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

Acute aortic dissection belongs to life-threatening conditions, requiring thorough diagnosis and selection of individual therapeutic policy depending on peculiarities of the pathology course. Although at the moment, the main method of treatment of a patient with stable DeBakey type III acute aortic dissection is conservative management, we would like to present a clinical case of hybrid surgical treatment using a stent graft for correction of a dissecting aneurysm as an alternative option to major open aortic replacement and endovascular stenting.

Background: The incidence of primary dysfunction of arteriovenous fistulas (AVF) created as a permanent vascular access (PVA) for maintenance hemodialysis (HD) remains high, reaching 20-30%. Various risk factors lead to AVF delayed maturation and thrombosis.

Objective: We aimed to identify risk factors for the development of such variants of primary AVF failure as delayed maturation and thrombosis.

Patients and methods: Our retrospective cohort study included a total of 1595 adult patients first starting maintenance HD treatment. Primary AVF dysfunction was defined as failure of successful double-needle puncture for standard HD or hemodiafiltration, insufficient blood flow into the extracorporeal circuit three months after the permanent vascular access had been created, or the development of AVF thrombosis before its first successful use.

Results and discussion: The mean age of the patients was 49.1±8.6 years, ranging from 22 to 81 years. There were 720 (45.1%) females and 875 (54.9%) males. The average body mass index amounted to 28.4±3.7, ranging from 17.5 to 40.7 kg/m2. Primary AVF failure was found to occur in 369 patients (23.1% of 1595). Of these, 127 (34.4% of 369, 8.0% of 1595) had AVF delayed maturation and 242 (65.6% of 369, 15.2% of 1595) had thrombosis. The risk factors for thrombosis were as follows: persistent hypotension, polycystic kidney disease, and systemic processes (vasculitis, multiple myeloma, HIV-associated nephropathy, etc.): RR=2.2 [95% CI 1.6; 3.1], p<0.001; RR=3.2 [95% CI 2.5; 4.2], p<0.001; RR=5.3 [95% CI 4.4; 6.5], p<0.001, respectively. The risk factors for delayed maturation included female sex, persistent hypotension, diabetes mellitus, polycystic kidney disease, and excess body weight: RR=2.7 [95% CI 1.9; 3.9], p<0.001; RR=2.8 [95% CI 1.8; 4.4], p<0.001; RR=3.3 [95% CI 2.4; 4.6], p<0.001; RR=7.1 [95% CI 5.3; 9.6], p<0.001; RR=2.3 [95% CI 1.3; 3.8], p=0.002, respectively. A preoperative ultrasound examination performed by or in the presence of the operating surgeon was an important factor contributing to a decrease in the incidence of both variants of dysfunction. Formation of a permanent vascular access within 4 weeks before HD and within two weeks thereafter was associated with an increased risk of thrombosis.

Conclusion: AVF thrombosis and delayed maturation, as types of primary failure are influenced by different risk factors. The surgeon-performed preliminary examination should be supplemented with Doppler ultrasonography of the zone of AVF creation to select an optimal vascular access.

Objective: The purpose was to study different types of the common carotid artery bifurcation, taking into account the characteristics of geometry and hemodynamics to predict the risk of developing atherosclerosis and postoperative restenosis.

Patients and methods: At the State Budgetary Healthcare Institution 'Research Institute - Regional Clinical Hospital № 1 named after Professor S.V. Ochapovsky' with the support of the Kemerovo State University, a retrospective non-randomized single-center study was conducted, assessing the findings of multislice computed tomography of patients examined in the clinic from 2021 to 2022. The inclusion criteria were intact brachiocephalic arteries at the extracranial level. The study comprised a total of 85 bifurcations of the common carotid artery (CCA) with no atherosclerotic stenosis, dysplastic diseases, vasculitis, nor pathological tortuosity of the internal carotid artery (ICA). The following geometric data were studied: the diameters of the common and internal carotid arteries, the bifurcation angle of the common carotid artery, delta and diameter ratio, with the shape of the bulb of the internal carotid artery also assessed. Three-dimensional models of the bifurcation were constructed, the conditions of blood flow in these models were created, and, using specialized software, hemodynamic parameters responsible for the formation of conditions for the growth of an atherosclerotic plaque were calculated.

Results: Having analyzed the geometric and hemodynamic data in the area of the bifurcation of the common carotid artery in patients without pathology, we came to the conclusion that it is advisable to divide the entire variety of bifurcations of the CCA into groups according to the potential risk of developing atherosclerosis. Types of bifurcation with a high and low risk of atherosclerotic plaque formation were identified, with the bifurcations also divided into types depending on the location of risk zones.

Conclusion: Stratification of the risk of atherosclerosis is useful from the point of view of implementing a personalized approach to the management of patients with subclinical forms of atherosclerosis. The criteria making it possible to identify geometric signs of the risk of developing atherosclerosis can also be used in surgical decision-making in order to improve postoperative outcomes.

The review article presents data on the structural organization of the endothelial glycocalyx and its function in health and endothelial dysfunction accompanying circulatory system pathology. Particular attention is paid to the possibilities and peculiarities of its visualization using various techniques, as well as modern trends in correcting disorders of its function and structure.

Objective: Updating of modern methods of diagnostics and treatment of Budd-Chiari syndrome (BCS), endovascular treatment tactics (balloon angioplasty, TIPS, DIPS, etc.) in order to raise awareness of this pathology among general practitioners, hepatologists, X-ray surgeons and doctors of other specialities.

Material and methods: We analysed full-text publications included in the abstract systems eLibrary, Cyberleninka, PubMed, Google Scholar mainly for the last 5 years (69%). The main focus was on diagnosis (ultrasound, CT, MRI) and treatment (anticoagulants, thrombolytics, balloon angioplasty, TIPS, liver transplantation).

Results: BCS is a rare disease associated with impaired venous outflow from the liver resulting in suprahepatic portal hypertension. Etiology includes thrombosis, myeloproliferative diseases and congenital vascular anomalies. Epidemiology is variable, with a higher prevalence in Asia. The clinical picture varies from asymptomatic course to fulminant hepatic failure. The main manifestations are variceal haemorrhage and refractory ascites. Without treatment, survival is poor, with fatal outcome occurring within three years. The modern strategy implies a stepwise approach: drug therapy (anticoagulants, thrombolytics), balloon angioplasty, TIPS and radical treatment - liver transplantation.

Conclusion: Modern diagnostic methods and staged strategy of BCS have significantly improved treatment outcomes, based on endovascular approach and new technologies (stent grafts, intraoperative use of ultrasound, etc.). However, further research is needed to optimise approaches to early diagnosis and individualisation of therapy.

Acute kidney injury is the most common complication after open abdominal aortic aneurysm repair, thus significantly deteriorating the postoperative period. Traditionally, preoperative and intraoperative factors are considered as risk factors for the development of acute kidney injury. Intraoperative risk factors are recognized by many authors as determining factors in the development of this complication after abdominal aortic aneurysm repair. To date, there is no scientifically based strategy for the prevention of acute renal dysfunction in open abdominal aortic surgery that would reduce the risk of this complication. This article presents a review of Russian and foreign literature dedicated to acute kidney injury after open abdominal aortic aneurysm repair. The modern classifications of this complication, as well as the evolution of their formation are given. The main preoperative and intraoperative risk factors for the development of acute kidney injury are considered in detail. It is noted that in many studies factors of surgical and anesthesiologic 'aggression' were the most significant in influencing postoperative renal function. Clinical guidelines, systematic reviews and meta-analyses regarding the prevention of acute kidney injury after open abdominal aortic aneurysm repair were analyzed in detail. It was concluded that at present there is no sustainable strategy for preventing this complication after open surgery, with most protective procedures performed empirically.

Background: Venous thromboembolic complications (VTE) represent a serious problem for neurosurgical patients, especially after brain tumor resection surgeries. Due to the specific nature of neurosurgical diseases, the risk of these complications significantly increases.

Objective: This study aimed to assess the effectiveness of implementing a systematic approach to VTE prophylaxis in patients undergoing brain tumor resection, using risk stratification algorithms and early administration of low molecular weight heparin.

Patients and methods: The study was conducted at the Federal Center of Neurosurgery in Novosibirsk, using a retrospective analysis of data from 3486 brain tumor resection surgeries. By means of propensity score matching, the patients were divided into two groups: the control group (1002 patients who underwent surgery before the implementation of the new prophylactic algorithm) and the study group (1002 patients who underwent surgery with the application of a systematic approach to VTE prophylaxis). The results of VTE risk stratification, early administration of low molecular weight heparin, and their association with the frequency of complications were evaluated.

Results: The obtained findings showed that the application of the new prophylactic algorithm significantly reduced the incidence of clinically significant pulmonary embolism to 0.2 vs 0.6% in the control group. No fatalities from pulmonary embolism were recorded in the study group. However, there was a slight increase in cases of intracranial hemorrhage (1.8 vs 1.3%).

Conclusion: Preoperative risk stratification for VTE and early administration of prophylactic doses of low molecular weight heparin can reduce the frequency of thromboembolic events with comparable risks of intracranial hemorrhage.

Background: Methods of endovascular treatment of patients with arterial lesions expand the possibilities for limb salvage. However, one of the main reasons for the reduced long-term effectiveness of these surgical interventions is restenosis. Endothelial-mesenchymal transition is considered one of the reasons for the development of restenosis.

Objective: The aim was to study the possibilities of predicting the development of restenosis after endovascular interventions on the main arteries of the lower extremities in patients with atherosclerotic peripheral artery disease (PAD) by assessing the levels of endothelial-to-mesenchymal transition biomarkers.

Patients and methods: The study included 50 patients divided into groups depending on treatment (operative or conservative). The mean age of the patients in the surgical group was 66.1±8.83 years and that in the conservative group 70±8.62 years. The groups were comparable in terms of gender, stage of the disease, side of the lesion, concomitant diseases and baseline values of the ankle-brachial index (ABI). The control group additionally comprised 10 apparently healthy volunteers with neither PAD nor other identified diseases. Peripheral venous blood was collected to assess the level of EndMT markers (endothelial markers - PECAM-1, vWF, mesenchymal markers - vimentin, alpha-Anti-Actin Alpha 2 - antiACTIN, and integral EndMT marker - TGF-b1) in the apparently healthy subjects, as well as patients with stage IIb-IV PAD according to the classification of A.V. Pokrovsky-Fontaine before and after endovascular reconstructive interventions on the arteries of the lower extremities. All patients underwent duplex ultrasonography to assess restenosis at the site of the endovascular interventions performed, with the ABI also determined.

Results and discussion: Decreased values of the ABI in the post-operative period were associated with elevated levels of vimentin (VIM). Vimentin concentration above 2.98 ng/ml was associated with the development of restenosis 3 months after endovascular surgery.

Conclusion: At this stage of the study, it is only possible to assess the role of the mesenchymal parameter vimentin as a potential marker for predicting the development of restenosis after endovascular interventions on lower extremity arteries.

Besides new advanced thoracic stent graft and devices, as well as an improvement of surgical skill, open repair of thoracoabdominal aortic aneurysms is still very important. The main indications for it include patients with unfavorable aneurysm anatomy, patients with connective tissue disorders, good-risk patients with life expectancy of at the least 10 years regardless of anatomic suitability and genetic, then patients with mycotic thoracoabdominal aortic aneurysms and finally patients with same long-term complications after previous TEVAR. Open repair of thoracoabdominal aortic aneurysms can be only performed in high volume centers, while younger generation of vascular surgeons should be educated in both endovascular and open aortic surgery.