The article is devoted to analyzing the surgical and scientific activity of physician-in-ordinary privy councilor N.F. Arendt (1786–1859) in the field of angiology and vascular surgery and putting into scientific circulation his article published in 1823 in the first issue of the “Military Medical Journal”. The content analysis of the article revealed that N.F. Arendt was one of the first in Russian literature to describe arteriovenous malformation and its surgical treatment by ligation of the common carotid artery. It was also shown that for the first time in Russia N.F. Ardent performed ligations of the external iliac and subclavian arteries, brachiocephalic trunk, constructed and introduced into practice an instrument for applying ligations onto vessels, also publishing several scientific works dedicated to vascular surgery. N.F. Arendt’s priority achievements significantly contributed to the development of angiology and vascular surgery in Russia.

Objective: to evaluate effectiveness of Cilostazol in prevention of restenosis in the reconstruction area in patients undergoing endovascular reconstructive procedures on the lower extremity arteries.

Patients and methods. Our prospective study included 80 patients with stage IIb–III chronic lower limb ischemia due to atherosclerotic peripheral arterial disease. They were divided into two groups, 40 patients each (using the envelope randomization method). The study was approved by the local ethics committee. All patients after roentgenendovascular interventions received conservative therapy (acetylsalicylic acid at a dose of 75 mg once daily, Atorvastatin 10 mg QD with lipid spectrum control, and Clopidogrel 75 mg QD). One month after, the study group patients were switched from Clopidogrel to Cilostazol (Aducil^®) taken at a dose of 100 mg twice daily for 2 months. The control group patients continued receiving therapy with Clopidogrel for 3 months. All subjects underwent laboratory (assessment of endothelial nitric oxide synthase (eNOS), prostacyclin, endothelin-1, and interleukin-6) and instrumental diagnostic procedures prior to operation and 1, 3, 6 and 12 months thereafter.

Results. There was a statistically significant increase in the level of eNOS in the study group patients after 3 (р=0.001), 6 (р=0.002), and 12 months (р<0.001) as compared with the control group. At 3, 6, and 12 months after the interventions, there was a statistically significant decrease of interleulin-6 and endothelin-1 levels in the study group as compared with the control (р<0.001).

According to the findings of duplex scanning of lower limbs at 3 months, 13 (32.5%) patients in the control group and 7 (17.5%) patients in the study group developed neointimal hyperplasia and restenosis (>30%) in the arterial reconstruction zone (p<0.05). 15 (37.5%) patients in the control group and 10 (25%) patients in the study group had restenosis at 6 months (p=0.04). By 12 months, the number of patients with restenosis increased up to 26 (65%) and 18 (45%) in the control and study group, respectively (p=0.04).

Conclusion. Including Cilostazol 100 mg B.I.D. in the study group patients resulted in an increased level of endothelial nitrogen oxide synthase (p<0.05), decreased levels of endothelin-1 (p<0.001) and interleukin-6 (p<0.001) as compared with the control group patients. Prescription of Cilostazol after endovascular interventions on lower limb arteries decreased possibility of developing restenosis in the reconstruction zone.

This article is a review discussing neural networks used in the field of intravascular ultrasound examinations and performing functions of automatic identification of unstable plaques, isolation of vascular walls, prediction of the fractional flow reserve. Based on the analysed material, it was determined that neural networks in the field of ultrasound studies are currently an emerging and actively developing trend of intravascular imaging. In case if it is possible to achieve the human-comparable accuracy of the obtained results and to prove them in direct comparison in a clinical trial it could lead to decreasing the cost and increasing the rapidity of performing a percutaneous coronary intervention. We also believe that in future it will be possible to combine the algorithms of automated detection of unstable plaques and prediction of fractional flow reserve, thus unifying intravascular ultrasound examinations for many clinical situations.

Objective. To study the incidence, causes and peculiarities of conversion of dorsopalmar (modified distal) radial approach in primary percutaneous coronary interventions in patients with acute coronary syndrome.

Patients and methods. The study included a total of 75 patients subjected to primary endovascular interventions using dorsopalmar (modified distal) radial approach. The operators’ experience performing these interventions was more than 100 punctures of the radial artery in distal portions. On POD 5–7, we assessed the diameter of the radial artery of the arm and dorsal surface of the palm.

Results. 4 (5.3%) patients required conversion due to radial artery spasm at the stage of puncture or guidewire insertion. The patients were subjected to the “traditional” radial approach through the proximal portion of the artery of the ipsilateral limb. There were no conversions to the femoral approach. The artery diameter in patients with approach conversion, measured on POD 5–7 was below the average value. The diameter of the radial artery on the forearm turned out to be significantly higher than that on the dorsal surface of the palm in all patients.

Conclusion. The dorsopalmar radial approach performed by experienced operators demonstrated compared with the classical transradial approach frequency of conversion. The main cause of conversion was radial artery spasm developing during puncture or guidewire insertion. The first-choice approach is conversion in the “classical” transradial approach on the ipsilateral limb. Ultrasonography of distal portions of the radial artery prior to endovascular intervention contributes to decreasing the frequency of conversions. The diameter of the artery at the site of the envisaged access less than 2 mm should be considered as a contraindication to the use of dorsopalmar distal radial approach.

Mycotic (infectious) aneurysm is a rare pathology resulting from infectious destruction of the artery. Approximately 0.65–2% of aortic aneurysms in Europe are of infectious nature, in Asia this rate is higher. The most common pathogens are salmonellae (predominant in Asia) and staphylococci (predominant in European and North American patient populations) – about 40% of the total number of cultured organisms.

Diagnosis is based on the clinical picture (pain, fever, sepsis), and laboratory tests include inflammatory markers. Characteristic morphological signs: baggy, sometimes multi-chambered arterial wall protrusion, perivascular edema, hematoma and/or fibrous tissue. The presence of perivascular gas and rapid aneurysm growth are pathognomonic symptoms.

Currently, there is no international consensus on the optimal treatment of mycotic aneurysms, but the extremely unfavorable prognosis makes surgical treatment necessary regardless of aneurysm size.

Two strategies are used – open aneurysm resection with in situ reconstruction or extra-anatomic revascularization and stent-graft implantation. In both cases, prolonged antibiotic therapy is required. According to the literature, its duration should be at least 6–8 weeks, and possibly longer, up to lifelong.

The main disadvantage of endovascular method is the lack of open surgical sanation of septic focus. Nevertheless, the available literature data suggest that the integral results of open surgery and X-ray endovascular techniques are comparable. It is impossible to draw statistically reliable conclusions due to the small number of observations – available clinical reports do not exceed dozens of cases.

This article describes two cases of mycotic aneurysm of the infrarenal aorta. In the first case (male, 60 years old), aortic endoprosthesis was performed, followed by open sanation and drainage of retroperitoneal space and antibacterial therapy for 6 weeks (until clinical and laboratory signs of systemic infection normalized). There was no recurrence at 14 months follow-up.

In the second observation (male, 62 years old), the diagnosis of mycotic aneurysm was not established. Endoprosthesis of a ruptured infrarenal aortic aneurysm was performed. Absence of massive antibiotic therapy resulted 3 months later in the manifestation of local infectious process with the development of fatal complication – aortoduodenal fistula with fatal bleeding.

Objective. To study the possibility and determine the safety of using stent grafts with on table and in situ fenestration in patients with acute aortic syndrome.

Patients and methods. From 2019 to 2021, specialists of the Republican Cardiological Center (Ufa) retrospectively analyzed the results of endovascular treatment of 34 patients with acute aortic syndrome.

Results and discussion. All 34 patients were operated on within the first 48 hours after the disease was detected. They were subjected to various types of endovascular debranching. In 26 patients, zone 2 according to Ishimaru was selected with on table or in situ TEVAR (Thoracic Endovascular Aortic Repair) of the left subclavian artery; in 6 cases, double fenestration of the left common carotid and left subclavian arteries were performed during implantation into zone 1 according to Ishimaru. In 2 cases, total endovascular debranching was performed during implantation into zone 0 according to Ishimaru. The average operation time was 137.35±61.4 minutes, the average contrast consumption was 295.2±79.2 ml, and the average volume of blood loss was 78±121.1 ml. In all cases, the technical success was 100%, however, during the control MSCT, 2 cases of type 3 endoleaks were identified, which were further embolized. One patient developed retrograde dissection of the ascending aorta and the aortic arch 2 months after surgery. Further surgical correction was performed. Overall in-hospital mortality was 0%, and only 3 (8.8%) patients died in the remote period.

Conclusion. Thoracic endovascular aortic repair (TEVAR) of the aortic arch with various types of endovascular debranching can be considered as an alternative and effective method for treatment of patients with acute aortic syndrome.

Objective. To study the possibility and determine the safety of using stent grafts with on table and in situ fenestration in patients with acute aortic syndrome.

Patients and methods. From 2019 to 2021, specialists of the Republican Cardiological Center (Ufa) retrospectively analyzed the results of endovascular treatment of 34 patients with acute aortic syndrome.

Results and discussion. All 34 patients were operated on within the first 48 hours after the disease was detected. They were subjected to various types of endovascular debranching. In 26 patients, zone 2 according to Ishimaru was selected with on table or in situ TEVAR (Thoracic Endovascular Aortic Repair) of the left subclavian artery; in 6 cases, double fenestration of the left common carotid and left subclavian arteries were performed during implantation into zone 1 according to Ishimaru. In 2 cases, total endovascular debranching was performed during implantation into zone 0 according to Ishimaru. The average operation time was 137.35±61.4 minutes, the average contrast consumption was 295.2±79.2 ml, and the average volume of blood loss was 78±121.1 ml. In all cases, the technical success was 100%, however, during the control MSCT, 2 cases of type 3 endoleaks were identified, which were further embolized. One patient developed retrograde dissection of the ascending aorta and the aortic arch 2 months after surgery. Further surgical correction was performed. Overall in-hospital mortality was 0%, and only 3 (8.8%) patients died in the remote period.

Conclusion. Thoracic endovascular aortic repair (TEVAR) of the aortic arch with various types of endovascular debranching can be considered as an alternative and effective method for treatment of patients with acute aortic syndrome.

We performed a comparative analysis of the course of arterial hypertension after internal carotid artery stenting (CAS) (group I, n=31) and carotid endarterectomy with glomectomy (Keni’s modification) (SEA) (group II, n=32). The study was randomized, including patients with grade 2 and higher arterial hypertension, ischemic stroke ipsilateral to carotid lesion, stenosis of the internal carotid artery exceeding 70%, no clinical signs of vertebrobasilar insufficiency, renal artery stenosis, or diabetes mellitus, with the glomerular filtration rate exceeding 80.

In the early postoperative period, the mean values of blood pressure decreased significantly after both CEA and CAS, with the Wilcoxon criteria amounting to 293.5 and 27, respectively (p<0.05). However, a statistically significant difference between the baseline and 1-year values was observed only in the CEA group (р<0.001). Long-term follow-up revealed a statistically significant decrease in the proportion of patients with grade 3 hypertension in the CEA group (р<0.001). Whereas after carotid stenting, the difference turned out to be statistically insignificant. There were between-group statistically significant differences in the Kaplan–Meier estimates for arterial hypertension recurrence and freedom from cardiovascular events, thus suggesting clinical advantage of CEA with glomectomy over CAS in patients with arterial hypertension (р<0.005).

Conclusion. When choosing a method of reconstruction in patients with initially uncontrolled hypertension, unilateral carotid bifurcation stenosis, a history of ischemic stroke ipsilateral to carotid lesion, preference should be given to CEA with glomectomy, as it leads to a long-term (over 1 year) blood pressure decrease.

Background. There is a limited number of studies concerning the results of urgent coronary artery bypass grafting (CABG) in high-surgical risk patients with non-ST elevation acute coronary syndrome. Deficit of an evidence-supported base is related to peculiarities of organization and availability of emergency CABG, the process of decision-making, and a series of tactical and technical aspects of performing this type of intervention within the first 24 hours in high-surgical risk patients with manifest symptoms of ischemia and myocardial lesion in severe multivessel coronary atherosclerosis and involvement of the left coronary artery trunk.

Objective. The purpose of this study was to carry out a comparative analysis of the in-hospital outcomes of emergency surgical and endovascular revascularization (CABG and percutaneous coronary intervention) in high-surgical risk patients with non-ST elevation acute coronary syndrome.

Patients and methods. In our retrospective study with propensity score matching, we analyzed the in-hospital results of CABG (n=67) and percutaneous coronary intervention (n=67) in high-surgical risk patients with non-ST-segment elevation acute coronary syndrome within the first 24 hours after admission. The patients had severe lesions of coronary arteries with a median of the SYNTAX score of 24 points. The endpoints of the study were all-cause mortality, cardiac mortality, myocardial infarction, repeat non-elective revascularizations, and a composite endpoint combining all the above enumerated events. Besides, we evaluated completeness of the scope of myocardial revascularization in the groups.

Results. The patients in the groups were comparable by the main clinical and anamnestic data which was ensured by propensity score matching. The majority of CABGs were performed in conditions of artificial circulation. In the group of percutaneous coronary intervention, the strategy of multivessel and staged stenting was used approximately in a similar proportion (47.8 and 52.2%, respectively). There were no significant differences between the groups of CABG and percutaneous coronary intervention by the endpoints. Mortality from cardiac causes in the groups turned out to be similar, each amounting to 4.5%. CABG was characterized by significantly higher frequency of complete myocardial revascularization as compared with percutaneous coronary intervention: n=62 (92.5%) vs n=48 (71.6%), respectively, p=0.001.

Conclusion. Urgently performed CABG demonstrated comparable with percutaneous coronary intervention in-hospital results of revascularization in high-surgical risk patients with severe multivessel lesions with non-ST elevation-acute coronary syndrome, ensuring fuller scope of myocardial revascularization as compared with percutaneous coronary intervention.

Objective. The study was aimed at reducing the risk for the development of intraoperative embolism during thrombectomy from the iliofemoral venous segment.

Danger of surgical treatment of patients with phlebothrombosis of the iliofemoral segment with flotation remains of current concern primarily due to the risk of pulmonary embolism. The authors worked out a method of surgical treatment making it possible to decrease the risk of this complication.

This method was used in a total of 34 patients diagnosed with acute deep vein thrombosis. All patients, both preoperatively and in the early postoperative period, underwent chest and abdominal contrast-enhanced X-ray computed tomography, ultrasonographic duplex scanning of veins of both lower limbs. After making the final diagnosis, all patients were subjected to surgical treatment: transjugular thrombectomy from the iliocaval and femoral segments, with no postoperative complications observed. All patients were discharged in a satisfactory condition to be followed up by district surgeon. The iliofemoral segment remained patent during the whole follow-up period, with no evidence of rethrombosis.

Conclusion. The developed method of transjugular thrombextraction from the iliocaval and femoral segments for phlebothrombosis makes it possible to safely restore patency of veins in the involved segment with minimal risk of both intra- and postoperative complications.

Objective. The aim of the study was to assess safety and reliability of using the MANTA closure device in endovascular treatment of patients with aortic aneurysms.

Patients and methods. The obtained results were retrospectively analysed based on the experience of treating 19 patients (from July 01, 2021 to November 31, 2021) for abdominal aortic aneurysms (n=14) and thoracic aortic pathology (n=5). All operations were performed at the Vascular and Endovascular Surgery Clinic, St. Katharine’s Hospital, Frechen, Germany. In all cases, sheaths 9–14F were used for graft implantation. The primary endpoint of efficacy was technical success, with neither acute bleeding nor thromboembolic complications. In our study we used the MANTA closure device (Teleflex, Wayne, Pennsylvania), a novel device for closing percutaneous access to the femoral artery following the use of 10–20F (12–25F OD) devices or sheaths in endovascular catheterization procedures.

Results. Of the total number of patients, three had a dissection of the thoracic aorta, two penetrating aortic ulcer, in 14 cases aneurysm of the abdominal aorta. The mean age of the patients was 67±2.2 years. There were 16 males and 3 females. Of the 19 patients, bilateral access was used in 18 (37 inguinal approaches), in one case a monoiliac graft was implanted. The technical success of implantation of the MANTA closure device was 100%, with no conversion to open access to the femoral vessels. The findings of CT angiography confirmed neither complications in the area of ​​the vascular access, nor stenosis of the access area requiring surgical treatment. Fourteen of the 19 patients underwent ultrasound duplex scanning of vessels in the access zone prior to discharge from the clinic, demonstrating no significant stenosis in the area of arterial closing.

Conclusion. The use of the MANTA CD closure device is safe and accompanied by good immediate results, however, further experience is needed with this device.

Carotid paragangliomas are rare disease. Radical removal of the tumor is the method of choice in the treatment such patients. The risks of surgical treatment are potential injury of the branches of the cranial nerves of the caudal group and the possible reconstruction of the carotid arteries. The combination of a tumor process with an atherosclerotic lesion of the carotid artery bifurcation is extremely rare. Single cases of both simultaneous and staged removal of the tumor and reconstruction of the carotid bifurcation due to atherosclerotic lesions are observed.

We present a unique clinical case of simultaneous open surgical treatment of a patient with a large carotid chemodectoma type I according to the Shamblin classification and hemodynamically significant atherosclerotic stenosis of the ipsilateral internal carotid artery. Accumulated experience in treating patients with paragangliomas of the neck, as well as atherosclerotic lesions of the brachiocephalic arteries, allowed us to choose the optimal tactics of surgical treatment and achieve acceptable results.

One of the causes of intra-abdominal bleeding may be a ruptured aneurysm of visceral arteries of the abdominal aorta. Given high mortality from ruptured aneurysms, treatment for both symptomatic and asymptomatic aneurysms is mandatory.

This article reports a clinical case concerning treatment of a splenic artery aneurysm with the help of a robot-assisted surgical system da Vinci Xi. Based on the analysis of the world experience in visceral arteries aneurysm treatment and the presented clinical case, the most rational treatment method is an endoscopic method of aneurysm resection using the da Vinci surgical system, which has proved reliable and yields excellent functional, clinical, and economically promising positive results.

Background. Diffuse atherosclerosis of the coronary arteries with the involvement of distal vessels, extensive calcification and a small diameter of the coronary arteries can be the reasons for refusal of invasive treatment of patients with coronary heart disease. The only option of surgical treatment for these patients is coronary artery bypass grafting, but it is associated with technical difficulties in the creation of distal anastomoses and worse long-term survival. Nevertheless, the use of microsurgical techniques makes it possible to successfully treat such patients.

Patients and methods. A 59-year-old male patient with coronary artery disease was hospitalized for elective coronary artery bypass grafting. Coronary angiography revealed a multivessel diffuse lesion with calcification of the coronary arteries. The estimated severity of coronary atherosclerosis according to the Syntax Score amounted to 39 points. Severe three-vessel distal coronary calcification was confirmed by multislice computed tomography.

Results. Using an operating microscope and artificial circulation, we performed autovenous bypass grafting of the diagonal artery, obtuse marginal artery and posterior descending artery according to the method of extended anastomoses (2 cm long) through the atherosclerotic plaque. Due to severe calcification of the anterior descending artery, 4-cm long arteriotomy was performed, followed by prolonged shuntoplasty of the arteriotomic incision of the left internal mammary artery with anterior descending artery in the area of stenosis through the calcified atherosclerotic plaque. The diameter of the target coronary arteries at the site of distal anastomoses was less than 1.5 mm. The postoperative period turned out uneventful with no complications. The patient was discharged on POD 8.

In order to prevent shunt thrombosis, the patient was prescribed to receive dual antiplatelet therapy for 1 year (aspirin and clopidogrel), as well as therapy with statins (atorvastatin 80 mg). The control examination at 12 months revealed no clinical signs of ischemia return. The findings of MSCT bypass angiography confirmed patency of all shunts.

Conclusion. The use of microsurgical techniques, an operating microscope, and coronary reconstructions as shuntoplasty makes it possible to perform coronary artery bypass grafting in severe coronary artery disease with satisfactory clinical outcomes.

Presented herein are two clinical case reports regarding endovascular treatment of acute myocardial infarction in patients with the new coronavirus infection COVID-19.

The first clinical case report describes the development of acute myocardial infarction in a 60-year-old male patient with the novel coronavirus infection and bilateral pneumonia (60% lesion of the lung parenchyma) with neither significant atherosclerotic process in coronary arteries nor cardiovascular risk factors. Acute myocardial infarction was characterized by isolated thrombosis of the right coronary artery.

In the second case report, a 72-year-old woman was diagnosed as having atherosclerotic pathology of coronary arteries with unstable plaques and a predisposition to intracoronary thrombus formation. She was found to have critical stenoses of the anterior descending and circumflex branches of the left coronary artery, uncontrolled arterial hypertension, and dyslipidemia.

Discussed in the article are technical peculiarities of coronary interventions in patients with COVID-19, accompanied and followed by analyzing clinical patterns of the diseases involved.

Atherosclerosis of the lower extremities arteries accounts for 20% of the pathology of the cardiovascular system. The spread of the pathological process, high rates of disability, amputations, and mortality are characteristic of this pathology. In patients with lower limb ischemia, the state of the deep femoral artery performs a significant role. With femoral-popliteal occlusion, the viability of the limb depends entirely on the condition of the deep femoral artery. The elimination of stenotic changes in this arterial pool more frequently envisages open reconstructions, however, the correction of the inflow and outflow pathways is often carried out by the endovascular method. Proponents of open surgery note satisfactory long-term clinical results, while balloon angioplasty is becoming a less invasive method, accompanied by a low incidence of postoperative complications in persons with a high surgical risk, both in the presence of intermittent claudication and in the case of critical ischemia.

Peripheral artery diseases have increasingly been gaining in medical and social importance due to not only growing morbidity but also therapeutic outcomes not fully satisfying both clinicians and patients, especially those with manifestations of critical limb ischemia. Revascularizing interventions combined with optimal medicamentous treatment are the “gold standard” in treatment of symptomatic lesions of peripheral arteries. Along with it, risks for the development of thrombotic complications both in the zone of the reconstruction and in other vascular basins, negatively influence overall rates of patients’ mortality and disability. Antiplatelet agents have so far remained in fact the only substantiated from the point of view of evidence-based medicine therapeutic factor decreasing the risks for the development of thrombotic complications in this patient cohort. A series of other drugs influencing blood coagulation system, as well as a combination thereof, by the findings of hitherto performed trials failed to demonstrate sufficient efficacy and/or safety. Oral anticoagulants opened new possibilities for antithrombotic prevention and treatment and have widely been used in various cardiovascular diseases. The results of a series of trials the most significant of which may be considered VOYAGER PAD showed possibilities and feasibility of introducing anticoagulants into therapeutic regimens for patients with PAD. Safety and efficacy of treatment regimens envisaging a combination of antiplatelet drugs with rivaroxaban at a dose of 2.5 mg twice daily were demonstrated both for patients undergoing conservative treatment and those after endured endovascular revascularizing interventions.