of CT angiography confirmed neither complications in the area of the vascular access, nor stenosis of the access area requiring surgical treatment. Fourteen of the 19 patients underwent ultrasound duplex scanning of vessels in the access zone prior to discharge from the clinic, demonstrating no significant stenosis in the area of arterial closing.

Conclusion: The use of the MANTA CD closure device is safe and accompanied by good immediate results, however, further experience is needed with this device.

The article is devoted to analyzing the surgical and scientific activity of physician-in-ordinary privy councilor N.F. Arendt (1786-1859) in the field of angiology and vascular surgery and putting into scientific circulation his article published in 1823 in the first issue of the 'Military Medical Journal'. The content analysis of the article revealed that N.F. Arendt was one of the first in Russian literature to describe arteriovenous malformation and its surgical treatment by ligation of the common carotid artery. It was also shown that for the first time in Russia N.F. Ardent performed ligations of the external iliac and subclavian arteries, brachiocephalic trunk, constructed and introduced into practice an instrument for applying ligations onto vessels, also publishing several scientific works dedicated to vascular surgery. N.F. Arendt's priority achievements significantly contributed to the development of angiology and vascular surgery in Russia.

This article is a review discussing neural networks used in the field of intravascular ultrasound examinations and performing functions of automatic identification of unstable plaques, isolation of vascular walls, prediction of the fractional flow reserve. Based on the analysed material, it was determined that neural networks in the field of ultrasound studies are currently an emerging and actively developing trend of intravascular imaging. In case if it is possible to achieve the human-comparable accuracy of the obtained results and to prove them in direct comparison in a clinical trial it could lead to decreasing the cost and increasing the rapidity of performing a percutaneous coronary intervention. We also believe that in future it will be possible to combine the algorithms of automated detection of unstable plaques and prediction of fractional flow reserve, thus unifying intravascular ultrasound examinations for many clinical situations.

Atherosclerosis of the lower extremities arteries accounts for 20% of the pathology of the cardiovascular system. The spread of the pathological process, high rates of disability, amputations, and mortality are characteristic of this pathology. In patients with lower limb ischemia, the state of the deep femoral artery performs a significant role. With femoral-popliteal occlusion, the viability of the limb depends entirely on the condition of the deep femoral artery. The elimination of stenotic changes in this arterial pool more frequently envisages open reconstructions, however, the correction of the inflow and outflow pathways is often carried out by the endovascular method. Proponents of open surgery note satisfactory long-term clinical results, while balloon angioplasty is becoming a less invasive method, accompanied by a low incidence of postoperative complications in persons with a high surgical risk, both in the presence of intermittent claudication and in the case of critical ischemia.

Carotid paragangliomas are rare disease. Radical removal of the tumor is the method of choice in the treatment such patients. The risks of surgical treatment are potential injury of the branches of the cranial nerves of the caudal group and the possible reconstruction of the carotid arteries. The combination of a tumor process with an atherosclerotic lesion of the carotid artery bifurcation is extremely rare. Single cases of both simultaneous and staged removal of the tumor and reconstruction of the carotid bifurcation due to atherosclerotic lesions are observed. We present a unique clinical case of simultaneous open surgical treatment of a patient with a large carotid chemodectoma type I according to the Shamblin classifi cation and hemodynamically significant atherosclerotic stenosis of the ipsilateral internal carotid artery. Accumulated expirience in treating patients with paragangliomas of the neck, as well as atherosclerotic lesions of the brachiocephalic arteries, allowed us to choose the optimal tactics of surgical treatment and achieve acceptable results.

One of the causes of intra-abdominal bleeding may be a ruptured aneurysm of visceral arteries of the abdominal aorta. Given high mortality from ruptured aneurysms, treatment for both symptomatic and asymptomatic aneurysms is mandatory. This article reports a clinical case concerning treatment of a splenic artery aneurysm with the help of a robot-assisted surgical system da Vinci Xi. Based on the analysis of the world experience in visceral arteries aneurysm treatment and the presented clinical case, the most rational treatment method is an endoscopic method of aneurysm resection using the da Vinci surgical system, which has proved reliable and yields excellent functional, clinical, and economically promising positive results.

Peripheral artery diseases have increasingly been gaining in medical and social importance due to not only growing morbidity but also therapeutic outcomes not fully satisfying both clinicians and patients, especially those with manifestations of critical limb ischemia. Revascularizing interventions combined with optimal medicamentous treatment are the 'gold standard' in treatment of symptomatic lesions of peripheral arteries. Along with it, risks for the development of thrombotic complications both in the zone of the reconstruction and in other vascular basins, negatively influence overall rates of patients' mortality and disability. Antiplatelet agents have so far remained in fact the only substantiated from the point of view of evidence-based medicine therapeutic factor decreasing the risks for the development of thrombotic complications in this patient cohort. A series of other drugs influencing blood coagulation system, as well as a combination thereof, by the findings of hitherto performed trials failed to demonstrate sufficient efficacy and/or safety. Oral anticoagulants opened new possibilities for antithrombotic prevention and treatment and have widely been used in various cardiovascular diseases. The results of a series of trials the most significant of which may be considered VOYAGER PAD showed possibilities and feasibility of introducing anticoagulants into therapeutic regimens for patients with PAD. Safety and efficacy of treatment regimens envisaging a combination of antiplatelet drugs with rivaroxaban at a dose of 2.5 mg twice daily were demonstrated both for patients undergoing conservative treatment and those after endured endovascular revascularizing interventions.

Background: Diffuse atherosclerosis of the coronary arteries with the involvement of distal vessels, extensive calcification and a small diameter of the coronary arteries can be the reasons for refusal of invasive treatment of patients with coronary heart disease. The only option of surgical treatment for these patients is coronary artery bypass grafting, but it is associated with technical difficulties in the creation of distal anastomoses and worse long-term survival. Nevertheless, the use of microsurgical techniques makes it possible to successfully treat such patients.

Patients and methods: A 59-year-old male patient with coronary artery disease was hospitalized for elective coronary artery bypass grafting. Coronary angiography revealed a multivessel diffuse lesion with calcification of the coronary arteries. The estimated severity of coronary atherosclerosis according to the Syntax Score amounted to 39 points. Severe three-vessel distal coronary calcification was confirmed by multislice computed tomography.

Results: Using an operating microscope and artificial circulation, we performed autovenous bypass grafting of the diagonal artery, obtuse marginal artery and posterior descending artery according to the method of extended anastomoses (2 cm long) through the atherosclerotic plaque. Due to severe calcification of the anterior descending artery, 4-cm long arteriotomy was performed, followed by prolonged shuntoplasty of the arteriotomic incision of the left internal mammary artery with anterior descending artery in the area of stenosis through the calcified atherosclerotic plaque. The diameter of the target coronary arteries at the site of distal anastomoses was less than 1.5 mm. The postoperative period turned out uneventful with no complications. The patient was discharged on POD 8. In order to prevent shunt thrombosis, the patient was prescribed to receive dual antiplatelet therapy for 1 year (aspirin and clopidogrel), as well as therapy with statins (atorvastatin 80 mg). The control examination at 12 months revealed no clinical signs of ischemia return. The findings of MSCT bypass angiography confirmed patency of all shunts.

Conclusion: The use of microsurgical techniques, an operating microscope, and coronary reconstructions as shuntoplasty makes it possible to perform coronary artery bypass grafting in severe coronary artery disease with satisfactory clinical outcomes.