Objective: to study the natural history of atherosclerotic lesions of the innominate artery (IA) and to identify factors influencing the disease progression.

Material and methods. The study included 82 patients with atherosclerotic lesions of the IA observed for various diseases in A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2010 to 2022. All patients were divided into 4 groups depending on the initial degree of IA stenosis: less than 50% – 35 (42.7%) patients, 50–69% – 29 (35.4%), 70–99% – 14 (17.1%), and occlusion – 4 (4.8%).

Results. The incidence of increasing grade of IA stenosis in the groups with initial stenosis less than 50% and 50–69% was statistically significant (p=0.001 and p=0.000, respectively). Significantly more often there was an increase in the degree of IA stenosis, and hence migration to groups with a more severe degree of stenosis, in persons not taking statins (p=0.000), in smokers (p=0.005), and in patients suffering from diabetes (p=0.015).

In the groups with 50–69% and 70–99% stenosis, differences between the number of asymptomatic and symptomatic patients at the beginning and end of the follow-up period were significant (p=0.000). In the groups with less than 50% stenosis and occlusions the dynamics of initial cerebrovascular insufficiency was insignificant (p=0.643). It is worth noting that in 1 (25%) case of initial asymptomatic occlusion, a stroke developed. History of arterial hypertension (p=0.007), smoking (p=0.03), as well as hemodynamically significant stenosis of IA (p=0.000) had statistically significant effect on the dynamics of initial cerebrovascular insufficiency. Patients with initial or developed hemodynamically significant IA lesions had the development of strokes in half of the cases (53.5%) (p=0.000), and every third case was fatal (p=0.009). The incidence of myocardial infarction and mortality due to myocardial infarction, as well as the overall mortality in patients with hemodynamically significant (initial or developed) and insignificant lesions did not differ significantly (p>0.05).

Cumulative freedom from stroke by year 10 in hemodynamically significant lesions of the IA fell to 0, and in stenoses 50–69% and up to 50% it was 38% and 100%, respectively. The 10-year cumulative survival rate for hemodynamically significant IA lesions was 34%, whereas for stenoses 50–69% and up to 50% was 54% and 88%, respectively.

Conclusion. At the initial degree of IA stenosis up to 50% and 50–69%, patients should be recommended to correct any risk factors (primarily diabetes, smoking, hypercholesterolemia, arterial hypertension), and to undergo duplex scanning of the brachiocephalic arteries with a frequency of 1–2 times a year. In hemodynamically significant lesions surgical intervention is absolutely indicated regardless of the initial degree of cerebrovascular insufficiency, followed by optimal drug therapy and correction of risk factors.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Beloyartsev D.F.; data collection and handling – Polyansky D.V., Timina I.E.; draft manuscript preparation – Polyansky D.V.; manuscript revision – Beloyartsev D.F., Adyrkhaev Z.A.

For citation: Beloyartsev D.F., Polyansky D.V., Adyrkhaev Z.A., Timina I.E. Natural history of atherosclerotic lesions of the innominate artery. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 7–14. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-7-14 (in Russian)

Background. In the progression of atherosclerotic lesions of the brachiocephalic arteries, disturbances occur interdependently in the venous system, its extra- and intracranial sections. Therefore, an adequate assessment of the venous component of cerebral hemodynamics should be an important addition to the study of the arterial bed. The most common diagnostic method for detecting pathological changes in cerebral vessels today is ultrasound. However, there is still not enough information about which parameters clinically most valuable reflect venous remodeling and outflow disturbance. Changes in the structural and functional parameters of the internal jugular veins with varying degrees of stenosis of the carotid arteries were studied in fragments.

Aim. To study the venous outflow through the internal jugular veins at different degrees of the internal carotid arteries stenosis.

Material and methods. The study included 91 patients who underwent ultrasound examination of the carotid arteries and internal jugular veins. According to the ultrasound results, patients were initially divided into three groups: group 1 (main) – 26 patients with hemodynamically significant stenosis of the internal carotid arteries of 70% or more by area (stenosis of «high» degree), group 2 (comparison) – 31 patients with stenosis of the ICA 50–60%, which we defined as «borderline», group 3 (control) – 34 patients with stenosis of the ICA less than 30% («small» stenoses). In 9 patients, a comprehensive MR-tomographic and MR-angiographic examination of the brain was performed.

Results. In the group with «high» degree stenoses, the venous peripheral and central venous pressure were statistically significantly lower, the area of the internal jugular vein were larger, and the linear velocity and volumetric flow rate on the side of the stenosis were higher than in the groups with «borderline» and «small» stenoses. The indicators in the group of «borderline» stenoses were statistically significantly different from the group with «high» degree stenosis and did not differ from the indicators of the control group, the division of this group into two subgroups: with stenoses up to 55% and more than 55% showed a statistically significant difference in linear velocity and volumetric flow rate as between subgroups and between the subgroup with stenoses greater than 55% and the control group.

Conclusion. Evaluation of the geometric and hemodynamic parameters of the internal jugular veins during a comprehensive ultrasound examination in patients with various degrees of stenosis allows clarifying the hemodynamic significance of stenotic lesions of the internal carotid arteries and then confirming the significant nature of the stenosis on MRA. Quantitative assessment of venous blood flow should be included in the complex ultrasound examination in patients with carotid atherosclerosis.

Funding. The study had no financial support.

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

Author’s contribution. Study conception and design – Bukhovets I.L.; data collection and handling – Bukhovets I.L., Kuznetsov M.S., Maksimova A.S.; statistical processing – Maksimova A.S.; draft manuscript preparation – Bukhovets I.L., Ussov W.Yu., Maksimova A.S.; manuscript revision – Bukhovets I.L., Zavadovsky K.V., Kozlov B.N., Ussov W.Yu., Stepanov I.V.

For citation: Bukhovets I.L., Maksimova A.S., Kuznetsov M.S., Kozlov B.N., Stepanov I.V., Zavadovsky K.V., Ussov W.Yu. The internal jugular veins outflow with varying degrees of internal carotid arteries stenosis using ultrasound assessment. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 15–23. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-15-23 (in Russian)

Objective. The purpose of the study was to determine clinical and laboratory predictors suggesting an unfavorable outcome of acute limb ischemia.

Patients and methods. The work was based on retrospective assessment of treatment of 556 patients with confirmed acute limb ischemia, undergoing treatment in 2000–2018. All patients were operated on. The mean age amounted to 69.9±12.8 years. Women accounted for 51.3%. According to the classification of I.I. Zatevakhin, degree I ischemia was in 36.1% of patients, degree II in 59.2%, and degree III in 4.7%. In the majority of patients, acute ischemia was caused by arterial embolism. The patients were divided into two groups: Group 1 included those discharged with the saved limb after restoration of arterial blood flow and Group 2 comprised patients discharged after amputation.

Results. The time from the onset of the disease to the moment of surgical intervention in Group 2 was 10.3-fold longer (p=0.0001). Arterial thrombosis was 2.5 times more associated with the risk of major amputation (p=0.002). The chance of amputation in acute ischemia of upper extremities was 6.8 times less than in lesions of lower limbs (p=0.003). Distal lesions of lower-limb arteries increased 3.6-fold the risk of amputation (p=0.001). The chance of limb loss directly depended on the ischemia degree (p<0.024). In Group 2 patients, the neutrophil-to-lymphocyte ratio was 1.5-fold higher (p=0.001).

Conclusion. The duration prior to revascularization, limb ischemia degree, etiology and the level of the arterial bed lesion remain the most significant predictors of an unfavorable outcome in acute limb ischemia. Elevated values of the neutrophil-to-lymphocyte ratio appeared to directly associated with the necessity to perform amputation.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Khorev N.G.; data collection and handling – Khorev N.G., Beller A.V., Chichvarov A.A.; statistical processing – Chichvarov A.A., Sapelkin S.V.; draft manuscript preparation – Khorev N.G., Chichvarov A.A.; manuscript revision – Khorev N.G., Sapelkin S.V.

For citation: Khorev N.G., Chichvarov A.A., Sapelkin S.V., Beller A.V. Clinical and laboratory predictors of amputation in patients with acute limb ischemia. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 24–30. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-24-30 (in Russian)

Regional thrombolytic therapy for acute ischemia of lower extremities is one of therapeutic methods, which in some cases is a method of choice, especially when open reconstructive surgical intervention is associated with a high risk of complications. Besides, thrombolytic therapy can be considered as the first stage of treatment, as well as a method of choice to restore patency of the arterial distal bed.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Papoyan S.A., Chizhova E.S., Shegolev A.A.; data collection and handling – Papoyan S.A., Chizhova E.S., Asaturyan K.S., Syromyatnikov D.D., Gromov D.G.; statistical processing – Chizhova E.S., Asaturyan K.S.; draft manuscript preparation – Chizhova E.S., Asaturyan K.S. Syromyatnikov D.D.; manuscript revision – Papoyan S.A., Shegolev A.A.

For citation: Papoyan S.A., Shegolev A.A., Chizhova E.S., Asaturyan K.S., Syromyatnikov D.D., Gromov D.G. Catheter-guided thrombolysis for acute lower-limb ischemia. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 31–7. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-31-37 (in Russian)

This clinical case demonstrates an example of successful isolated repeat revascularization of the deep femoral artery using surgical and endovascular methods in a patient with rapidly progressive atherosclerosis and renal failure. Multiple attempts at direct revascularization for critical limb ischemia of the collateral lower limb for less than 2 years had resulted in amputation at the level of the thigh. With the development of critical ischemia of the contralateral limb, the tactics of indirect restoration of blood flow through the deep femoral artery made it possible to achieve regression of critical ischemia and save the limb. We consider it expedient to perform surgical treatment in patients with widespread atherosclerotic lesions of the distal segment, starting with isolated revascularization of the limb through the deep femoral artery.

Funding. Research support: grant of the Ministry of Education and Science No. 075-15-2022-1110.

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

Authors’ contribution. Study conception and design – Gamzatov T.Kh., Kebriakov A.V., Svetlikov A.V.; data collection and handling – Kebriakov A.V.; draft manuscript preparation – Kebriakov A.V.; manuscript revision – Svetlikov A.V., Kashchenko V.A., Ratnikov V.A., Gurevich V.S.

For citation: Gamzatov T.Kh., Kebriakov A.V., Svetlikov A.V., Kashchenko V.A., Ratnikov V.A., Gurevich V.S. Successful isolated limb revascularization through the deep femoral artery in a patient with a high risk of amputation (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 38–45. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-38-45 (in Russian)

Here we describe a clinical case of successful staged treatment of descending thoracic and abdominal aorta aneurysmal lesions with unchanged segment of the visceral portion between them. An anatomical peculiarity of the abdominal aortic aneurysm was the presence of angulation and an aneurysmal lesion of the left iliac artery, thus requiring the use of a hybrid strategy. The patient had a high surgical risk associated with comorbidity. At the first stage, he underwent aortofemoral prosthetic repair and 3 months thereafter received an endograft implanted into the descending thoracic aorta with the positioning of the distal portion of the stent graft at the level of the XI thoracic vertebra. Previous aortofemoral prosthetic repair was an independent risk factor for spinal complications avoided by optimal perioperative and postoperative patient management. The control studies showed an adequate position of the stent graft, patency of the aortofemoral prosthesis, and no dilatation of the visceral portion of the aorta.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Ivanov L.N., Mukhin A.S.; data collection and handling – Naumov S.V., Kozina M.V., Yurasova E.V.; draft manuscript preparation – Ivanov L.N., Nagaev R.Yu., Pugin V.A.; manuscript revision – Mukhin A.S.

For citation: Ivanov L.N., Mukhin A.S., Nagaev R.Yu., Naumov S.V., Pugin V.A., Kozina M.V., Yurasova E.V. Staged hybrid treatment of a patient with descending thoracic and abdominal aortic aneurysm (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 46–52. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-46-52 (in Russian)

In this article, we present a clinical case of staged treatment of a patient with lung cancer and a thoracic aortic aneurysm. At the first stage, the patient underwent an extended upper lobectomy on the right with resection of the apical segment of the lower lobe of the lung and mediastinal lymph node dissection. At the second stage, a hybrid operation was performed, including partial debranching of the aortic arch and endovascular thoracic aortic aneurysm repair. The chosen approach made it possible to reduce the overall traumaticity of surgical interventions, while maintaining the radical nature of treatment.

This clinical example is an illustration of the fact that the modern hybrid strategy for the treatment of thoracic aortic pathology (in particular, the aortic arch) significantly expands the possibilities of treating patients with combined pathology, allowing to reduce the risks of both general surgical complications and cerebral circulation impairments. However, the place of this approach can only be determined after assessing the long-term results, in particular the risks and frequency of aortic remodeling.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Papoyan S.A.; data collection and handling – Ter-Ovanesov M.D., Shchegolev A.A.; draft manuscript preparation – Chernaya N.R.; manuscript revision – Amirkhanyan D.S., Chernaya N.R.

For citation: Papoyan S.A., Ter-Ovanesov M.D., Shchegolev A.A., Chernaya N.R., Amirkhanyan D.S. Hybrid treatment of a patient with a thoracic aortic aneurysm and lung cancer (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 53–8. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-53-58 (in Russian)

Presented herein is a clinical case report concerning successful use of cyanoacrylate glue obliteration in a female patient with lower limb varicose veins, restless leg syndrome, and a long history of epilepsy. The intervention was performed under local anesthesia.

Positive results were achieved regarding varicose disease symptoms, with a decrease in the frequency and intensity of epileptic seizures. It is noted that a multidisciplinary approach is an important condition for achieving success in treatment of such patients and improving their quality of life.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Shirinbek O., Mnatsakanyan G.V.; data collection and handling – Mnatsakanyan G.V.; statistical processing – Mnatsakanyan G.V., Odinokova S.N.; draft manuscript preparation – Mnatsakanyan G.V., Shirinbek O.; manuscript revision – Shirinbek O., Baeva E.Yu.

For citation: Shirinbek O., G.V. Mnatsakanyan G.V., Odinokova S.N., Baeva E.Yu. Cyanoacrylate adhesive closure of varicose veins in a woman with juvenile epilepsy and restless leg syndrome (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 59–63. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-59-63 (in Russian)

Background. A congenital malformation in the form of an abnormal origin of the left coronary artery from the pulmonary artery leads to the phenomenon of stealing the coronary arteries with a shunt from left to right, causing aberrant left ventricular perfusion. 9 out of 10 children die before reaching the age of one without surgery due to cardiac ischemia, infarction, or congestive heart failure secondary to mitral regurgitation. Some of them survive to a later age thanks to an adequate collateral blood supply through the entrapment of the right coronary artery.

Material and methods. The article presents a rare case of Bland–White–Garland syndrome manifestation in a woman aged 43 years.

Results. The angina clinic developed after a coronavirus infection, and was provoked by a constant tachycardia at rest of 90–100 beats per minute, aggravated by exercise. ECG Holter monitoring revealed episodes of severe ST-T depression. On the electrocardiogram – signs of focal cicatricial changes in the anterior septal and high lateral myocardium. Echocardioscopy established that the left coronary artery does not originate from the aorta, but from the pulmonary artery. Detection of a zone of reduced contractility of the myocardium of the left ventricle. A decrease in systolic function of the left ventricle was found (ejection fraction 48–50%). Spiral computed tomographic coronary angiography also confirmed the presence of this anomaly, an increase in the diameter of the left coronary artery up to 5 mm. The diameter of the right coronary artery was also increased to 8 mm. Multiple tortuous collaterals between the left and right coronary systems were revealed. Invasive coronary angiography confirmed the presence of this anomaly. An operation was performed: an anastomosis was made between the aorta and the left coronary artery in an end-to-side manner. The trunk of the pulmonary artery was reconstructed with a xenopericardial patch.

Conclusion. In the presented case, it was possible to demonstrate a late manifestation of the Bland–White–Garland syndrome at the age of 43 years. Reconstruction of the coronary bed significantly improved the patient’s condition and her quality of life.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Chepurnenko S.A.; data collection and handling – Chepurnenko S.A., Kostenko V.L., Lobachev D.K.; draft manuscript preparation – Chepurnenko S.A., Safonova A.V.; manuscript revision – Chepurnenko S.A., Kostrykin M.Y.

For citation: Chepurnenko S.A, Kostrykin M.Y., Kostenko V.L., Lobachev D.K., Safonova A.V. New coronavirus infection as a provoking factor for the clinical manifestation of Bland–White–Garland syndrome (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 64–9. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-64-69 (in Russian)

Background. Carotid endarterectomy is one of the most frequently performed peripheral vascular operations. We present herein a retrospective and prospective analysis of carotid endarterectomy performed without an intraluminal arterial shunt in a total of 3615 patients.

Objective. The purpose of this study was to assess efficacy and safety of the technology of perioperative management and the technique of carotid endarterectomy with no intraluminal arterial shunt.

Patients and methods. Our study included 3615 patients successively operated on at the same department. All patients underwent elective carotid endarterectomy without an intraluminal arterial shunt. The stages of perioperative management were standardized. All operations were performed under combined general anesthesia. Prior to clamping carotid arteries, we elevated the level of arterial pressure (AP) by 20–30% above the “working” level. Adequacy of blood supply of the brain was controlled by means of cerebral oximetry using the Somanetics INVOS 3100 unit and by the assessment of retrograde blood flow through the internal carotid artery. 3145 (87%) patients underwent modified carotid endarterectomy with creation of high divarication. 470 (13%) patients were subjected to classical carotid endarterectomy with autovenous plasty of the internal and common carotid arteries. The criteria for making the diagnosis of ischemic stroke with determination of the mechanism of its development were standardized.

Results. 3566 (98.64%) patients had no evidence of perioperative stroke and 49 (1.36%) patients developed intraoperative stroke. In 41 (1.13%) of the 3615 patients, the mechanism of development of intraoperative ischemic stroke was atheroembolic, in five (0.14%) – hemodynamic, and in three (0.08%) – lacunar. Eleven (0.3%) patients died from ischemic stroke.

Conclusion. Carotid endarterectomy without an intraluminal shunt did not increase the risk of developing ischemic stroke. Correction of cerebral hypoperfusion during carotid artery cross-clamping should be recognized as an anesthesiological task.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Vachev A.N.; data collection and handling – Vachev A.N., Chernysheva N.I., Dmitriev O.V., Stepanov M.Yu., Golovin E.A., Prozhoga M.G., Tereshina O.V., Kuznetsov P.O.; statistical processing – Golovin E.A., Stepanov M.Yu.; draft manuscript preparation – Golovin E.A., Stepanov M.Yu.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Chernysheva N.I., Dmitriev O.V., Stepanov M.Yu., Golovin E.A., Prozhoga M.G., Tereshina O.V., Kuznetsov P.O. 3615 consecutive carotid endarterectomies without intraluminal shunt. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 78–84. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-78-84

Background. Carotid endarterectomy is one of the most frequently performed peripheral vascular operations. We present herein a retrospective and prospective analysis of carotid endarterectomy performed without an intraluminal arterial shunt in a total of 3615 patients.

Objective. The purpose of this study was to assess efficacy and safety of the technology of perioperative management and the technique of carotid endarterectomy with no intraluminal arterial shunt.

Patients and methods. Our study included 3615 patients successively operated on at the same department. All patients underwent elective carotid endarterectomy without an intraluminal arterial shunt. The stages of perioperative management were standardized. All operations were performed under combined general anesthesia. Prior to clamping carotid arteries, we elevated the level of arterial pressure (AP) by 20–30% above the “working” level. Adequacy of blood supply of the brain was controlled by means of cerebral oximetry using the Somanetics INVOS 3100 unit and by the assessment of retrograde blood flow through the internal carotid artery. 3145 (87%) patients underwent modified carotid endarterectomy with creation of high divarication. 470 (13%) patients were subjected to classical carotid endarterectomy with autovenous plasty of the internal and common carotid arteries. The criteria for making the diagnosis of ischemic stroke with determination of the mechanism of its development were standardized.

Results. 3566 (98.64%) patients had no evidence of perioperative stroke and 49 (1.36%) patients developed intraoperative stroke. In 41 (1.13%) of the 3615 patients, the mechanism of development of intraoperative ischemic stroke was atheroembolic, in five (0.14%) – hemodynamic, and in three (0.08%) – lacunar. Eleven (0.3%) patients died from ischemic stroke.

Conclusion. Carotid endarterectomy without an intraluminal shunt did not increase the risk of developing ischemic stroke. Correction of cerebral hypoperfusion during carotid artery cross-clamping should be recognized as an anesthesiological task.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Vachev A.N.; data collection and handling – Vachev A.N., Chernysheva N.I., Dmitriev O.V., Stepanov M.Yu., Golovin E.A., Prozhoga M.G., Tereshina O.V., Kuznetsov P.O.; statistical processing – Golovin E.A., Stepanov M.Yu.; draft manuscript preparation – Golovin E.A., Stepanov M.Yu.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Chernysheva N.I., Dmitriev O.V., Stepanov M.Yu., Golovin E.A., Prozhoga M.G., Tereshina O.V., Kuznetsov P.O. 3615 consecutive carotid endarterectomies without intraluminal shunt. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 78–84. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-78-84

Analyzed herein are therapeutic outcomes in a total of 42 patients diagnosed as having vertebrobasilar insufficiency and vertebral artery ostial stenosis treated by means of deployment of drug-eluting stents, with the immediate and remote results of stenting of the vertebral artery ostium assessed.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Karimov Sh.I.; data collection and handling – Dzhalilov A.A., Akhmatov O.M.; draft manuscript preparation – Yulbarisov A.A.; manuscript revision – Alidzhanov Kh.K., Irnazarov A.A.

For citation: Karimov Sh.I., Irnazarov A.A. Yulbarisov A.A., Alidzhanov Kh.K., Akhmatov O.M., Dzhalilov A.A. Stenting of the vertebral artery ostium in patients with vertebrobasilar insufficiency. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 85–90. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-85-90 (in Russian)

Objectives. Remote iliac artery endarterectomy is disputable technique of restore patency of iliac arteries, whereas iliac artery bypass is a “gold standard” treatment lesion of iliac artery TASC C and D, but more invasive. The aim of study evaluatelong-term outcomes of remote endarterectomy from iliac artery and comparative with iliac artery bypass.

Material and methods. A retrospective cohort study identified patients with aorto-iliac arteries lesion TASC C and D treatment with remote iliac artery endarterectomy (n=83) and iliac artery bypass (n=63). The outcomes were patency (primary, primary-assisted, secondary, patency association with SFA lesion), survival, freedom from cardiovascular events. Proportional hazard regression model were used to analyze predictors of restenosis/reocclusion.

Results. A total of 146 procedures were analyzed. The mean follow-up period was 54.1 months. There was no 30-day mortality in both group. 30-day occlusion in 4 (6.35%) patient in IAB group. There was no 30-day amputation in group 1, but 2 (3.17%) cases in group 2. Primary patency in group 1 and 2 at 12, 24, 60 months was 87.5; 82.8; 66.6% and 93.5; 93.5; and 90.1%, respectively (p<00001). Primary-assisted patency and secondary patency was no significant difference in both group (p=0.553 and p=0.582). 5-year limb salvage and freedom from cardiovascular events was no significant difference (p=0.134 and p=0.113). 5-year survival was significantworse in group 2. At multivariable analysis in group REIA age > 65 y.o. (HR 5.363; 95% Confident interval (CI) 1.194–24.097; p=0.028) and SFA lesion without intervention (HR 3.460; CI 0.957–12.513; p=0.058) were independently associated with loss of primary patency.

Conclusion. Our study demonstrateIAB is durable procedure for long lesion iliac artery. However, native occlusion may have a risk of early graft occlusion. Occlusion of SFA in long term period is not lower patency of IAB. Although REIA less invasive procedure, long term patency is not well. Age over 65 and SFA lesion without procedures increase risk of reocclusion iliac arteries.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Oborin A.A.; data collection and handling – Oborin A.A.; statistical processing – Oborin A.A.; draft manuscript preparation – Oborin A.A.; manuscript revision – Mukhamadeev I.S.

For citation: Mukhamadeev I.S., Oborin A.A. Loop endarterectomy from the iliac arteries and aorto-femoral bypass surgery: long-term results. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 91–8. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-91-98 (in Russian)

Background. The number of endovascular interventions on the arteries of the lower extremities is increasing every year. To improve the long-term results of stenting, many different options are proposed (the use of biomimetic devices with increased flexibility or the use of drug coating with cytostatics to reduce neointimal hyperplasia). However, a recent meta-analysis of randomized trials examining the long-term risk of major amputation with paclitaxel-coated balloons in peripheral arterial disease (3760 people) showed that there is an increased risk of major amputation following the use of paclitaxel-coated balloons in peripheral arteries (HR 1.66 (95% CI 1.14–2.42; p=0.008, one-stage stratified Cox model). This may be due to distal embolism of drug coating elements, resulting in poor peripheral blood flow to the extremity. Additional randomized prospective studies are needed to identify or refute the fact of intraoperative distal embolism when using drug-coated balloons.

Purpose – еvaluate the efficacy and safety of using drug-coated balloons up to 12 months after treatment.

Material and methods. A prospective, randomized, single-center study. 20 patients with peripheral arteries disease with above the knee atherosclerotic lesions with symptomatic chronic limb ischemia (Rutherford categories 3–6) were randomized into two groups (10 people, respectively). The first group of patients underwent percutaneous transluminal angioplasty using a drug-coated balloon, the second group – using a conventional balloon. Before surgery, after 2 days and after 6 months of observation, transcutaneous oximetry (ТсрО₂, mm Hg) and laser doppler flowmetry (perfusion units – perf. units) were used to study microcirculatory blood flow of the lower extremities, as well as duplex scanning of arteries and examination by a vascular surgeon with the definition of quality of life, using the SF-36 questionnaire. Intraoperatively were provided emboli-detection.

Results. The groups were comparable in terms of baseline clinical and anthropometric characteristics. The procedural success was 100% in all patients. Intraoperative emboli-detection showed the fact of distal embolism in 10 (100%) patients in the drug-coated balloon group (median number of emboli = 200) and in 8 (80%) patients in the conventional balloon group (median number of emboli = 135) without statistically significant differences (p=0.47). In the early and late postoperative periods (6 months of follow-up), there were no cases of thrombosis, amputations, significant cardiovascular events (myocardial infarction, stroke), deaths, or any complications associated with endovascular access (hematomas, infection, neuropathy). Primary patency in the drug-coated balloon group was 100%, in the conventional balloon group 70% (2 cases of hemodynamically significant restenosis and 1 case of occlusion of the operated segment), p_log-rank=0.06. Evaluation of the lower limb microcirculation showed a statistically significant improvement by laser doppler flowmetry (by 428% perf. u in the drug-coated balloon group, p=0.01, and by 117% perf. u in the conventional balloon group, p=0,05). A significant increase in ТсрО₂ on the back of the foot by 13% mm Hg was also noted in the drug-coated balloon group, p=0.001, and a statistically insignificant improvement of 7% mm Hg. in the conventional balloon group, p=0.28. On the lower leg, the increase in TcPO₂ in the drug-coated balloon group was 27.7% mm Hg, p=0.21, in the conventional balloon group was 20.9% mm Hg, p=0.005. It should be noted that both laser doppler flowmetry and TcPO₂ on the dorsum of the foot showed a systematic increase in indicators in both groups in the early and late postoperative periods compared with the preoperative level. At the same time, TcPO₂ on the lower leg in the drug-coated balloon group after surgery tended to slightly decrease compared to the preoperative level by 6% mm Hg, p=0.64 followed by an increase of 35.3% mm Hg after 6 months of observation, p=0.22, while in the conventional balloon group this phenomenon was not observed, and there was a significant increase in indicators by 48% mm Hg, immediately in the early postoperative period compared with the preoperative level, p=0.01.

Conclusion. When using drug-coated balloon, there is a tendency to a higher incidence of intraoperative distal embolism and the number of emboli compared to conventional balloon group. As a result of the analysis of ТсрО₂ on the lower leg, an initial decrease in the indices in the early postoperative period in the drug-coated balloon group was revealed, followed by an increase in the indices in the late postoperative period, in contrast to the conventional balloon group, where a significant increase in the indices of ТсрО₂ occurred already in the early postoperative period. These changes can be explained by the phenomenon of micro-embolization by drug coating elements when using appropriate devices and temporary blocking of the distal microvasculature. It should be noted that the groups were comparable in terms of efficacy and safety both in the early and late postoperative periods.

Funding. The reported study was funded by Grants Council of the President of the Russian Federation, project No. МК-3982.2022.3.

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

Authors’ contribution. Study conception and design – Karpenko A.A., Kamenskaya O.V., Gostev A.A.; collection and processing of material – Osipova O.S., Gostev A. A., Klinkova A.S.; statistical processing – Gostev A.A.; draft manuscript preparation – Gostev A.A.; manuscript revision – Karpenko A.A., Kamenskaya O.V., Osipova O.S., Klinkova A.S.

For citation: Gostev A.A., Osipova O.S., Klinkova A.S., Kamenskaya O.V., Karpenko A.A. Evaluation of embologenicity in endovascular treatment of peripheral arteries using drug-coated balloons: interim results. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 99–108. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-99-108 (in Russian)

Objective. The study was aimed at improving the technique and results of X-ray endovascular surgical interventions by investigation of the anatomical and clinical aspects of surgical access to the left radial artery on the back of the hand.

Patients and methods. From 2019 to 2021, we operated on a total of 210 patients randomly assigned to undergo X-ray endovascular surgical interventions through distal approaches from the radial artery on the back of the left hand or in the lower third of the right forearm. The distal approach to the radial artery of the back of the left hand was successful in 100 of 104 patients, and the conventional radial approach in the lower third of the right forearm in 100 of 106 patients. All patients underwent anthropometric measurements and Doppler ultrasonography in the zone of the arterial access. We evaluated the potential efficacy and feasibility of accesses for the intervention, the frequency of access conversion, early (hemorrhagic) and late local postoperative complications (occlusion of the radial artery) associated with a specific type of the arterial access. Subjective pain perception was evaluated using a visual analog scale during both the vascular access and hemostatic bandage application.

Results. Distal radial access on the back of the left hand was effectively performed in 96.2% of cases, and conventional radial access on the inner surface of the lower third of the right forearm in 94.3% of cases. The analysis of X-ray endovascular surgical interventions was performed in 100 patients with successful puncture of the radial artery on the back of the left hand (Group 1) and in 100 patients with successful conventional puncture of the radial artery on the internal surface of the lower third of the right forearm (Group 2). The mean age was 68.4±11.9 and 65.2±11.2 years in Group 1 and Group 2 patients, respectively (p<0.05). There were no statistically significant between-group differences in gender or anthropometric parameters (p<0.005). In male patients, the internal diameter of the radial artery on the inner surface of the lower third of the forearm (2.36±0.09 mm) and on the back surface of the hand (1.83±0.1 mm) was significantly larger (p<0.0001) compared with women (2.14±0.11 mm and 1.70±0.09 mm, respectively). In men, the average wrist circumference was 17.98 cm, and in women – 16.20 cm. The correlation analysis identified a statistically significant association of both the internal diameter of the radial artery on the inner surface of the lower third of the forearm (p<0.0001) and the diameter of the vessel on the back of the hand (p<0.0001) with the results of measuring the circumference of the wrist. There was no statistically significant relationship between the diameter of the artery on the inner surface of the lower third of the forearm (p=0.4118) and on the back surface of the hand (p=0.2242) with the body mass index. In Group 1 patients, the time of successful artery puncture was longer (p<0.0001) compared with that in Group 2 patients (18.8±4.3 s versus 12.2±2.8 s, respectively). However, no statistically significant differences in the time of X-ray, time of intervention and number of punctures were revealed. None of the Group 1 patients had clinically meaningful hemorrhagic complications at the site of vascular access in comparison with Group 2 patients (p<0.0001). After the intervention and within an average of 41.3±9.8 days, no radial artery occlusion was detected in Group 1 patients, whereas six (6%) Group 2 patients were found to have radial artery occlusion within 40.9±7.7 days postoperatively (p=0.0289). Comparing the intensity of pain during vascular access by a visual analog scale demonstrated no between-group statistically significant differences (p>0.05). Assessing the comfort of the compression dressing applied for hemostasis showed a significant advantage in the group of patients with distal access (p<0.0001).

Conclusion. Operative access to the left radial artery on the back of the hand for X-ray endovascular surgical interventions may and should be more widely included in clinical practice. Such access may be considered as a rational alternative to the conventional puncture of the radial artery in the lower third of the forearm.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Milenkin B.I., Prazdnikov E.N., Baranov G.A.; data collection and handling – Milenkin B.I.; statistical processing – Milenkin B.I.; draft manuscript preparation – Milenkin B.I., Baranov G.A.; manuscript revision – Prazdnikov E.N., Baranov G.A.

For citation: Milenkin B.I., Prazdnikov E.N., Baranov G.A. Operative access to the left radial artery on the back of the hand for X-ray endovascular surgical interventions. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 109–18. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-109-118 (in Russian)

Acute stroke is the second cause of death in Russia. Currently, carotid endarterectomy remains the “gold standard” for stroke prevention in patients with stenosis of the internal carotid arteries. Endovascular treatment of atherosclerotic lesion of the carotid bifurcation claims to be an alternative to open reconstructions. The problem of restenosis after both types of intervention remains a significant problem at the moment. According to the literature, massive calcification of an atherosclerotic plaque is a predictor of a greater number of complications during stenting and the impossibility of achieving technical success due to residual stenosis and stent deformation in the long-term period. We summarized the literature data regarding the results of stenting in patients with calcified plaques, risk factors for restenosis, and analyzed the published results of open surgical interventions for in-stent restenosis after endovascular procedures.

We also present our own clinical case of sequential bilateral eversion carotid endarterstenectomy in a patient with critical in-stent restenosis of the internal carotid arteries after Wallstent stent implantation.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Golovyuk A.L., Kutovaya A.S.; data collection and handling – Kutovaya A.S.; draft manuscript preparation – Golovyuk A.L., Kutovaya A.S.; manuscript revision – Chupin A.V., Golovyuk A.L.

For citation: Kutovaya A.S., Golovyuk A.L., Chupin A.V. Eversion endarterstentectomy for treatment critical in-stent restenosis after Wallstent carotid stenting. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 119–28. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-119-128 (in Russian)

Introduction. Currently, there are no unified recommendations on the timing of surgical treatment regarding the development of the first symptoms of carotid stenosis. Accordingly, the question of the most effective and, at the same time, safer deadlines for the implementation of the carotid endarterectomy remains open.

The objective of this meta-analysis is comparison of the results of carotid endarterectomy in the early and delayed periods of acute cerebrovascular accident.

Material and methods. The meta-analysis included 11 clinical trials. The results of treatment of 5003 patients from 10 studies were analyzed, in which early CEE was related to surgery performed within the first 14 days, and delayed – more than 14 days after the onset of the first symptoms of carotid stenosis. Another 4 publications studied the results of carotid endarterectomy before and more than 1 month (28–30 days) from the onset of stroke in 873 patients.

Results. As a result of the analysis of the incidence of perioperative complications (bleeding, hematomas, damage to the cranial nerves), transient ischemic attack or acute cerebrovascular accident, myocardial infarction, deaths within 30 days after carotid endarterectomy, as well as acute cerebrovascular accident, lethal There were no statistically significant differences between the groups of early and delayed surgery in patients who underwent surgery within the first 14 days from the onset of the first symptoms of carotid artery stenosis. When comparing data on the same indicators in patients who underwent surgery within the first month (28–30 days) from the onset of the first symptoms of carotid artery stenosis, no statistically significant differences were found between the groups of early and delayed surgery.

Conclusion. The meta-analysis of the incidence of perioperative complications and deaths after carotid endarterectomy in the early and delayed period of acute cerebrovascular accident in patients with carotid artery stenosis showed comparable results, regardless of the timing of the surgical intervention.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Gavrilenko A.V.; data collection and handling – Nekrasov D.A.; statistical processing – Nekrasov D.A.; draft manuscript preparation – Nekrasov D.A.; manuscript revision – Gavrilenko A.V.

For citation: For citation: Nekrasov D.A., Gavrilenko A.V. Carotid endarterectomy in the early and delayed period of acute cerebral circulation disturbance Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 129–39. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-129-139 (in Russian)

The article presents the data of domestic and foreign literature on the surgical treatment of DeBakey type I acute aortic dissection, as one of the most challenging pathologies in the practice of a cardiac surgeon. Unfavorable nature of the disease, a variation in presentation and clinical course along with an urgent treatment require significant attentiveness. A unified concept of treatment is practically excluded due to the variety of surgical approaches, clinical experience and interventions. There have been demonstrated approaches to surgical treatment and level of a distal anastomosis formation including simple clamp on operations only on the ascending aorta to total arch replacement with hybrid-techniques and their combination in the form of proximalization of the distal anastomosis zone. The clinic’s own vision of this problem is also presented.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Selyaev V.S.; data collection and handling – Selyaev V.S.; draft manuscript preparation – Selyaev V.S.; manuscript revision – Redkoborody A.V.

For citation: Selyaev V.S., Redkoborody A.V. Contemporary strategies to the level of distal anastomosis formation for patients with acute DeBakey type I aortic dissection (literature review and own view on the problem). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 140–7. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-140-147 (in Russian)