Background. Lesions of the femoropopliteal segment are encountered approximately in half of patients with lower limb ischemia. With time, the strategy of treatment of such patients was changing – from open operations to endovascular interventions. However, not only the strategy of surgical treatment but also methods of examinations, as well as interpretation of their results have been revised.

Objective. The aim of our study was to assess the results of endovascular treatment for superficial femoral artery lesions using color duplex scanning.

Patients and methods. The study included a total of 93 patients with clinical manifestations of lower limb chronic ischemia, undergoing various roentgenendovascular interventions performed on the femoropopliteal segment. Color duplex scanning was used to preoperatively assess the anatomical and hemodynamic pattern of the lesion. The obtained findings were used to decide upon the scope of a surgical intervention. The examinations were then performed on POD 1 and at 6 and 12 months. Color duplex scanning made it possible not only to evaluate patency of the reconstruction zone but also to determine the length and degree of restenosis. The most important ultrasonographic criterion for in-stent restenosis was such dopplerographic parameter as the ratio of the peak systolic velocity at the portion of the maximal narrowing of the vessel lumen to the value of the peak systolic velocity in the prestenotic zone.

Results. The reconstruction zone was fully patent in 68 (74%) patients within 12 postoperative months. Color duplex scanning demonstrated a 60–65% residual stenosis in 4 (4%) patients and thrombosis of the reconstruction zone in 12 (13%) patients (of these, balloon angioplasty had been performed in 5 patients and stenting of the superficial femoral artery in 7 patients). Reconstruction zone restenosis, up to the critical one was revealed in 9 (10%) patients. Regular color duplex scanning in patients after endovascular treatment for femoropopliteal lesions contributed to diagnosis of the cause and degree of impaired patency of the reconstruction zone. The use of such dopplerographic criterion as the ratio of the peak systolic velocity made it possible to avoid the effect on the informative value of the study of such factors as the state of the central hemodynamics and multisegmentarity of the lesion, the presence of proximal and distal lesions of the arterial bed.

Conclusion. The use of the peak systolic velocity ratio gives advantages in assessment of severity of the lesion of the main artery compared with such parameter as the absolute value of the peak systolic velocity, since the peak systolic velocity ratio is independent of the central and peripheral hemodynamics and the presence of a tandem lesion.

The use of the proposed criteria in assessment of the results of operation will make it possible to standardize an approach to interpretation of the data, thus decreasing the degree of operator-dependency of this method of diagnosis.

Background. One of the causes of acute intestinal ischemia and necrosis is mesenteric venous thrombosis or its larger-scale and prognostically less favorable variant, i. e., portomesenteric thrombosis. Despite the fact that the main method of treatment for mesenteric venous thrombosis is anticoagulant therapy, the necessity to perform the operation of intestinal resection for mesenteric venous thrombosis remains high, accounting for 17–91%, with the pathology-related mortality amounting to 41%.

Objective. This study was aimed at analyzing possibilities of diagnostic methods and the use of various strategies in treatment of patients with massive mesenteric and portomesenteric venous thrombosis.

Patients and methods. The work was based on therapeutic outcomes in a total of 25 patients with mesenteric venous thrombosis. Of these, 19 patients underwent conservative treatment and 6 patients were subjected to resection of the necrotized intestine. The patients’ age ranged from 33 to 92 years (mean 63±11 years). There were 15 (60%) men and 10 (40%) women. The diagnosis of mesenteric venous thrombosis was verified by means of the following instrumental diagnostic methods: laparoscopy (n=10), laparotomy (n=6), and computed tomography of the abdominal cavity with intravenous contrast enhancement (n=9).

Results and discussion. Amongst all patients admitted to our clinic with acute intestinal ischemia over a 12-year period, mesenteric venous thrombosis accounted for 7.7%. The need for small bowel resection appeared in 6 patients, with 5 of them requiring further programmed relaparotomy and formation of an anastomosis. All those 6 patients had presented with a clinical picture of peritonitis. The remaining 19 patients received anticoagulant therapy alone.

7 of the 25 patients with mesenteric venous thrombosis died, with the overall in-hospital mortality thus amounting to 28%. The mortality rate in the group of operated-on patients and in the group of conservative treatment amounted to 50% and 21%, respectively (p=0.169). The volume and spread of venous thrombosis in the portomesenteric venous system also significantly influenced the lethality rate. Amongst 14 patients having developed thrombosis only in the system of the superior mesenteric vein, mortality was 21%. In those with massive portomesenteric venous thrombosis (11 patients), mortality was 36% (p=0.409).

Conclusion. Intravenous contrast-enhanced computed tomography and diagnostic laparoscopy should be recognized as the main methods of making the diagnosis of mesenteric venous thrombosis. Anticoagulant therapy may prevent the development of intestinal venous gangrene and improve therapeutic outcomes in patients with mesenteric venous thrombosis.

Mechanical thrombectomy is widely used in treatment of patients with ischemic stroke in the anterior cerebral circulation, with the problem of a tandem lesion remaining fundamentally important, since the main clinical studies devoted to mechanical thrombectomy excluded patients with lesions of the internal carotid artery bifurcation. Currently, there is no generally accepted optimal strategy of treating patients with tandem lesions. Possibly, therapeutic decision-making and choosing the sequence of revascularization should be based on a patient’s individual peculiarities, the findings of invasive diagnosis, and experience of the operating team.

Presented in the article are 2 clinical case reports regarding staged treatment of patients with acute ischemic stroke induced by a tandem lesion of the internal carotid artery and its intracranial branches.

Presented herein is a clinical case concerning a routine follow-up examination performed 18 years after successful endoprosthetic repair of a false aneurysm of a proximal anastomosis of a vascular prosthesis of the thoracic aorta using a stent graft TAG (GORE, USA), demonstrating efficacy and reliability of endovascular intervention having made it possible to avoid repeat open intervention on the aorta. The authors underline the importance of periodical long-term (lifelong) follow-up of patients with the pathology involved.

The novel coronavirus infection makes alterations in the course of such an already severe disease as a ruptured abdominal aortic aneurysm. Suppuration of a vascular prosthesis is a formidable complication for which there is no single solution.

This article presents a clinical case report regarding successful treatment of a 54-year-old patient who underwent abdominal aortic replacement for an aneurysm rupture. The postoperative period was complicated by the new coronavirus infection, suppuration of the retroperitoneal hematoma and vascular prosthesis. The patient was subjected to removal of the infected abdominal aortic prosthesis and repeat autovenous bifurcation prosthetic repair of the abdominal aorta.

Objective. The purpose of the study was to determine the tactics of surgical treatment of patients with lower limb ischemia and a hemodynamically significant lesion of the deep femoral artery and occlusion of the superficial femoral artery.

Patients and methods. The study is based on the retrospective results of examination and treatment of 99 patients suffering from chronic arterial insufficiency of the lower extremities. Of these, 31 (31.3%) patients had trophic ulcers and/or necrosis corresponding to categories 5 and 6 of chronic arterial insufficiency according to the R. Rutherford classification. All patients had occlusion of the superficial femoral artery and a hemodynamically significant stenosis of the common femoral artery, involving the deep femoral artery. 50 (50.5%) patients had hemodynamically significant impairment of the patency of ipsilateral iliac arteries. Revascularization of the limb was in all cases performed through the deep femoral artery by open or endovascular restoration of patency of the common femoral artery and the deep femoral artery. In the case of a hemodynamically significant lesion of the iliac artery, the operation was supplemented by its stenting. A new modified method – flow-guided femoroprofundoplasty – was performed in 28 (28%) patients. Therapeutic outcomes were evaluated during hospitalization, in the early postoperative period (1 month after surgery) and in the late postoperative period (from 6 months to 5 years).

Results. In the early postoperative period, complications developed in 11 (11%) patients, including 1 (1%) death. 91 (93%) patients had clinical improvement in the postoperative period, with regression of trophic disorders observed in 26 (84%) out of 31 patients. The five-year patency of the operated segment was 97%, with the limb-salvage and survival rates amounting to 100% and 76.9%, respectively. A predictor of effective revascularization through the deep femoral artery for critical lower limb ischemia turned out to be the presence of a patent recipient zone (p<0.001).

Conclusion. The results obtained indicate high efficiency of limb revascularization through the deep femoral artery. We do not recommend performing revascularization operations through the deep femoral artery in the absence of a recipient zone, as well as in the presence of trophic disorders corresponding to the 6^th category of chronic arterial insufficiency according to R. Rutherford.

Proposed herein is a method of hybrid open and endovascular recanalization of the extra- and intracranial portions of the internal carotid artery in patients in the acutest period of ischemic stroke. The method is aimed at restoring adequate blood flow in arteries of the anterior cerebral circulation.

Objective. The purpose of this study was to substantiate efficacy and feasibility of performing open recanalization of the proximal portion of the internal carotid artery with thromboaspiration from the intracranial segments in patients in the hyperacute period of ischemic stroke.

Patients and methods. We studied the results of hybrid recanalization of the internal carotid artery in 11 patients with acute ischemic stroke (Group 1). The control group included 14 patients subjected to endovascular recanalization of the internal carotid artery alone (Group 2). All patients were operated on at the Regional Clinical Hospital of the Kaliningrad Region.

Results. A longer time of hybrid operations, averagely amounting to 90 (60; 130) minutes versus 57 (40; 70) minutes (p<0.01) for endovascular recanalization of the internal carotid artery did not negatively affect further outcomes. Significant regression of neurological symptoms to the mRs score ≤2 was recorded at discharge in eight (72.7%) patients after hybrid operations, thus statistically differing from that in Group 2, i. e., three (21.4%) patients. Restoration of adequate blood flow on the mTICI 2c-3 scale was more frequent in Group 1 patients: nine (81.8%) versus five (35.7%) patients in Group 2, but the difference was statistically non-significant (p=0.06). The frequency of hemorrhagic transformations and lethal outcomes did not differ statistically in both groups.

Conclusion. A simultaneous hybrid method of open and endovascular recanalization of the extra- and intracranial portions of carotid arteries may be regarded as one of promising methods of surgical treatment of patients in the hyperacute period of ischemic stroke in acute thrombosis of the internal carotid artery.

Background. The gold standard for revascularization of the anterior descending artery is the use of the left internal mammary artery. The majority of retrospective studies documented better long-term results of using 2 internal mammary arteries for myocardial revascularization as compared with only 1 internal mammary artery. Despite these findings, the number of works devoted to using 2 internal mammary arteries in women for aortocoronary bypass grafting (CABG) is scarce.

Objective: The study was aimed at evaluating the results of using 2 internal mammary arteries for surgical treatment of coronary artery disease in women.

Patients and methods: Between October 2012 and April 2022, we retrospectively analyzed the outcomes in 4905 patients who underwent CABG. Of these, the study enrolled a total of 1085 (39.5%) cases.

The inclusion criterion was the use of 2 internal mammary arteries for CABG. The primary endpoint was mortality, with secondary endpoints being myocardial infarction, stroke and wound infections. The mean age was 64.9±14.2 years (from 46 to 80 years), with an average EuroSCORE II of 2.3±1.4.

Results. Overall mortality amounted to 0.5% (5 patients). Operations were performed on-pump with cardioplegia in 55.1% of cases, off-pump in 36.4% of cases, and parallel on-pump in 8.5%. The frequency of procedure-related complications was as follows: postoperative bleeding – 2% (22 patients), wound infection – 1% (11 patients) and stroke – 0.1% (1 patient). The mean intensive care unit length of stay was 1.2±0.7 days. The average hospital stay was 9.8±1.2 days. The median duration of follow-up period amounted to 68.4 months (95% CI 65.1–66.7). The Kaplan–Meier method showed a 36-month survival rate of 94.8% (95% CI 93.1–97.4) and 60-month survival of 85.3% (95% CI 83.2–88.5).

Conclusion. Using 2 internal mammary arteries in women for myocardial revascularization is an effective and safe procedure, demonstrating satisfactory results of surgical treatment of coronary artery disease.

Background. Currently, effective methods have been developed to protect the myocardium during operations with cardiopulmonary bypass with different pharmacological effects on cardiomyocytes, the method of administration and the temperature regime. At the same time, the problem of myocardial damage and myocardial infarction associated with the surgical procedure remains a frequent and urgent problem that significantly affects the result of surgical treatment. A set of factors, their qualitative and quantitative characteristics, determined by several scientific groups and used in clinical practice for the diagnosis of perioperative myocardial infarction, differ significantly. Such a variety of definitions affects the analysis of both immediate and long-term results in patients with intraoperative myocardial injury.

Objective. The purpose of the study was to analyze the ten-year survival of patients after elective coronary artery bypass grafting, diagnosed in the early postoperative period with type 5 myocardial infarction and dysfunction of coronary bypass grafts.

Patients and methods. From 2011 to 2020, a total of 8801 patients underwent isolated coronary artery bypass grafting at the Federal Center of Cardiovascular Surgery. Of these, 196 (2.23%) patients were subjected to emergency coronary graft angiography due to signs of myocardial ischemia and manifestations of acute heart failure.

Eligibility criteria: patients with stable coronary artery disease who were diagnosed as having type 5 myocardial infarction after elective coronary artery bypass grafting according to the Fourth Universal Definition of Myocardial Infarction, based on Troponin I >10 times the 99^th percentile and acute coronary bypass graft dysfunction revealed during emergency coronary angiography (n=111/1.26%).

Exclusion criteria: patients who died in the clinic within 30 days (n=10/0.11%), lost-to-follow-up patients (n=20/0.23%). The primary endpoint was long-term mortality, with secondary endpoints being adverse cardiovascular events. Using a random number generator for comparative analysis, group II was formed, consisting of 196 patients with an uncomplicated postoperative period. The exclusion criteria were as follows: in-hospital mortality (n=1/0.01%), acute type 5 infarction (n=5/0.06%), and loss to follow-up (n=27/0.31%). After applying the exclusion/inclusion criteria, there were 81 patients in group I and 163 patients in group II. Contact with patients was carried out using a telephone survey.

Results. Analyzing long-term overall mortality and the incidence of adverse cardiovascular events using the Kaplan-Meier method, no statistically significant differences were found in groups I and group II: 102.6±4.8 months versus 111.3±3 months (log-rank test, p=0.115) and 90.9±4.2 months versus 107.4±3.3 months (log-rank test, p=0.087), respectively. Comparing cardiovascular mortality, statistically significant events were found: in group I amounting to 111.4±4 months and in group II to 121.2±1.9 months (log-rank test, p=0.029). Evaluating the survival of patients undergoing CABG with dysfunction of coronary bypass grafts, depending on the time of coronary bypass surgery (more than 24 hours after surgery and less than 24 hours after surgery) and subsequent treatment, showed no statistical differences in long-term survival (log-rank test, p=0.354), when analyzing cardiovascular mortality, there were statistically significant differences (log-rank test, p=0.029), and adverse cardiovascular events tended to occur earlier in the group of patients who underwent emergency bypass angiography within >24 hours after surgery.

The multivariate Cox regression analysis revealed in group I an increase of the risk for developing a fatal outcome from all causes in the presence of a history of stroke by 16.7 times (p=0.001), pulmonary hypertension by 3.345 times (p=0.034), the risk of cardiovascular vascular lethality was found to increase 18.5-fold with a history of stroke (p=0.021), with the factor of pulmonary hypertension increasing the risk 6.6-fold (p=0.008).

Conclusion. Comparing the 10-year cardiovascular mortality in group I (patients with type 5 MI and shunt dysfunction) with the control group revealed statistically significant differences. The factors increasing the risk of long-tern cardiovascular mortality in group I were pulmonary hypertension and a history of acute cerebral ischemia.

Background. Venous malformations (VMs) constitute the largest group among patients with congenital vascular malformations. Recently, in the treatment of this category of patients, modern minimally invasive methods of obliteration of venous caverns and dysplastic veins have been widely used.

Objective. The purpose of this study was to compare the results of treatment of patients with VM using sclerobliteration (SO), laser coagulation (LC) and radiofrequency ablation (RFA).

Patients and methods. Our retrospective study with a prospective component included (a total of) 156 patients with VM. Of these, 111 were women aged 18 to 42 years (mean age 38.5) and 45 men aged 18 to 56 years (mean age 30.2). Depending on the surgical intervention performed, all patients were divided into 3 groups: SO (n=48), LC (n=56), and RFA (n=54). Establishment of the diagnosis of VM, clarification of the localization, depth, and extent of the lesion were carried out based on the findings of duplex scanning (DS) of vessels and soft tissues. The dimensions of the venous cavities ranged from 5 to 42 mm. LC and RFA were not used with a lesion depth of less than 10 mm.

The effectiveness of treatment was evaluated by the results of DS at 12 months, taking into account obliteration of cavities in the intervention zone, the presence of residual cavities and their sizes. Pain was assessed by means of a visual analogue scale.

Results. In the RFA group, complete obliteration of venous caverns in the area of ​​intervention at 12 months of follow-up was achieved in 50 (92.6%) patients. At the same time, occlusion of rather large caverns (more than 30 mm in diameter) was noted. Three (5.5%) patients were found to have partial occlusion of the venous caverns, which was associated with a diffuse lesion.

Complete obliteration of cavities in the LC group was achieved in 43 (76.8%) patients. The best result was recorded for cavities smaller than 30 mm. In the presence of partial obliteration, according to the DS findings, the blood flow continued to be registered. In the SO group, positive results were obtained in 44 patients (91.7%). The technical success of the performed procedure in this case can be explained by the presence of single limited cavities of small and medium diameter (less than 30 mm).

In the RFA group, there were fewer complications than in other groups (p_RFA,LC=0.0038, p_RSA,SO=0.004). There was no significant difference between the results of obliteration in all groups, but there was a trend towards slightly worse results for obliteration in the LC group (p>0.05).

Conclusion. The effectiveness of obliteration techniques in treatment of patients with VM directly depends on the depth, extent of the lesion and the diameter of the vascular formation. These methods make it possible to alleviate the course of the disease and reduce the recovery time after surgery. This is especially important, given the relapsing nature of the disease. Despite the fact that all these operations are palliative, their goal is to reduce primary complaints and improve quality of life of patients.

Background. Most open operative interventions in vascular surgery are performed in conditions of systemic hypocoagulation, thus additionally complicating the achievement of hemostasis. A reliable level of hemostasis in the reconstruction zone is achieved at the expense of observing a series of factors. Frequently, when the traditional methods of hemostasis are not enough for the purpose, the use of local hemostatic agents becomes absolutely necessary.

Objective. Our study was aimed at investigating the efficacy and safety of using the hemostatic agent “Hemoblock” to achieve hemostasis during reconstructive operations on the aorta in combination with synthetic materials in a laboratory experiment on animals.

Materials and methods. The study included 80 mongrel cats divided into 4 equal groups by blind randomization: 2 experimental groups and 2 control groups. In the vivarium under general anesthesia, the animals underwent surgery – alloplasty of the abdominal aorta. Dacron patches, being woven and knitted prosthetic grafts made of polyester fiber (n=40), and PTFE patches (n=40) were used as the material for alloplasty.

Results and discussion. The mean volume of blood loss volume in group 2A (Dacron) and in group 1A (Dacron + Hemoblock) amounted to 15.69 ml and 14.6 ml, respectively, with no significant difference between the groups (p=0.24). The volume of blood loss in group 2B, using PTFE as a plastic material, was 20.12 ml, and in group 1B (PTFE + Hemoblock) it was 14.2 ml. Statistical analysis demonstrated significantly better values obtained with the additional use of Hemoblock (p=0.03). The mean bleeding time in group 2A (Dacron) was 265.8 s and in group 1A (Dacron + Hemoblock) it was 240.6 s, which was a statistically better time to achieve hemostasis (p<0.001). In group 2B (PTFE), the bleeding time was 285 s and in group 1B (PTFE + Hemoblock) it was 259.2 s, with a statistically significant between-group difference in favor of the additional use of Hemoblock (p<0.001).

Conclusion. Applying the hemostatic solution Hemoblock made it possible to significantly improve the results of surgical interventions in terms of such parameters as reducing blood loss by 29.4% when using PTFE and by 6.9% when using Dacron, as well as to decrease the bleeding time by 9% when using PTFE patches and by 9.5% when using Dacron patches. During the experiment, there were no complications associated with the use of the local hemostatic solution Hemoblock.

Objective. This study was undertaken to investigate the effect of pelvic venous reflux (PVR) and the activity of vasoactive neuropeptides on the development of chronic pelvic pain (CPP) in patients with pelvic venous disease (PeVD).

Patients and methods. Our prospective cohort study sequentially included 110 patients with PeVD and 20 volunteers (healthy women). Amongst patients with PeDV, 70 had a symptomatic form of the disease (i. e., there were complaints of CPP, hypogastric discomfort, dyspareunia) and 40 had an asymptomatic form (i. e., with no clinical manifestations of PeVD). Patients underwent a clinical examination, duplex ultrasound scanning (DUS) of pelvic and lower-limb veins, as well as single-photon emission computed tomography (SPECT) of pelvic veins with in vivo labelled red blood cells. The frequency of reflux in pelvic veins, its duration and the degree of blood deposition in the varicose veins of the pelvis were assessed. Volunteers underwent only a clinical examination and DUS. All the 130 participants underwent enzyme immunoassay of blood plasma to determine the levels of calcitonin-gene-related peptide (CGRP) and substance P (SР).

Results. According to DUS, reflux in the gonadal veins (GVs) was found in 45.7% of patients with symptomatic PeVD, and only in 10% of asymptomatic patients (p=0.001). Reflux duration in GVs in symptomatic patients was 4.1±1.7 s and in asymptomatic patients – 1.4±0.3 s (p=0.002). There were no statistically significant differences in the diameters of GVs with reflux among patients with symptomatic and asymptomatic PeVD. Similar data were obtained by comparing the duration of reflux in parametrial veins (PVs) and their diameters. Reflux in GVs for more than 2 s was found in 41.4% of symptomatic patients and only in 5% with asymptomatic PeVD (p=0.001). In patients with CPP, reflux in the GVs, PVs and uterine veins (UVs) was detected in 24.2%, in the GVs and PVs in 45.7%. In 90% of patients without CPP, reflux was detected only in the PVs. Pronounced pelvic venous congestion was found in 95.7% of patients with CPP and in 15% of patients without CPP (p=0.001) according to SPECT. CGRP and SP levels in symptomatic patients significantly exceeded those in asymptomatic patients (CGRP – 0.48±0.06 ng/ml vs 0.19±0.02 ng/ml, respectively, p=0.001; SP – 0.38±0.08 ng/ml vs 0.13±0.03 ng/ml, respectively, p=0.001).

Conclusion. Reflux in the pelvic veins for more than 2 s, involvement of more than 1 pelvic venous collector in the pathological process, combined with an increase in the levels of CGRP and SP in blood plasma, can be considered as hemodynamic and neurobiological factors in the development of CPP in patients with PeVD.

Objective. This study was undertaken to investigate the effect of pelvic venous reflux (PVR) and the activity of vasoactive neuropeptides on the development of chronic pelvic pain (CPP) in patients with pelvic venous disease (PeVD).

Patients and methods. Our prospective cohort study sequentially included 110 patients with PeVD and 20 volunteers (healthy women). Amongst patients with PeDV, 70 had a symptomatic form of the disease (i. e., there were complaints of CPP, hypogastric discomfort, dyspareunia) and 40 had an asymptomatic form (i. e., with no clinical manifestations of PeVD). Patients underwent a clinical examination, duplex ultrasound scanning (DUS) of pelvic and lower-limb veins, as well as single-photon emission computed tomography (SPECT) of pelvic veins with in vivo labelled red blood cells. The frequency of reflux in pelvic veins, its duration and the degree of blood deposition in the varicose veins of the pelvis were assessed. Volunteers underwent only a clinical examination and DUS. All the 130 participants underwent enzyme immunoassay of blood plasma to determine the levels of calcitonin-gene-related peptide (CGRP) and substance P (SР).

Results. According to DUS, reflux in the gonadal veins (GVs) was found in 45.7% of patients with symptomatic PeVD, and only in 10% of asymptomatic patients (p=0.001). Reflux duration in GVs in symptomatic patients was 4.1±1.7 s and in asymptomatic patients – 1.4±0.3 s (p=0.002). There were no statistically significant differences in the diameters of GVs with reflux among patients with symptomatic and asymptomatic PeVD. Similar data were obtained by comparing the duration of reflux in parametrial veins (PVs) and their diameters. Reflux in GVs for more than 2 s was found in 41.4% of symptomatic patients and only in 5% with asymptomatic PeVD (p=0.001). In patients with CPP, reflux in the GVs, PVs and uterine veins (UVs) was detected in 24.2%, in the GVs and PVs in 45.7%. In 90% of patients without CPP, reflux was detected only in the PVs. Pronounced pelvic venous congestion was found in 95.7% of patients with CPP and in 15% of patients without CPP (p=0.001) according to SPECT. CGRP and SP levels in symptomatic patients significantly exceeded those in asymptomatic patients (CGRP – 0.48±0.06 ng/ml vs 0.19±0.02 ng/ml, respectively, p=0.001; SP – 0.38±0.08 ng/ml vs 0.13±0.03 ng/ml, respectively, p=0.001).

Conclusion. Reflux in the pelvic veins for more than 2 s, involvement of more than 1 pelvic venous collector in the pathological process, combined with an increase in the levels of CGRP and SP in blood plasma, can be considered as hemodynamic and neurobiological factors in the development of CPP in patients with PeVD.

Background. Objective control of alterations in indurated cellulitis and lipodermatosclerosis, as well as correlation of these conditions with other venospecific symptoms caused by chronic venous insufficiency appear to be a poorly explored but at the same time currently important problem.

Objective. The purpose of this study was to assess efficacy of combined compression and pharmacological therapy in patients with chronic venous insufficiency of lower limbs of clinical classes C4a and C4b according to CEAP in routine clinical practice.

Patients and methods. This prospective observational study enrolled a total of 381 patients with CEAP class C4a, b chronic venous insufficiency, undergoing for 6 months combined conservative treatment. The basic therapy consisted in standardized compression with pharmacological phlebotropic support (micronized purified flavonoid fracture – MPFF). Therapeutic efficacy was assessed based on the dynamics of venospecific symptoms, using visual analog scales (VAS), CEAP classification with the application of the Venous Clinical Severity Score (VCSS), as well as the Chronic Venous Insufficiency Questionnaire (CIVIQ-14). The state of soft tissues in the area of trophic disorders in all patients was objectively assessed by measuring subcutaneous-fat thickness by means of ultrasonographic examination. In 55 patients, we additionally used durometry, and in 60 patients – curvimetry.

Results. Of the 381 patients initially included into the study, 365 subjects fully completed it. At 6 months, subcutaneous adipose tissue thickness, VCSS and VAS improved significantly (p<0.001 for all evaluated parameters). The number of patients with C4b clinical class decreased by 6.9% compared with the baseline level. Besides, there was a significant decrease in the borders of the zone of trophic disorders (p<0.001), skin hardness (p=0.002), with significant improvement of quality of life by the CIVIQ-14 scores. There were no adverse reactions requiring discontinuation of treatment.

Conclusion. Combined conservative therapy including compression and administration of MPFF in the observed group of patients significantly improved the condition of the skin and soft tissues in patients with CEAP C4a, b chronic venous insufficiency. The dynamics of venospecific symptoms directly correlated with the condition of the skin and subcutaneous fat, evaluated by means of instrumental methods, which may be used in real clinical practice.

Background. According to the scientific medical literature, venous thromboembolic complications (VTEC) in the wounded occur in 2.2–28% of cases. VTEC-associated mortality after evacuation by air transport reaches 1.1%.

Objective. This study was undertaken to investigate speed characteristics of venous blood flow in the lower limbs of military personnel during evacuation by air.

Patients and methods. We analyzed the results of ultrasound examination of lower-limb veins in 40 servicemen (males) fit for military service for health reasons, who had neither chronic diseases of the cardiovascular system nor overweight. The average age was 29.3±1.5 years, the average weight was 79.5±1.1 kg.

Ultrasound examination was carried out in the AN-26 aircraft and the MI-8 helicopter at altitudes from 100 to 2500 meters using portable ultrasound devices with linear sensors with a frequency of 3–11 and 4–15 MHz in the vascular mode and was performed 2 hours before departure, when climbing, at altitude, during descent and within 1 hour after landing. Blood flow velocity was measured in the common femoral vein (CFV), superficial femoral vein (SFV), popliteal vein (PV), posterior tibial veins (PTV), and sural veins.

Results. Analyzing the results of studying the velocity blood flow in the CFV, SFV, PV and PTV in the aircraft revealed significant differences in the values (р<0.01) 2 hours before departure compared with the results when climbing, at altitude and during descent. In the helicopter, a significant (р<0.05) increase in blood flow velocity was revealed in the CFV, SFV, and PTV during takeoff and at altitude as compared with values before the flight, and the values in the PV were at the border of statistical significance (p=0.058).

Conclusion. During evacuation by an aircraft, blood flow velocity in the veins of the lower extremities significantly decreases (p<0.01) throughout the flight, whereas during air evacuation by a helicopter, it significantly increases at takeoff and during the flight (p<0.05), decreasing to the initial values at landing.

The determined changes in blood flow velocity in the veins of the lower extremities make it possible to consider air transport evacuation as a risk factor of VTEC development. The revealed hemodynamic patterns suggest the need for mandatory prevention of venous thrombosis during air evacuation.

According to recent guidelines, the main criterion for decision-making in aneurysmal thoracic aorta is its diameter. However, it is now well known that not only this parameter is responsible for aortic related events. Many authors confirm the need for searching additional indications for surgical interventions, including anatomical peculiarities revealed by the findings of multislice computed tomography.

At present, the primary emphasis is on analyzing peculiarities of diagnosis of and surgical approaches to thoracic aortic aneurysms, with the treatment of thoracic aortic dilatation (40–49 mm) being mainly out of the scope. Thoracic aortic dilatation requires additional investigations aimed to determine whether conservative or surgical management is adequate. To date, a scarce evidence base determines diversity of researchers’ opinions on this issue.

Present-day guidelines on treatment of non-ST-segment elevation acute coronary syndrome do not determine the place of emergency coronary artery bypass grafting in this condition, however underlining that in high-risk patients, revascularization should be performed within the first 24 hours. Analysing the evidence-based data of using emergency coronary artery bypass grafting demonstrated that performing intra-aortic balloon counterpulsation prior to operation in high-risk patients with non-ST segment elevation acute coronary syndrome improved clinical outcomes. It was shown that CABG on the beating heart in patients with acute coronary syndrome improved outcomes of surgical revascularization and may be a method of choice in such patients, provided complete revascularization is achieved.

We also analysed studies comparing the results of coronary artery bypass grafting and percutaneous interventions, demonstrating that CABG at the expense of a persistent effect improved the long-term prognosis and reduced the risk of repeat revascularizations in future.

The choice of antithrombotic therapy for treatment of patients with venous thromboses and renal dysfunction supposes a special approach due to increased risk of both hemorrhagic and thrombotic events. Therapeutic decision-making is difficult because of concomitant renal dysfunction. Improved quality of life and prognosis in elderly patients with chronic renal insufficiency largely depend on adequate anticoagulant therapy with modern drugs.

Presented herein are the findings of several studies in patients with deep vein thrombosis/pulmonary embolism, receiving therapy including that with rivaroxaban, demonstrating its high anticoagulation effect and a favorable safety profile as low risks of hemorrhage in high-risk patients, i. e., those with renal dysfunction, as well as in frail patients.