Yudin S.S. (1891–1954) outstanding physician, surgeon of the twentieth century. His achievements are associated with the development of a method for transfusion of postmorten blood to patient, reconstructive surgery of the esophagus, surgery of the stomach and duodenum, and traumatology. Yudin was encyclopedically educated, he is one of the organizers of the Academy of Medical Sciences of the USSR, he received recognition in our country (winner of two State Prizes, the Lenin Prize, member of Academy of Medical Sciences of the USSR) and the international medical community (honorary member of the Royal Society of Surgeons, etc.). In 1948–1953 he was repressed, completely rehabilitated. In 1952–1953 he was in exile in Novosibirsk, conducted research on the clinical physiology of the stomach and small intestine. In 1953 he returned from exile to Moscow and then fully rehabilitated.

Neointimal hyperplasia is one of the leading factors of thrombosis of arteriovenous shunts. Search for ways of inhibiting its development is currently an important task for vascular surgery. This study was aimed at investigating the periadventitial effect of paclitaxel on the development of neointimal hyperplasia in the area of an arterial anastomosis in an experiment on laboratory animals.

The authors worked out and experimentally tested on laboratory animals a method of multicomponent pharmacologically active covering of the zone of a surgical anastomosis. The method consists in coating the zone of vascular anastomosis with a semitransparent membrane containing the cytostatic agent. Two months after the operation, we compared the findings of the histological examination of the anastomosis zone with and without application of the cytostatic agent. Owing to an external hydrophobic layer in the proposed method of application, no cytostatic action of the agent in the surrounding tissues was found, with the experimental specimens showing significantly decreased signs of neointimal hyperplasia and thrombosis as compared with the controls.

The proposed technique of multicomponent covering of a surgical anastomosis with the cytostatic agent using a semitransparent membrane demonstrated efficacy and safety in an experiment and may be of interest for clinical studies in order to increase the duration of patency of vascular reconstruction zones.

Objective. The study was aimed at investigating the clinical significance of the gradient of luminal narrowing of atherosclerotically altered internal carotid arteries as a risk factor for ischemic cerebral damage by means of ultrasonographic techniques and magnetic resonance imaging.

Patients and methods. The study enrolled a total of 20 patients, mean age 62.4±1.3 years. Based on the findings of cerebral magnetic resonance imaging, they were subdivided into two groups: those without ischemic cerebral damage (13 subjects) and with ischemic lesion (7 patients). The vessels of carotid basin were assessed by means of ultrasonographic techniques, calculating the gradient of narrowing of the lumen of atherosclerotically altered arteries using 2 methods: A – as the ratio of the percentage of the internal carotid artery stenosis to the distance between near-to-stenosis distal/proximal segment of the non-stenotic artery and the site of maximal narrowing; B – as the ratio of the difference of the cross-sectional areas of the internal carotid artery in the place of stenosis and the nearest maximal non-stenotic distal/proximal portion to the distance between them.

Results. In the group of confirmed foci of ischemic lesion of the brain as compared with the group having no ischemic lesions according to the A method, we revealed a statistically significant difference in the parameters of the gradient of luminal narrowing on the distal portion of the internal carotid artery, with no statistically significant differences in the examined parameters revealed on the proximal portion. There were no statistically significant differences in the gradient of luminal narrowing calculated according to the B method on either distal or proximal portion.

Conclusion. The gradient of narrowing of arterial lumen characterizes the degree of incrementing luminal narrowing from the «normal» (without stenosis) proximal portion of the artery to the area of maximal stenosis and further to free distal lumen, which is an important diagnostic criterion for stenosis severity and prediction of ischemic cerebral lesion. There is yet no sufficient experience in using this index in clinical practice, since it was proposed relatively recently. However, this parameter appears to possess an advantage, primarily a prognostic one, as compared with the classical methods of measuring stenosis by the ECST and NASCET methods. The most preferable should be recognized calculation of the luminal narrowing according to the A method supposing measuring the ratio of the percentage of stenosis (according to the ECST method) of the internal carotid artery to the distance between the near-to-stenosis distal/proximal region without stenosis and the site of maximal narrowing.

It is known that polymorphisms at gene encoding GUCY1A1 (α-subunit 1 of guanylate cyclase type 1) are associated with a predisposition to coronary artery disease and arterial hypertension, however, the relationship between these polymorphisms and the risk of peripheral artery disease (PAD) remains unexplored. This pilot study aimed to study the association of two polymorphisms such as rs7692387 and rs13139571 of the GUCY1A1 gene with the risk of peripheral artery disease. The study included 1277 unrelated individuals of Slavic origin, including 629 PAD patients and 648 relatively healthy volunteers. Genotyping of polymorphisms was done by the MassARRAY-4 system. We found that the rs7692387-A allele (OR=1.42, 95% CI 1.17–1.74, p=0.0005) and the rs7692387-G/A-A/A genotypes (OR=1.77, 95% CI 1.28–2.44, p=0.0005) were associated with an increased risk of peripheral artery disease, regardless of sex, age, body mass index, coronary artery disease, and hypertension. In addition, haplotype rs7692387A-rs13139571A (OR=1.52, 95%CI 1.17–1.98, p=0.002) was associated with an increased risk, while haplotype rs7692387G-rs13139571A (OR=0.26, 95%CI 0.12–0.58, p=0.0090), on the contrary, possessed a protective effect against disease risk. However, the observed associations occurred in cigarette smokers. Bioinformatics analysis showed that polymorphism rs7692387 is a functionally significant variant associated with increased GUCY1A1 expression and alternative polyadenylation in the tibial artery as well as a target for transcription factors and epigenetic regulation of gene expression. Thus, polymorphism rs7692387 of the GUCY1A1 gene represents a new genetic variant by which cigarette smoking, a major risk factor for peripheral artery disease, contributes to the disease development.

Background. In the structure of surgical events, acute limb ischemia is a cause of death in 25–30% of patients.

Objective. The present study was aimed at examining the structure of patients with lower and upper limb acute ischemia in the Barnaul urban agglomeration.

Patients and methods. We analyzed a total of 1,366 patients presenting with arterial embolism or limb thrombosis within 14 days after the onset of the acute event and hospitalized to the Department of Vascular Surgery during 2000–2018. The epidemiological index of acute limb ischemia amounted to 10.1 per 100 thousand people per year, being comparable with the data of the international statistics. Of these, 865 patients were hospitalized during 2000–2010, and 501 during 2011–2018.

Results. Comparing the groups demonstrated an increased number of hospitalizations of women (from 4.6 to 5.3 per 100 thousand/year) in the structure of all patients with acute ischemia, a statistically significant decrease in the number of patients with arterial thromboses, and an increase in the number of those admitted with arterial embolisms. We revealed a tendency to a decrease in the overall number of hospitalized patients and an increase in the number of patients with stage II–III arterial ischemia, with upper limb ischemia diagnosed significantly more often (from 1.4. to 3.2 per 100 thousand/year).

Conclusion. Along with a trend towards a decrease in the total number of hospitalized patients with acute limb ischemia, we revealed an increase in the number of patients with acute limb ischemia in the presence of arterial embolism and a decreased number of patients with acute arterial thrombosis.

Aneurysms and pseudoaneurysms of visceral arteries are extremely rare and difficult-to-diagnose nosological entities, since patients are often asymptomatic or present non-specific complaints of abdominal discomfort. In the natural course of the disease, the risk of aneurysmal rupture amounts to 50%, with the mortality rate varying from 30 to 90%. The most frequently encountered are aneurysms of the splenic artery (from 60 to 70%), hepatic artery (about 20%), aneurysms of celiac trunk and mesenteric arteries (approximately 10%). According to various data, the prevalence of aneurysms of the superior mesenteric artery does not exceed 3.2–8% in the structure of aneurysmatic lesions of visceral arteries. The incidence of superior mesenteric artery aneurysms is 1 per 12,000–19,000 autopsies. Given the paucity of review data, ambiguity of recommendations, and frequent revision of the clinical experience, the patients with superior mesenteric artery aneurysms present difficulty in planning surgical policy and management.

This article contains a review of the literature dedicated to the problem of surgical treatment of patients with aneurysms of the superior mesenteric artery, covering historical aspects, approaches to diagnosis, and principles of treatment. This is followed by describing a clinical case report regarding surgical treatment of a patient with a large aneurysm of the superior mesenteric artery, presumably of a mycotic origin.

The incidence of lower-extremity arterial disease is growing year after year. According to the world literature data, progression of the disease leads to the development of major adverse cardiovascular events during both in-hospital and remote periods, to critical ischaemia of lower limbs, as well as to amputations. The primary purpose of treatment of chronic lower limb ischemia is not only to save the lower extremities but also to reduce the cardiovascular risk in this patient cohort. Our study was undertaken to analyse the efficacy of various strategies of treatment of patients with stage IIB chronic lower-limb ischemia combined with coronary artery disease. It included a total of 87 patients. Depending on the therapeutic policy chosen, they were divided into two groups: Group 1 consisted of 41 (47.1%) patients undergoing staged roentgenendovascular treatment (percutaneous coronary intervention, stenting and angioplasty of lower-limb arteries) and Group 2 comprised 46 (52.9%) patients subjected to staged combined treatment (percutaneous coronary intervention and open surgery of lower-limb arteries).

The purpose of the present study was to examine the in-hospital outcomes of combined treatment: percutaneous coronary intervention and open surgical operations on arteries of lower limbs in patients with chronic lower-limb ischemia and accompanying coronary artery disease. The forty-six Group 2 patients endured a total of 111 operations: 53 primary open operations on lower-limb arteries and 58 percutaneous coronary interventions, followed by no major adverse cardiovascular events such as death, acute myocardial infarction, acute cerebral ischemia/transient ischemic attack or hemorrhage, with 1 (2.1%) major adverse limb event in the form of shunt thrombosis encountered.

Concomitant lesion of coronary and carotid arteries is not uncommon pathology in patients undergoing treatment in cardiosurgical hospitals, with a frequently arising question on staged treatment of this patient cohort.

We describe herein two clinical case reports concerning patients presenting with combined pathology of coronary and carotid arteries and admitted to the cardiosurgical department with a clinical course of unstable angina pectoris. One patient underwent staged treatment, with the first stage consisting of stenting of the internal carotid artery, followed by coronary artery bypass grafting performed several days later. The second patient was subjected to combined operation – eversion carotid endarterectomy and coronary artery bypass grafting. The interventions proved uneventful, with no complications. The patients were discharged on POD 10. Also discussed are the main clinical manifestations of combined pathology of coronary and carotid arteries, ultrasonographic and radiological peculiarities of diagnosis, as well as methods of surgical treatment.

Presented herein is a clinical case report regarding surgical reconstruction of the thoracoabdominal aorta according to a new method aimed at reducing the time of ischemia of visceral organs. The procedure began with distal bypass of the iliac arteries, followed by sequential debranching of the left renal artery, superior mesenteric artery, and celiac trunk in the presence of natural blood circulation without aortic cross-clamping. And it was only at the stage of prosthetic repair of the right renal artery and intercostal arteries that the left ventricular bypass (pulmonary vein – branch of the prosthesis) was added, with the aorta cross-clamped and opened. The final step was a proximal anastomosis at the level of the aortic isthmus.

The proposed new method of surgical reconstruction of the thoracoabdominal aorta makes it possible to decrease the duration of aortic cross-clamping, artificial circulation, ischaemia of the visceral organs and spinal cord, thus directly contributing to the improvement of surgical treatment outcomes in this cohort of severely ill patients.

Acute impairment of arterial blood supply is accompanied by a high mortality rate and is a serious surgical problem requiring timely diagnosis and restoration of blood flow as soon as possible.

The article deals with a clinical case report of successful hybrid intervention in a 95-year-old woman with combined embolism of the superior mesenteric artery with the development of acute mesenteric ischemia, and the left common femoral artery with grade IIB acute ischemia of the left lower extremity.

Underlined is the importance of timely restoring blood flow in the visceral branches of the abdominal aorta and arteries of the lower limbs in the stage of reversible ischemia. It was demonstrated that early detection of patients with significant stenosis of mesenteric arteries with chronic intestinal ischemia and performing elective surgical interventions would also make it possible to reduce mortality.

In patients with severe accompanying pathology, the use of open methods of surgical treatment of abdominal aortic aneurysms is associated with high traumaticity and significant operative risk. The development of endovascular methods made it possible to implement into clinical practice a new method – endoprosthetic repair of abdominal aortic aneurysms. Presented herein is a retrospective analysis of the immediate results of endovascular prosthetic repair of abdominal aortic aneurysms in a total of 45 patients with high surgical risk, assessed according to the Classification of the American Society of Anaesthesiologists. All patients belonged to class III risk. The mean age amounted to 66.3±6.0 years (ranging from 57 to 79 years). Endoprosthetic repair was successfully performed in 43 (96%) patients. Two (4%) patients required emergency conversions to open operative intervention. There were no cases of either intraoperative or in-hospital mortality. In one patient intraoperative type IB endoleak was eliminated by means of implanting an additional limb of endograft with closure of the orifice of the internal iliac artery. Three patients in the early postoperative period were found to have type II endoleaks. Control ultrasound duplex scanning (at 2 and 6 months) showed that the endoleak persisted in 1 patient.

Conclusion. Endoprosthetic repair of abdominal aortic aneurysms in high-risk surgical patients may be regarded as a safe and effective procedure yielding good in-hospital results.

Objective. The purpose of this study was to retrospectively analyze our experience in endoprosthetic repair of infrarenal aneurysms of the abdominal aorta with the assessment of both immediate and remote results of treatment.

Patients and methods. Analyzed herein are the results of endoprosthetic repair of infrarenal aneurysms of the abdominal aorta in a total of 32 elderly and aged patients with high operative risk. The patients’ age ranged from 60 to 80 years (median 68 years). Of these, 15 patients underwent endoprosthetic repair of the abdominal aorta using the Gore Excluder endoprosthesis and 17 patients received the Anaconda stent graft manufactured by the company Vascutek Ltd. The average diameter of abdominal aortic aneurysms amounted to 6.6 cm (from 50 mm to 75 mm). All patients met the anatomical criteria for roentgenoendovascular treatment.

Results. Technical success was achieved in 100% of cases, with no 30-day mortality. There were neither cardiac nor respiratory complications immediately after the operation. One patient was found to have an intraoperative complication in the form of a type IIIA endoleak related to insufficient sealing between the branch of the endoprosthesis and the main trunk, diagnosed at control angiography and eliminated by means of implanting an additional coated stent into the stent graft’s branch. Local postoperative complications in the area of the wound were observed in 4 (12.5%) patients. In the early postoperative period, 1 patient with implanted stent-graft Anaconda developed thrombosis of the graft’s branch. Blood flow was restored after thrombectomy from the graft followed by restenting. In the remote period, graft’s thrombosis was diagnosed in 2 patients. In 1 case we performed restenting of the graft’s branch and in the other case femorofemoral crossover bypass grafting. No migration of the stent graft was observed. The overall 5-year survival rate amounted to 70.0%.

Conclusion. Roentgenoendovascular prosthetic repair of infrarenal aneurysms of the abdominal aorta is a method of choice in elderly and aged patients with significant concomitant pathology.

Background. Currently, the approach to the management of symptomatic concomitant lesions of the carotid and coronary arteries remains controversial. No randomized trials on this issue have been conducted.

Objective. The purpose of this study was to validate the choice of surgical strategy in patients with significant symptomatic carotid and coronary artery lesions.

Patients and methods. Our single-center cohort prospective study included a total of 117 consecutively operated patients presenting with significant concomitant carotid and coronary artery disease. All patients underwent surgery at the Clinic of Faculty Surgery of the Samara State Medical University, being symptomatic in both carotid and coronary circulations. They were subdivided into two groups depending on the staging of surgical treatment: 42 patients were subjected to one-stage surgical intervention [carotid endarterectomy (CEA) + coronary artery bypass grafting (CABG) during single anesthesia] and the remaining 75 patients underwent two-stage surgery (CEA at the first stage, followed by CABG performed within not more than a 3-month period). The groups were comparable by most parameters. The primary endpoints were stroke and myocardial infarction, as well as mortality from stroke and mortality from myocardial infarction in the perioperative period.

Results. There were no significant statistical differences in the incidence of myocardial infarction, stroke, and perioperative mortality between the two groups (p>0.05). A risk factor significantly associated with perioperative stroke appeared to be the presence of transitory ischemic attacks (TIAs) during 6 months before surgery (OR 18.400; 95% CI, p=0.002). Risk factors for perioperative myocardial infarction were the occurrence of postoperative bleeding and resternotomy (OR 12,333; 95% CI, p=0.021). A risk factor for patient death was the presence of TIAs within 6 months before surgery (OR 7.360; 95% CI, p=0.019).

Conclusions. Two-stage or one-stage surgical tactics in symptomatic patients with significant ICA and coronary artery disease had similar rates of perioperative myocardial infarctions, cerebrovascular events, and mortality. The main risk factors for the development of adverse outcomes in these patients were the presence of TIA during 6 months before surgery, as well as postoperative bleeding combined with resternotomy.

Introduction. Optimal surgical approach of patients undergoing coronary artery bypass graft surgery with significant carotid disease remains controversial. The accumulation of clinical data. especially with the evaluation of long-term outcomes is relevant.

The study aim was to examine the effectiveness and safety of simultaneous carotid endarterectomy and coronary artery bypass grafting.

Material and methods. Retrospective study. The group of 114 patients with indications for carotid endarterectomy and coronary artery bypass grafting who underwent simultaneous surgery from January 2010 to December 2019, was considered. The hospital and mid-term outcomes was analyzed.

Results. Hospital mortality was 2/114 (1.8%); the cause of death in both cases was cardiac. Non-fatal myocardial infarction occurred in 1/114 (0.9%). Perioperative cerebrovascular events developed in 2/114 (1.8%): in one case it was an ipsilateral stroke, in the other it was a transient ischemic attack. 112 patients were discharged from the clinic. At the time of the mid-term assessment, complete data were available in 81/112 (72.3%). Median follow-up is 46 months (12 to 120). In the mid-term period, all-cause mortality was 11/81 (13.6%), angina recurrence developed in 14/81 (17.3%) patients, of which 6 underwent percutaneous coronary interventions. Neurological events developed in 2/81 (2.5%): one had a transient ischemic attack, the other had a fatal hemorrhagic stroke. An important fact was the absence of cases of ischemic stroke. Actuarial survival at 3, 5, and 7 years was 93%, 88%, and 81%, respectively.

Conclusion. Simultaneous surgery in patients with carotid disease and coronary artery disease can be performed with an acceptable hospital outcomes and good mid-term incidence angina recurrence and cerebrovascular events.

Objective. The purpose of this study was to assess efficacy of staged operations in patients presenting with lower limb critical ischemia caused by multilevel lesions of lower limb arteries.

Patients and methods. Our study enrolled a total of 56 patients with critical lower limb ischemia, including 40 (71.4%) men and 16 (28.6%) women, mean age 68±7.9 years. 33 (58.9%) patients had trophic disorders. All patients underwent open surgical and endovascular treatment: 36 patients (Group I) were subjected to staged surgery and the remaining 20 (Group II) to hybrid operations. Staged interventions were performed at various hospital admissions, with the intervals between them amounting to 4–25 days. These stages were performed in separate operating rooms. Hybrid operations were carried out in an elective vascular surgery ward equipped with a C-arm. The duration of follow-up amounted to 12 months.

Results. The mean duration of open surgical operations was 112±74.7 min, with that of endovascular stages and of simultaneous hybrid interventions amounting to 130.4±80.2 min and 212±56 min, respectively Primary patency of the reconstructed zones during 12 months was preserved in 32 (88.9%) Group I patients. Four (11.1%) patients of this group developed thrombosis of the reconstructed zone in the remote period and one (2.8%) – ischemic gangrene. Primary patency at 12 months was preserved in 18 (90.0%) Group II patients, with improvement of lower limb blood supply. Two (10.0%) patients developed thrombosis of the reconstruction zone. There were neither amputations nor lethal outcomes in the group of hybrid operations.

Conclusion. The division of open and endovascular stages appeared to be an admissible method of surgical treatment of patients with lower limb critical ischemia and by primary patency, limb salvage and survival rates proved not inferior to hybrid operations.

Objective. The purpose of this study was to assess efficacy of original reconstructions of arteriovenous fistulas in the development of their dysfunctions related to formation of arterial and perianastomotic stenosis.

Patients and methods. Presented herein are two techniques of original reconstructions of arteriovenous fistulas for stenotic vascular changes leading to dysfunction of a vascular access: modification of side-to-side radial-cephalic fistulas and modification of Gracz-type arteriovenous fistulas. The main concept while working out these operations was to preserve the previous length of the functioning portion of an arteriovenous fistula without its shortening. The first technique (Group One) was used in 11 patients and the second technique (Group Two) in 19 patients. The duration of replacement therapy with hemodialysis averagely amounted to 6.8 years and 5.6 years for Group Oneand Group Two patients, respectively. After clinical examination the findings of ultrasonographic mapping in Group One patients revealed the following alterations: local stenosis of the radial artery and lower third of the forearm proximal to the anastomosis (n=2), anastomotic stenosis (n=3) or fistula vein stenoses (n=6) at a distance of 1 to 5 cm from the anastomosis. All Group Two patients were found to have a stenosing lesion of the radial artery along the whole length of the forearm with pronounced calcinosis, including in combination with perianastomotic stenosis (n=2).

Results. In Group One, the results were available for 10 (91%) of 11 patients within a period from 1 year to 4 years. Of these, 2 patients died with “functioning” fistulas. The remaining patients continue receiving replacement therapy by programmed hemodialysis. One patient developed fistula vein thrombosis followed by recanalization. Primary and secondary (functional) survival of the reconstructed vascular access amounted to 90% and 100%, respectively. In Group Two, the results were known for 12 (63%) of 19 patients (over the same period of follow up). One woman died of cardiac failure, with her fistula functioning. Another woman was found to have an immature fistula and underwent creation of a loop brachiobasilic arteriovenous fistula. A further patient after creation of an arteriovenous fistula developed venous insufficiency of the limb, which was eliminated by endovasal laser coagulation of the cephalic vein on the forearm. Primary survival of the access in Group Two amounted to 83.3%.

Conclusion. The proposed variants of reconstructions for perianastomotic stenosis of arteriovenous fistula proved optimal, since they preserve (Group One) or increase (Group Two) the length of the functioning portion of the fistula.

Objective. The purpose of this study was to assess safety of semiclosed endarterectomy supplemented by drug-coated balloons in treatment of patients with occlusion of the superficial femoral artery.

Patients and methods. The study enrolled a total of 60 patients with total occlusion of the superficial femoral artery. They were divided into 2 groups, each consisting of 30 patients. The primary endpoint was wound healing by first intention. Secondary endpoints included primary patency, assisted primary patency, secondary patency, ankle-brachial index, amputation-free survival, and all-cause mortality.

Results. No statistically significant difference in healing of postoperative wounds in both groups was revealed. Neither were there differences in primary patency (Kaplan–Meyer) between the groups at 12 months (63.3% in the hybrid group vs 70% in the control group, p≤0.6). 9 events during the follow-up period in the group of semiclosed endarterectomy and 11 in the hybrid group. Technical success was 95% in both groups. Primary assisted patency in the control and study groups amounted to 76.6 and 73.3%, respectively (p=0.32). Secondary patency in the control group amounted to 86.6 vs 93.3% in the hybrid group (p=0.67), with no statistically significant difference.

Conclusion. Semiclosed endarterectomy of the occluded superficial femoral artery followed by a local application of a drug-coated balloon did not lead to an increased rate of perioperative complications, whereas the assessment of primary patency revealed no between-group differences at 12 months.

Background. During the last decades, the dynamic development of thoracic aorta surgery has led to implementation of a hybrid technology known as the «frozen elephant trunk» procedure combining open prosthetic repair of the aortic arch and endovascular intervention on the descending thoracic aorta. This procedure has a series of technical peculiarities, including those related to restoration of the blood flow through the vessels of the aortic arch.

Objective. The study was aimed at assessing the effect of different variants of reimplantation of aortic arch branches on in-hospital outcomes of the «frozen elephant trunk» procedure.

Patients and methods. Our study included a total of 92 patients who from March 2012 to November 2021 underwent the «frozen elephant trunk» procedure using hybrid stent grafts. They were subdivided into 3 groups depending on the type of reimplantation of supra-aortic vessels: «island» technique (34 patients), partial debranching (34 patients), and total debranching (24 patients).

Results. The duration of artificial circulation (p=0.315) and the time cardiac arrest (p=0.586) in the analyzed groups were comparable. Statistically significant differences in the groups were obtained for the duration of the operative intervention (p=0.002). It was observed that in the group of total debranching, the time of surgical intervention was longer. The groups had no differences in the incidence of postoperative stroke, delirium and paraplegia, with a tendency towards an increase in respiratory complications (prolonged artificial pulmonary ventilation, tracheostomy) in the group of patients with total debranching of the supra-aortic vessels as compared with other groups of patients (p=0.065). 30-day mortality amounted to 7.2%.

Conclusion. Making the variant of reconstruction of supra-aortic branches during a hybrid intervention on the aortic arch more difficult was not associated with higher rates of postoperative complications, despite a statistically significant increase in the time of the intervention.

Background. During the last decades, the dynamic development of thoracic aorta surgery has led to implementation of a hybrid technology known as the «frozen elephant trunk» procedure combining open prosthetic repair of the aortic arch and endovascular intervention on the descending thoracic aorta. This procedure has a series of technical peculiarities, including those related to restoration of the blood flow through the vessels of the aortic arch.

Objective. The study was aimed at assessing the effect of different variants of reimplantation of aortic arch branches on in-hospital outcomes of the «frozen elephant trunk» procedure.

Patients and methods. Our study included a total of 92 patients who from March 2012 to November 2021 underwent the «frozen elephant trunk» procedure using hybrid stent grafts. They were subdivided into 3 groups depending on the type of reimplantation of supra-aortic vessels: «island» technique (34 patients), partial debranching (34 patients), and total debranching (24 patients).

Results. The duration of artificial circulation (p=0.315) and the time cardiac arrest (p=0.586) in the analyzed groups were comparable. Statistically significant differences in the groups were obtained for the duration of the operative intervention (p=0.002). It was observed that in the group of total debranching, the time of surgical intervention was longer. The groups had no differences in the incidence of postoperative stroke, delirium and paraplegia, with a tendency towards an increase in respiratory complications (prolonged artificial pulmonary ventilation, tracheostomy) in the group of patients with total debranching of the supra-aortic vessels as compared with other groups of patients (p=0.065). 30-day mortality amounted to 7.2%.

Conclusion. Making the variant of reconstruction of supra-aortic branches during a hybrid intervention on the aortic arch more difficult was not associated with higher rates of postoperative complications, despite a statistically significant increase in the time of the intervention.

Objective. To present our experience of single-stage repair of descending thoracic aorta (DTA) with concomitant pathology of heart and/or proximal thoracic aorta.

Material and methods. We conducted a retrospective medical chart review of all patients who performed thoracic aortic repair and/or cardiac operations with concomitant descending thoracic aorta repair through median sternotomy in our center between 2016 and April 2021. Descending thoracic aorta pathologies were presented coarctation, false aneurysm, and extensive thoracic aortic aneurysm. In coarctation cases, we performed open anatomical repair or extranatomic ascending-to-descending bypass depending on the technical feasibility. Importantly, in extensive aneurysm cases, distal anastomosis was performed using horizontal mattress sutures with Teflon pledgettes that tied outside the aortic wall in circulatory arrest due to technical complexity. We analyzed surgical technique, early results and complication.

Results. We included 14 patients according to inclusion criteria. There was no hospital mortality. Median cardiopulmonary bypass time was149.71±54.3 min, aortic cross clamp time – 86.14±37.46 min, “skin-to-skin” operation time – 340.8±91.49 min, circulatory arrest – 48.25±25.93 min, blood loss – 971±319 ml. Hospital stay was 11±3 days (8–17 days), ICU stay – 1.5±0.8 days (1–3 days).

Conclusion. Single-stage thoracic aortic replacement with concomitant descending thoracic aorta repair through median sternotomy had satisfactory results.

This article is a review of the most relevant information concerning the nature of polygenic diseases, considering the mechanisms of pathogenesis of cardiovascular diseases from the point of view of their regulation by genes located on the Y-chromosome, with a detailed analysis of the literature data dedicated to studying the association of polygenic diseases with the Y-chromosome and Y-DNA haplogroups.

Various countries over the past decades, based on which a conclusion was drawn on ­possible involvement of the Y-chromosome in regulation of the function of the cardiovascular system, which may serve as one of the strongest genetic markers of cardiovascular diseases.

Occlusive disease of lower limb arteries is one of manifestations of systemic atherosclerosis. In this pathology, the probability of systemic complications combined with acute or progressive chronic ischemia of lower limbs is extremely high. The number of open and endovascular operations in occlusion of arteries below the inguinal ligament is constantly growing, but even a successfully performed restorative operation decreases only the threat of limb loss and cannot influence progression of the disease or diminish the risk of ischemic complications. The VOYAGER PAD randomized international double-blind, placebo-controlled trial studying the profile of efficacy and safety of rivaroxaban at a dose of 2.5 mg twice daily added to conventional therapy with acetylsalicylic acid or to dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) demonstrated the capability of combined antithrombotic therapy to improve the results of surgical treatment of patients with lower limb artery pathology.

The VOYAGER PAD trial showed that patients receiving combined therapy with rivaroxaban at a dose of 2.5 mg twice daily + acetylsalicylic acid 100 mg/day had a significantly lower risk for the development of acute limb ischemia, major amputation, myocardial infarction and cardiovascular death as compared with those taking therapy with acetylsalicylic acid alone (HR 0.85; 95% CI 0.76–0.96; p=0.0085). The frequency of major hemorrhage did not significantly differ between the groups (HR 1.43; 95% CD 0.97–2.10; p=0.07).

Thus, the choice of pathogenetically substantiated antithrombotic therapy inhibiting both links of thrombus formation in patients after endured revascularization of lower limbs may help preserve patency of the reconstructed zone, decrease the risk of limb loss and systemic thrombotic complications in a long-term perspective.