The article deals with the information concerning the history of formation of notions on pathogenesis of cerebrovascular insufficiency, development of diagnostic measures for this disease, palliative attempts of its surgical correction, substantiation and implementation into clinical practice of methods of preventing ischemic strokes and coping with their consequences by means of arterial reconstructions.

Funding. The study had no sponsor support.

Conflict of interest. The author declares no conflict of interest.

For citation: Beloyartsev D.F. History of the study of chronic cerebrovascular insufficiency. Angiology and Vascular Surgery. 2022; 28 (1): 9–12. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-9-12 (in Russian)

Analysed in the article is translated for the first time from Latin into Russian and introduced into scientific use “Dissertatio medico chirurgica inauguralis de aneurysmate” (St. Petersburg, 1816) written by Associate Professor of the Imperial Russian Medical and Surgical Academy and then holder of the higher orders of Russian Empire, Actual Privy Councillor V.V. Pelikan (1790–1873).

Part 4 of the article contains selected fragments of his dissertation with brief comments dedicated to describing the principles of collateral blood circulation, fundamentals of the teaching on reduced circulation and a method of treatment of an aneurysm by the V.V. Pelikan’s technique.

The scientific novelty and practical significance of the Dissertation consist in substantiated by the author theoretically, experimentally developed and approved in clinical practice method of ligation of the afferent artery after being dissected proximal to an aneurysm. An important peculiarity of the method suggested by V.V. Pelikan was the idea of simultaneous ligation of the artery and eponymous vein. Introduced in the history of surgery as the “teaching on reduced blood circulation” (Oppel V.A., 1911), this idea became the first in the Russian medicine development in the area of clinical angiology; suggested by V.V. Pelikan method of ligation of the artery with its dissection was the first priority of Russian vascular surgery and the author himself should be considered the first in Russia vascular surgeon with the degree of Doctor of Medicine and Surgery. It may also be stated that at the beginning of the 19^th century, the academic surgical clinic of the Imperial Medical and Surgical Academy was the first surgical clinic containing specialised beds for vascular patients. Stylistically, V.V. Pelikan’s dissertation is an heir of European scientific treatises of XVI–XVIII centuries and its language characterises the author as a witty and emotional person.

Funding. The study had no sponsor support.

Conflict of interest. The author declares no conflict of interest.

For citation: Glyantsev S.P., Kryukov Yu.Yu., Sochilin A.A. Actual privy councillor V.V. Pelikan (1790–1873) and his «Dissertatio Medico Chirurgica Inauguralis de Aneurysmate» (St. Petersburg, 1816). Part 4. Treatment of arterial aneurysms according to V.V. Pelikan’s technique and the beginnings of his teaching on reduced blood circulation Angiology and Vascular Surgery. 2022; 28 (1): 13–21. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-13-21 (in Russian)

Objective. The purpose of the study was to examine the effect of cilostazol on isoforms of targets of phosphodiesterase 3 and phosphodiesterase 5 by means of molecular modeling.

Material and methods. Inhibition of phosphodiesterases (PDEs) was studied by means of molecular docking using software Maestro Schrodinger Inc. The structure of all mentioned proteins was taken from the Protein Data Bank (PDB): 7L27-PDE3A, 1JOS-PDE3B, 4MD6-PDE5. The structures of cilostazol and vardenafil ligands were obtained from the PubChem database. The Glide Docking SP mode was used to determine the best pose of the ligand in the supramolecular complex PDE-ligand with the function of minimal assessment of energy. The structures of PDEs were taken from protein database. Each molecule of PDE was prepared before docking using the Protein Preparation Wizard module. The ligand geometry was optimized using the force field MMF4 in the software package of molecular dynamics GROMACS. The active center of enzymes was considered rigid, with the change of torsion angles being allowed for cilostazol. The results were visualized using the function Ligand Interaction in the Maestro module. The inhibition constant (Ki) was obtained from the binding energy (ΔG) using the formula: Ki=exp (ΔG/RT), where R is the universal gas constant (1.985 × 10⁻³ kcal · mol^{− 1} · K⁻¹) and T is the temperature (298.15 К).

Results. Cilostazol possesses higher affinity to isoform of PDE3A (Ki=54 nM) as compared with PDE3B (Ki=1.13 µM) based on the findings of the performed molecular docking. Also, cilostazol can inhibit PDE5 in therapeutic doses (Ki=10 µM).

Conclusion. Cilostazol-mediated inhibition of the isoform PDE3A to a greater degree than PDE3B explains a low incidence of side effects from the side of PDE3B inhibition in clinical practice. Cilostazol may also inhibit PDE5 at therapeutic doses (Ki=10 µM), in which connection it may have an additional therapeutic effect in treatment of intermittent claudication, diabetes mellitus and its complications, especially neuropathy.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Koreyba K.A., Stupin V.A., Silina E.V., Syuzev K.N., Serebryakova O.A. Molecular study of mechanisms of action of cilostazol on certain families of phosphodiesterases. Angiology and Vascular Surgery. 2022; 28 (1): 22–8. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-22-28 (in Russian)

Background. Computational fluid dynamics is currently widely used to study the parameters of blood flow and their alterations in pathological states and are important indicators for diagnosis of atherosclerosis.

Objective. This study was aimed at determining risk zones for development of atherosclerosis by means of computational fluid dynamics in patients without carotid artery pathology.

Patients and methods. Using contrast-enhanced computed tomography, a total of 10 bifurcations of common carotid arteries were examined. The obtained findings were analyzed by means of computational fluid dynamics. The area of bifurcation was divided into segments. In each segment, we identified zones most prone to the development of atherosclerosis.

Results. The obtained findings made it possible to draw a conclusion that in patients without pathology of carotid arteries, the zone of bifurcation is a place of potential development of atherosclerotic plaques. It was confirmed by low values of wall shear stress. Besides, our study made it possible to determine exact localization of risk zones, i. e., proximal portion of the internal carotid artery.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Derbilova V.P., Vinogradov R.A., Zakharov Yu.N., Borisov V.G., Tregubenko K.A., Meshcheryakova O.M., Kapran T.I., Matusevich V.V., Vinogradova E.R., Хeteeva E.E., Zyablova E.I., Baryshev A.G., Porkhanov V.A. Computer-assisted modeling of hemodynamic parameters in normal bifurcation of common carotid artery. Angiology and Vascular Surgery. 2022; 28 (1): 29–35. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-29-35 (in Russian)

Objective. This experimental study was aimed at assessing efficacy of an original non-invasive method of preparing an autovein for shunting with thermovisual evaluation of the internal relief of the autovein.

Patients and methods. In 2018, we analysed a total of 20 segments of the great saphenous vein procured during classic femoral phlebectomy. The segments of the great saphenous vein were examined with the help of a thermal imager according to an original technique for verification of venous internal wall lesions. After thermovisual evaluation, the autovein was transversally dissected for visual examination of the internal lumen, photographing and comparison with the findings of thermovisual imaging.

Results. During visual examination, 12 conduits of the great saphenous vein were found to be free from lesions, 5 cases demonstrated severe damage of the endothelium and 3 conduits had mild endothelial lesions. The findings of thermal imaging completely correlated with those of the subsequent visual control.

Conclusion. Thermovisual examination of the autovenous shunt makes it possible to atraumatically detect defects of the internal wall of the shunt immediately before establishing anastomoses.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Krepkogorsky N.V., Bredikhin R.A., Khairullin R.N. Thermovisual examination of the internal relief of autovein. Angiology and Vascular Surgery. 2022; 28 (1): 36–40. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-36-40

The purpose of this study was a comparative analysis of the immediate and short-term (up to 1 year) results of clinical use of cyanoacrylate compound proposed by «Medtronic» in the «VenaSeal» system and the domestic adhesive «Sulfacrylate» in the «VenoGlue» Russian system for obliteration of varicose veins. A fundamental difference of the domestic cyanoacrylate compound from all foreign analogues is that it is synthesized on the basis of ethyl ether of α-cyanoacrylic acid, while all foreign analogues are synthesized on the basis of butyl ether of α-cyanoacrylic acid.

Cyanoacrylate obliteration of varicose veins was performed in 73 patients using a foreign compound and in 75 patients using a domestic substance. All patients had a C2-C3 clinical class according to CEAP. In the postoperative period, we assessed severity of phlebitis and pain response according to a visual analogue scale (VAS), changes in the quality of life according to CIVIQ-2, and the degree of occlusion of the segment of the main saphenous vein exposed to the adhesive substance according to the results of ultrasound duplex angioscanning.

The conducted studies with a follow-up period of up to 1 year allow us to conclude about safety and high efficiency of using the domestic adhesive compound "Sulfacrylate" for endovasal obliteration of varicose veins in humans. By the effect on quality of life, severity and duration of inflammatory reaction, degree of obliteration of the target vein, the Russian glue adhesive proved not inferior to a foreign analogue used in the VenaSeal system. Undeniable advantages of using domestic cyanoacrylate adhesive are its staged biodegradation with complete connective tissue obliteration of the lumen of the veins and low cost of manipulation.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Shaydakov E.V., SannikovA.B., Belentsov S.M. Use of glue adhesives for obliteration of major varicose veins (multicenter comparative study)Angiology and Vascular Surgery. 2022; 28 (1): 41–9. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-41-49 (in Russian)

Objective. The aim of the study was to assess efficacy of a new method of cyanoacrylate obliteration of veins, analyzing immediate and remote results.

Patients and methods. The primary endpoints were the pain intensity during surgery (as assessed by the visual analogue scale), occlusion of the vein and severity of the venous disease according to the Venous Clinical Severity Score at various terms. The results were analyzed during the first 10 days after manipulation and then after 1, 3, 6, 12 and 24 months. This study included 37 patients who from October 2018 underwent cyanoacrylate obliteration of veins according to a new technique on a total of 44 lower extremities.

Results. We performed 41 manipulations on the great saphenous vein (93.2%) and 3 on the small saphenous vein (6.8%). The diameter of the target vein ranged from 0.3 to 1.0 cm (mean 0.63 cm), with the length varying from 10 to 50 cm (mean 30.9 cm). We used from 0.2 to 1.6 ml (mean 0.76 ml) of glue composition “Sulfacrylate”. The average pain level was 1.6 (minimum – 1, maximum 4) according to the visual analogue scale. In the early postoperative period, there were no serious complications. The most frequent complication of the early period was cyanoacrylate phlebitis having appeared on POD 3-4. During the first 10 days, complete occlusion was observed in 100 % of cases. The occlusion rate at 1 month, 3 months, 6 months, 12 months and 24 months amounted to 93.2%, 86%, 90.2% and 84.6%, respectively, with no clinical relapses observed.

Conclusion. The technique of vacuum-assisted glue obliteration of veins using Russian-made glue composition “Sulfacrylate” proved safe and effective. Further studies are warranted for accumulation of experience and follow up of remote results.

Objective. The study was aimed at determining adherence of patients with lower limb varicose veins to medical recommendations in relation to compression therapy during a year.

Patients and methods. A prospective comparative study Patients cOMmitment to coMpression theraPy (POMP) was carried out, involving surgeons-phlebologists each of whom had for 5 weeks enrolled into the study patients presenting with varicose disease of lower limbs veins, seeking advice, and requiring compression therapy. 12 months after the consultations, an outsourcing call center performed telephone questioning of patients in order to obtain information concerning peculiarities of adherence to the recommendations given.

Results. The overall registration database of the study contained individual data on 394 patients. 12 months after the recommendations on using compression knitwear available for telephone questioning turned out to be a total of 246 patients: mean age 44 (IQR 35–55) years, including 42 (17.1%) men and 204 (82.9%) women. Of these, class C1, class C2, class C, class C4 and class C6 had 32 (13.1%), 83 (33.7%) 109 (44.3%), 20 (8.1%) and 2 (0.8%) patients, respectively. Compliant to medical recommendations turned out to be 189 (76.8%) patients: 110 patients using compression knitwear and 79 patients who stopped using them based on medical recommendations. The number of respondents reporting decreased manifestations of varicose disease turned out to be significantly higher in the group of patients using compression knitwear (p<0.001). More adherent to compression therapy were patients having had previous experience using it (p<0.001) and patients whose professional activity was related to hard physical labor and prolonged orthostasis (p=0.031). There were no significant differences in compliance of patients depending on gender and level of education.

Conclusion. We determined high adherence of patients to medical recommendations in relation to compression therapy 12 months thereafter.

Funding. The study had no sponsor support.

Conflict of interest. Telephone survey was conducted with the sponsorship of the network of orthopedic salons ORTOS. The authors declare that there are no other conflicts of interest.

For citation: Ignatovich I.N., Bontsevich D.N., Klimchuk I.P., Kornievich S.N., Maslyanskii B.A., Nebylitsyn Yu.S., Novikova N.M., Kosinets A.V., Kress D.V., Mikhnevich A.V., Pavlov A.G., Poznyakova O.V. Adherence of patients with varicose veins to compression therapy. Angiology and Vascular Surgery. 2022; 28 (1): 57–63. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-57-63 (in Russian)

Described herein is a technique of aortic hemi-arch repair without circulatory arrest in the variant “warm head-warm body”. Discussed in detail is a situation when it is possible to manage with unilateral cerebral perfusion and in what cases it is necessary to switch to bihemispheric perfusion.

Also presented is the world experience in aortic arch repair without circulatory arrest according to the PubMed database, suggesting that the main disputable technical problems of performing such operations include the technique and place of blocking retrograde blood flow from the distal portion of the aorta.

A conclusion was made that the absence of pathological changes in the distal portion of the aortic arch and technical possibility of applying a clamp distal to the left subclavian artery are the conditions for prosthetic repair of the aortic arch according to the hemi-arch technique without circulatory arrest. If it is necessary to expand the scope of intervention, such technique does not prevent switching to operation with circulatory arrest.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Vachev A.N., Dmitriev O.V., Kozin I.I., Chernovalov D.A., Italiantsev A.Yu., Gryaznova D.A., Kutsenko V.V. When is it possible to perform aortic arch repair according to hemi-arch technique without circulatory arrest? Angiology and Vascular Surgery. 2022; 28 (1): 64–71. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-64-71 (in Russian)

The authors performed a single-group retrospective analysis of the results of endovascular interventions in a total of 8 patients suffering from critical limb ischemia with trophic changes on the foot and the novel coronavirus infection. The degree of pulmonary lesion according to the findings of computed tomography varied from 0.0% to 36.0% (median 25.0%). 87% were found to have infiltrative alterations by the type of polysegmental bilateral pneumonia (SpO₂ at rest amounted to not less than 95% without oxygen inhalation). Significant deviations in laboratory parameters were more often represented by anemia (8 of 8, 100%), lymphopenia (7 of 8, 87%). hypoalbuminemia (6 of 8, 75%), neutrophilic leukocytosis (5 of 8, 62%). Increased concentration of platelets was observed in only 2 patients of 8 (25.0%). The estimated value of predicted perioperative lethality according to the ACS NSQIP scale varied from 0.8 to 4.0%. In the remote period, we assessed overall survival, limb salvage rate and healing of trophic defects on the foot.

Revascularization was always technically successful. There were no intraoperative complications in the studied group. Early postoperative mortality amounted to 13% (n=1). The duration of postoperative follow up was form 1 to 8 months (median 5 months).

Overall survival amounted to 87%, limb salvage rate to 100%, freedom from repeat revascularization to 85%, rate of trophic defect healing to 43%.

Conclusion. Balloon angioplasty on lower-limb arteries in chronic limb critical ischemia and a combination with novel coronavirus infection was effective in patients with a non-severe course of coronavirus infection. Additional comparative studies are warranted for more accurate prediction of immediate and remote outcomes of interventions in this difficult cohort of patients.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Kuriyanov P.S., Zaichenko E.P., Zhukov D.V., Gusev A.A., Yakimova A.V., Bubnova N.A., Shatil M.A., Dobrydin O.N., Strizheletsky V.V., Chernyshev O.B., Andreev S.A., Taranenko M.Yu., Osadchiy A.A., Antiya A.E. Immediate results of balloon angioplasty for critical limb ischemia combined with coronavirus infection COVID-19. Angiology and Vascular Surgery. 2022; 28 (1): 72–9. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-72-79 (in Russian)

Objective. The purpose of this study was to evaluate the impact of left atrial appendage closure in patients with coronary artery disease and without atrial fibrillation undergoing off-pump coronary artery bypass on the development of ischemic stroke and mortality in long-term follow-up.

Patients and methods. We performed a retrospective review of 316 patients who underwent off-pump coronary artery bypass from January 2011 to December 2011 at our institution. Exclusion criteria: acute coronary syndrome, conversion to on-pump coronary artery bypass grafting, redo procedure, left-sided intracardiac thrombus, atrial fibrillation in history, hemodynamically significant lesions of the brachiocephalic vessels, concomitant cardiac surgery, secondary to off pump coronary artery bypass and left atrial appendage closure, and minimally invasive access. After propensity score matching, 250 patients were recruited (mean age 58.0±7.5 years). Depending on the intervention on the left atrial appendage, two groups were formed: 170 patients with left atrial appendage ligation (mean age 57.8±7.7 years) and 80 patients without left atrial appendage ligation (mean age 58.3±7.5 years). The primary endpoints were stroke, all-cause death, and a composite endpoint (ischemic stroke + all-cause death in hospital and during long-term follow-up). Secondary endpoints: resternotomy for bleeding, perioperative myocardial infarction, postoperative atrial fibrillation, length of stay in intensive care and clinic. The median follow-up period was 100 (72–105) months.

Results. Both groups were comparable in terms of baseline demographic and operational characteristics. After propensity score matching, there were no statistically significant differences between the groups in the incidence of stroke (0.6% versus 1.3%, p=0.538), all-cause mortality (0% versus 1.3%, 0.320), or composite endpoint (stroke + mortality from all causes) (0.6% versus 2.5%, p=0.241). Similarly, other results remained similar (p>0.05). During follow-up, 27 patients developed stroke (n=12 in the ligation of left atrial appendage group and n=15 in the non-left atrial appendage ligation group), while 38 patients died [n=17 (10%) and n=21 (26%), respectively]. Kaplan-Meier curves showed that there were no significant differences for the primary endpoints during long-term follow-up in the incidence of stroke (p=0.250), mortality (p=0.560), and composite endpoint (stroke + all-cause mortality) (p=0.320).

Conclusion. Routine epicardial ligation of the left atrial appendage during off-pump coronary artery bypass in patients without atrial fibrillation was not associated with reduction of risk for stroke, all-cause death, and a composite of stroke and all-cause death in hospital and during long-term follow-up.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Enginoev S.T., Chernov I.I., Arian Arjomandi Rad, Jef Van den Eynde, Kondratyev D.A., Magomedov G.M., Kadyraliev B.K., Tsaroev B.S., Aliev E.-H.A., Tarasov D.G., Zhigalov K.Yu. Long-term outcomes of preventive left atrial appendage ligation during off-pump coronary artery bypass. Angiology and Vascular Surgery. 2022; 28 (1): 81–93. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-81-93 (in Russian)

The article summarizes the experience with extra-anatomical crossover femorofemoral bypass in correction of chronic critical and acute ischemia, as well as other complicated clinical situations, assessing both immediate and remote results.

Objective. The purpose of the study was to evaluate efficacy and feasibility of extra-anatomical femorofemoral crossover bypass at the present-day stage of the development of vascular surgery.

Patients and methods. Our single-centre study included a total of 33 patients with chronic and acute impairments of blood flow through the aortofemoral segment, in whom for various reasons it was impossible to use direct revascularization or endovascular intervention. The choice in favour of less traumatic extra-anatomical bypass grafting was made due to severity of concomitant pathology associated with an extremely high risk of aortofemoral bypass grafting. In all these patients, the character of lesions of the arterial bed did not allow us to perform endovascular correction (TASC II type C and D lesions). The main arterial blood flow was restored by extra-anatomical crossover femorofemoral bypass grafting.

Results. A favourable clinical outcome was achieved in 30 (91%) patients, with limbs saved. Four (12%) patients developed complications in the early postoperative period. Two (6%) patients died of infarction and sepsis. However, both interventions were performed for infectious complications, preceding aortoiliac-femoral reconstructions. We followed up for 5 years the fate of 22 (73%) of 30 patients discharged with limbs saved. Of these, five patients died of progressing concomitant pathology, acute cardiac events, with the crossover graft’s function preserved. Four patients were found to have thromboses, making it necessary to perform amputations in 3 cases. The 5-year primary patency of grafts amounted to 73.9%.

Conclusion. Extra-anatomical femorofemoral crossover bypass is an effective method of revascularization. Technical capabilities of such type of reconstruction appear appropriate in impaired blood flow through one of the iliac arteries with preserved adequate patency of the aorta and contralateral side and impossibility to perform a direct revascularizing operation or roentgenoendovascular correction. In some cases, especially in patients with limited life expectancy, this operation may be a method of choice.

Funding. The article was prepared under the grant of the President of the Russian Federation No. MD-922.2022.3.

Conflict of interest. The authors declare no conflict of interest.

For citation: Pinchuk O.V., Kokhan E.P. , Obraztsov A.V., Bogatyrev A.R., Zharikov S.B. Extra-anatomical femorofemoral crossover bypass grafting. Angiology and Vascular Surgery. 2022; 28 (1): 94–103. DOI: https://doi.org/10. 33029/1027-6661-2022-28-1-94-103 (in Russian)

Myocardial revascularization is most often performed using the internal thoracic artery. However, its uniqueness as a transplant is limited by length and the necessity to use several conduits, which in turn does not decrease the requirements to use the great saphenous vein for surgical treatment of ischemic heart disease. Competence of autovenous conduits is lower as compared to that of the internal thoracic artery. One of the causes of decreased competence of venous shunts may be thrombotic occlusion associated with peculiarities of procurement of and damage to the vein.

We performed a morphological study of autovenous conduits in 60 patients subjected to isolated coronary artery bypass grafting. Depending on the autovenous conduit harvesting technique, the patients were divided into 2 groups. In Group One patients (n=30), the great saphenous vein was harvested using the classical method described by Favaloro. In Group Two patients (n=30), the great saphenous vein was procured in the composition of perivascular adipose tissue without hydraulic dilatation. To assess morphological changes occurring while exposing the autovein, we examined 30 specimens containing fragments of the autovein of patients of the first group and 30 specimens containing fragments of the autovein of patients of the second group. The obtained specimens were analyzed using the light microscope Carl Zeiss & MT at 20× and 100× magnification. Photography was performed using the light microscope Axioscop 40 and camera Pixera Pro 150ES (Germany). We assessed endothelial damage to the autovein, as well as preservation of the vasa vasorum. It was determined that procurement of the great saphenous vein in the composition of the perivascular adipose tissue was accompanied by an increased number of the vasa vasorum, thus decreasing severity of endothelial damage, with the use of systemic pressure for dilatation of the vein making it possible to preserve thickness of the intimal and adventitial layers.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Bazylev V.V., Tungusov D.S., Mikulyak A.I., Nachkebiya B.R., Batrakov P.A., Elfimov D.A. Morphological assessment of autovenous conduits in the composition of perivascular adipose tissue. Angiology and Vascular Surgery. 2022; 28 (1): 104–9. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-104-109 (in Russian)

According to the data of various statistical studies, 76% of patients with occlusion of the aortoiliac arterial bed are found to have lesions of the femoropopliteal segment. Surgical treatment of patients presenting with multi-layered atherosclerotic lesions still remains one of the most complicated problems of vascular surgery, since adequate revascularization of lower limbs requires correction of the inflow and outflow pathways. In the early postoperative period in patients with lower limb ischemia with multilevel lesions, as well as while performing conventional open reconstructions on the aortoiliac segment, the complication rates still remain high.

Presented in the article are the results of a single-center randomized study comparing a hybrid procedure and aortofemoral bypass grafting for lesions of iliac arteries and the common femoral artery. All patients were enrolled into the study according to inclusion and exclusion criteria.

The duration of follow up amounted to 24 months. The obtained findings demonstrated safety of the hybrid procedure in the early postoperative period, as well as a shorter length of hospital stay. High efficacy of hybrid operative interventions: clinical improvement in 92–98% of cases with low incidence of postoperative complications make promising the development of this direction of reconstructive vascular surgery in this cohort of patients as compared with aortofemoral bypass grafting.

Our study was aimed at revising the guidelines on endovascular treatment of TASC II type C/D lesions of the aortoiliac segment, as well as implementing hybrid techniques in treatment of this cohort of patients.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Mitrofanov V.O., Karpenko A.A., Starodubtsev V.B., Ignatenko P.V., Rabtsun A.A., Saaya Sh.B., Popova I.V., Cheban A.V., Bugurov S.V. Open and hybrid interventions in steno-occlusive lesions of the iliac-femoral segment (TASC C, D): intermediate results. Angiology and Vascular Surgery. 2022; 28 (1): 110–5. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-110-115 (in Russian)

The main treatment of the developed lower limb critical ischemia consists in carrying out an operative intervention including open and endovascular techniques. If it is impossible to perform open surgery, as well as in case of complications in antegrade recanalization of occluded superficial femoral artery, a transcpedal approach might become a way out from this complicated situation. In this article we present our experience with transpedal approaches in patients with lower-limb critical ischemia, describing the technique of a transpedal approach.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Papoyan S.A., Shchegolev A.A., Gromov D.G., Khutornoy N.V., Syromyatnikov D.D., Sazonov M.Yu. Transpedal approaches for complicated lesions of superficial femoral artery. Angiology and Vascular Surgery. 2022; 28 (1): 116–22. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-116-122 (in Russian)

Analysed herein are the remote results of various methods of carotid reconstruction in a total of 115 patients with combined haemodynamically significant stenosis of the common and internal carotid arteries. Depending on the type of carotid reconstruction used, the patients were subdivided into 4 groups: Group I – simultaneous eversion endarterectomy from the internal and common carotid arteries – 35 (30.4%) patients, Group II – eversion carotid endarterectomy with plasty of longitudinal arteriotomy of the common carotid artery by a primary suture – 30 (26.1%), Group III – eversion carotid endarterectomy with prosthetic repair of the common carotid artery – 25 (21.7%); Group IV – angioplasty and stenting of the common and internal carotid arteries – 25 (21.7%). We assessed the remote postoperative results of surgical treatment: survival rate, incidence of acute cerebral circulation impairment, and patency of the reconstructed zone. Statistically significant differences were revealed in relation to the frequency of carotid reconstruction zone restenosis of more than 65% (according to the NASCET criteria). The best remote postoperative results were observed in patients after simultaneous eversion endarterectomy from the internal and common carotid arteries (p<0.005). Repeat operations were performed in five (16.7%) patients after plasty of the common carotid artery with primary suture due to restenosis of the reconstruction zone of more than 65% (according to the NASCET criteria).

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Kazakov Yu.I., Yakovlev A.O. Results of various methods of reconstruction in patients with extended atherosclerotic lesions of carotid arteries. Angiology and Vascular Surgery. 2022; 28 (1): 123–8. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-123-128 (in Russian)

Patent ductus arteriosus in adults is an extremely rare clinical phenomenon, since it is usually discovered and treated during childhood. Presented herein is a case report regarding successful single-stage endovascular treatment of a 66-year-old male patient with newly diagnosed patent ductus arteriosus and type III aortic dissection. High risk of conventional surgical treatment due to systolic myocardial dysfunction and high pulmonary hypertension became the ground for choosing an endovascular approach. The patient underwent endoprosthetic repair of the thoracic aorta in zone 2 according to Ishimaru with endobranching of the left subclavian artery in combination with implantation of an occluder into the Botallian duct. We obtained good immediate and one-year results of the operation as positive remodeling of cardiac chambers, with improved contractility of the left ventricle and normalization of pressure in the pulmonary artery, as well as thrombosis of the false lumen in the thoracic aorta.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Imaev T.E., Salichkin D.V., Komlev A.E., Kabardieva M.R., Kolegaev A.S., Fedotenkov I.S., Makeev M.I., Akchurin R.S. Single-stage endovascular correction of patent ductus arteriosus and type III aortic dissection. Angiology and Vascular Surgery. 2022; 28 (1): 129–34. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-129-134 (in Russian)

Spontaneouss coronary artery dissection is one of the poorly investigated causes of the development of acute coronary syndrome predominantly diagnosed in women under 50 years of age. From the pathophysiological point of view, this condition may be characterised by sudden dissection of the coronary artery vascular wall with formation of a false lumen inside the vessel and obstruction of blood flow by the detached endothelium. Many researchers believe that a provoking factor becomes intimal tear on the background of bleeding from the vasa vasorum, thus leading to the appearance of a subintimal hematoma whose enlargement results in extension of the dissection zone, followed by detachment of vascular wall layers and formation of the true and false thrombus-containing lumens of the coronary artery. Optical coherence tomography may be a method of choice in suspected spontaneous coronary artery dissection.

This article describes a clinical case report regarding treatment of spontaneous coronary artery dissection in a young woman on the background of exposure to an exogenous factor.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Golukhova E.Z., Abrosimov A.V., Losev V.V., Petrosyan K.V. Endovascular treatment of a female patient with spontaneous dissection of the right coronary artery. Angiology and Vascular Surgery. 2022; 28 (1): 135–9. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-135-139 (in Russian)

Presented herein is a clinical case report of hybrid treatment of a patient with DeBakey type II chronic aortic dissection, aneurysm of the ascending aortic portion, and acute dissection of the descending portion.

A peculiarity of this case consists in a successful hybrid approach in prosthetic repair of the ascending portion and aortic arch, i. e., by means of the frozen elephant trunk technique with the use of the hybrid stent graft “MedEng” in combination with emergency placement of the Valiant Thoracic stent grafts into the descending aortic portion in acutely onset dissection.

A favourable outcome of the intervention was possible owing to correctly chosen policy, performing interventions in a hybrid operating room, and well-coordinated work of teams of cardiovascular and roentgenoendovascular surgeons.

Currently, due to importance of the problem and complications occurring in such a situation we consider it appropriate to describe this case, paying special attention to tactical and technical aspects of performing the intervention.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Shmatkov M.G., Pyanzin A.I., Bazylev V.V. Successful hybrid policy in treatment of pathology of thoracic portion of the aorta. Angiology and Vascular Surgery. 2022; 28 (1): 140–6. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-140-146 (in Russian)

Currently, biochemical markers occupy an important position in diagnosis and treatment of a series of diseases and conditions such as myocardial infarction (troponines I and T), oncological diseases (prostate-specific antigen, carcinoembryonic antigen, and others) etc. Brain damage markers have long been investigated in patients with endured strokes, transitory ischemic attacks, as well as with a history of dyscirculatory lesions of the brain and other cerebral diseases. For patients after surgical interventions on the carotid basin, there are no precisely developed markers of controlling the lesion at the serological level, thus making it necessary to consider possible parameters to assess brain damage.

This article reviews the Russian and foreign literature dedicated to biochemical markers of cerebral tissue lesions associated with interventions on carotid arteries, providing general characteristics of the parameters regarded as factors related to cerebral cell lesions, and selecting those more suitable for assessment of namely cerebral damage, such as neuron-specific enolase (NSE), protein S-100B, brain-derived neurotrophic factor (BDNF).

Markers associated with vascular damage or inflammation should be regarded only in conjunction with main proteins of cerebral lesion or neurovisualization. It should be underlined that there are no markers with 100% specificity to nervous tissue damage, and any of the represented indicators may be higher than reference values in one or another condition or disease.

This is followed by describing various clinical situations of their application, such as the use of a temporary shunt in carotid endarterectomy, assessment of postoperative neurological deficit, cerebral hyperperfusion syndrome, intraoperative control, comparing their alterations during stenting of carotid arteries and carotid endarterectomy. Also discussed are possibilities of their use for diagnosis of various changes in the neurological status of patients in the early and remote postoperative period, relationship of these markers with various types and techniques of interventions on carotid arteries. A conclusion was drawn regarding their use in clinical practice.

Funding. The article was prepared under the grant of the President of the Russian Federation No. MD-922.2022.3.

Conflict of interest. The author declares no conflict of interest.

For citation: Kalinin R.E., Pshennikov A.S., Zorin R.A., Suchkov I.A., Solyanik N.A. Biochemical parameters of cerebral lesions in carotid artery surgery (literature review). Angiology and Vascular Surgery. 2022; 28 (1): 148–53. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-148-153 (in Russian)

Background. Current strategies of treatment for lower limb chronic ischemia continue to be controversial. Previously performed reviews on this subject had no rigorous restrictions in selection of inclusion criteria for patients with the pathology involved.

Objective. The purpose of our study was to compare the results of endovascular interventions and bypass surgery in patients with lower limb chronic ischemia.

Methods. We performed a detailed retrieval in several databases prior to 2019, taking into consideration prospective studies with the duration of not less than 2 years aimed at comparing the results of procedures of revascularization of the infrarenal region in adults with lower limb chronic ischemia. Independent pairs of reviewers selected the articles from which the necessary data were then extracted.

Results. Our meta-analysis included 17 studies comprising a total of 22 369 patients. In the overall population, endovascular treatment decreased the risk of 30-day mortality (HR=0.73, 95% CI 0.59–0.90, p=0.004). Cases of amputation of lower extremity within 30 days after vascular reconstructions were reported in 7 articles, with no statistically significant difference between the results of endovascular and open surgical interventions for this criterion (HR=0.67, 95% CI 0.67–1.10, p=0.113). Early postoperative complications concerning cardiovascular and cerebrovascular systems were described in 9 articles, with infections of postoperative wounds reported in 8 publications. The incidence of postoperative complications was statistically higher in patients after bypass surgery as compared with the group after endovascular interventions. The overall survival rate in the remote postoperative period: combined results of 12 studies demonstrated that patients after endured endovascular interventions had had significantly higher risk of remote death than patients after bypass surgery (HR=0.78, 95% CI 0.67–0.92; p=0.002). It was revealed that the difference of the results after autovenous bypass grafting was more significant (HR=1.01; 95% CI 0.87–1.22, p=0.0001). As to infrapopliteal lesions, endovascular and bypass interventions ensured a comparable survival rate (HR=1.12, 95% CI 0.83–141; p=0.12). Nevertheless, we discovered that endovascular interventions were associated with significantly elevated risk of death or amputation compared with autovenous shunting (HR=1.81; 95% CI 1.35–2.21; p=0.03, I²=59%).

Endovascular interventions were associated with significantly higher risk of impaired patency of the reconstruction zone with moderate heterogeneity (HR=1.30, 95% CI 1.2–1.56; p=0.005, I²=38%). Similar results were also observed in subgroup analysis of autovenous shunting and infrapopliteal lesions (HR=1.42, 95% CI 1.13–1.67; p=0.009, I²=0%; HR=1.40, 95% CI 1.12–1.80; p=0.007, I²=0%, respectively).

Conclusion. Endovascular interventions yield better 30-day results compared with bypass surgery, including decreased risk of the development of cardiovascular and cerebrovascular complications, infections of postoperative wounds, but leading to an elevated risk of all-cause mortality in the remote postoperative period and impaired patency in the reconstruction zone. We suppose that bypass grafting may be regarded as a first-line strategy of revascularization for patients with a good physical functional state and may have long-term benefits, especially in the presence of a venous bed suitable for shunting.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Gavrilenko A.V., Al-Yusef N.N., Khaozhan E., Bulatova L.R., Sarkhanidze Ya.M. Comparing the results of endovascular interventions and bypass surgery in patients with chronic lower limb ischemia (literature review). Angiology and Vascular Surgery. 2022; 28 (1): 154–62. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-154-162 (in Russian)

Widespread implementation of coronary artery stenting into clinical practice has resulted in the fact that nowadays predominantly difficult cohorts of patients with multiple occlusions and diffuse lesions have been sent to coronary artery bypass grafting, with a constantly increasing number of patients refused operations due to “small” coronary arteries (less than 1.5 mm in diameter). We analyzed Russian and foreign scientific publications investigating the problem of bypass grafting of coronary arteries measuring less than 1.5 mm in diameter. This review considers small-diameter coronary arteries as a risk factor for and predictor of the worst prognosis in patients concerned, studying causes of possible occlusion of shunts to such arteries, and showing peculiarities of diagnosis and surgical treatment in such patients. It was noted that anastomoses performed using microsurgical technique in the majority of cases ensured complete revascularization, yielding favorable early postoperative outcomes. Nevertheless, no detailed comparative analysis of remote results to solve the problem of advisability of reconstructions of arteries less than 1.5 mm in diameter have hitherto been conducted. Besides, there are no clear-cut indications for, contraindications to, nor guidelines on shunting of small-diameter arteries, with no optimal technique devised. Hence, the problem concerning efficacy of CABG surgery using microsurgical technique for multiple shunting in patients with coronary artery less than 1.5 mm in diameter is one of the most urgent problems in modern coronary surgery.

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Zaikovskii V.Yu., Shiryaev A.A., Akchurin R.S., Vasiliev V.P., Galyautdinov D.M., Vlasova E.E., Mukimov Sh.D. Shunting of coronary arteries less than 1.5 mm in diameter. Analytical review. Angiology and Vascular Surgery. 2022; 28 (1): 163–8. DOI: https://doi.org/10.33029/1027-6661-2022-28-1-163-168 (in Russian)