Background. Currently, an established indication for surgical repair of an ascending aortic aneurysm is the aortic diameter greater than 55 mm without hereditary connective tissue disorders and bicuspid aortic valve. The aortic size from 40 to 54 mm, regardless of the body surface area, is classified as aortic dilation. Histopathological changes in the dilated ascending aorta without genetic diseases still remain poorly investigated. There are no specific guidelines determining the surgical strategy in patients with the pathology concerned.

Objective. This study was undertaken to investigate histopathological alterations in the wall of the dilated ascending aorta.

Material and methods. A total of 25 gross specimens of the ascending aorta were obtained from corpses after sudden death. They were divided into two groups. The first group (n=5) included the samples of the dilated ascending aorta (diameter of 40 to 54 mm) and the second group (n=20) consisted of the samples of the ascending aorta of less than 40 mm in diameter. Three samples of the aortic wall were taken from each gross specimen at the level of the ascending aorta in the most dilated area. The obtained samples were fixed, stained with hematoxylin-eosin, Van Gieson, Weigert–Van Gieson stains and analyzed by means of light microscopy. Degenerative changes in the aortic wall were assessed according to the Consensus «Noninflammatory degenerative diseases – nomenclature and diagnostic criteria» (2016). The groups were compared using the Student’s t-test for the quantitative data and Chi-squared test and Fisher’s exact test for categorical variables. The statistical significance threshold was set at p<0.05.

Results. The obtained findings revealed a more severe grade of accumulation and distribution of the intralamellar mucoid extracellular matrix in the dilated ascending aorta (р=0.007; p=0.005, respectively), as well as a more pronounced grade and extent of elastic fiber degradation (р<0.001; p<0.001). Moreover, in the first group multifocal medial fibrosis was observed more frequently (p=0.027). The groups were not statistically different in the grade of translamellar mucoid extracellular matrix accumulation and distribution (p=0.103; p=0.504), the extent of smooth muscle cell alterations (p=0.179), and the grade of medial fibrosis (p=0.074).

Conclusion. Dilation of the ascending aorta is related with degenerative changes of the aortic wall. Mucoid extracellular matrix accumulation and elastic fiber alterations are the first degenerative manifestations. Thus, dilation of the ascending aorta is indicative of morphological alterations of the aortic wall and should be taken into consideration while determining the surgical strategy.

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., Kozin I.I.; data collection and handling – Kozin I.I., Poletaeva S.V., Kulakhmetova N.F., Ivanova O.V.; statistical processing – Kozin I.I.; manuscript revision – Vachev A.N., Frolova E.V.

For citation: Kozin I.I., Poletaeva S.V., Kulakhmetova N.F., Ivanova O.V., Frolova E.V., Vachev A.N. Histological peculiarities of degenerative changes in the dilated ascending aorta. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 7–13. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-7-13

Objective. The purpose of this study was to evaluate the dynamics of changes in the shear stress of the internal carotid artery wall by visualizing the vector flow before and after carotid endarterectomy.

Patients and methods. We examined 30 apparently healthy male and female volunteers (34±2.2 years), 23 patients with pathology of the internal carotid artery prior to carotid endarterectomy (65±2.9 years), and 14 patients (of the 23 surgically treated patients) on POD 4–5 after carotid endarterectomy (61.6±2.7 years).

The study was carried out on an ultrasound machine Mindray Resona 7 (China) equipped with a linear transducer (3–11 MHz) and the updated V flow software. Systolic blood flow velocity (Vs) before and after stenosis is correlated with the wall shear stress (WSS) by vector analysis. The WSS was analyzed in the internal carotid artery downstream and upstream of the plaque. The change in the direction of the WSS vector during the cardiac cycle was described using the oscillatory shear index (OSI). The turbulence of the flow, the wall thickness 1 cm proximal to the bifurcation of the common carotid artery, and the percentage of stenosis at the plaque level before and after surgery were evaluated. Stenosis of the internal carotid artery was determined by longitudinal scanning using the ECST method. The intra-group correlation coefficient was calculated when measuring the stress and shear of the wall.

Results. The average values of turbulence in stenosis were higher in systole than in diastole (p<0.001). The turbulent flow correlated with the wall shear stress before the operation (-0.5137; p<0.05). The adequacy of correction of ICA stenosis >70% was assessed by the blood flow rate and the ratio of WSS to the proximal and distal bed. The criteria for adequate correction were considered normalized values of intravascular blood flows, wall shear stress, and oscillatory shear index.

Conclusion. In stenosis of the internal carotid artery, the wall shear stress was significantly higher in the direction of blood flow, which is characteristic of turbulence. Movement speeds at medium and high values of deformation serve as one of the indicators for assessing pathology and identifying areas of vessel stenosis. In the postoperative period, the direction of the flow vectors corresponds to normal values, which serves as an additional criterion for the effectiveness of surgical correction. Recording of the wall shear stress using vector flow mapping in patients with cerebrovascular diseases is a new direction for evaluating the results of surgical treatment.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Sandrikov V.A., Gavrilenko A.V.; data collection and handling – Kulagina T.Yu., Dutikova E.F., Lebedeva E.Yu.; statistical processing – Zhigulina O.A., Dutikova E.F.; draft manuscript preparation – Sandrikov V.A., Kulagina T.Yu.; manuscript revision – Gavrilenko A.V.

For citation: Sandrikov V.A., Dutikova E.F., Gavrilenko A.V., Kulagina T.Yu., Zhigulina O.A., Lebedeva E.Yu. Vector mapping of intravascular flows to assess wall shear stress in patients with internal carotid artery stenosis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 14–20. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-14-20

Objective. The aim of our investigation was to evaluate the efficacy and safety of transcatheter arterial embolization for spontaneous soft tissue bleeding in patients with COVID-19.

Material and methods. We retrospectively analyzed the outcomes of treating 60 patients with confirmed COVID-19 and spontaneous hematomas of the abdominal, thoracic wall and retroperitoneal space. All patients underwent multispiral computed tomography (MSCT) and contrast-enhanced angiography for possible embolization. 41 (68.3%) patients were subjected to transcatheter arterial embolization (TAE) and 19 (31.7%) only to diagnostic angiography. The severity of the underlying disease (COVID-19), as well as clinical and laboratory data were evaluated. The immediate results of the manipulations were assessed based on the findings of ultrasound examination (n=57) and multispiral computed tomography (n=13). Complications of the endovascular procedures and 30-day mortality were also studied.

Results. More than half of the patients (51.3%) had severe COVID-19. In 86.6% of patients, therapeutic doses of low-molecular-weight heparins were used. Extravasation on MSCT was detected in 57 (95%) patients. At the subsequent transcatheter angiography, extravasation was revealed only in 27 (45%) patients. Extravasation on angiography was more often detected if extravasation was determined in the arterial phase on MSCT.

Transcatheter arterial embolization was performed in 41 patients, in 27 (65.8%) of them due to established extravasation of the contrast agent revealed on angiography (“therapeutic” TAE). In 14 (34.2%) patients, TAE was performed in the absence of extravasation (“preventive” TAE). Technical success was achieved in 100% of patients. Dissection of the common femoral artery occurred in two patients (4.9%), when attempting catheterization of the inferior epigastric artery, which required balloon angioplasty in one of them, and stenting of the common femoral artery in the other.

In the postoperative period, 26 (43.3%) patients died, all diagnosed as having extremely severe COVID-19 (p<0.001), with 15 of these subjected to transcatheter arterial embolization and 11 to diagnostic angiography.

Conclusion. Transcatheter arterial embolization for spontaneous bleeding into soft tissues in patients with COVID-19 is accompanied by a high frequency of technical success and a low risk of perioperative complications. High mortality in such patients is associated primarily with the severity of COVID-19.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Polyaev A.Yu., Tyagunov A.E.; data collection and handling – Polyaev A.Yu., Trudkov D.Yu., Mosin S.V.; statistical processing – Stradymov E.A., Polonsky A.A.; draft manuscript preparation – Polyaev A.Yu., Tyagunov A.E.; manuscript revision – Sazhin A.V.

For citation: Polyaev A.Yu., Tyagunov A.E., Stradymov E.A., Polonsky A.A., Trudkov D.Yu., Mosin S.V., Sazhin A.V. Transcatheter arterial embolization for the treatment of spontaneous bleeding into soft tissues in COVID-19 patients. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 21–9. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-21-29

Background. According to the literature, the frequency of pacemaker (PM) pocket hematomas ranges from 0.2 to 16%. In patients on antiplatelet or anticoagulant therapy, the incidence of PM pocket hematomas increases to 2–20%. Hemorrhagic complications often prolong the length of hospital stay, may require repeated surgical interventions and, most importantly, significantly increase the risk of infection.

Objective. This study was undertaken to investigate the risk factors for hemorrhagic complications after permanent PM implantation, their relationship with the baseline parameters of the hemostasis system and the possibilities of prevention using an incomplete silver salt of polyacrylic acid.

Material and methods. The patients enrolled in our prospective, single-center study were assigned to the experimental and control groups by block randomization. In the experimental group, the hemostatic agent incomplete polyacrylic acid silver salt Hemoblock^® was used during PM placing. Before surgery, all patients underwent peripheral venous blood sampling to determine a series of parameters of the patient’s hemostasis system: levels of fibrinogen, P-selectin, soluble fibrin-monomer complexes, D-dimer, type 1 plasminogen activator inhibitor, activity of blood coagulation factors II (FII), V (FV), VII, VIII, IX, X (FX), XI (FXI), XII, von Willebrand factor, plasminogen, antithrombin III, protein C, additionally determining the parameters of total blood count: the level of platelets, thrombocrit, platelet distribution width, mean platelet volume. The postoperative wound was examined daily, with an ultrasound examination of the soft tissues of the PM pocket area performed on POD 3-5. After 1 month, the patients visited the research center for the final examination of the postoperative wound and testing of PM parameters.

Results and discussion. The follow-up period was completed by 91 patients (44 of the experimental group and 47 of the control group). In the experimental group, 9 (20.5%) patients were found to have soft tissue hematomas, whereas in the control group, 25 (53.2%) patients developed soft tissue hematomas and 6 (12.8%) PM pocket hematomas, with the differences being statistically significant (p=0.001 and p=0.027). Patients with hemorrhagic complications had lower activity of factors FII (p=0.007), FV (p=0.035), FX (p=0.012), FXI (p=0.048). According to multivariate analysis, the factors reducing hemorrhagic complications after PM implantation on the background of anticoagulant therapy turned out to be the use of apixaban as an anticoagulant drug (OR 0.25, 95% CI 0.07–0.889, р=0.032) and the use of incomplete silver salt of polyacrylic acid (OR 0.191, 95% CI 0.072–0.504, р=0.001). The chances of developing hemorrhagic complications increased against the background of reduced FXI activity (OR 0.975, 95% CI 0.951–0.999, р=0.044).

Conclusion. The use of incomplete polyacrylic acid silver salt proved to be an effective and safe method of preventing hematomas after PM placing in patients on anticoagulant therapy. It was found that patients with hemorrhagic complications initially had lower FII, FV, FX and FXI activity compared to other patients. In addition, the results of multivariate analysis proved that low FXI activity increased the chances of developing hemorrhagic complications.

Funding. The study was financed from the extra-budgetary funds of the Federal State Budgetary Educational Facility of Higher Education “Ryazan State Medical University” of the RF Ministry of Public Health. The hemostatic agent incomplete silver salt of polyacrylic acid (Hemoblock^®) was provided by the Autonomous Nonprofit Organization “Moscow Regional Blood Research Institute” free of charge.

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

Authors’ contribution. Study conception and design – Kalinin R.E., Suchkov I.A., Zhurina O.N.; data collection and handling – Povarov V.O., Mzhavanadze N.D.; statistical processing – Povarov V.O., Mzhavanadze N.D.; draft manuscript preparation – Povarov V.O.; manuscript revision – Mzhavanadze N.D., Suchkov I.A.

For citation: Povarov V.O., Kalinin R.E., Mzhavanadze N.D., Zhurina O.N, Suchkov I.A. Prevention of hemorrhagic complications after operations performed on the background of anticoagulant therapy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 30–9. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-30-39

Background. The incidence of venous thromboembolic complications (VTEC) in the wounded remains high and reaches 28%. Therefore, the problems pertaining to their prevention are currently important for modern healthcare.

Objective. The aim of our investigation was to study the incidence and methods of preventing VTEC in victims with combat gunshot injury inflicted during a special military operation.

Patients and methods. We analyzed the results of treating a total of 98 wounded patients recently admitted to the Chief Military Clinical Hospital of the Russian National Guard Troops with a combat gunshot injury inflicted while performing service and combat missions.

All victims were men, average age 32.4±4.3 years. The mean severity of injuries on the ISS scale was 8.8±1.3 points, on the national Military Field Surgery (Gunshot Wound) scale MFS (GW) – 2.2±0.3 points.

Depending on the severity of injuries sustained, the wounded were divided into 2 groups. Group I included 55 (56.1%) patients with ISS ≤6, and Group II comprised 43 (43.9%) patients with ISS >6.

For Group I patients, anticoagulant drugs were prescribed in prophylactic dosages only in the presence of extensive soft tissue injuries in the projection of blood vessels, injuries to the major veins with no risk of bleeding, as well as when bed rest was prescribed. Elastic bandages and intermittent pneumatic compression (IPC) were prescribed according to indications.

All Group II wounded patients were prescribed anticoagulant therapy in prophylactic dosages, with mechanical methods used to accelerate venous blood flow: elastic bandages, IPC, electrical myostimulation (including cases with external fixation devices applied). Surgical prevention of VTE consisted in placing a removable vena cava filter in the infrarenal portion of the inferior vena cava, followed by its removal after resolution of embolic thrombosis.

Results. The average length of hospital stay in Group I was 26.7±2.1 bed days and in Group II 45.7±3.2 bed days (p<0.001).

A statistically significant relationship was revealed between the severity of the injury and the incidence of deep vein thrombosis (DVT) – a significant increase in the number of DVTs in Group II compared with Group I (χ²=10.2; p<0.002). It was found that with ISS >6, the risk of developing VTEC in Group II patients was 4.5-fold higher (95% CI: 1.6–12.6; p=0.003) than in Group I patients with the severity of injuries according to ISS ≤6; DVT of the lower extremities developed in 77.8% of cases with ISS >6.

Floating thrombi were detected in 4 (4.1%) and pulmonary embolism in 3 (7%) patients of Group II. Six (14%) Group II wounded patients developed VTEC during a course of standard pharmacoprophylaxis.

Conclusion. The incidence of VTEC in wounded people in modern armed conflict is 18.4%. Of these, VTEC develops in 7.3% of victims with ISS ≤ 6 and in 32.6% – with ISS >6. For wounded patients with ISS ≤6, VTEC prophylaxis is indicated in case of extensive damage to the soft tissues of the extremities in the projection of the vessels, in case of injury to the main veins of the extremities and the prescription of bed rest.

It is advisable to classify wounded patients with ISS >6 and a score of 11 or greater on the Caprini scale into a group of very high risk of developing VTEC. The basis for the prevention of VTEC in this group is the noctidial use of IPC or electrical myostimulation, with the prescription of conventional anticoagulant therapy in the absence of hemorrhagic complications.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Nikolaev K.N., Ivchenko D.R., Zubritsky V.F.; data collection and handling – Chevychelov S.V., Nikolaeva G.K., Arefieva T.A., Kukushkina E.A., Zherebtsov A.I., Anishchenko V.V., Fedosov M.V.; statistical processing – Nikolaev K.N., Akimov A.V.; draft manuscript preparation – Nikolaev K.N., Golubov E.A., Kovalev A.S.; manuscript revision – Zubritsky V.F., Ivchenko D.R., Akimov A.V., Vardanyan A.V.

For citation: Nikolaev K.N., Chevychelov S.V., Ivchenko D.R., Akimov A.V., Golubov E.A., Anishchenko V.V., Kovalev A.S., Nikolaeva G.K., Arefieva T.A., Kukushkina E.A., Zherebtsov A.I., Fedosov M.V., Zubritsky V.F., Vardanyan A.V. Venous thromboembolic complications in the wounded with combat gunshot injury in contemporary armed conflict. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 40–8. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-40-48

Displacement of a temporary shunt during operations on the carotid arteries to various parts of the aorta and arteries of the lower extremities is an extremely rare complication, with only two reports encountered in the available literature.

We herein describe a case of successful endovascular retrieval of a temporary intraluminal Flexcel™ shunt (LeMaitre Vascular, Inc.) having spontaneously migrated to the left common iliac artery during a left-sided carotid endarterectomy in a 69-year-old woman. CT with intravenous contrast enhancement of the abdominal cavity and lesser pelvis was used for topical localization of the migrated temporary shunt. The main tools for percutaneous endovascular removal of foreign bodies from the vascular bed were special nitinol loop snares.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Kondrashin S.A.; data collection and handling – Koblikov V.V., Kuzmenkov D.V.; draft manuscript preparation – Kondrashin S.A., Koblikov V.V.; manuscript revision – Kondrashin S.A., Koblikov V.V., Kuzmenkov D.V.

For citation: Kondrashin S.A., Koblikov V.V., Kuzmenkov D.V. Percutaneous endovascular removal of temporary intraluminal shunt migrated during carotid endarterectomy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 49–53. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-49-53

Displacement of a temporary shunt during operations on the carotid arteries to various parts of the aorta and arteries of the lower extremities is an extremely rare complication, with only two reports encountered in the available literature.

We herein describe a case of successful endovascular retrieval of a temporary intraluminal Flexcel™ shunt (LeMaitre Vascular, Inc.) having spontaneously migrated to the left common iliac artery during a left-sided carotid endarterectomy in a 69-year-old woman. CT with intravenous contrast enhancement of the abdominal cavity and lesser pelvis was used for topical localization of the migrated temporary shunt. The main tools for percutaneous endovascular removal of foreign bodies from the vascular bed were special nitinol loop snares.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Kondrashin S.A.; data collection and handling – Koblikov V.V., Kuzmenkov D.V.; draft manuscript preparation – Kondrashin S.A., Koblikov V.V.; manuscript revision – Kondrashin S.A., Koblikov V.V., Kuzmenkov D.V.

For citation: Kondrashin S.A., Koblikov V.V., Kuzmenkov D.V. Percutaneous endovascular removal of temporary intraluminal shunt migrated during carotid endarterectomy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 49–53. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-49-53

Stenoses of the thoracoabdominal aorta and its branches in nonspecific aortoarteritis are observed with a frequency of 19.4–39.2%. Such changes have previously been often described as “atypical aortic coarctation”, “middle aortic syndrome”. According to the literature, only a small number of authors have experience with surgical interventions in the progression of the process in the visceral and renal arteries after aortic reconstructions.

We herein present a clinical case report regarding sequential surgical treatment for nonspecific aortoarteritis: almost 38-year outcome after thoracoabdominal aortic repair, 14-year outcome after inferior mesenteric-left renal bypass, and 7-year outcome after right common iliac-superior mesenteric bypass.

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 – Kulbak V.A., Polyansky D.V., Timina I.E.; draft manuscript preparation – Beloyartsev D.F., Kulbak V.A., Polyansky D.V.; manuscript revision – Beloyartsev D.F.

For citation: Beloyartsev D.F., Kulbak V.A., Polyansky D.V., Timina I.E. Long-term outcome of thoracoabdominal aortic repair for nonspecific aortoarteritis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 59–65. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-59-65

We herein report a clinical case concerning successful staged (laparoscopic and endovascular) treatment of an elderly patient with tandem celiac trunk stenosis due to extravasal compression (Dunbar syndrome) and atherosclerotic lesion.

A 65-year-old male patient was admitted to the Angiosurgical Department in July 2019 with complaints of episodes of loss of consciousness occurring after meals, lasting up to a minute and followed by a spontaneous complete recovery.

On examination (ultrasound duplex scanning of the iliac trunk, MSCT angiography of the thoracic and abdominal aorta), he was diagnosed as having a hemodynamically significant stenosis (up to 80%) of the ostial segment of the celiac trunk caused by compression of the median arcuate ligament of the diaphragm, as well as an atherosclerotic lesion of the ostium of the celiac trunk (up to 70%). A decision was made to perform two-stage surgical treatment – laparoscopic decompression of the celiac trunk by dissection of the arcuate ligament, followed by delayed stenting of the celiac trunk in the area of the atherosclerotic lesion, with a positive clinical effect obtained in the form of complete relief of symptoms.

Four years later, the patient’s control examination revealed asymptomatic in-stent restenosis (up to 60%) managed by endovascular angioplasty with a drug-coated balloon catheter.

In the presented clinical case, staged minimally invasive treatment (laparoscopic and endovascular) made it possible to avoid traumatic surgical procedures (laparotomy, direct dissection of the arcuate ligament of the diaphragm, and direct endarterectomy of the celiac trunk with patch plasty), hence decreasing the risks of intra- and postoperative complications and contributing to the reduction of rehabilitation time and rapid return of the patient to his usual way of life.

Funding. This work was financed within the framework of the RF Government Decree No. 220 and Agreement dated 30.06.2022 No. 075-15-2022-1110 on state support of scientific research carried out under the supervision of leading scientists.

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

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

For citation: Moiseev M.K., Gamzatov T.Kh., Lodygin A.V., Svetlikov A.V., Ratnikov V.A., Gurevich V.S., Kashchenko V.A., Kebryakov A.V. Staged surgical treatment (laparoscopic and endovascular) of a patient with extravasal compression and atherosclerotic stenosis of the celiac trunk. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 66–73. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-66-73

Background. Carotid endarterectomy (CEA) is a proven effective method of preventing stroke. However, in significant propagation of the plaque to the distal portion of the internal carotid artery (ICA), prosthetic repair of the latter may be an operation of choice. Currently, there is a small number of published studies concerning long-term results of prosthetic repair of the ICA with an autovein or synthetic graft.

Patients and methods. We conducted a retrospective single-center study enrolling a total of 165 patients divided into two groups. Group I included 61 patients undergoing prosthetic repair of the ICA and Group consisted of 104 patients subjected to eversion carotid endarterectomy. The indications for prosthetic repair were plaques spreading to the distal portion of the ICA and a thrombogenic surface after endarterectomy more than 4 cm in length.

Results. The median follow-up period for both groups was 51.46 months (range, 1–65 months). The average time of carotid artery clamping was significantly longer in the ICA-replacement group than in the CEA group, amounting to 20.59±4.78 minutes and 12.27±3.45 minutes, respectively (p<0.00001). In the early postoperative period, one patient in Group I experienced an ipsilateral stroke. Wound hematoma was observed in two (3.28%) Group I patients and in one (0.96%) Group II patient (p=0.282). Myocardial infarction occurred in two (3.28%) Group I patients and in one Group II patient. Stroke developed in 3 (4.01%) Group I patients and in one (0.96%) Group II patient (p=0.110). One patient developed thrombosis of the prosthesis in the early postoperative period. Two Group I patients experienced cranial nerve neuropathy. The total number of postoperative complications was higher in Group I than in Group II, encountered in 9 (14.51%) and 2 (1.92%) cases, respectively (p=0.0014). Within the 30-day postoperative period, no events of stroke or myocardial infarction were registered in either group.

In the remote period, the results of treatment were assessed in 60 Group I patients and in 104 Group II patients. Long-term survival turned out to be significantly higher in the CEA Group (p=0.007). Long-term freedom from stroke also differed between the two groups and was better in the group of carotid endarterectomy (p=0.032). In 1 patient, after 36 months, restenosis of the proximal anastomosis with the common carotid artery was revealed, requiring carotid artery stenting. Of 18 Group I patients who had experienced stroke, only 6 developed prosthetic thrombosis in the remote period.

Conclusion. In patients with significant carotid stenosis, it is advisable to perform prosthetic repair of the internal carotid artery only in cases when performing eversion carotid endarterectomy is technically impossible.

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., Mukhamadeev I.S., Vronsky A.S.; 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., Vronsky A.S. Comparative study of prosthetic repair of the internal carotid artery and eversion carotid endarterectomy: long-term outcomes. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 75–81. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-75-81

Background. Complications developing on the part of a vascular access appear to be one of the main challenges in treatment of patients undergoing programmed hemodialysis. In such patients, every effort should always be made to keep at a maximum the duration of the functioning access. Ultrasound navigation while performing endovascular correction of vascular access complications possesses a series of advantages over the conventional X-ray imaging.

Objective. The purpose of this study was to examine the advantages of ultrasound navigation during endovascular angioplasty of arteriovenous fistulas created for programmed hemodialysis.

Patients and methods. We carried out a retrospective analysis of treating 27 patients undergoing renal replacement therapy and admitted to the Nizhnevartovsk Regional Clinical Hospital with dysfunction of the permanent vascular access. Between October 2021 and February 2023, in order to correct the arteriovenous fistula they were subjected to endovascular operations using ultrasound navigation. The 27 patients endured a total of 33 procedures of endovascular correction of the access under ultrasound navigation.

Results. The technical success rate was 95.8%. There were no events of vascular access dysfunction during a 17-month follow-up period. Freedom from reinterventions at 3, 6 and 12 months amounted to 92.6, 82.3 and 79.3%, respectively.

Conclusion. The method of ultrasound-based navigation when performing endovascular operations of correcting early and late failure of arteriovenous fistulas in patients on programmed hemodialysis demonstrated high efficacy and safety.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Kornilov D.Yu., Maksimov A.V.; data collection and handling – Kornilov D.Yu., Maksimov A.V., Abduzhalil G.; statistical processing – Kornilov D.Yu., Maksimov A.V.; draft manuscript preparation – Kornilov D.Yu., Maksimov A.V.; manuscript revision – Maksimov A.V., Satinov A.V.

For citation: Kornilov D.Yu., Satinov A.V., Abduzhalil G., Maksimov A.V. Endovascular angioplasty of native arteriovenous fistulas using ultrasound navigation. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 82–7. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-82-87

Background. Unsatisfactory results of open operations after endoprosthetic repair of abdominal aortic aneurysms are mainly due to technical difficulties of the intervention and associated with a longer time of aortic cross-clamping and a higher frequency of visceral complications.

Objective. The purpose of this study was to investigate the causes of performing late open operations and their results after endoprosthetic repair of abdominal aortic aneurysms.

Patients and methods. We retrospectively analyzed remote outcomes in a total of 82 patients after endoprosthetic repair of abdominal aortic aneurysms, carried out from 2012 to 2022 at the National Medical Research Center of High Medical Technologies – Central Military Clinical Hospital named after A.A. Vishnevsky. Long-term complications developed in 33 (40.2%) patients. Endoleaks turned out to be the most frequent complications encountered in 26 (31.7%) cases. Sixteen (19.5%) patients required repeat surgical interventions. Open surgical conversion was carried out in five (6.1%) patients.

Results. During late conversions performed emergently for a ruptured aneurysm, two patients died. There were no lethal outcomes in elective interventions. The indications for late conversion in all cases were endoleaks with an increased size or rupture of the aneurysm. Described in the article is a clinical case report regarding successful treatment of a patient with type II endoleak combined with endoprosthesis branch thrombosis and clinical manifestations of critical ischemia of the left lower limb. During open surgery, instead of an aortic cross-clamp we used an occluding aortic balloon placed above the proximal edge of the stent graft.

Conclusion. An indication for open surgery in the remote period after EVAR is most often an endoleak associated with an increased-size aneurysm and impossibility to perform endovascular correction.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Yamenskov V.V., Obraztsov A.V., Pinchuk O.V.; data collection and handling – Abrosimov A.A., Yamenskov V.V.; statistical processing – Abrosimov A.A., Ivanov A.V.; draft manuscript preparation – Abrosimov A.A., Yamenskov V.V.; manuscript revision – Pinchuk O.V., Obraztsov A.V.

For citation: Abrosimov A.A., Yamenskov V.V., Obraztsov A.V., Pinchuk O.V., Ivanov A.V. Late surgical conversions after endoprosthetic repair of abdominal aortic aneurysms. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 88–94. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-88-94

Background. Currently, there are no exact recommendations on the possibility of performing endovascular repair of an abdominal aortic aneurysm if the requirements for the anatomy of its proximal neck go beyond the recommended criteria.

Objective. The aim of our study was to evaluate the immediate and mid-term results of endovascular repair of an abdominal aneurysm with hostile anatomy of its proximal neck.

Patients and methods. We retrospectively analyzed therapeutic outcomes in 88 patients who underwent endovascular abdominal aortic aneurysm repair with a hostile proximal landing zone. The stent grafts implanted into the patients were as follows: Seal, Zenith Alpha, ELLA, Ovation Prime, Anaconda, Endurant. The outcome measures comprised the incidence of clinically significant complications, reoperations, and mortality within 2 years after surgery.

Results. The study included a total of 88 patients, of whom there were 75 (85%) men and 13 (15%) women. A conical neck of the aneurysm was present in 12 (14) patients. Parietal thrombotic masses in the zone of proximal fixation were moderately pronounced (<50% of the circumference) in 33 (38%) cases and significantly pronounced (50% and more of the circumference) in eight (9%) cases. Moderate angulation from 60° to 75° was observed in ten (11%) patients, with pronounced neck angulation of 75° and more encountered in six (7%) patients. Calcification of more than 50% of the cervical circumference was observed in 66 (75%) patients. An aneurysm neck length of less than 10 mm was observed in four (5%) cases.

The technical success of the operation was achieved in 98.86% of cases. One (1%) patient developed thrombosis of the endograft limb in the early postoperative period. The 2-year primary patency of the stent-grafts was 82.95%. The total number of endoleaks during the in-hospital and mid-term postoperative periods did not differ significantly, amounting to 20 (22.72%) and 24 (27.27%), respectively (p=0.60). The presence of parietal thrombotic masses in the area of the proximal neck increased the risk of thrombosis of the stent-graft limbs in the postoperative period [RR 5.03 (1.28; 19.81), p=0.02]. Angulation of the proximal aneurysm neck elevated the risk of endoleaks [RR 1.55 (1.06; 5.30), p=0.04].

Conclusion. Endovascular abdominal aortic aneurysm repair in hostile anatomy of the proximal landing zone is a safe and effective method of treatment, with a technical success rate of 98.86%. It was found that angulation in the area of the proximal aneurysmal neck contributed to the development of endoleaks in the mid-term follow-up period, with thrombotic masses in the region of the proximal neck of the aneurysm being predictive factors for thrombosis of the stent-graft limbs.

Funding. This study was financially supported by the Russian Science Foundation grant 21-15-00091.

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

Authors’ contribution. Study conception and design – Karpenko A.A., Rabtsun A.A., Osipova O.S., Ignatenko P.V.; data collection and handling – Rabtsun A.A., Efimova–Syakina K.A., Osipova O.S., Cheban A.V., Gostev A.A., Saaya Sh.B.; statistical processing – Rabtsun A.A., Gostev A.A., Osipova O.S., Saaya Sh.B.; draft manuscript preparation – Osipova O.S., Rabtsun A.A., Efimova-Syakina K.A.; manuscript revision – Karpenko A.A., Osipova O.S., Ignatenko P.V.

Acknowledgments. The authors express their sincere thanks to Aivazov Sakhib Allaz ogly, a resident physician of the “Novosibirsk State Medical University” of the RF Ministry of Public Health, for help in data collection.

For citation: Osipova O.S., Rabtsun A.A., Efimova–Syakina K.A., Cheban A.V., Gostev A.A., Saaya Sh.B., Ignatenko P.V., Karpenko A.A. Early and mid-term results of endovascular abdominal aortic aneurysm repair with hostile proximal neck anatomy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 102–7. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-102-107

Background. Acute limb ischemia often leads to disability and death of patients with vascular trauma, which is especially important in difficult conditions of limited resources, with the necessity of long-distance transportation of patients, with the absence of vascular surgeons. “Non-operative” methods of extracorporeal perfusion of the limb, such as passive arterio-arterial shunting (PassS) and active veno-arterial shunting (ActS), using the extracorporeal membrane oxygenation technology potentially can reduce the number of complications and poor outcomes in such patients.

Objective. This study aimed to investigate the effectiveness of modern methods of temporary extracorporeal restoration of limb perfusion in an animal experiment.

Material and methods. 22 sheep weighing 36.6 (34.0–44.0) kg were enrolled into the study. Acute arterial obstruction was modeled by endovascular balloon occlusion of the distal aorta for 30 minutes. After that, the animals were randomized into 3 groups: the control group (CG, n=7), the PassS group (n=8), and the ActS group (n=7). During the next 6 hours, the CG animals were monitored without intervention; The PassS group animals underwent extracorporeal shunting from the carotid to the femoral artery sheaths by means of a connecting line; the ActS group animals underwent extracorporeal shunting from the inferior vena cava via a centrifuge pump and an oxygenator to the femoral artery (flow rate 0.5–0.7 l/min). All animals received identical anticoagulant therapy. The total experimental time was 24 hours.

Results. During aortic occlusion, the blood flow rate in the extremity arteries decreased to zero. Passive shunting led to a significant increase of the blood flow rate to 15.5 (8.2–19.5) cm/s (p=0.036 compared to the CG), and active shunting led to an increase to 26.5 (12.5–62.5) cm/s (p=0.014 compared to the CG). During ActS, the values of tissue oximetry increased significantly (above 40%), and non-significantly – in the PassS group (at the level of 40%). During blood shunting in the ActS group, a progressive decrease of blood pressure was noted due to venous “stealing”, thus requiring vasopressor support of 1.6 (0.0–8.0) mg (p = 0.016 compared to the PassS). As a result, a significantly higher mortality rate was observed in the ActS group: only 2 out of 7 animals in the ActS group survived, while 4 out of 7 animals in the CG group and 7 out of 8 animals in the PassS group survived by the end of the experiment (p=0.041).

Conclusion. Extracorporeal limb perfusion is an effective tool for temporary restoration of blood flow in the injured limb. At the same time, PassS provides low blood flow without affecting systemic hemodynamics, while ActS provides better perfusion of limb tissues, but at the cost of impaired systemic hemodynamics.

Funding. This work was financially supported by the grant of the Strategic Academic Leadership Program “Priority-2030”.

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

Authors’ contribution. Study conception and design – Reva V.A., Ershov E.N.; data collection and handling – Potemkin V.D., Baranov M.I., Tatarintsev S.А.; statistical processing – Reva V.A., Potemkin V.D.; draft manuscript preparation – Reva V.A., Ershov E.N., Tatarintsev S.А., Potemkin V.D., Baranov M.I.; manuscript revision – Reva V.A., Seleznev A.B.

Acknowledgments. We express our sincere gratitude to the staff of the Multidisciplinary Scientific and Educational Center “DuoCor” for the highly professional assistance during the research.

For citation: Reva V.A., Potemkin V.D., Baranov M.I., Ershov E.N., Tatarintsev S.А., Seleznev A.B. Temporary extracorporeal perfusion – an alternative technique for maintaining limb viability in case of arterial injury (an experimental study). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 108–19. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-108-119

Background. One of the causes of anastomotic bleeding during prosthetic repair of the thoracic aorta is aortic wall cut-through by monofilament threads due to insufficient mechanical strength of the vascular wall. The tightness of the anastomosis depends on such components as blood coagulation system state, presence of aseptic inflammation of the vascular wall, surgical technique and properties of the materials used to form anastomoses (felt, pericardium).

Objective. The aim of this study was to estimate the deformation and strength properties of materials used for reconstruction of the thoracic aorta, investigating such parameters as the peak stress, peak strain, and initial elastic modulus, as well as evaluating alterations appearing under load on various types of anastomoses with the normal and dilated aorta.

Material and methods. The mechanical properties of the materials were examined in the uniaxial stress-strain testing mode on the Instron 1122 tensile testing machine. To study the properties of the aorta, two groups were formed: group 1 including anastomoses with normal aorta (n=38) and group 2 comprising anastomoses with dilated aorta (n=30). The comparison between the groups was made according to the following parameters: peak stress (σ_max), peak strain (ε_max), and initial elastic modulus (E_init). The same parameters were obtained and analyzed for the group of the human pericardium (n=30) and medical felt (n=10).

Results and discussion. It was shown that the peak stress (σ_max) of the normal aorta both in the longitudinal and transverse direction exceeds more than two-fold that of the dilated aorta. At the same time, the patterns of deformation of the normal and altered aorta are similar, which is illustrated by close values of the initial elastic modulus (E_init). The pericardium possesses similar to the aorta strength characteristics and has comparable with the aorta value of the initial elastic modulus. Deformation of medical felt occurs quite differently, for the initial elastic modulus of felt is ten-fold higher than that of biological objects. Such a difference in deformation-strength properties of felt and the aorta may lead to cut-through of the middle layer of the anastomosis (aorta) and intimal dissection.

Assessing the aortic wall strength in experiments for cut-through by monofilament threads demonstrated that disruption of integrity of reinforced three-layer anastomoses is due to intimal dissection (under loads not leading to cut-through of the rest layers of the anastomosis). Being a homogenous in structure serous membrane, the pericardium is more resistant to cut-through than the aorta. Unlike the pericardium, aortic layers have different histological structure and hence different resistance to cut-through.

Conclusion. When forming sandwich-type (tree-layer) anastomoses of the thoracic aorta with the use of felt and monofilament threads, the integrity of the aortic wall is disrupted due to intimal dissection under loads not leading to cut-through of the rest anastomotic layers.

The pericardium possesses similar to the aorta deformity-strength properties and more likely will contribute to optimal distribution of loads on the anastomosis line compared with medical felt.

A decrease in strength properties of the dilated aorta in the area of anastomosis is not critical and the aorta may therefore continue fulfilling its function after reinforcement of its wall with auxiliary materials (pericardium, felt).

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Khubulava G.G., Marchenko S.P., Darvish D.M.; data collection and surgical processing of specimens – Bobylkov V.A.; conducting experiments – Bobylkov V.A., Vasilyeva V.V., Polyakov L.G., Fink M.A.; harvesting of cadaveric material – Avagyan K.L.; statistical processing – Bunenkov N.S.; draft manuscript preparation – Bobylkov V.A.; manuscript revision – Darvish D.M., Bobylkov V.A.

For citation: Bobylkov V.A., Darvish D.M., Marchenko S.P., Avagyan K.L., Bunenkov N.S., Vasilyeva V.V., Polyakov L.G., Fink M.A., Khubulava G.G. Mechanical properties of materials used to reinforce aortic anastomoses in thoracic aortic surgery. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 120–9. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-120-129

One of innovative trends in modern medicine is robot-assisted technologies that allow performing the most complex surgical interventions with high accuracy and efficiency. The active use of such technologies in vascular surgery can be characterized as a new stage of minimally invasive interventions, the world experience of which is not yet sufficiently vast.

This literature review analyzes the data on surgical interventions, anastomoses formation methods, length of hospital stay, and the number of complications occurring during the use of robotic surgical systems in vascular surgery.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Vinogradov R.A., Zakeryaev A.B.; data collection and handling – Khangereev G.A., Ignatenko D.A.; draft manuscript preparation – Bakhishev T.V., Butaev S.R.; manuscript revision – Baryshev A.G., Porkhanov V.A.

For citation: Bakhishev T.V., Vinogradov R.A., Zakeryaev A.B., Khangereev G.A., Butaev S.R., Ignatenko D.A., Baryshev A.G., Porkhanov V.A. Application of robotics in vascular surgery (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 130–6. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-130-136

This systematic review analyzes modern aspects of surgical treatment of patients with acute thrombosis of lower-limb deep veins and the inferior vena cava, characterizing operative interventions for surgical prevention of pulmonary embolism and deep vein desobstruction, describing current indications for their use and the outcomes thus obtained. Separately highlighted are peculiarities of operations in the involvement of the caval segment into the pathological process.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Khubulava G.G., Gavrilov E.K.; data collection and handling – Gavrilov E.K., Varavin N.A., Zokhrabov F.I.; statistical processing – Gavrilov E.K., Varavin N.A., Zokhrabov F.I.; draft manuscript preparation – Gavrilov E.K.; manuscript revision – Khubulava G.G.

For citation: Gavrilov E.K., Varavin N.A., Zokhrabov F.I., Khubulava G.G. Modern aspects of surgical treatment of patients with acute thrombosis of lower-limb deep veins and inferior vena cava (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 137–49. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-137-149

Leiomyosarcoma of the inferior vena cava is a rare malignant tumor arising from smooth muscle cells. This article is a review of the world literature on the pathology concerned, outlining the historical background, as well as touching upon the etiology, classification, diagnosis, modern methods of treatment, and long-term results. The greatest attention in the article is paid to surgical aspects of treatment for leiomyosarcoma, depending on the affected segment of the inferior vena cava, i. e., the lower one located below the level of the confluence of the renal veins, the middle one including the ostia of the renal and hepatic veins, or the upper portion being the suprahepatic segment.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Gurmikov B.N., Trifonov S.A., Kovalenko Yu.A.; data collection and handling – Trifonov S.A., Kalinin D.V.; statistical processing – Trifonov S.A.; draft manuscript preparation – Gurmikov B.N., Trifonov S.A., Kovalenko Yu.A.; manuscript revision – Sapelkin S.V., Karmazanovsky G.G., Stepanova Yu.A., Chzhao A.V.

For citation: Gurmikov B.N., Sapelkin S.V., Trifonov S.A., Kovalenko Yu.A., Karmazanovsky G.G., Stepanova Yu.A., Chzhao A.V., Kalinin D.V. Leiomyosarcoma of the inferior vena cava (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 150–60. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-150-160