Angiology and Vascular Surgery

Peripheral arterial disease (PAD) is one of the most common manifestations of systemic atherosclerosis. PAD affects millions of people worldwide, thus greatly contributing to the structure of mortality and disability of the population of developed countries. Along with surgical revascularization, pharmacotherapy is becoming increasingly important in improving the prognosis in such patients. Modern clinical guidelines define optimal therapy for patients with PAD as simultaneous prescription of several classes of drugs (hypolipidemic, antithrombotic, antihypertensive and, probably, vasodilators), thus making it necessary for the surgeon to take into consideration possible drug interactions...

Currently, there are no widely used available techniques for reliable prognosis of the onset and course of peripheral artery disease. Working out of optimal test systems including genetic ones for assessment of risks for the development of the disease, its progression or development of complications in patients with peripheral atherosclerosis is an important mission of modern medicine. This article deals with a promising technique of genetic studies in patients with peripheral artery disease, i. e., study of gene expression...

The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound...

Endovascular intervention is one of the main methods of treatment in atherosclerotic lesions of the infrainguinal segment in patients with chronic lower limb ischaemia. Recent years have witnessed active use of drug-eluting techniques, significantly improving the long-term outcomes of peripheral reconstructions. This article is a review of publications on the results of using modern drug-eluting balloon catheters and stents in the femoropopliteoltibial position. The accumulated data will help solve the main problems of the classic balloon angioplasty, reducing the incidence of restenosis, improving primary patency, and decreasing the need for repeat interventions in the remote period of follow-up...

Myocardial infarction is the leading cause of mortality during peripheral artery surgery. The review summarizes the data on cardiac event risk stratification in angiosurgical patients by preoperative stress testing. The prognostic value of positive and negative results is described. Stress testing with physical activity or pharmacological agents is rarely indicated in patients at low risk of major adverse cardiovascular events. Stress testing may be used in patients at increased risk of myocardial infarction (functional activity less than <4 metabolic equivalents), and if the test results should change the approaches to perioperative therapy, anesthesia or the volume of surgical intervention and, in rare situations, to perform coronary revascularization...

Presented herein is a clinical case report demonstrating uncontrolled development of fatal complications in a young parturient woman with vascular Ehlers-Danlos syndrome. The disease had not been known previously. In the third period of natural term delivery we revealed a complete linear vertical uterine rupture with a clinical picture of haemorrhagic shock. After hysterectomy we encountered sequential ruptures of the iliac veins, arteries, abdominal portion of the aorta and inferior vena cava. Attempts at restoring the integrity of vessels followed by ligation thereof, terminating in cutting of vascular walls, with the appearance of new sources of bleeding...

Presented in this article is a clinical case report regarding treatment of a patient with deep vein thrombosis complicated by venous gangrene having developed 10 days after the onset of the disease. Conservative therapy (infusion of colloids and crystalloids, anticoagulants, agents improving microcirculation, venotonics, nonsteroidal anti-inflammatory drugs, elevated position of the limb) made it possible to stabilize the patient's condition, but not improving haemodynamics of the affected limb. A decision was made to use endovascular techniques...

Total left-sided haemothorax is a rare and severe complication of acute DeBakey type III aortic dissection. The primary aim of treatment is immediate arrest of haemorrhage and stabilization of the haemodynamic status of the patient. Endovascular isolation of the ruptured thoracic portion of the aorta using a stent graft (TEVAR) has recently become the 'gold standard' in treatment of acute, rupture-complicated aortic dissections of this localization. Described in the article is a clinical case report concerning successful endovascular treatment of a seriously ill patient with dissection of the thoracoabdominal portion of the aorta, rupture and massive haemorrhage into the left pleural cavity...

Infection of arterial vascular grafts is a rare but utterly severe complication in vascular surgery. Therapeutic policy in patients with graft infection has not been standardized, to be determined individually. One of the variants of surgical treatment is considered to be repeat aortic repair using a cadaveric graft. Presented in the article is a clinical case report concerning a 60-year-old male patient previously subjected to aortofemoral bifurcation bypass grafting with stage IV ischaemia of lower limbs according to the Pokrovsky-Fontaine classification...

AIM: To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. PATIENTS AND METHODS: The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3...

AIM: The study was aimed at comparing the immediate clinical and haemodynamic results of open implantation of the balloon-expandable aortic prosthesis 'MedLab-KT' with the respective parameters of standard replacement of the aortic valve by a mechanical prosthesis in high-risk surgical patients. PATIENTS AND METHODS: We analysed a total of 209 cases of prosthetic repair of the aortic valve. The Study Group comprised 28 patients subjected to open implantation of the 'MedLab-KT' prosthesis in conditions of extracorporeal circulation and myocardial ischaemia and belonging to a high-surgical risk cohort...

BACKGROUND: Femoral endarterectomies are often performed by means of longitudinal arteriotomies with patching. Autologous and synthetic patches can be used. Synthetic patches in the groin may expose patients to infection. We present two alternative techniques for the treatment of femoral atherosclerotic lesions. MATERIAL AND METHODS: The alternative endarterectomies (AE) included eversion (EE) and semi-closed endarterectomies (SCE). An EE with an oblique transection of a femoral bifurcation (FB) was used for lesions extending to the FB...

AIM: The aim of our investigation was to analyse the results of autotransplantation, creation of a neobifurcation or prosthetic repair of the internal carotid artery during the in-hospital and long-term follow-up periods. PATIENTS AND METHODS: The study included a total of 241 patients presenting with and treated for extended atherosclerotic lesions of the internal carotid artery from 2016 to 2019. The patients were divided into three groups depending on the surgical modality employed: group 1 - autotransplantation of the internal carotid artery (27...

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta...

AIM: The study was aimed at assessing efficacy and safety of micronized purified flavonoid fraction (MPFF, Detralex) in comprehensive treatment of chronic venous oedema induced by lower limb varicose veins. PATIENTS AND METHODS: We performed a post hoc analysis of the results of treatment of 708 patients included into the observational programme VAP-PRO-C3 (ClinicalTrials.gov. NCT03722836). These patients, depending on the type of treatment, were divided into 8 subgroups: MPFF (n=32); MPFF + compression (n=145); MPFF + compression + topical treatment (n=158); MPFF + compression + topical treatment + endovasal laser coagulation (n=197); MPFF + endovasal laser coagulation (n=3); MPFF + compression + endovasal laser coagulation (n=152), patients not receiving MPFF (n=16); MPFF + topical treatment (n=2)...

AIM: The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm. PATIENTS AND METHODS: During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry...

Described in the article is a clinical case report regarding complete endovascular arterialization of deep crural and pedal veins in a male patient with accompanying pathology and impossibility of intraluminal restoration of the arterial bed. Peculiarities of the presented case report consisted in creation of an arteriovenous anastomosis in the upper third of the crus using an endovascular technique. During treatment, a repeat intervention was required, i. e., balloon angioplasty of veins and implantation of an additional stent graft due to reocclusion of veins because of long-term local treatment of wounds and cytostatic therapy for background diseases (chronic myeloleukaemia and rheumatoid arthritis)...

Interventions on bifurcation lesions of the coronary bed are one of the most complicated tasks of interventional cardiology. Recent trends are toward active study of using drug-eluting balloons for interventions in this type of lesions. Using such technique makes it possible to minimize the risks associated with implantation of stents in sites of coronary artery bifurcations with good angiographic results. This article is a review of the literature data concerning the use of drug-coated balloons in interventions on bifurcation lesions of the coronary bed, discussing peculiarities of the balloon catheter design, dynamics of delivery of an antiproliferative drug to the vascular wall...

AIM: The study was aimed at assessing the in-hospital results of aortic arch endoprosthetic repair using different variants of endovascular supraaortic debranching. PATIENTS AND METHODS: The analysis included 27 patients subjected within the framework of aortic arch endoprosthetic repair to various types of supraaortic endobranching, including the technique of parallel prostheses and implantation of fenestrated stent grafts. We analysed the clinical and morphological status of patients prior to operation, peculiarities of the intervention (type of debranching and Ishimaru's classification zones in which the reconstruction was performed) and in-hospital results of treatment...

Endovascular abdominal aortic aneurysm repair is an operation of choice in rendering hi-tech care for patients with aneurysms of the infrarenal aortic portion. The most frequently performed reoperations account for cases related to removing endoleaks. The article deals with assessing the presence of various types of endoleaks depending on the time elapsed after abdominal aortic aneurysm repair by means of duplex scanning and multislice computed tomography. Duplex scanning proved highly informative in detecting various types of endoleaks, being comparable with the findings of multislice computed tomography (p=0...