[Subclavian-femoral bypass grafting in treatment of lower-limb critical ischaemia in an elderly patient with an inoperable thoracoabdominal aortic aneurysm].

The authors describe herein a variant of successful palliative treatment of a 73-year-old male patient suffering from an inoperable thoracoabdominal aortic aneurysm accompanied by coronary artery disease, painless myocardial ischaemia, pathological tortuosity of the left internal carotid artery, type 2 diabetes mellitus, and chronic renal insufficiency. The patient was admitted to the Department of Vascular Surgery presenting with critical ischaemia of his left lower limb, complaining of numbness and gnawing pain both at rest and while walking a distance of up to 10-15 metres, demonstrating portions of skin ischaemia up to 2 cm long on the anterior surface of the femoral upper third, clinical signs of a thoracoabdominal aortic aneurysm, the presence of a pulsating formation in the projection of the infrarenal portion of the abdominal aorta measuring 5x6 cm. The diagnosis was made based on the findings of instrumental examination, ultrasonography, multispiral computed tomographic angiography, and coronarography, having confirmed the following: a thoracoabdominal aortic aneurysm, occlusion of the left common artery and anterior iliac artery, coronary artery disease, painless myocardial ischaemia, pathological kinking of the left internal carotid artery, chronic renal insufficiency, and type 2 diabetes mellitus.

A Specialized device designed for eversion carotid endarterectomy.

Carotid endarterectomy (CEAE) is currently considered to be one of the most efficient methods of treatment for chronic cerebrovascular insufficiency and prevention of recurrent acute impairments of cerebral blood supply. Methodically, the manipulation concerned is in the majority of cases carried out by one of two most commonly employed techniques, i. e.

[The effect of carotid endarterectomy on cognitive disturbances in patients with atherosclerotic stenosis of carotid arteries].

Clinical and neuropsychological features of non-dementia cognitive disturbances were studied in 102 patients with atherosclerotic carotid stenosis. Cognitive disturbances were assessed after the carotid endarterectomy (CEAE). Mild cognitive impairment was found in 37 (36,3%) of patients, moderate cognitive impairment was diagnosed in 36 (35,3%)patients.

[Gigantic aneurysm resulting from pathological kinking of the internal carotid artery].

Described in the article is a case report of successful surgical management of a 50-year-old male patient presenting with a gigantic aneurysm of the right internal carotid artery, pathological tortuosity of the right and left internal carotid arteries, successfully treated by resection of the aneurysm of the right internal carotid artery with autovenous prosthetic repair of the right internal carotid artery.

[Determining surgical policy in combined atherosclerotic lesion of carotid arteries in patients with uncomplicated aortic aneurysm].

Presented herein are the outcomes of managing a total of twenty-six patients suffering from an uncomplicated abdominal aorta aneurysm with a concomitant atherosclerotic lesion of the coronary arteries, referred to our Clinic over the period form 2003 to 2006. Of these, nineteen (70%) patients were diagnosed with the first (symptom-free) stage of cerebral ischaemic disease, and six presented with the second stage [to have endured a transient ischaemic attack (TIA) within the terms from 16 to 3 months prior to admission]. Two patients had residual events of the previously sustained acute cerebral ischaemia (ACI) (stage 4).

[Transection of secondary chordae of anterior mitral valve leaflet as a method of correction of functional mitral insufficiency during resection of left ventricular aneurism].

Dominating factor of development of functional mitral insufficiency in patients with ischemic heart disease and dilated cardiomyopathy is deformation of atrioventricular valve leaflets due to traction by chordae apparatus. In patients candidates for left ventricular reconstruction because of its postinfarction aneurism the problem of preexisting or recurrent dysfunction of mitral valve acquires special value as operation itself implies surgical ventricular remodeling and therefore change of mitral valve geometry. Supplementation of the volume of surgical intervention with resection of chordae responsible for impaired coaptation of mitral valve leaflets in some cases appears to be effective and simple method of correction of mitral insufficiency.

[Experience in treating embologenic thromboses of deep veins of lower extremities].

The present work deals with analysing the outcomes of surgical management carried out in a total of five hundred and sixty-six patients diagnosed as having embologenic thrombosis of the lower-limb deep veins. Of these, 377patients received a cava filter implanted, with the remaining 189 patients being subjected to thrombectomy from the iliac and femoral veins. In nineteen patients, the operation was supplemented by establishing an arteriovenous fistula.

[Abdominal aorta ruptured aneurysm in patients with previously endured endovascular grafting for aortic aneurysm: clinical case reports].

The article deals with four reports of rarely encountered clinical cases, i. e., a ruptured aneurysm of the abdominal aorta in patients having previously sustained endovascular grafting of the abdominal aorta for the pathology concerned.

[Plasma lipids oxidation in patients with occlusive atherosclerosis of lower extremities and ischemic heart disease].

Dynamics of lipoprotein oxidation in blood plasma was studied by Cu-induced plasma oxidation in 114 patients with atherosclerosis of lower extremities of various severity with and without ischemic heart disease. Preparedness of plasma lipoproteins to oxidation in patients was higher than in healthy subjects. Degree of oxidizeability increased with increase of severity and extent of atherosclerosis and was highest in patients with atherosclerosis of lower extremities and ischemic heart disease.

[Mini-invasive technologies in diagnosis and treatment of major vessels diseases].

Experience with 150 endovascular stents and endoprostheses including ones of vertebral and carotid arteries (first experience in Russia) is analyzed. Mini-invasive surgery is indicated for patients with isolated arterial lesions (segmental stenosis, short occlusions), changed and hard for surgery parts of vascular system (renal, visceral arteries, branches of aortic arch), restenosis after traditional surgeries and also for patients with severe concomitant diseases. Rate of complications of carotid endovascular stenting was 4,3%.

Formation of a genuine aneurysm of the vein graft 16 years after femoropopliteal bypass grafting.

Presented herein is a case of vein graft aneurysm formation 16 years after femoropopliteal bypass grafting using the reverse autogenous vein.

[Potential of tomographic methods of diagnosis and three-dimensional analysis of abdominal aortic aneurysm images].

Between 1998 and 2002, 256 tomographic investigations of the abdominal aorta were performed. Aortic aneurysms were identified in 29 (11.3%) patients.

[The simultaneous operation for rectal cancer and abdominal aortic aneurysm].

The authors present a successful case of simultaneous operation for rectal cancer and abdominal aortic aneurysm.

[Surgical treatment of ruptured abdominal aortic aneurysm].

Over the last 30 years more than 1000 patients with abdominal aortic aneurysms (AAA) were treated. Results of treatment of 367 patients with disruption of AAA from 1989 to 2002 were analyzed. Elderly and old patients account for 92% (338) of them.

[Bypass surgeries from remote vascular beds in the treatment of critical limb ischemia in elderly and old patients].

The problem of surgical treatment of elderly and old patients with critical limb ischemia and severe concomitant diseases is discussed. Surgical bypass from remote vascular beds is the only real possibility of effective care for such patients with the lowest risk. The results of treatment of 90 patients with critical limb ischemia were analyzed.

[Comparative assessment of the results of open carotid endarterectomy and carotid aftery stenting].

A comparative study of 48 carotid stent grafting and 23 open carotid endarterectomies was carried out. Patients of both groups were comparable by cerebrovascular insufficiency degree and concomitant diseases. General rate of complications after carotid stent grafting (CSG) was 5.

[On validity of the term "chronic" rupture of abdominal aortic aneurysm].

Treatment of patients with abdominal aortic aneurysms has been analyzed. From 506 patients (265 emergency and 241 elective cases) treated in the department of urent vascular surgery 36 had "chronic disruptions". Validity of this term is discussed.

[The dynamics of blood serum middle-molecule peptides in the prognosis of the course of acute pancreatitis].

The work is devoted to studying the dynamics of endogenous toxemia by the level of middle mass peptides of blood serum in patients with acute pancreatitis. The level of middle mass peptides was investigated in 116 patients spectrophotometrically after Gabriélian with the wave length 254 nm (1st fraction, MMP-1) and with the wave length 282 nm (2nd fraction, MMP-2). It was found that the ratio of these fractions could be used as a prognostic index of the complicated course of acute pancreatitis.

[Diet regimes in acute pancreatitis].

A method of determination of the duration of curative fasting in acute pancreatitis, depending on the degree of severity of patients' condition is described. The dependence between the probability of exacerbation of the process after resumption of feeding, the degree of severity of the condition at admittance, the duration of the fast vs degree of the severity of the condition in which the feeding was resumed was studied, for this purpose the method for calculation of so called coefficient of the degree of severity of acute pancreatitis was developed. 130 patients with acute pancreatitis underwent the treatment according to this method.