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

Here we describe a clinical case of successful staged treatment of descending thoracic and abdominal aorta aneurysmal lesions with unchanged segment of the visceral portion between them. An anatomical peculiarity of the abdominal aortic aneurysm was the presence of angulation and an aneurysmal lesion of the left iliac artery, thus requiring the use of a hybrid strategy. The patient had a high surgical risk associated with comorbidity. At the first stage, he underwent aortofemoral prosthetic repair and 3 months thereafter received an endograft implanted into the descending thoracic aorta with the positioning of the distal portion of the stent graft at the level of the XI thoracic vertebra. Previous aortofemoral prosthetic repair was an independent risk factor for spinal complications avoided by optimal perioperative and postoperative patient management. The control studies showed an adequate position of the stent graft, patency of the aortofemoral prosthesis, and no dilatation of the visceral portion of the aorta.

Background: Carotid endarterectomy is one of the most frequently performed peripheral vascular operations. We present herein a retrospective and prospective analysis of carotid endarterectomy performed without an intraluminal arterial shunt in a total of 3615 patients.

Objective: The purpose of this study was to assess efficacy and safety of the technology of perioperative management and the technique of carotid endarterectomy with no intraluminal arterial shunt.

Patients and methods: Our study included 3615 patients successively operated on at the same department. All patients underwent elective carotid endarterectomy without an intraluminal arterial shunt. The stages of perioperative management were standardized. All operations were performed under combined general anesthesia. Prior to clamping carotid arteries, we elevated the level of arterial pressure (AP) by 20-30% above the 'working' level. Adequacy of blood supply of the brain was controlled by means of cerebral oximetry using the Somanetics INVOS 3100 unit and by the assessment of retrograde blood flow through the internal carotid artery. 3145 (87%) patients underwent modified carotid endarterectomy with creation of high divarication. 470 (13%) patients were subjected to classical carotid endarterectomy with autovenous plasty of the internal and common carotid arteries. The criteria for making the diagnosis of ischemic stroke with determination of the mechanism of its development were standardized.

Results: 3566 (98.64%) patients had no evidence of perioperative stroke and 49 (1.36%) patients developed intraoperative stroke. In 41 (1.13%) of the 3615 patients, the mechanism of development of intraoperative ischemic stroke was atheroembolic, in five (0.14%) - hemodynamic, and in three (0.08%) - lacunar. Eleven (0.3%) patients died from ischemic stroke.

Conclusion: Carotid endarterectomy without an intraluminal shunt did not increase the risk of developing ischemic stroke. Correction of cerebral hypoperfusion during carotid artery cross-clamping should be recognized as an anesthesiological task.

Presented herein is a clinical case report concerning successful use of cyanoacrylate glue obliteration in a female patient with lower limb varicose veins, restless leg syndrome, and a long history of epilepsy. The intervention was performed under local anesthesia. Positive results were achieved regarding varicose disease symptoms, with a decrease in the frequency and intensity of epileptic seizures. It is noted that a multidisciplinary approach is an important condition for achieving success in treatment of such patients and improving their quality of life.

Background: A congenital malformation in the form of an abnormal origin of the left coronary artery from the pulmonary artery leads to the phenomenon of stealing the coronary arteries with a shunt from left to right, causing aberrant left ventricular perfusion. 9 out of 10 children die before reaching the age of one without surgery due to cardiac ischemia, infarction, or congestive heart failure secondary to mitral regurgitation. Some of them survive to a later age thanks to an adequate collateral blood supply through the entrapment of the right coronary artery.

Material and methods: The article presents a rare case of Bland-White-Garland syndrome manifestation in a woman aged 43 years.

Results: The angina clinic developed after a coronavirus infection, and was provoked by a constant tachycardia at rest of 90-100 beats per minute, aggravated by exercise. ECG Holter monitoring revealed episodes of severe ST-T depression. On the electrocardiogram - signs of focal cicatricial changes in the anterior septal and high lateral myocardium. Echocardioscopy established that the left coronary artery does not originate from the aorta, but from the pulmonary artery. Detection of a zone of reduced contractility of the myocardium of the left ventricle. A decrease in systolic function of the left ventricle was found (ejection fraction 48-50%). Spiral computed tomographic coronary angiography also confirmed the presence of this anomaly, an increase in the diameter of the left coronary artery up to 5 mm. The diameter of the right coronary artery was also increased to 8 mm. Multiple tortuous collaterals between the left and right coronary systems were revealed. Invasive coronary angiography confirmed the presence of this anomaly. An operation was performed: an anastomosis was made between the aorta and the left coronary artery in an end-to-side manner. The trunk of the pulmonary artery was reconstructed with a xenopericardial patch.

Conclusion: In the presented case, it was possible to demonstrate a late manifestation of the Bland-White-Garland syndrome at the age of 43 years. Reconstruction of the coronary bed significantly improved the patient's condition and her quality of life.

Acute stroke is the second cause of death in Russia. Currently, carotid endarterectomy remains the 'gold standard' for stroke prevention in patients with stenosis of the internal carotid arteries. Endovascular treatment of atherosclerotic lesion of the carotid bifurcation claims to be an alternative to open reconstructions. The problem of restenosis after both types of intervention remains a significant problem at the moment. According to the literature, massive calcification of an atherosclerotic plaque is a predictor of a greater number of complications during stenting and the impossibility of achieving technical success due to residual stenosis and stent deformation in the long-term period. We summarized the literature data regarding the results of stenting in patients with calcified plaques, risk factors for restenosis, and analyzed the published results of open surgical interventions for in-stent restenosis after endovascular procedures. We also present our own clinical case of sequential bilateral eversion carotid endarterstenectomy in a patient with critical in-stent restenosis of the internal carotid arteries after Wallstent stent implantation.

The article presents the data of domestic and foreign literature on the surgical treatment of DeBakey type I acute aortic dissection, as one of the most challenging pathologies in the practice of a cardiac surgeon. Unfavorable nature of the disease, a variation in presentation and clinical course along with an urgent treatment require significant attentiveness. A unified concept of treatment is practically excluded due to the variety of surgical approaches, clinical experience and interventions. There have been demonstrated approaches to surgical treatment and level of a distal anastomosis formation including simple clamp on operations only on the ascending aorta to total arch replacement with hybrid-techniques and their combination in the form of proximalization of the distal anastomosis zone. The clinic's own vision of this problem is also presented.

Regional thrombolytic therapy for acute ischemia of lower extremities is one of therapeutic methods, which in some cases is a method of choice, especially when open reconstructive surgical intervention is associated with a high risk of complications. Besides, thrombolytic therapy can be considered as the first stage of treatment, as well as a method of choice to restore patency of the arterial distal bed.

In this article, we present a clinical case of staged treatment of a patient with lung cancer and a thoracic aortic aneurysm. At the first stage, the patient underwent an extended upper lobectomy on the right with resection of the apical segment of the lower lobe of the lung and mediastinal lymph node dissection. At the second stage, a hybrid operation was performed, including partial debranching of the aortic arch and endovascular thoracic aortic aneurysm repair. The chosen approach made it possible to reduce the overall traumaticity of surgical interventions, while maintaining the radical nature of treatment. This clinical example is an illustration of the fact that the modern hybrid strategy for the treatment of thoracic aortic pathology (in particular, the aortic arch) significantly expands the possibilities of treating patients with combined pathology, allowing to reduce the risks of both general surgical complications and cerebral circulation impairments. However, the place of this approach can only be determined after assessing the long-term results, in particular the risks and frequency of aortic remodeling.