JOURNAL «ANGIOLOGY AND VASCULAR SURGERY»

The article discusses the main historical events related to the diagnosis and treatment of thoracic aortic aneurysms, tracing the evolution of surgical approaches in patients with this pathology, as well as describing the facts and events that influenced the development of thoracic aortic surgery as an independent branch of cardiovascular surgery.

Objective. The purpose of this study was to compare the incidence of distal embolization during two procedures of restoring blood flow through the superficial femoral artery (SFA): endovascular recanalization and open endarterectomy, both supplemented with paclitaxel-coated balloon angioplasty.

Patients and methods. Our prospective, randomized, single-center pilot study included 20 patients diagnosed as having extensive occlusions of the SFA. Group 1 patients (n=10) underwent SFA recanalization using percutaneous transluminal angioplasty with a drug-coated balloon (PTA + DCB). Group 2 patients (n=10) underwent semiclosed loop endarterectomy (LE) from the SFA followed by drug-coated balloon angioplasty (LE + DCB). Doppler ultrasonography was used to detect emboli during the revascularization procedure.

Results. The patients had no statistically significant differences in age, concomitant pathology, and severity of lower limb ischemia. The majority of patients had Rutherford class 3 chronic limb ischemia. The median number of emboli during the procedure in Group 1 and Group 2 patients amounted to 200.0 [100.0; 200.0] and 7 [6; 8], respectively, p=0.0002. Moreover, in Group 1, peripheral embolism occurred both during recanalization of the target artery (in 100% of cases) and during drug-coated balloon angioplasty (in 60% of cases), whereas in Group 2, peripheral embolism occurred only during drug-coated balloon angioplasty (100% of cases).

Conclusion. Endovascular recanalization of long-segment SFA occlusions followed by DCB angioplasty (PTA + DCB) was associated with a higher incidence of material distal embolism compared with the hybrid technique (LE + DCB).

Relevance. The growth of the aneurysmal sac after endovascular treatment of infrarenal abdominal aortic aneurysms remains a significant problem associated with the risk of late complications. Identifying reliable predictors of this process is essential for improving long-term treatment outcomes.

The aim to evaluate the predictors of aneurysmal sac growth after endovascular treatment of infrarenal abdominal aortic aneurysms.

Material and methods. A retrospective study was conducted on 214 patients who underwent endovascular treatment of infrarenal abdominal aortic aneurysms between 2017 and 2023. Patients were divided into two groups: those with aneurysm regression or stability (n=180) and those with aneurysm growth (n=34). Clinical, demographic, anatomical, and technical predictors of sac growth were assessed.

Results. It was found that the most significant factors influencing aneurysmal sac growth were the initial aneurysm diameter, the volume of its patent lumen, and the patency of the inferior mesenteric artery. Some patients with a stable aneurysm diameter showed an increase in sac volume of more than 10%.

Conclusion. Measuring the volume of the aneurysmal sac allows for the identification of patients at risk of disease progression, even when the aneurysm diameter remains stable. The identified predictors will improve the results of endovascular treatment of infrarenal abdominal aortic aneurysms.

Objective. The aim of the FORAT clinical trial is to evaluate the efficacy and safety of intra-arterial intrathrombus administration of recombinant non-immunogenic staphylokinase in patients with acute limb ischemia vs surgery.

Patients and methods. Non-immunogenic staphylokinase has high thrombolytic activity and fibrin selectivity. The FORAT clinical trial is a randomized, open-label, multicenter, comparative study in two parallel groups. At the clinical sites, eligible patients (with a recruitment target of 170 subjects, taking into account a possible 10% dropout) diagnosed as having grade I-IIb acute limb ischemia will be equally randomized by the “envelope” method into two groups assigned to receive either non-immunogenic staphylokinase or undergo surgical intervention. Surgical methods of treatment are taken to mean the possibility of endovascular intervention, open surgery and/or bypass surgery in accordance with the current National Guidelines, depending on the accepted tactics of patient management in the clinical center and the patient’s condition.

The study protocol presents the inclusion and exclusion criteria, sample size estimation, and the plan of the trial. The primary efficacy endpoint is the number of patients without amputations at day 30. Safety criteria will be defined as cases of hemorrhagic stroke, bleeding according to the BARC criteria (types 3 and 5), the incidence of adverse events and lethal outcomes within 30 days of follow-up.

Results. Based on the results of the study, data will be obtained on the efficacy and safety of intra-arterial thrombolysis administration of non-immunogenic staphylokinase in patients with acute limb versus surgical methods of treatment. A report will be drawn up with attachments of individual data and statistical analysis of the results. The findings of the study will be published and presented at conferences.

Registration. The FORAT trial protocol was approved by the Ministry of Health of Russia No. 184 dated March 18, 2022, the Ethics Council of the Ministry of Health of Russia No. 303 dated March 1, 2022, and registered at clinicaltrials.gov No. NCT05372718 (FORAT).

Presented herein is a clinical case report regarding successful surgical treatment of a patient for stage III stomach cancer and an infrarenal abdominal aortic aneurysm. Such a combination is a sufficiently rare and complicated clinical situation. The treatment was performed by a multidisciplinary team. The chosen policy of a simultaneous operation made it possible to reduce the time to initiating a course of chemotherapy.

The article is devoted to the use of artificial intelligence in medicine. The advantages, disadvantages, and prospects of its application, including in robotic surgery, are outlined. An excursion into the history of the origin and formation of artificial intelligence is also made.