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

Objective: The purpose of the study was to determine the parameters of remodeling of and alterations in hemodynamics of the jugular and extrajugular pathways in non-thrombotic extrinsic compression and hypoplasia of the internal jugular vein (IJV).

Patients and methods: We examined the relevant characteristics in patients with extrinsic IJV stenosis (n=50), IJV hypoplasia (n=27), after IJV ligation/resection (n=6) and in the control group (n=31), performing such studies as neurological examination, ultrasound examination of the IJV (level J2 and at the level of stenosis), common carotid artery and renal artery (level V2), as well as magnetic-resonance venography of the cervical veins. We determined the degree of IJV stenosis, vessel area, time-averaged blood flow velocity and the calculated parameter of the venous-arterial balance (VAB, %).

Results: Extrinsic compression and hypoplasia of the IJV were clinically manifested predominantly by cerebral venous discirculation, but 7.4-12% of patients were found to have venous encephalopathy. The area of the IJV at the level of stenosis was on average 6 times smaller and in the J2 segment 3 times smaller than the area of the opposite IJV. The stenotic IJV undergoes negative remodeling, and the opposite IJV and other venous collectors of the neck undergo positive remodeling. For comparison, we used a relatively new calculated parameter, i. e., the 'venous-arterial balance', revealing a decrease in this parameter on the pathology/anomaly side by 3-4 times (about 9% on average) from the norm (25-33%) and a twofold (53-54% on average) increase on the opposite side. If compensation at the expense of the opposite IJV does not occur, then the clinical signs of cerebral venous discirculation and venous encephalopathy develop and the mechanisms of extrajugular positive remodeling are activated. The threshold VAB values for the transition of the opposite IJV from compensatory dilatation to the formation of extrajugular pathways of outflow varied from 40 to 60%.

Conclusion: The jugular pathway of the cerebral venous outflow is predominant and in case of its unilateral stenosis, the opposite IJV becomes most important. Meanwhile, despite the inclusion of additional extrajugular outflow pathways, cerebral venous discirculation and venous encephalopathy may develop, thus suggesting their limited compensatory capabilities.

Presented herein is a clinical case report of successful treatment of an 18-year-old female patient with an iatrogenic injury and thrombosis of the superior vena cava having occurred during mediastinal tumor biopsy. While undergoing videothoracoscopy and mediastinal tumor biopsy she developed profuse bleeding from the superior vena cava. The vein defect together with the surrounding tissues was sutured during thoracotomy. This was complicated by the development of thrombosis of the superior vena cava and marked edema of soft tissues of the face, neck and upper half of the trunk. External jugular-femoral bypass turned out to be ineffective. A day later, she was subjected to reconstructive surgery. Complete removal of the mediastinal tumor, thrombectomy of brachiocephalic veins and reconstruction of the superior vena cava were performed from a sternotomy. For the reconstructive surgery, a spiral-shaped conduit from the great saphenous vein of the thigh was used. Within a day, complete regression of soft tissue edema of the face, neck and upper half of the torso was noted. After 15 months according to the data of CT angiography, the autovenous conduit was passable, with no signs of either thrombosis or restenosis. This is followed by a literature review of the modern state of the problem of treatment of patients with superior vena cava syndrome.

Background: Catheter-directed thrombolysis today is, along with open revascularization, the method of choice in the treatment of patients with acute limb ischemia (not more than Rutherford class IIa-b), with a positive result achieved in at least 80% of cases. However, the main factor limiting its use is the need for technical, economic and staff resources, an X-ray endovascular operating room with appropriate consumables and trained personnel.

Objective: To develop a technique for injection intra-arterial thrombolysis using only ultrasound navigation and evaluate its immediate results.

Patients and methods: We retrospectively analyzed a group of 23 patients (13 men and 10 women aged from 47 to 47 years, mean 64.6±1.7 years) admitted to the Nizhnevartovsk District Clinical Hospital from October 2023 to January 2024 with thrombosis and embolism of the arteries of the extremities and operated on using injection thrombolysis. Tissue plasminogen activator (t-PA - Actilyse) was used as a thrombolytic drug administered under ultrasound guidance by puncturing the thrombosed segment with an 18-25 G needle from 2-4 points, achieving impregnation of the thrombus with the drug along the entire length. The initial dose of the drug was 10-20 mg t-PA. If necessary, repeated injections were performed, usually after 2-4 hours depending on the clinical effect. The average frequency of injections was 1.8±0.19 (1-4).

Results: Technical success (restoration of antegrade blood flow and reduction in thrombus volume by more than 95%) of injection thrombolysis was achieved in 87% of the cases, with the overall clinical effect (relief of acute ischemia or its decrease to grade I) amounting to 100%. The duration of thrombolysis ranged from 20 minutes to 48 hours (average - 8.7±1.6 hours, median - 6 hours). The amount of the drug used was 29.5±3.0 mg (15-65 mg), 7.8±2.2 mg/hour (1.7-40.0 mg/hour). 3 (13%) subjects developed local hematomas at the puncture sites, requiring no revision. One patient died from polysegmental viral pneumonia. In 15 patients, after relief of acute ischemia, an angiographic examination was carried out to verify the primary cause of thrombosis. Once pathology revealed, endovascular correction was additionally performed. In two patients with an extended thrombus, the procedure was supplemented with catheter-directed thrombolysis.

Conclusion: The method of injection intra-arterial thrombolysis using ultrasound navigation alone allows achieving the results comparable to those yielded by the conventional procedure of catheter-directed thrombolysis. The described technique can urgently be performed in any surgical hospital.

The guidelines were worked out in accordance with the requirements of the Ministry of Health of the Russian Federation by the all-Russian public organization 'Russian Society of Angiologists and Vascular Surgeons' with participation of the Russian Society of Surgeons, Association of Cardiovascular Surgeons of Russia, Russian Scientific Society of Specialists in X-Ray Endovascular Diagnosis and Treatment, Association of Phlebologists of Russia, Russian Association of Specialists in Functional Diagnostics.

Background: The dual-catheter technique of aneurysm coil embolization, as well as balloonassistance are procedures making it possible to exclude wide-neck aneurysms from the blood flow.

Objective: The aim of this work was to compare angiographic results and clinical outcomes in patients with cerebral aneurysms treated by either the double-catheter technique or balloon-assisted coil embolization.

Patients and methods: The study included a total of 184 patients presenting with cerebral aneurysms and operated on in the period 2019-2023 at the Russian Scientific Research Institute of Neurosurgery named after A.L. Professor Polenov. Of these, 58 patients underwent the balloon-assisted procedure and 126 were subjected to the double-catheter technique.

Results: A statistically significant difference between the methods was revealed by the angiographic results in both the immediate and remote periods, with no difference revealed by the clinical outcome.

Conclusion: Mastery of the dual-catheter technique allows the surgeon to disconnect wide-necked aneurysms from the blood flow, as well as to reliably protect the arterial branches incorporated into the aneurysm without worsening the functional outcome.

The article presents data on the etiology, risk factors, classification, methods of conservative and surgical treatment of venous acute mesenteric ischemia, describing the possibilities of various diagnostic methods for this pathology, as well as underlining the importance of timely diagnosis and the most rapid initiation of treatment in order to reduce mortality and improve both immediate and long-term results.

Background: One of the most dangerous manifestations of atherosclerosis is acute aortic syndrome, in particular, a penetrating atherosclerotic aortic ulcer. According to a number of sources, the incidence of penetrating aortic ulcers varies from 2 to 7% of all cases of acute aortic syndrome. In turn, acute aortic syndrome occurs in 30 cases per million people per year. Penetrating atherosclerotic ulcers are most often localized in the descending thoracic aorta, however, some authors point out their possible localization in the abdominal aorta and iliac arteries with a variety of clinical manifestations and the likelihood of wall rupture.

Objective: To demonstrate variants of the clinical course and necessity of performing emergency operations in detection of penetrating aortic ulcers localizing in various portions of the aorta and also in the iliac arteries.

Material and methods: We analyzed case histories of patients with penetrating atherosclerotic ulcers, in particular, the results of instrumental methods of study (multislice computed tomography of the thoracic, abdominal aorta and iliac arteries), also evaluating histological characteristics of the obtained biopsy materials. Literature search for additional information, as well as its systematization and analysis were carried out with the help of scientific literature sources included in the PubMed, Web of Science, eLibrary databases.

Study design: a retrospective study.

Results: In the course of practical work, we analyzed three clinical cases of a penetrating atherosclerotic ulcer of the descending aorta, infrarenal aorta, and iliac arteries.

Conclusion: Multislice computed tomography is the gold standard in the diagnosis of penetrating atherosclerotic ulcers. Urgent surgical interventions on the aorta are not indicated for many patients; in such cases, watchful waiting is feasible. In the presence of small saccular aneurysms, it is possible to implant a stent graft, however, when symptoms indicating a threat of aortic rupture appear, open surgical intervention is the prevailing tactics. A clinic providing emergency care to patients with cardiovascular diseases should have a consignment warehouse of consumables for emergency or urgent endovascular operations, including deployment of stent grafts at various levels of the aorto-arterial system.

The article presents a clinical case of repeat surgical treatment of a patient with aneurysms of the abdominal aorta and iliac arteries on the background of a giant ventral abdominal hernia 4 years after midline laparotomy aortofemoral bifurcation bypass with ligation of the aorta. The redo intervention consisted in thoracophrenolumbotomy along the VIII intercostal space, resection of aneurysms of the infrarenal aorta and iliac arteries, creation of a proximal end-to-end anastomosis with the old graft, ligation of the right common femoral artery, iliac arteries aneurysms reduction. The postoperative period was uneventful. The patient was discharged of POD 16. MSCT angiography at 12 months revealed no significant pathology. This clinical case demonstrates a long-term complication after non-radical abdominal aortic aneurysm treatment.

Background: One of the most common arterial operations in the 19th century was aneurysm surgery. However, there were practically no publications on artery aneurysm surgery in Moscow in the last quarter of the nineteenth century. Meanwhile, it is known that this period was characterized by the introduction of anesthesia and the antiseptic method into Russian surgery. The issues of aneurysm surgery in the historical period under review were actively discussed at meetings of the Surgical Society in Moscow.

Objective: To characterize the state of arterial aneurysm surgery in Moscow in the last quarter of the nineteenth century.

Material and methods: The materials of this retrospective study were the minutes of the meetings of the Moscow Surgical Society published in the 'Annals of the Surgical Society in Moscow' from 1873 to 1898, with historical, evolutionary-chronological and comparative methods used for their analysis.

Results and discussion: From 1873 to 1898, over 700 communications and reports were heard at the meetings of the Moscow Surgical Society, of which only 20 reports were related to cardiovascular pathology, with only 9 of them devoted to arterial aneurysms.

Conclusion: The diagnosis of arterial aneurysms in patients in Moscow in the last quarter of the nineteenth century was relatively rare: only 9 reports out of 700 (1%) were devoted to this disease. Among others, surgeons reported such difficult-to-diagnose lesions as aneurysm of the aortic arch (1881), intracranial artery (1881) and abdominal aorta (1897). Aneurysm operations performed under anesthesia with the use of antiseptics consisted in ligation of the afferent and efferent ends of the artery. A peculiarity of the approach to the treatment of aneurysms by I.K. Spizharny (1886) was the use of a combined method of treating aneurysms with compression and ligation of the artery.