JOURNAL «ANGIOLOGY AND VASCULAR SURGERY»

Background. The relevance of this study is determined by the significance and relatively low awareness of N.S. Korotkov’s priorities described in his dissertation “Experience in determining the strength of arterial collaterals”, the content analysis of which from the point of view of angiology and cardiovascular surgery has not yet been conducted.

Objective. To confirm the priority of Russian surgeon and scientist N.S. Korotkov in the fields of angiology, cardiology and vascular surgery through a content analysis of his doctoral dissertation and to show the historical and medical significance of the results he obtained.

Material and methods. N.S. Korotkov’s dissertation “Experience in determining the strength of arterial collaterals” (1910) and materials from periodicals have been studied using historical-genetic, chronological, comparative, and retrospective methods.

Results. N.S. Korotkov identified a number of priorities based on his clinical observations of the ligation of major arteries in the extremities in cases of traumatic aneurysms of various locations that occurred after combat vascular injuries. It was established that N.S. Korotkov was the first to describe a method for determining the degree of development (“strength”) of arterial collaterals in order to make a preoperative prediction of the success of arterial trunk ligation: a) by the shape of the sphygmogram (pulse wave), b) by the characteristic change in its appearance after external compression of the aneurysm, and c) by the level of blood pressure in the peripheral arteries, determined by reactive hyperemia. It was shown that during the research process, the author discovered sounds that appear and disappear at a certain blood pressure during dynamic compression of the arteries. N.S. Korotkov’s priorities also include the idea of reduced blood circulation, which was developed by V.A. Oppel, as well as the description of methods for preserving the viability of ischemic tissues, among others.

Conclusion. N.S. Korotkov’s comprehensive method allowed him to establish indications for and contraindications to performing arterial ligation surgery in cases of traumatic aneurysms, leaving it only for those patients where the underdeveloped collateral circulation poses a risk of gangrene in the distal parts of the limb. The “sound phenomenon” discovered by the author later became the basis for the sound method of measuring blood pressure in humans. Thus, not only were a number of N.S. Korotkov’s priorities proven, but their significance for modern angiology, cardiology, and cardiovascular surgery was also confirmed.

Background. Thoracic aortic aneurysms are associated with a high risk of fatal complications. In most cases, acute dissections develop when the aortic diameter is less than 5.5 cm. Using only the aortic diameter as the determining criterion for surgical indications is insufficient. In this regard, patients with ascending aortic dilatation (45–49 mm) are of clinical interest.

Objective. To evaluate the prognostic significance of morphometric and biomechanical characteristics of the ascending aorta, as determined by ECG-gated computed tomography (CT) aortography in patients with dilatation of the ascending aorta.

Patients and methods. This prospective, single-center cohort study enrolled a total of 100 patients who were divided into three groups: patients with an ascending aortic aneurysm >50 mm (n=42), patients with ascending aortic dilation 45–49 mm (n=29), and normal subjects with a non-dilated ascending aorta <40 mm (n=29). All patients underwent ECG-gated computed tomography (CT) aortography with the calculation of morphometric and biomechanical parameters. The follow-up period was 36 months. The primary endpoints were defined as an increase in the ascending aortic diameter to ≥50 mm and an increase in the thoracic aortic diameter of >3 mm per year. Binary logistic regression was used to identify independent predictors of reaching the primary endpoint.

Results. A significant impairment of the ascending aortic wall’s deformational properties (decreased circumferential strain and increased stiffness) was observed in the dilation zone compared to the non-dilated aorta. During the 36-month follow-up period, 79.3% of patients reached the primary endpoint. No significant differences in biomechanical parameters were observed when comparing the subgroups of patients with dilation progression and those with stable aortic dimensions. The maximum aortic diameter was found to be the sole independent predictor of disease progression (OR 1.54; 95% CI 1.02–2.35; p=0.042). The optimal prognostic threshold for the diameter in the dilation zone was found to be 47.6 mm (sensitivity – 81.8%, specificity – 77.8%). Patients with a diameter >47.6 mm were 3.98 times more likely to experience rapid disease progression than those with a smaller diameter (log-rank test, p=0.0034).

Conclusion. A CT assessment of the biomechanical properties of the aortic wall confirms the presence of structural remodeling of the ascending aorta and may be considered a marker of aortopathy, alongside its diameter. A threshold diameter of 47.6 mm may be regarded as an important morphometric criterion determining the disease’s transition to the phase of active dilation.

Background. Peripheral artery disease remains one of the leading causes of limb amputation, thus resulting in disability and decreased quality of life. Despite the development of open and interventional technologies, therapeutic outcomes are far from ideal. The greatest difficulties arise in treatment of patients with femoropopliteal arterial lesions, not least because this is the most active segment from the point of view of biomechanics. Therefore, studying biomechanical factors in this anatomical segment seems currently important.

Objective. To systematize the modern data on the role of biomechanical forces in the pathogenesis of occlusive diseases of arteries of the femoropopliteal segment and substantiate the need to take into account biomechanical parameters in therapeutic decision-making.

Material and methods. We analyzed Russian and foreign studies dedicated to biomechanics of the femoropopliteal segment, shear stress, methods of angioplasty and stenting, as well as mathematical modeling, using the data of meta-analyses and randomized studies.

Results. According to the National Health and Nutrition Examination Survey (NHANES), the prevalence of a decreased ankle-brachial index below 0.9 is 4.64% in the general population, amounting to 16.62% in people older than 72 years. While walking, the distal portions of the femoral and popliteal arteries experience axial shortening to 13.9%, twisting to 3.5°/cm, and compression to 12.5%. The shear stress in the femoral artery amounts to 0.3–0.5 Pa, with its oscillating pattern being a powerful pro-atherogenic signal.

Conclusion. Biomechanical forces largely determine the localization of atherosclerotic lesions and risk of restenosis after surgery. Personalized mathematical modeling with due regard for individual anatomy and mechanical properties of arteries is a promising direction of predicting therapeutic outcomes and optimizing the tactics of revascularization for lesions of the femoropopliteal segment.

Background. Aortic arch branching variants represent a critical factor in cardiac surgical planning, influencing vascular access selection and cannulation strategy. Expanding indications for minimally invasive and transcatheter procedures have made precise preoperative arch imaging a prerequisite for procedural safety.

Objective. To evaluate the prevalence and spectrum of aortic arch branching variants on CT angiography in patients undergoing aortic valve surgery, as well as to retrospectively compare clinical and anthropometric parameters, treatment selection, and perioperative complication rates between those with normal and variant arch anatomy.

Patients and methods. Data from 158 patients (59 females, 99 males; median age 54 [38–67] years) who underwent aortic valve surgery between 2020 and 2024 were analyzed. All patients underwent thoracic CT angiography with 3D reconstruction. Branching patterns were classified according to the Natsis system with modifications. Comparative statistical analysis of clinical, anthropometric and anatomical parameters was performed.

Results. Normal aortic arch anatomy was observed in 131 patients (82.9%), while anatomical variants were detected in 27 (17.1%) cases. Of these, type 2b1 (bovine arch) was the predominant anomaly type revealed in 7 (25.9%) cases. Type 3b2 was identified in 5 (18.5%) patients. Types 2b2 (V-shaped), 4b1, and an aberrant right subclavian artery occurred with equal frequency in 4 cases each (14.8%). Types 2b3, 3b7, and right-sided aortic arch were each recorded in 1 (3.7%) case. Patients with arch anomalies were significantly older (median 59 vs 52 years, p=0.028) and had lower anthropometric indices. Branching type did not influence treatment choice (surgical replacement 77.3% vs TAVI 22.7%, p=0.79). Anatomical variants prolonged the procedural duration by 18±6 min and were associated with embolic complications: transient ischemic attacks in 2 (7%) cases, intraoperative stroke in 1 (3.7%) case. In an aberrant right subclavian artery, the distance from the prosthesis landing zone to the vessel orifice was an important anatomical parameter warranting preoperative assessment.

Conclusion. The prevalence of aortic arch branching variants was 17.1%, with type 2b1 predominating. Branching pattern did not determine the choice between surgical replacement and TAVI but was associated with increased technical complexity and embolic complications. In an aberrant right subclavian artery, the distance from the prosthesis landing zone to the vessel orifice is an important anatomical parameter that warrants preoperative assessment. CT angiography with 3D reconstruction is essential for identifying clinically relevant anatomical variants and assessing critical distances.

Background. Endovascular aneurysm repair (EVAR) has firmly established itself as the standard treatment for an infrarenal abdominal aortic aneurysm; however, type II endoleak and the associated aneurysm sac enlargement remain one of the leading causes of reinterventions. In this context, the development of reproducible protocols for preoperative planning of selective embolization of aneurysm sac side branches is of particular interest.

Objective. To assess the technical feasibility and early outcomes of applying a standardized protocol for preoperative mapping and selective embolization of aneurysm sac side branches in patients with infrarenal abdominal aortic aneurysm undergoing endovascular repair.

Patients and methods. The study included 36 patients with an infrarenal abdominal aortic aneurysm who underwent preoperative selective embolization of aneurysm sac side branches between 2023 and 2025. Preoperative planning was based on multidetector CT aortography with quantitative assessment of the number of side branches, skeletal topographic localization of their origins, and predefined selection of endovascular equipment. Follow-up CT aortography was performed at 12 months.

Results. In 10 (27.8%) patients, only the inferior mesenteric artery was embolized, in 12 (33.3%) only lumbar arteries, and in 14 (38.9%) both vascular territories. At 12‑month follow‑up, type II endoleak was detected in 4 (11.1%) patients, whereas clinically significant aneurysm sac enlargement was observed in 2 (5.6%) patients and required repeat embolization.

Conclusions. A standardized protocol for CT-based preoperative mapping of aneurysm sac side branches with subsequent selective embolization of lumbar arteries and the inferior mesenteric artery is technically feasible and reproducible in patients with an infrarenal abdominal aortic aneurysm. This approach is associated with an acceptable rate of type II endoleaks and a low incidence of clinically significant aneurysm sac enlargement and may be considered a promising component of type II endoleak prevention strategies

Background. Minimally invasive coronary artery bypass grafting (MIDCAB/MICS-CABG) techniques have gained wide acceptance in modern medicine. The number of robotic-assisted operations increases annually, with more and more surgeons mastering minimally invasive techniques.

Objective. To analyze the outcomes and evaluate the technical advantages of robotic-assisted coronary artery bypass grafting (RACAB) technique compared to minimally invasive techniques (MIDCAB/MICS-CABG).

Patients and methods. In the Department of Minimally Invasive and Robotic Cardiovascular Surgery Cardiovascular Surgery at University Clinical Hospital № 1, 80 coronary artery bypass grafting procedures utilizing minimally invasive techniques were performed: 40 patients underwent MIDCAB/MICS-CABG, and 40 patients underwent robotic-assisted surgery. The two groups were comparable in terms of baseline demographic and preoperative clinical characteristics. A comprehensive assessment of intraoperative parameters, early postoperative outcomes, and patient status during the first 30 days after surgery was conducted.

Results. All surgical procedures were completed by a single surgical team using the da Vinci Si robotic system. In both groups, there were no cases of hospital mortality, conversion to sternotomy, acute cerebrovascular accidents, acute renal failure, or clinically significant postoperative bleeding. The robotic-assisted coronary artery bypass group demonstrated statistically significantly lower intraoperative and postoperative (POD day 1) blood loss (p<0.05). Pain intensity in the early postoperative period was also significantly lower in the RACAB group (p<0.001). The length of hospital stay was significantly shorter in the RACAB group, amounting to 10 [9, 14] days compared to 14 [13, 21] days in the MIDCAB/MICS-CABG group (p<0.001). However, the duration of surgery was statistically significantly longer for robotic-assisted coronary artery bypass – 299±70 minutes versus 256±69 minutes for MIDCAB/MICS-CABG (p=0.007).

Conclusion. Robotic-assisted cardiac surgery not only is non-inferior to standard minimally invasive approaches but also demonstrates superior outcomes across several key parameters.

Background. Ocular ischemia is regarded as a clinical marker of an atherosclerotic lesion of brachiocephalic arteries and neurological deficit. The best-known manifestations include amaurosis fugax, occlusion of the central retinal artery and its branches, as well as acute ischemic optic neuropathy. Amaurosis fugax is defined as a form of transient ischemic attack, thus making it possible to consider these patients symptomatic and candidates for surgical treatment.

Objective. To assess the clinical significance of acute ocular ischemia (AOI) as a prognostic factor for ischemic stroke.

Patients and methods. This prospective cohort study included 102 patients with internal carotid artery (ICA) stenosis ≥70% and clinical manifestations of AOI (amaurosis fugax, occlusion of the central retinal artery and its branches, anterior ischemic optic neuropathy). The patients were divided into two groups: surgical treatment (carotid endarterectomy, n=50) and conservative therapy (n=52). Changes in visual function (visual acuity, visual fields, optic nerve function) and neurological outcomes were assessed at 1 month and 1 year of follow-up.

Results. In the surgical group, a statistically significant improvement in visual acuity was observed at 1 month and 1 year (p<0.001), along with a higher rate of improvement in visual fields (44.9% vs 8%) and optic nerve function (46.9% vs 8.0%) compared to conservative therapy (p<0.01). The likelihood of visual function improvement after surgery was significantly higher (OR up to 10.17). Patients after carotid endarterectomy demonstrated regression of neurological symptoms, including complete resolution of amaurosis fugax episodes. In contrast, the conservative treatment group showed progression of cerebrovascular insufficiency with an increased incidence of transient ischemic attacks and ischemic stroke.

Conclusion. Acute ocular ischemia represents a clinical equivalent of cerebrovascular ischemia and is a significant predictor of ischemic stroke. In patients with AOI and hemodynamically significant ICA stenosis, surgical treatment provides significant improvement in visual function and reduces the risk of cerebrovascular complications. These patients should be considered symptomatic and candidates for surgical treatment.

There is currently no answer to the question as to from the point of view of normalization of renal filtrating function it is expedient to perform stenting of renal arteries (RA) at initial stages of chronic kidney disease (CKD) at an estimated glomerular filtration rate (GFR) >60- 80 ml/min/1.73 m² even in significant stenoses (>70%).

Objective. To assess clinical effects after RA stenting in patients with arterial hypertension (AH) and chronic kidney disease 1C and 2C (KDIGO 2013).

Patients and methods. Our retrospective study included a total of 40 patients with hemodynamically significant stenoses of RA, AH and CKD 1C and 2C. RA patency was restored by stenting. Treatment results were assessed at discharge, 1 postoperative month, then at 1, 3 and 5 years. The endpoints – changes in the average blood pressure (BP) and alteration of renal function.

Results. The average systolic BP prior to operation amounted to 196±7.6 mm Hg, at 1 year postoperatively – 142±11.7 mm Hg, at 3 years – 158±17.2 mm Hg. The difference turned out to be statistically significant (p<0.001). The dispersion analysis showed regularities in renal function changes after restoration of RA patency. A statistically significant increase of the GFR was noted during the first postoperative months (prior to operation vs 6 months: p=0.001 (the most significant effect), to be then followed by a gradual decrease, with the preoperative GFR not significantly differing from that at 36 months (p>0.05), meaning that renal function remained stable, but after 3 months returned to the baseline, preoperative level. During the period after 36 months the median GFR (73.0 ml/min/1.73 m²) dropped below the initial preoperative level (78.5 ml/min/1.73 m²) (p<0.05). The multivariable Cox regression analysis demonstrated that a statistically significant risk factor for deterioration of renal function was only the preoperative presence of proteinuria – HR = 4.22 (p=0.009).

Conclusion. In a patient with vasorenal AH and CKD 1C and 2C, a clinical effect in the form of improvement and stabilization of renal function may surely be expected in the period up to 3 years after removal of RA stenosis, with the most unfavorable prognosis as to progressing deterioration of renal function being characteristic of patients with baseline proteinuria.

Background. Balloon angioplasty is the first-line treatment for dialysis access dysfunction caused by central vein lesions. Unfortunately, in some cases, restenosis occurs within 6 months. Identifying predictors of unfavorable outcomes will optimize the intervention technique and improve long-term patency. Creating a prognostic tool for assessing the risk of early recurrence will allow for additional focus on the most vulnerable patient group.

Objective. To determine factors influencing the 6-month primary patency of central veins after isolated balloon angioplasty in hemodialysis patients.

Patients and methods. This retrospective cohort study included a total of 80 patients who underwent central vein balloon angioplasty between 01.07.2020 and 01.07.2024. The inclusion criteria were as follows: symptomatic central vein stenosis/occlusion, mature vascular access, and no prior interventions on the target vein. The primary endpoint was vein patency at 6 months. The patients were divided into two groups based on 6-month patency. Predictors of early restenosis were analyzed. Statistical analysis included univariate and multivariate methods (Firth-penalized logistic regression), ROC analysis, multi-component model validation, and bootstrap validation.

Results. The following key predictors were identified: residual stenosis (OR 0.94; 95% CI 0.88–0.99; p=0.012), balloon oversize (OR 1.08; 95% CI 1.01–1.17; p=0.014), the square of balloon oversize (OR 0.997; 95% CI 0.993–0.999; p=0.002), and white blood cell count (OR 0.76; 95% CI 0.56–0.996; p=0.046). The obtained prognostic model (AUC 0.882; 95% CI 0.809–0.955) demonstrated high discriminative ability and good calibration (p=0.068). Model stability analysis and bootstrap validation were performed. A quadratic dependence of patency on balloon catheter oversize was demonstrated for the first time, indicating the existence of its optimal value. Based on the model, a formula for quantifying the individual probability of 6-month patency is provided.

Conclusion. Residual stenosis is the most significant risk factor: each additional 1% is associated with approximately a 6% decrease in the odds of 6‑month patency. Optimization of the balloon catheter diameter and achieving minimal residual stenosis are key elements for improving the balloon angioplasty technique. Leukocytosis is associated with increased odds of early restenosis, which may reflect the role of systemic inflammation.

Background. Patients with prolonged atherosclerotic occlusion of the femoropopliteal arterial segment, suffering from critical lower limb ischemia are candidates for femorotibial bypass. The primary patency of femorotibial bypasses is 43–55% over three years. Most often, graft thrombosis occurs within the first year.

Objective. To improve the patency of femorotibial bypasses in patients with chronic critical limb ischemia.

Patients and methods. From 2019 to 2022, a total of 45 patients underwent femorotibial bypass. They were divided into 2 groups: the first group included patients who regularly underwent preventive examinations in the postoperative period. When hemodynamically significant stenoses of the inflow, outflow, anastomoses or the graft itself were detected, patients underwent preventive surgical intervention aimed at correcting the pathology. The patients of the second group either did not show up for preventive examinations, or refused the surgical intervention with the revealed pathology of the reconstruction zones. The follow-up period was 2 years.

Results. Technical success after the first operation was achieved in all cases. The primary patency rate within two years in patients of group I was 59%, and in patients of group II – 56% (p=0.38). Primary-assisted patency rate was 80% in patients of group I and it was significantly higher than primary patency in group II (p=0.05). The limb salvage rate was 87% and 72% and was closely correlated with the survival rate amounting to 87% and 76%, respectively in patients of group I and II.

Conclusion. In the postoperative period, patients who have undergone femorotibial bypass need regular preventive examinations with ultrasound duplex scanning of the arteries of the operated limb. Preventive interventions after femorotibial bypass yield good immediate and medium-term results and reduce the frequency of amputations.

Background. The femoropopliteal segment is one of the most frequent targets of an atherosclerotic lesion of lower-limb arteries, which is usually associated with an unfavorable clinical course and increased risk of amputation.

Objective. To assess the mid-term results of directional atherectomy in patients with atherosclerotic lesions of the femoropopliteal segment.

Patients and methods. We analyzed treatment outcomes in 20 patients with chronic lower limb ischemia stage IIb–III according to the A.V. Pokrovsky classification, corresponding to Rutherford categories 2–4, who underwent directional atherectomy between February 1, 2022 and May 30, 2025 for stenoses ≥50% or occlusions of the superficial femoral artery and/or proximal popliteal artery segments (P1–P2). The assessed parameters included technical success, the rate of bailout stenting, perioperative complications, changes in the ankle-brachial index (ABI), pain-free walking distance, as well as primary patency and freedom from clinically driven target lesion revascularization (CD-TLR) at 12 months.

Results. Technical success was achieved in all patients. In 16 patients (80%), the intervention was completed without stent implantation; bailout stenting was required in 4 cases (20%) due to persistent flow-limiting dissection or marked elastic recoil. The ABI increased from 0.62±0.10 to 0.91±0.08 (p<0.01), and pain-free walking distance increased from 142±50 to 312±85 m (p<0.01). Perioperative complications were observed in 4 patients and were minor in nature: distal embolization was registered in 2 cases, and local vascular access-site complications in another 2 patients. No in-hospital mortality occurred. At 12 months, primary patency was 80%, freedom from CD-TLR was 90.0%, limb salvage was 100%, and no major adverse limb events (MALE) were registered.

Conclusion. In this single-center study, duplex ultrasound-assessed primary patency of the target segment at 12 months after endovascular femoropopliteal revascularization using directional atherectomy was maintained in 16 of 20 patients and amounted to 80%. The obtained data confirm the clinical feasibility of this technique as part of a lesion preparation strategy, provided that patient selection is appropriate and lesion morphology is taken into account.

Background. Autologous vein common femoral-popliteal bypass grafting remains the “gold standard” in the treatment of patients with obstructive atherosclerosis of the lower extremity vessels. Deep femoral-popliteal bypass grafting is less popular, but it offers several advantages over traditional interventions.

Objective. To determine the role of autologous vein deep and common femoral-popliteal bypass grafting in the treatment of patients with critical limb ischemia.

Patients and methods. We retrospectively examined the immediate and long-term results of autovenous femoropopliteal bypass grafting in 174 patients presenting with chronic critical limb ischemia and operated on in 2019–2023. Group 1 consisted of patients in whom the deep femoral artery was selected as the inflow artery (n=106), while Group 2 consisted of patients in whom the common femoral artery was selected as the inflow artery (n=68). The study groups were comparable in terms of key demographic and clinical parameters. The follow-up period was 24 months.

Results. In both groups, the distal anastomosis was more often formed with the P1 segment of the popliteal artery – 72 (67.9%) and 38 (55.9%) cases, respectively (p=0.108). Femoropopliteal bypass grafting was supplemented with an endovascular stage in 32 (30.2%) cases in Group 1, and in 29 (42.6%) cases in Group 2 (p=0.093). In Group 2, endovascular correction of the inflow tract was performed significantly more often (21.7% vs 14.7%), and in Group 1 – of the outflow tract (21.7% versus 14.7%) (p=0.004). The average duration of the operations in Groups 1 and 2 was 210 and 230 minutes, respectively (p=0.004). The average postoperative hospital stay was 11 and 13 days in Groups 1 and 2 (p=0.112).

Complications in the early postoperative period occurred in 39 (36.8%) and 30 (44.1%) patients (p=0.346). Amputations at the hip level were performed in 6 (5.7%) and 2 (2.9%) patients (p=0.404). Lethal outcome was recorded in 6 (5.7%) and 5 (7.4%) patients (p=0.618). Cumulative survival for 2 years was 62.4% and 66.1% of observations, respectively. Limb preservation for 24 months was 81.8% in Group 1 and 87.5% in Group 2 (p=0.440). Using the common femoral artery as an inflow artery was associated with a higher freedom from repeat revascularization – 82.9% vs 67.8% (p=0.111).

Conclusion. The advantages of deep femoral-popliteal bypass include the ability to shorten the venous conduit length and bypass scar tissue and major lymphatic vessels. Common femoral-popliteal bypass should be performed when reconstruction of the overlying arterial segment is planned, or when a distal anastomosis below the knee space is required.

Background. Numerous large-scale studies on the etiology and pathogenesis of lower limb varicose vein disease have been conducted, forming the basis for modern preventive and therapeutic approaches. In recent years, there has been a steady shift from traditional open surgical interventions to minimally invasive endovenous and non-thermal techniques, aimed at reducing treatment trauma, decreasing complication rates, and improving aesthetic outcomes. One of these methods is a modified laser coagulation technique for tortuous tributaries, known as skewer obliteration.

Objective. To evaluate the effectiveness of modern surgical methods for treating varicose veins of the lower extremities and the frequency of complications associated with their use.

Materials and methods. A review of domestic and foreign literature published over the past five years was conducted using PubMed, eLibrary and CyberLeninka databases with the query: “modern/innovative methods/treatment of varicose veins of the lower extremities.” A total of 1281 publications were identified at the initial search stage. After excluding duplicates, irrelevant works, and sources with low evidence levels, 51 publications were included in the final analysis. Key assessment criteria included treatment effectiveness, complication rates, severity of postoperative pain, cosmetic outcomes, and recurrence rates.

Results. According to the literature analysis, there is a consistent increase in the use of minimally invasive technologies. Thermal methods such as endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) demonstrate stable occlusion of major veins in 93–98% of cases one year after treatment, with a low incidence of serious complications (0.5–3%). Non-thermal methods (cyanoacrylate and mechanochemical ablation) are associated with less postoperative pain and do not require tumescent anesthesia; however, they may lead to specific hypersensitivity reactions in up to 13% of cases. Techniques for removing tortuous tributary veins (miniphlebectomy, sclerotherapy) remain effective but increase the risk of hematomas (up to 50%) and hyperpigmentation (up to 42%). Current trends in phlebology include laser coagulation of saphenous vein tributaries, specifically the modified skewer-obliteration technique. This technology enables the obliteration of tributaries through a minimal number of skin punctures, thereby reducing tissue trauma and ensuring a superior cosmetic outcome. Given the current lack of comparative studies with alternative treatments and the absence of long-term data required for an objective efficacy assessment, this area of research remains highly promising.

Conclusion. Minimally invasive methods for treating varicose vein disease demonstrate high effectiveness and low complication rates compared with traditional interventions and can be recommended as standard therapeutic approaches. The skewer-obliteration technique represents a promising direction that requires further prospective studies with long-term follow-up.

The article describes different methods of X-ray endovascular treatment of posttraumatic aneurysms of the internal carotid artery after a mine-blast injury.

In order to exclude a pseudoaneurysm from the circulation, one patient was subjected to sequential implantation of two self-expanding double-mesh stents and another patient received a balloon-expandable endoprosthesis.

These clinical cases demonstrate the possibility of using X-ray endovascular methods of treatment of patients with posttraumatic aneurysms of the internal carotid artery, thus making it possible to replace technically complicated open operations.

Arterial aneurysms of the upper extremities account for less than 1% of all peripheral arterial aneurysms. The most common first manifestation is the appearance of a pulsating and expanding mass in the shoulder area.

The article presents a clinical case of successful surgical treatment of a 35-year-old female patient with a brachial artery aneurysm associated with intravascular papillary endothelial hyperplasia (IPEH). Based on duplex ultrasound scanning and multislice computed tomography findings, aneurysm resection with reversed autologous vein grafting was performed. The postoperative period was uneventful. Repeat multislice computed tomography one year after surgery demonstrated the viability of the reconstruction.

Type B aortic dissection in a patient with antiphospholipid syndrome is a complicated clinical situation requiring an individual approach to surgical decision-making. Presented herein is a clinical case report concerning treatment of a patient with antiphospholipid syndrome and chronic type B aortic dissection. A hybrid method of surgical treatment was chosen consisting in carotid-subclavian bypass performed as the first stage and thoracic endovascular aortic repair as the second stage. No perioperative complications were encountered.

This review focuses on the problem of using a primary retrograde distal access during endovascular revascularization in patients with lower limb ischemia. It describes the background for performing endovascular revascularization through the tibiopedal arterial segment with no previous antegrade intervention, indications, some features of the procedure, as well as results and limitations of the technique.

Background. The growing interest in hybrid techniques for the treatment of aortofemoral disease is driven by the need to optimize revascularization outcomes while maintaining procedural safety. Although open surgical reconstruction has demonstrated durable long-term patency, it is associated with substantial surgical trauma and an increased risk of intra- and postoperative complications, particularly in patients with significant comorbidities. Therefore, the development and refinement of hybrid approaches represent a promising strategy to enhance the safety profile of vascular interventions without compromising their effectiveness.

Objective. To review and analyze current literature data evaluating the efficacy and safety of hybrid techniques in aortofemoral surgery, with particular emphasis on their ability to reduce complication rates while maintaining patency outcomes comparable to open and endovascular interventions.

Material and methods. A comprehensive bibliographic search was conducted in international and national databases including PubMed, Scopus, Web of Science, and eLibrary.ru. Systematic reviews, meta-analyses, and original research articles reporting clinical outcomes, safety profiles, and primary and secondary patency rates of vascular reconstructions for steno-occlusive aortofemoral disease at various follow-up intervals were included in the analysis.

Results. In the treatment of extensive aortofemoral lesions, hybrid procedures demonstrate lower intra- and postoperative complication rates compared with open surgery. Primary and secondary patency rates are comparable to those achieved with open reconstruction and superior to isolated endovascular interventions. Additionally, hybrid approaches exhibit a favorable economic profile due to reduced intensive care requirements, shorter rehabilitation periods, and decreased length of hospital stay.

Conclusion. Hybrid technologies constitute a rational clinical and economic compromise in the management of complex aortofemoral disease. They reduce procedural invasiveness, preserve high long-term patency of reconstructed segments, and optimize overall treatment costs, thereby occupying a key position in contemporary revascularization algorithms for the aortofemoral segment.