Background. Acute pulmonary embolism (PE) is the third leading cause of cardiovascular mortality after ischemic heart disease and stroke. Along with thrombolysis, reducing pulmonary vascular resistance in PE is one of the important pathogenetic ways of treating this pathology.

The article presents a review of current literature data on the prospects for fundamental research into potential pulmonary vasodilators. A vasodilator used in clinical practice should be selective, if possible, for pulmonary vessels, not contribute to the aggravation of arterial hypotension, and not have a negative inotropic effect on the heart.

Objective. The purpose of this study was to analyze the available literature data on experimental research aimed at using vasodilators in modeling of PE in animals. The publications were retrieved from such databases as PubMed, Scopus, Web of Science, and Russian Science Citation Index.

Results and discussion. Since the development of pulmonary vasoconstriction in PE is promoted by neurogenic, humoral, and local mechanisms, it is impossible to single out the only key “target” for the use of a vasodilator. Promising areas of research may include the search for new nitric oxide donors and the study of the vasodilator properties of such compounds as 1.2-propanediol and N-nitroso-N-morpholino-amino-acetonitrile. It is also necessary to study the vasodilator properties of argon as a potential agonist of GABA receptors in pulmonary vascular smooth muscle cells. Selective action on Ca²⁺, K⁺, and Na⁺ ion channels in pulmonary vascular smooth muscle cells could be a potential method of vasodilation in pulmonary thromboembolism.

Piezo1 mechanosensitive channels of the pulmonary vascular endothelium may be a pharmacological target for vasodilation in PE. Further study of the mechanisms regulating intrapulmonary and bronchopulmonary shunt blood flow is also necessary to find new approaches to reducing pulmonary vascular resistance in PE. The effects of vasodilators in PE could be more pronounced if pathogenetic constrictor neurogenic mechanisms are eliminated simultaneously with their use. One of the approaches to reducing the neurogenic component of the constrictor reaction of pulmonary vessels in PE conditions could be the effect on inhibitory presynaptic receptors located at the endings of sympathetic nerves.

Background. Carotid endarterectomy (CEA) is an established method for stroke prevention in patients with significant carotid bifurcation stenosis. The carotid body (CB), a peripheral chemoreceptor located at the bifurcation, participates in the regulation of respiration and blood pressure. Whether the CB should be preserved during CEA remains a matter of debate, particularly in patients with atherosclerosis and resistant hypertension.

Objective. To study morphological and histological changes of the CB in patients with significant carotid artery stenosis and resistant arterial hypertension undergoing CEA.

Materials and methods. Thirty-four CBs were excised during unilateral CEA in patients with >70% internal carotid artery stenosis and resistant hypertension. Histological, immunohistochemical, and morphometric analyses were performed to quantify stromal, vascular, neural, and parenchymal components.

Results. The mean CB section area was 31.941 µm². The median number of lobules was 4. The ratio of functional parenchyma (lobules) to connective tissue was 1:2.08. Functional tissue accounted for ~30% of the CB area, whereas connective tissue comprised up to 62%. Morphological examination revealed lobular deformation, intralobular fibrosis, and vascular wall sclerosis. Despite preservation of lobule number, their size and structure showed marked involutional remodeling.

Conclusion. In patients with advanced carotid atherosclerosis and resistant hypertension, the CB exhibits profound involutional changes characterized by connective tissue expansion and loss of functional parenchyma. These findings suggest that CB preservation during unilateral CEA may be unwarranted, as its physiological role appears to be largely abrogated under chronic hypoxia.

Background. Stratification of the risk of acute ischemic cerebrovascular events in atherosclerotic carotid artery stenosis is an urgent task, which has traditionally been based on the degree of narrowing of the arterial lumen, underestimating the role of morphological characteristics of plaque. In 2024, a new Carotid Plaque system, RADS, was proposed, standardizing the morphological description of plaques revealed by different imaging modalities and supplementing the assessment of the degree of stenosis by NASCET.

Objective. The purpose of this work was to identify the possibilities and limitations of ultrasound examination within the framework of the Carotid Plaque-RADS classification as a first-line diagnostic method.

Сontent of the review. Ultrasound criteria of Carotid Plaque RADS 1–4 categories are described: normal wall (RADS 1); uncomplicated eccentric plaques <3 mm high (RADS 2) and plaques ≥3 mm high with a thick/thin fibrous covering or healed ulceration regardless of their height (RADS 3a/3b/3c); complicated plaques with hemorrhage, fibrous cap rupture or parietal thrombus (RADS 4a/4b/4c). Additional signs of instability (calcifications, neovascularization, inflammation, positive remodeling, “plaque loading”, stenosis progression) and modifiers affecting the quality of ultrasound imaging are considered. A moderately high accuracy of the ultrasound method in the identification of key plaque components was demonstrated, while certain limitations remain in the differentiation of a thin/thick plaque cap, healed ulceration/rupture of the fibrous membrane, as well as in the distinction of the lipid necrotic core, intraplaque hemorrhage and parietal thrombus. The algorithm of a structured ultrasound conclusion is described.

Conclusion. The Carotid Plaque-RADS classification unifies the description of plaque characteristics, facilitates interdisciplinary communication, and improves patient selection for surgical treatment, but is currently not included in professional guidelines and requires further validation in large centers and prospective studies. Ultrasound evaluation of individual plaque components requires further refinement, possibly with the development of new software approaches.

Background. One of the main success factors in the treatment of patients with acute mesenteric ischemia is the timely diagnosis and the earliest possible start of treatment.

The aim is to evaluate the diagnostic accuracy and specificity of computed tomography (CT) with intravenous contrast and X-ray contrast angiography in the diagnosis of acute mesenteric circulatory disorders.

Material and methods. The work was carried out on the basis of two multidisciplinary hospitals of the third level, which include departments of general surgery and cardiovascular surgery. The study included 93 patients with suspected acute abdominal ischemia. CT angiography was performed in 68 of them, X-ray contrast angiography was performed in 14 of them, X-ray CT preceded endovascular intervention in 8 patients, and acute mesenteric ischemia was detected only intraoperatively after laparotomy in 28 patients after preliminary X-ray contrast examination.

Results. The sensitivity of CT angiography was 72.6%, and the specificity was 80.2%. Due to the accuracy and the possibility of detailed visualization of the distal parts of the mesenteric bed, the sensitivity of endovascular interventions was 94.6%, and the specificity was 100%.

Conclusion. The use of X-ray contrast angiography is preferable in patients in stable condition with suspected acute mesenteric ischemia, regardless of the severity of changes in the intestinal wall. CT angiography is an accessible and non-invasive research method, it is the primary diagnostic method in patients in order to identify complications of acute mesenteric ischemia, as well as the only method applicable in the absence of endovascular diagnostic methods in the clinic.

Background. According to WHO, the number of people suffering from atherosclerotic lesions of the brachiocephalic arteries in different age groups is 20–50%. The development of ischemic stroke with existing chronic occlusion of the internal carotid artery (ICA) occurs with a frequency of 6–15%, and the annual risk of developing acute ischemic disorders in the ipsilateral basin, despite adequate drug treatment, ranges from 6 to 20%.

The aim is to evaluate the efficacy and safety of endovascular recanalization in chronic ICA occlusion.

Material and methods. The analysis of the first results of intravascular treatment of 12 patients with chronic ICA occlusion on the basis of the vascular neurosurgical department of the Russian Research Neurosurgical Institute named after Professor A.L. Polenov. The age range is from 42 to 75 years (the average age is 57 years). There were 11 men (91.6%) and 1 woman (8.4%).

Depending on the type of chronic occlusion, according to the D. Hasan scale (2018), the distribution of patients was as follows: type A (the presence of a proximal ICA stump of the “candle” type + retrograde filling of the ICA to the stony/cavernous segments) – 4 patients; type B (the presence of a blindly ending proximal ICA stump without the formation of a “candle” + retrograde filling of the ICA to the rocky/cavernous segments) – 3 patients; type C (occlusion of the ICA from the mouth + retrograde filling of the ICA to the rocky/cavernous segments) – 2 patients; type D (occlusion of the ICA from the mouth with the absence of retrograde filling of the stony/cavernous segments of the ICA) – 3 patients.

Results. In 8 (66.6%) of the 12 patients, the ICA lumen was completely restored. According to the D. Hasan scale, type A was noted in 4 patients, type B in 3 patients, and type C in 1 patient. In 4 (33.3%) patients, technical success was not achieved, of which according to the D. Hasan scale: type D was observed in 3 patients, type C in 1 patient. Of the 8 patients with successful ICA recanalization, all underwent remote monitoring by computed tomographic angiography or digital subtraction angiography. No data confirming restenosis were obtained in 6 patients. There were no episodes of recurrent ischemic disorders. In 1 patient, thrombosis of stented ICA was detected against the background of the patient’s self-withdrawal of double disaggregant therapy. Unsuccessful recanalization (4 patients), in our opinion, is associated with convolution of the ICA and severe scarring in the lumen of the occluded artery.

Conclusion. Intravascular recanalization of chronic ICA occlusion is a promising method that can be effectively used to restore the full-fledged lost artery lumen and normalize brain perfusion to reduce the risks of recurrent ischemic cerebral events.

Carotid endarterectomy is the gold standard for stroke prevention. Although it is one of the most common procedures in vascular surgery, its technique has not been fully standardized. In particular, there is no consensus on the optimal approach for dissection of the carotid bifurcation. Data suggest differences in the safety and efficacy of the retrojugular and/or antejugular approaches, primarily regarding local wound complications and the incidence of cranial nerve injuries, which occur in 1.4–31% of cases and significantly impair patients’ quality of life.

Objective. To compare the safety and efficacy of the antejugular and retrojugular approaches to the carotid bifurcation within a prospective randomized study.

Material and methods. The study enrolled 280 patients (140 retrojugular, 140 antejugular). Inclusion criteria: internal carotid artery (ICA) stenosis >70% (asymptomatic) or >50% (symptomatic). Exclusion criteria: primary – pre-existing neurological deficits, reoperations. secondary – perioperative stroke, wound hematomas, early reinterventions. Design: Prospective randomized study.

Results. Common complications: perioperative acute cerebral circulatory disorders/transient ischemic attacks – 2.14%/1.43% with antejugular access, 1.43%/0.71% with retrojugular access (p=0.658/0.566); hematomas – 0.7%/2.1%, respectively (p=0.63). Local neurological symptoms: on day 1 – 33.8% (dysphonia – 33.1%, vocal fold paresis – 1.9%), on day 3 – 22.9%, after 3 months – complete regression in all patients. After applying the secondary exclusion criteria, 134 patients with retrojugular access and 132 patients with antejugular access were included in the comparative analysis. The frequency of cranial nerve damage, dysphonia, and dysphagia did not differ depending on the type of access (p>0.05). The surgery time was 76.1±1.8 min (antejugular) vs 74.2±2.4 min (retrojugular, p=0.51).

Conclusion. The retrojugular approach facilitates internal carotid artery exposure and obviates venous ligation but does not reduce local neurological complications or operative duration compared to the antejugular approach. Both techniques demonstrate comparable safety profiles, with approach selection contingent on surgeon preference and patient-specific anatomy.

Objective. To compare endovascular treatment (kissing stenting, KS) with traditional open aortobifemoral bypass grafting (ABBG) in management of patients with lesions of the abdominal aorta bifurcation and iliac arteries.

Patients and methods. We performed a single-center analysis of patients subjected to endovascular treatment with bare-metal stents by means of kissing stenting or ABBG for TASCII C/D lesions of the aortoiliac segment (AIS) from 2012 to 2021. We assessed the parameters of the perioperative risk scale (American Society of Anesthesiologists, ASA and Society for Vascular Surgery, SVS), frequency of hospital complications, early 30-day mortality and long-tern patency. The obtained results were analyzed by means of the Kaplan–Meyer curves, with the Cox regression used to determine predictors influencing patency parameters.

Results. The study included 57 patients with KS and 86 patients with ABBG. The KS group had a higher perioperative risk: ASA (ACP=0.06), SVS (ACP=0.08) and less frequent lesions of the AIS (TASC D lesions 26.3% vs 46.5%, ACP=0.202). After propensity score matching, the study comprised a total of 80 patients (40 with KS and 40 with ABBG), thus forming well balanced groups in terms of demographic data, risk factors, lower limb ischemia degree, perioperative risk: ASA (ACP=0.006), SVS (ACP=0.003) and AIS lesion anatomy (TASC D – 40%, ACP=0.000).

36-month mortality amounted to 5% after KS vs 2.5% in the ABBG group. The length of hospital stay in the KS group was significantly shorter than in the ABBG group (3.9±1.6 days vs 9.1±1.9 days, p<0.001), as well as that of ICU stay (0 days vs 2.1±0.4 days, p=0.001). The rate of early postoperative complications was comparable (7.5% vs 15%, p=0.47). Three-year primary patency was similar between the KS and ABBG groups (87.5% vs 95%, p=0.24); multivariate analysis showed that critical limb ischemia and hemodynamically significant lesions of the efferent arteries were risk factors for developing restenosis/reocclusion (6.65 [1.29; 34.37], p=0.02 and 6.4 [0.72; 50.22], p=0.04, respectively).

Conclusion. Endovascular treatment of lesions of the aortic bifurcation and iliac arteries with bare-metal stents demonstrated primary patency comparable with that of ABBG over the 3-year follow-up period. The incidence of early postoperative complications was comparable. Thus, endovascular reconstruction of the aortoiliac segment for TASC C, D lesions by means of kissing stenting can be considered as an alternative to ABBG.

Background. Improving transcatheter bioprostheses and systems of their delivery, gaining surgical experience, as well as optimizing patient selection made it possible to achieve high levels of efficacy and safety of the procedure of transcatheter implantation of the aortic valve (AV). Nevertheless, complications of this technique with a negative influence on both short- and long-term outcomes are still encountered in many patients. Despite the fact that transcatheter implantation of the AV has historically been associated with lower incidence of hemorrhagic events than traditional surgery, bleeding occurring during this operation is fraught with a worse prognosis. Complications of the vascular access still remain the main cause of hemorrhage.

Objective. To assess the incidence, predictors and prognostic significance of major vascular complications associated with the transfemoral vascular access for transcatheter implantation of the aortic valve.

Patients and methods. This retrospective study initially enrolled a total of 628 patients who underwent transcatheter implantation of the AV from March 2015 to October 2024. After exclusion of patients with other than transfemoral vascular approach, as well as with unsatisfactory quality of preoperative multislice computed tomography not allowing for the assessment of vascular anatomy, the final analysis included 548 patients. The primary endpoint of the study was defined as predictors of major vascular complications of the transfemoral approach after transcatheter implantation of the AV, with the secondary endpoint being long-term survival and freedom from cardiovascular death in patients having endured nonfatal major vascular complications of the access site at the in-hospital stage after transcatheter implantation of the AV.

Results and discussion. There were a total of 32 major vascular complications. Of these, 3 (0.6%) resulted in a lethal outcome, with 29 (5.3%) accompanied by BARC type 3a and 3b bleeding. Puncture percutaneous vascular access was used in 94.9% of patients. The most frequently applied method of vascular access closure was a combination of two ProGlide devices (70.9%). The group of patients with major vascular complications of the transfemoral access was found to have a higher frequency of puncture of the left common femoral artery (21.9% vs 10.5%, p=0.04), as well as a longer length of hospital stay (13.3±8.3 vs 9.4±5.8, p=001). The only independent predictor of major vascular complications was the left side of the vascular access (odds ratio 8.85; 95% confidence interval 1.58–69.40, p=0.02). With an average follow-up period of 2.1±2.2 years, the log-rank test revealed no statistically significant differences in freedom from all-cause mortality (log-rank p=0.11) and freedom from cardiovascular death (log-rank p=0.30) in patients with and without non-fatal major vascular complications of the access site after implantation of the AV.

Conclusion. The incidence of major vascular complications of the access site after the procedure of transcatheter implantation of the aortic valve amounted to 5.9%. The only independent predictor of major vascular complications was the left side of the vascular access. The development of major nonfatal vascular complications at the in-hospital stage influenced neither survival nor freedom from cardiovascular death in the remote period.

Background. Retrograde aortic dissection of type A is the most dangerous and difficult-to-predict complication of thoracic aortic arthroplasty. In this complication, without timely surgical treatment, mortality in the first 48 hours may exceed 40%.

The aim is to present the results of surgical treatment of patients with type A retrograde aortic dissection after thoracic aortic stenting.

Material and methods. From 2014 to 2024, 7 patients underwent open aortic arch replacement for type A retrograde aortic dissection after thoracic aortic arthroplasty. 3 patients underwent surgery in the early period, and 4 in the long–term period after stenting.

Results. There was no hospital mortality. In the early and late postoperative periods, neurological complications, the development of multiple organ failure, and malperfusion of internal organs were not noted. In the long-term follow-up period, 4 years after surgery, 1 patient died (aorto-unassociated mortality).

Conclusion. Emergency open surgery is the method of choice for type A retrograde aortic dissection after aortic arthroplasty. This approach leads to good early and long-term results. All patients with distal aortic dissection require lifelong monitoring for timely diagnosis of possible complications.

Background. The frequency of injury of the limb major arteries in the era of continuous improvement of firearm types has a pronounced upward trend. There is an increase in the severity of injuries due to changes of damaging agents against the background of the growing number of armed conflicts in the world. Limb injuries occupy a leading position in the structure of war wounds and account for 46 to 74%. The formation of peripheral aneurysms and arteriovenous fistulas (AVFs) is an outcome of vascular trauma in 48.9–68.7% of cases. The lower extremities appear to be the most frequent localization of traumatic arteriovenous fistulas – 17%.

Objective. The aim of our study was to evaluate hemodynamic significance of blood flow disorders at local and systemic levels and related clinical manifestations in patients with verified gunshot traumatic limb arteriovenous fistulas depending on localization.

Patients and methods. The study included a total of 102 patients with injuries of the main vessels of the extremities complicated by the formation of traumatic AVFs. All patients with verified traumatic arteriovenous fistulas of the limb, in addition to standard methods of AVF visualization underwent echocardiography in the preoperative period in order to assess the negative influence on the central hemodynamics in the form of right heart overload, to evaluate the presence of pulmonary hypertension. Echocardiography was also performed in the early postoperative period (1–3 days) to assess hemodynamic changes after disconnection of the AVF.

Results. Negative effects on local hemodynamics were instrumentally verified in 100% of cases by ultrasound assessment, as well as by the findings of X-ray contrast methods, with clinical manifestations of limb AVF noted only in 57% of cases. Surgical disconnection of the AVF was followed by statistically significant (p<0.05) changes in the length and volume of the right atrium, pulmonary artery systolic pressure, mean pulmonary artery pressure and right ventricular outflow tract diameter.

Conclusion. Traumatic AVFs of the extremities within a period of up to one year from the moment of formation have a negative effect on central hemodynamics when localized on the upper limb only in the region of the axillary artery, when localized on the lower limb - only in the region of the common femoral artery. Traumatic AVFs located more distally have no effect on central hemodynamics during 1 year.

Background. Cyanoacrylate adhesive сlosure (САС) of subcutaneous veins is a modern method of treating varicose veins of the lower extremities, demonstrating a number of advantages over traditional surgical and thermal ablation techniques. Unlike endovenous thermal сlosure, tumescent anesthesia is not performed in САС, which significantly reduces pain and impact on perivenous tissues, especially for patients with trophic skin disorders. In addition, postoperative compression is not required, which is contraindicated in the presence of obliterating atherosclerosis of the lower extremities. Given the relative novelty of the methodology, the number of studies with long-term results is limited.

The aim is to evaluate the long-term outcomes of the use of САС in the treatment of patients with IBD.

Material and methods. A retrospective analysis of electronic medical records of patients with IBD has been carried out since the integration of the considered technique into the work of the Phlebology Center of the Multidisciplinary Medical Holding SM-Clinic from 2019 to 2024. The study included patients with varicose-transformed tributaries of the main subcutaneous veins, corresponding to classes C2–C6 according to CEAP, with terminal valve dysfunction with axial reflux (>0.5 s, diameter of the trunk of the subcutaneous vein – 0.6 cm and higher). САС was performed using the VenaSeal Closure System (Medtronic) according to a standard protocol. In the course of the work, demographic and clinical data, key preoperative characteristics (diameter of the target subcutaneous vein, number of venous basins) were evaluated, which were analyzed using descriptive statistics methods. A visual analog scale (VAS) was used to assess the intensity of pain directly during surgery. Postoperative follow-up of patients, including ultrasound duplex scanning, was performed on the 3rd day, then 1, 3, 6 and 12 months after surgery, and thereafter annually. The criterion for the effectiveness of САС was the occlusion of the trunk of the target vein. The safety criterion is the frequency of postoperative adverse events and complications.

Results. Evaluation of long-term results with a follow-up period of 5 years was performed in 39 patients who underwent CT in the second half of 2019. 52 lower extremities and 53 venous basins corresponded to this number of patients. There were 24 women (61.5%) and 15 men (38.5%). The average age of the patients was 58.3±16.2 years. 19 (48.7%) patients were elderly and senile. The distribution of patients according to the CEAP classification: C2 – 21 (53.8%), C3 – 15 (38.5%), C4 – 3 (7.7%).

The average diameter of the large saphenous vein was 10.8±4.1 mm, the small saphenous vein was 6.7±2.3 mm. In 25 (64.1%) patients, CT was performed on the 1^st venous basin, in the remaining 14 (39.5%) – simultaneously on the 2nd venous artery. The average duration of the intervention was 35±25.7 minutes. In 26 patients, САС was performed as an isolated procedure, without intervention on the tributaries and did not require the use of postoperative compression. Simultaneous interventions on tributaries were performed in 13 (33.3%) patients: foam sclerotherapy in 9 (23.1%), miniflebectomy in 4 (10.2%). Intraoperative VAS pain was estimated at less than 3 points in 36 (92.3%) patients. The average VAS score was 2.9±0.7. Immediate technical and anatomical success was achieved in all 39 (100%) patients at the first 2 follow-up examinations (3 days and 1 month after the procedure). In subsequent controls, recanalization was registered in 3 (7.7%) patients. Glue-induced thrombosis was noted in 1 (2.6%) patient. 5 (12.8%) patients had a phlebitic skin reaction (delayed type) that occurred from 1 week to 1 year after surgery. This complication was eliminated by conservative treatment. Tributary thrombophlebitis was recorded in 2 (5.1%) patients. In 1 (2.6%) case, an abscessed soft tissue granuloma was diagnosed at the vein puncture site 5.5 months after the CT scan. Ecchymosis was observed in 4 (10.2%) patients. There were no postoperative neurological complications, pulmonary embolism, or deep vein thrombosis in this group of patients. The incidence of target vein occlusion at 3 months, 6 months, and 3 years after the intervention was 97.5%, 94.9%, and 92.3%, respectively. The last indicator remained until the 5-year observation period.

Conclusion. The САС technique demonstrates a high level of efficacy and safety in the treatment of patients with varicose veins of the lower extremities, with a 92.3% occlusion rate of target veins within 5 years after сlosure.

Introduction. Endovascular thermal ablation techniques, such as endovascular laser or radiofrequency ablation (RFA), have become the standard of care for treating varicose veins. However, some patients may experience unpleasant sensations, such as a “tourniquet” or “string”, in the area where the subcutaneous artery is obliterated. One way to reduce these adverse events is through the use of topical treatments, such as sodium heparin gel (1000 IU) and a combined preparation containing escin, heparin, and essential phospholipids.

The aim of this study was to evaluate the clinical symptoms, frequency, and severity of the “string” sensation in patients with varicose veins who underwent large saphenous vein ablation (LSVA), and to assess whether sodium heparin (1000 UI) or the combined preparation could alleviate these symptoms.

Material and methods. An open, randomized, prospective cohort study was conducted on 180 female patients aged 18–72 years (mean age 41.2±7.5 years) diagnosed with varicose veins of the lower extremities. The patients were divided into three groups: Group 1 underwent IVF without any additional conservative therapy; Group 2 received topical heparin (1000 IU) applied twice daily for two weeks after endovenous thermal ablation (EPR); and Group 3 received a topical medication containing escin, heparin, and essential phospholipids applied twice daily after EPO for two weeks.

Results. In the initial class of chronic venous disease, grade 3 according to the CEAR classification, a decrease in edema was recorded at the end of treatment in group 1 in 72.7% of cases, in group 2 – in 76.9% of cases and in group 3 – 91.7%, respectively. The differences between groups 3 (patients receiving a combination topical agent) and the other two were statistically significant (p<0.05). For grade 4 chronic venous diseases, a reduction in dermatitis symptoms was noted in group 3 in 83.3% patients compared to 50% and 57.1%, respectively, for groups 1 and 2. A decrease in induration of tissue was observed in 66.7% of patients in group three compared to 40%, in both group 1 and group 2. Healed ulcerative defects were noted in 60% of group 3 patients versus 33% and 25% in groups 1 and 2, respectively. Using a combination of topical agents, the number of “string” symptoms decreased from 50.6% to 93.5%.

Conclusion. The symptom of “string” after acute renal failure may occur 2 months after surgery in about 3–4% of patients on average. The use of topical agents containing a combination of venoactive drugs (escin), heparin, and essential phospholipids can help reduce the severity of this symptom.

Sclerotherapy firmly holds a leading position in the treatment of malformations, as it is effective, minimally invasive, and in many cases, can be performed on an outpatient basis under local anesthesia.

The advantages of sclerotherapy include minimizing risks and postoperative complications, creating optimal conditions for sclerosing agent-induced regression of pathological venous conglomerates, a short and uneventful postoperative period, and last but not least enabling outpatient treatment. The improved quality of life resulting from the reduction or elimination of pain and the restoration of functional activity of the maxillofacial region positively impacts the patients’ overall somatic and aesthetic state, as well as their mental health.

Relevance. Stroke continues to occupy a leading position among the causes of mortality in the population. In the Russian Federation, more than 450 thousand cases of acute cerebrovascular accident are recorded annually, with the vast majority (75–80%) being ischemic stroke. Timely restoration of cerebral blood flow allows minimizing the infarction zone by preserving viable areas in the ischemic penumbra, which significantly improves the prognosis of the disease.

The aim of the study is to analyze the results of endovascular thrombectomy by direct carotid access in the treatment of patients with ischemic stroke.

Material and methods. Within the theoretical section, an analysis of foreign and domestic experience in endovascular treatment of ischemic stroke with complex anatomy was carried out. Within the practical section, the results of our own experience were generalized and analyzed.

Over the past 5 years, 613 endovascular mechanical thrombectomies with occlusion in the anterior circulation basin have been performed at the V.V. Veresaev City Clinical Hospital. Of these, 17 patients underwent direct carotid access. The decision on direct access to the common carotid artery was made with unsuccessful selective catheterization of the common carotid artery on the affected side for 30 minutes.

Results and discussion. Mechanical reperfusion by direct carotid access in combination with systemic thrombolytic therapy was performed in 3 (17.6%) patients. Reperfusion at the TICI-2b-3 level was considered successful. Endovascular reperfusion was successful in 16 (95%) сases. Effective first-pass thrombectomy was performed in 14 (82%) cases. Manual hemostasis after introducer removal was performed in 6 (35.3%) patients, in 11 (64.7%) cases the puncture hole of the common carotid artery was sutured. Symptomatic hemorrhagic transformation was observed in 3 (17.6%) сases. Three patients died. Mortality was 17.6%. The average National Institutes of Health Stroke Scale at discharge was 13.4±6.2 points. In patients with percutaneous puncture, the average time from the beginning of the operation to reperfusion was 62 minutes.

Conclusion. Direct carotid access can be considered as an effective and safe method of mechanical thrombectomy in patients with difficult selective catheterization.

The article presents a clinical observation of successful treatment of a patient with post-thrombotic occlusion of the subclavian artery and critical ischemia of the left upper limb. According to computed tomography angiography, extravasal compression of segment 2 of the subclavian artery by an additional cervical rib was detected. Decompression of the subclavian artery with resection of the additional cervical rib, thrombectomy, and angiography were urgently performed via the left supraclavicular approach. Blood flow to the limb was restored, and no additional endovascular procedures were required. Regression of the clinical picture of critical ischemia was noted in the postoperative period.

Mid-aortic syndrome is a condition characterized by obstructive lesions of the thoracoabdominal aorta, occurring in approximately 0.5–2% of cases. This report presents the long-term outcomes of a clinical case involving transcatheter treatment of mid-aortic syndrome in a child. At an early age, the patient underwent recanalization of an occluded thoracoabdominal segment, followed by staged balloon angioplasty and implantation of an Advanta V12 OTW 9×59 mm stent-graft (Getinge Group, Sweden). After the initial procedure, the patient was followed up over a 3-year period. During a routine hospitalization, an increase in the peak pressure gradient between the upper and lower extremities up to 30 mmHg was noted, along with a stenosis of the mid-portion of the stent-graft to 3.3 mm in diameter. Due to the evolving clinical presentation, a decision was made to perform repeat endovascular intervention. A Visi-Pro stent (Medtronic Corp., USA), 9×17 mm in size was implanted at the site of maximum stenosis followed by sequential balloon angioplasty. Control angiography revealed moderate residual stenosis with a luminal diameter of 7.5 mm and a peak gradient of 10 mmHg. Antiplatelet therapy (acetylsalicylic acid) and antihypertensive therapy (enalapril) were prescribed. The patient was discharged in satisfactory condition on postoperative day 5.

Transcatheter techniques do not always achieve complete elimination of the stenotic area and require close follow-up due to the risk of neointimal hyperplasia. Nevertheless, the endovascular approach to palliative correction of mid-aortic syndrome allows the child to reach an optimal age for definitive surgical repair while reducing the need for repeated open procedures.

The article presents a clinical observation of successful multi-stage surgical treatment of a patient with severe cardiac insufficiency aggravated by long-standing posttraumatic arteriovenous fistula of the brachial artery. Additionally, during the examination, the patient was found to have significant stenotic lesions of both carotid arteries. This combination of pathological factors in one patient required a multidisciplinary discussion of surgical treatment tactics and has not been described in the literature before.

This clinical case demonstrates an example of successful lower limb revascularization in a patient with an extended distal type of atherosclerotic lesion and critical ischemia with the formation of necrosis of the heel area. Due to the inability to perform distal bypass and angioplasty, as well as high surgical risks, the patient underwent isolated stenting of common and deep femoral arteries, which made it possible to achieve regression of critical ischemia and save the limb.

The article provides a review of the no-touch technique for harvesting the great saphenous vein in coronary artery bypass grafting. The morphological advantages of the no-touch method are discussed, including preservation of the endothelium, adventitia, and perivascular tissue, thus contributing to improved long-term graft patency. The findings of clinical trials are presented demonstrating that no-touch – great saphenous vein yields outcomes comparable to those of arterial conduits and superior patency compared to the conventional technique. Various configurations of composite grafts (I-, Y-, and T-grafts) and their role in revascularization of the right coronary artery are also analyzed.

Despite rapid development of vascular and endovascular surgery, the rate of amputation remains high even in developed countries. Major amputations are performed in 20–40% of patients with critical ischemia. In conditions of failure or impossibility of vascular reconstruction in the absence of a distal arterial bed, some teams of specialists use various methods of indirect revascularization. Based on the literature sources, the article provides a brief overview of such methods, assesses their applicability and effectiveness, substantiates the concept of free flap indirect revascularization of the limb in critical ischemia.