JOURNAL «ANGIOLOGY AND VASCULAR SURGERY»

The article describes the main milestones (persons, dates, events, facts) of the origin and development of vascular surgery in Russia and the USSR from the beginning of the 18^th century. It is shown that N.L. Bidloo was the first to describe in 1710 methods of surgical treatment of diseases of arteries and veins. Clinical vascular surgery in Russia began in the 1810s in St. Petersburg within the academic surgical clinic of the Imperial Medical-Surgical Academy, where the first operations for arterial aneurysm were performed (I.F. Bush and his students), the first dissertation on vascular surgery was defended (V.V. Pelikan), the origin of angiology were laid (I.F. Bush) and the first school of vascular surgeons was created (I.F. Bush). Major investment to the development of vascular surgery and angiology in the mid-19^th century contributed by N.I. Pirogov. At the turn of the 19–20^th centuries operations for lateral and circular vessel suture were developed by A.A. Yasinovsky, I.F. Sabaneev, A.I. Morozova, etc., who laid the foundations of modern vascular surgery. In the first half of the twentieth century the development of reconstructive vascular surgery was influenced by the works of N.A. Bogoraz, during the Great Patriotic War the dissertations of A.I. Arutyunov and B.V. Petrovsky were defended, in the post-war years vascular surgery developed in parallel with the development of heart surgery. Great influence on its development in 1972–1973 provided orders from the USSR Ministry of Health (B.V. Petrovsky) and the RSFSR Ministry of Health (V.V. Trofimov) on the creation of republican and interregional cardiac surgery centers in the country. During these years, large scientific and practical schools in the field of vascular surgery began to form by B.V. Petrovsky, A.A. Vishnevsky, N.I. Krakovsky, A.N. Bakulev, V.S. Savelyev, A.V. Pokrovsky, P.A. Kupriyanov, A.N. Filatov and others. In parallel with traditional open vascular surgery, X-ray endovascular surgery began to develop. All this laid the foundation for the institutionalization of vascular surgery in Russia.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Revishvili A.Sh., Glyantsev S.P.; data collection and handling – Glyantsev S.P., Chupin A.V., Schelkunov N.B.; draft manuscript preparation – Glyantsev S.P., Schelkunov N.B.; manuscript revision – Revishvili A.Sh., Chupin A.V.

For citation: Glyantsev S.P., Revishvili A.Sh., Chupin A.V., Schelkunov N.B. Vascular surgery in Russia. Personalities, dates, events, facts, scientific and practical schools. 1710–1980s. Angiology and Vascular Surgery. Journal named Academician A.V. Pokrovsky. 2024; 30 (2): 7–21. DOI: DOI: https://doi.org/10.33029/1027-6661-2024-30-2-7-21

Presented herein are the results of a multicenter double-blind placebo-controlled randomized clinical trial of the safety and efficacy of “Unifuzol^®” (arginine sodium succinate, 1.4% solution for infusion) in 40-to-65-year-old patients with obliterating atherosclerosis of lower limb arteries stage II A according to the classification of A.V. Pokrovsky.

Objective. This study was undertaken to investigate the efficacy and safety of Unifuzol® at a daily dose of 500 ml during 1 course of 10 days and during 2 courses of 10 days each with an interval of 14 days between them.

Patients and methods. The study included a total of 460 patients randomized in a 1:1:1:1 ratio into each treatment group. The primary efficacy parameters were as follows: absolute (in meters) and relative (in %) gain in the pain-free walking distance and maximal walking distance in the treadmill test compared with the baseline measures (the mean value of 2 treadmill tests performed at the screening visit).

Results and discussion. After the 10-day course of therapy, the comparative between-group analysis demonstrated the most pronounced difference for the maximal walking distance measure, which averaged 25 meters (95% CI, p=0.036) 30 days after completion of therapy.

The 20-day therapy cohort showed a difference in the pain-free walking distance, amounting to 23 meters immediately after completion of the 2nd course of therapy and 29 meters 30 days after completion of therapy (p=0.039 and p=0.01, respectively).

Analyzing the significance of intergroup differences for each efficacy variable, the change in the pain-free walking distance was 10 (4%) meters immediately upon completion of the course and 17.8 (8.3%) meters 30 days after completion of therapy, and the change in the maximum walking distance was 13 meters and 22 meters in absolute terms and 4% and 7.6% in relative terms, respectively.

Conclusion. The obtained findings confirmed efficacy of infusion therapy with Unifuzol® in patients with stage II A obliterating atherosclerosis of lower limb arteries in course administration during both 10 and 20 days (10 and 20 infusions, respectively).

Funding. The study was sponsored by the LLC “NTFF POLISAN”, Russia.

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

Authors’ contribution. Study conception and design – Kovalenko A.L.; data collection and handling – Lukyanchikov V.V.; statistical processing – Savina L.V.; draft manuscript preparation – Savina L.V.; manuscript revision – Petrov A.Yu.

For citation: Savina L.V., Kovalenko A.L., Petrov A.Yu., Lukyanchikov V.V. Clinical study of Unifuzol^® in patients with intermittent claudication. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 22–32. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-22-32

Objective. The purpose of this study was to determine the frequency and severity of orthostatic responses of central and peripheral blood pressure (BP) during the active stand test (AST) in patients with arterial hypertension (HTN) and hemodynamically significant stenosis of the internal carotid artery (ICA).

Patients and methods. The study group included patients aged 18 years and older with HTN and ≥ 60% ICA stenosis (NASCET criteria). It consisted of 77 patients (mean age 68±6 years, 44 men). The control group comprised 77 ambulatory patients (mean age 68±6 years, 43 men) with hypertension but with no lesion of the internal carotid artery. The patients of both groups underwent the active stand test, i. e., measuring peripheral blood pressure in the sitting position and 3 minutes after standing up. Orthostatic hypotension was defined as a systolic blood pressure (SBP) drop of 20 mm Hg or more and/or a diastolic blood pressure (DBP) drop of 10 mm Hg and more upon standing. Besides, the study group patients were additionally subjected to assessing central blood pressure during the AST and pulse wave contour analysis.

Results. Overall, orthostatic hypotension was diagnosed in 21 (27%) patients of the study group and in 17 (22%) patients of the control group (p=0.46), with systolic orthostatic hypotension more frequently observed in the study group patients (21 vs 9 cases, p=0.015). A decrease in central systolic blood pressure was more pronounced than that of peripheral SBP (p_pSBP-cSBP <0.001). Changes in peripheral systolic blood pressure during the AST were found to be associated with the presence of a significant ICA lesion (β_ICA+= 0.201, p=0.03) and the baseline level of SBP (β=-0.348, p=0.001). The same variables (the fact of ICA stenosis and baseline SBP) mostly explained the development of systolic orthostatic hypotension (OR_ICA+ = 2.95 (95% CI [1.1 – 7.7], p=0.03 and β=0.437, p<0.001, respectively).

Conclusions. Asymptomatic OH occurred in 27% of patients with arterial hypertension and ICA stenosis, more frequently in the form of isolated systolic OH. In orthostasis, the range of change in central blood pressure significantly exceeded the range of change in peripheral blood pressure. The presence of an ICA lesion in patients with arterial hypertension is a factor exerting significant influence on changes in systolic blood pressure in orthostasis and the occurrence of OH.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Gurevich A.P., Emelyanov I.V., Ionov M.V., Konradi A.O.; data collection and handling – Gurevich A.P., Ionov M.V., Boyarinova M.A., Moguchaia E.V., Kolesova E.P.; statistical processing – Gurevich A.P., Ionov M.V.; draft manuscript preparation – Gurevich A.P., Ionov M.V.; manuscript revision – Rotar O.P., Chernyavskiy M.A.

For citation: Gurevich A.P., Emelyanov I.V., Ionov M.V., Rotar O.P., Boyarinova M.A., Moguchaia E.V., Kolesova E.P., Chernyavskiy M.A., Konradi A.O. Orthostatic responses of peripheral and central blood pressure in patients with hypertension and atherosclerotic carotid stenosis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 33–41. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-33-41

We evaluated multiple (use of both internal thoracic arteries) and single (use of one internal thoracic artery and the great saphenous vein) autoarterial bypass grafting in patients with an isolated lesion of the basin of the left coronary artery. In order to compare patients, we performed propensity score matching by the parameters having differences. Thus, the study consisted of two groups of patients: Group 1 (n=521) subjected to total myocardial revascularization using both internal thoracic arteries and Group 2 (n=521) undergoing shunting using one internal thoracic artery and the great saphenous vein. For differential diagnosis of relapse of angina pectoris in the remote period, coronary bypass angiography was performed in 169 patients. Occlusion of arterial shunts during a follow-up period of up to 13 years was revealed in 35 (14.3%) patients and that of venous shunts in 27 (30%) patients (log-rank = 0.043). With the help of a telephone survey or the data of repeat visits to the polyclinic, we assessed survival of patients after coronary bypass surgery. In the remote period, 56 (11%) Group 1 patients and 72 (14%) Group 2 patients died of cardiovascular pathology (log-rank = 0.045). Over the 13-year follow-up, acute cerebral circulation disorders were diagnosed in 31 (6%) and 35 (7%) cases in Group 1 and Group 2, respectively (log-rank = 0.456). The obtained findings suggest that multiple autoarterial bypass grafting ensures better results of coronary revascularization in the remote period of follow-up.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Bazylev V.V.; data collection and handling – Nachkebiya B.R.; statistical processing – Voevodin A.B.; draft manuscript preparation – Mikulyak A.I.; manuscript revision – Tungusov D.S.

For citation: Bazylev V.V., Tungusov D.S., Nachkebiya B.R., Mikulyak A.I., Voevodin A.B. Remote results of various strategies of coronary bypass surgery (a retrospective pseudorandomized study). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 43–8. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-43-48

Currently, a patient with significant stenosis of the carotid bifurcation can be offered both open and endovascular reconstruction. Potential complications after an open operation on carotid arteries include myocardial infarction, ischemic or hemorrhagic stroke of the brain, transient disorders of cerebral circulation, postoperative hematomas with compression of cranial nerves or respiratory organs. One of the starting points in the development of these complications is a significant increase in arterial pressure in the early postoperative period. One of the techniques of performing an open operation aimed at preventing postoperative hypertension is sinus-sparing eversion carotid endarterectomy. A peculiarity of this procedure consists in changing the geometry of arteriotomy followed by cutting off the internal carotid artery. Thus, the sinocarotid zone remains intact.

The use of such a modification makes it possible to achieve more manageable parameters of arterial hemodynamics, thereby preventing the development of persistent postoperative arterial hypertension and, accordingly, the complications described above.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Fokin A.A., Treiger G.A.; data collection and handling – Fokin A.A., Treiger G.A.; statistical processing – Treiger G.A.; draft manuscript preparation – Treiger G.A.; manuscript revision – Fokin A.A., Treiger G.A.

For citation: Fokin A.A., Treiger G.A. Arguments in favor of practical application of sinus-sparing modification of eversion carotid endarterectomy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 49–55. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-49-55

Objective. This study was aimed at comparing the results of superficial femoral artery recanalization using a drug-coated stent with and without fasciotomy of the adductor canal during 2 years of follow-up.

Patients and methods. We conducted a randomized clinical trial of 60 (1:1) patients with TASC II type D extensive steno-occlusive lesions of the femoropopliteal segment. All patients underwent recanalization of the occluded femoropopliteal arterial segment with a drug-eluting stent. The difference to compare was that the patients of the study group (ZilverFas) were additionally subjected to fasciotomy of the adductor muscles at the level of the Hunter’s canal, whereas the control group (Zilver-alone) patients did not receive this supplementary procedure. Patency of the reconstruction zone was assessed after 24 months.

Results. Two-year primary patency in the study group was 60% and 33% in the control group (p=0.03). 24-month freedom from revascularization of the inflow and outflow arteries was 96% in the study group and 80% in the control group (log-rank, p=0.04). Primary assisted patency after 24 months was 66.5% in the study group versus 46.7% in the control group (log-rank, p=0.14). Two-year secondary patency was 69% in the study group versus 53.3% in the control group (log-rank, p=0.24). Breakdowns at 24 months decreased twofold (p=0.05).

After 12 months of follow-up, the number of asymptomatic patients in the ZilverFas group was significantly higher than in the control group (37 vs 13%, p=0.03).

Conclusion. Recanalization of the superficial femoral artery using a drug-coated stent in combination with fasciotomy of the adductor canal demonstrated better two-year primary patency and freedom from reoperation compared with recanalization not supplemented by fasciotomy.

Funding. The study was financially supported by a grant from the Russian Science Foundation, project № 23-75-10047 entitled “Development of new approaches to determining optimal technology of revascularization of the superficial femoral artery based on studying its biomechanics by means of ultrasound imaging, computational, experimental fluid dynamics and neural network analysis”.

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

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

Acknowledgements. The stents were provided by the COOK Medical Company free of charge.

For citation: Cheban A.V., Osipova O.S., Khamyt K.A., Lysikov D.A., Ignatenko P.V., Gostev A.A., Saaya Sh.B.-O, Karpenko A.A. Comparing the results of superficial femoral artery recanalization using drug-coated stents with and without adductor canal fasciotomy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 56–63. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-56-63

Background. One of the main problems of hybrid interventions on lower extremity arteries with obliterating atherosclerosis is the decision-making as to the stages of manipulations within one operation.

Objective. This study aimed to improve the results of treating patients with lower limb critical ischemia by means of determining the sequence of stages of hybrid operations for lesions of the aortoiliac segment.

Patients and methods. Our study involved 226 patients who underwent hybrid surgery for critical lower limb ischemia at the Vascular Department of the City Clinical Hospital № 29 from 2018 to 2023. They were divided into 2 groups: Group 1 comprised 152 patients who underwent open intervention on femoral arteries as the first stage of a hybrid operation and Group 2 included 74 patients who underwent stenting of iliac vessels as the first stage. In order to retrospectively substantiate the sequence of stages of the hybrid operations, we used a mathematical model consisting in comparing the calculated total minimal diameter (d) of the lumens of the cross section of the femoral vessels, which would correspond to the clinical picture of critical limb ischemia, with the real one determined by means of CT angiography (d_CT). The obtained data were statistically analyzed using the SPSS Statistics 17.0 software.

Results. In Group 1, the immediate success of arterial reconstruction was noted in 144 (94.7%) patients, with in most cases d>d_CT and d=d_CT, as assessed retrospectively. In Group 2, the success was achieved in 69 (92.6%) patients, with the retrospective analysis showing d<d_CT in most cases. In the late postoperative period, amongst Group 2 patients with the ratio d>d_CT and d=d_CT, more frequently encountered were those with relapse of critical ischemia, a history of a large number of re-operations, and amputations (p<0.0005). Group 1 patients with the ratio d<d_CT were found to have a similar trend (p<0.0001).

Conclusion. The proposed mathematical model for determining the phasing of a hybrid operation on lower-limb arteries is effective in drawing up a plan of surgical intervention. When d>d_CT and d=d_CT, it is more effective to perform the open stage first, and when d<d_CT, the initially endovascular stage of the hybrid operation appears to yield better results.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Gavrilenko A.V.; development of mathematical model – Lisitsky D.A., Vaganov A.G., Nochnoy M.S.; statistical processing – Vaganov A.G., Nochnoy M.S.; draft manuscript preparation – Vaganov A.G., Lisitsky D.A.; manuscript revision – Gavrilenko A.V.

For citation: Vaganov A.G., Nochnoy M.S., Lisitsky D.A., Gavrilenko A.V. Planning of stages of a hybrid operation on iliofemoral arteries in critical lower limb ischemia using mathematical modeling. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 64–71. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-64-71

Background. The frequency of development of true aneurysms of native permanent vascular access according to the literature ranges from 5 to 40% of patients on program hemodialysis. Current clinical guidelines contain neither a clear definition of this notion nor specific treatment algorithms for this pathology.

Objective. The purpose of this study was to determine the prevalence of true degenerative aneurysms of a permanent vascular access (PVA), possible etiologic factors of their occurrence, clinical peculiarities of the course of the disease, and the most significant syndromes in this pathology of PVA.

Patients and methods. The study included a total of 219 patients undergoing program dialysis through a native arteriovenous fistula. The patients’ age ranged from 24 to 83 years (mean 59.1±0.9 years). There were 114 males and 105 females. The mean time on program hemodialysis was 60.7±3.9 (1–360) months. The average duration of the relevant vascular access functioning amounted to 45.3±3.1 months (1–312). An “aneurysm of the permanent vascular access” was defined as the size of the native vascular access exceeding 2.0 cm, i. e., a twofold increase in the median diameter of the arteriovenous fistula (AVF) in the study group (1.0).

Results and discussion. Aneurysms of the native permanent vascular access were detected in 11.8% of patients. No correlation between the frequency of aneurysm development and hereditary pathology was revealed. 54.5% of the patients diagnosed with PVA aneurysms had pathology of outflow tracts, with a peculiarity that catheterization of homolateral central veins was recorded 2.1 times more often in their medical histories. The duration of AVF function without aneurysms was 2.7 times shorter than in the group with aneurysms (36±3.9 vs. 96±9.7 months, p=0.000).

Volumetric blood flow through the AVF (QA AVF, ml/min) was 1.7 times higher in patients with aneurysms, and shunt cardiac fraction (QA to minute cardiac volume ratio – SCF) was 1.8 times higher (p<0.05). Abnormal SCF (greater than 0.3) was present in 80.0% of patients with aneurysms and only in 15.7% of patients without aneurysms (p<0.001). During a 12-month follow-up, these indices had significant negative dynamics, and the rate of change in these indices had a significant positive correlation with the diameter of the AVF. Progression of high-flow syndrome is associated with potential development of chronic heart failure and may be an indication for surgical correction of true degenerative aneurysms of the permanent vascular access.

Conclusion. One of the most significant clinical syndromes accompanying PVA degenerative aneurysms is high AVF flow, potentially leading to heart failure. This pathology progresses over time, and the rate of its development correlates with the diameter of the native AVF.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Maksimov A.V., Feiskhanov A.K., Grigoryan D.V.; data collection and handling – Maksimov A.V., Grigoryan D.V., Akhundova E.N.; statistical processing – Maksimov A.V., Grigoryan D.V.; draft manuscript preparation – Maksimov A.V., Grigoryan D.V.; manuscript revision – Maksimov A.V., Feiskhanov A.K., Poberezhnyi V.Ya.

For citation: Maksimov A.V., Feiskhanov A.K., Grigoryan D.V., Akhundova E.N., Poberezhnyi V.Ya. True degenerative aneurysms of permanent vascular access. Etiology, pathogenesis and clinical characteristics of patients. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 72–9. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-72-79

Background. After the ASTRAL (2009) and CORAL (2014) studies, many questions regarding renal artery stenting remained unanswered. First of all, it concerns defining the groups of patients in whom a good clinical effect of renal revascularization can be anticipated.

Objective. The purpose of this study was to assess the effect of renal artery stenting on the course of stage III–IV chronic ischemic kidney disease in patients with significant renal artery stenosis (>70%).

Patients and methods. Our single-center, retrospective-prospective study enrolled a total of 158 patients with a hemodynamically significant renal artery stenosis and confirmed stage III–IV chronic kidney disease. It was determined that progressing atherosclerotic renal artery stenosis was the main cause of the development of chronic kidney disease, since all other possible causes were ruled out. All patients were treated by a nephrologist but chronic kidney disease was progressing. These 158 patients besides medicamentous therapy were subjected to an operation in the scope of renal artery angioplasty and stenting. The results of treatment were evaluated at discharge from hospital (up to 7 days), 1 month after surgery and then after 1, 3 and 5 years. The endpoints included the change in the stage of the disease, stabilization of the course of chronic kidney disease, and transfer to renal replacement therapy (programmed hemodialysis).

Results. Prior to renal artery stenting, the average glomerular filtration rate in our patients was 47.5±10.4 ml/min/1.73 m², amounting to 61.3±20.2 ml/min/1.73 m², 62.7±20.1 ml/min/1.73 m², and 55.2±19.4 ml/min/1.73 m², at discharge, after 1 year, and after 3 years, respectively. The difference turned out to be statistically significant (p<0.001). “Transformation” of the grades of chronic kidney disease before and after surgery was determined. We managed to improve or stabilize the course of ischemic nephropathy in 91.9% patients within a period of up to 12 months and in 89.7% – more than 1 year of follow-up. We succeeded to avoid switching to renal replacement therapy in 11 patients with the glomerular filtration rate less than 30 ml/min/1.73 m². Prognostically meaningful factors influencing the outcome after renal artery stenting were found to be as follows: diabetes mellitus (HR 0.234; p=0.003), renal arcuate arteries resistive index less than 0.8 (HR 0.274), and an initially pronounced decrease in the glomerular filtration rate (C4 chronic kidney disease) (HR 0.219; p=0.006). A clear correlation was revealed between persistence of the clinical effect and the duration of chronic kidney disease prior to renal revascularization.

Conclusion. The presence of a significant renal artery stenosis in a patient with stage III–IV chronic ischemic kidney disease should be considered as an indication for renal revascularization. Such strategy results in improvement of the renal function for a period of not less than 3 years.

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., Frolova E.V.; data collection and handling – Kamenev E.V.; statistical processing – Kamenev E.V.; draft manuscript preparation – Frolova E.V., Kamenev E.V.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Kamenev E.V., Frolova E.V. Results of renal artery stenting in patients with stage III–IV ischemic nephropathy. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 80–7. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-80-87

Objective. This study was aimed at improving the results of surgical treatment of patients with infected synthetic prostheses in the aortoiliac zone by replacing them with an autovenous graft using in situ technique.

Patients and methods. Analyzed herein are therapeutic outcomes in a total of 78 patients who underwent redo surgery for infection of aortofemoral bifurcation allografts over the period from 2001 to 2023. These patients were initially operated on for atherosclerotic occlusion of the terminal aorta and its branches (Leriche syndrome) or aneurysms of the infrarenal aorta. Prosthetic infection was observed both in the immediate and long-term postoperative periods. After confirmation of the diagnosis and preoperative preparation, all patients were re-operated in the scope of aortofemoral bifurcation autovenous prosthetic repair according to in situ technique. Femoral and internal jugular veins were used as autografts.

Results. In the immediate postoperative period, the following complications were encountered: acute renal failure (ARF), multiple organ system failure (MOSF), and arrosive bleeding. Thrombosis of one of the branches of the autovenous prosthesis developed in two (2.5%) patients, one (1.3%) of whom was subjected to high-level hip amputation. Arrosive bleeding was observed in five (6.4%) cases. Perioperative mortality amounted to 15.3% (12 patients).

The remote results were evaluated in 62 patients during a 1-to-12-year follow-up period. Only one patient developed false aneurysms of distal anastomoses, which were operated on successfully. There was no long-term mortality.

Conclusion. Thus, the method of removing an infected synthetic bifurcation graft in the aortoiliac position with simultaneous autovenous redo prosthetic repair using femoral and internal jugular veins can be considered as a method of choice of surgical treatment in patients with suppuration of bifurcation prostheses.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Khamitov F.F.; data collection and handling – Khamitov F.F., Matochkin E.A., Kuzubova E.A.; draft manuscript preparation – Khamitov F.F., Gergedava G.K., Gadzhimuradov R.U.; manuscript revision – Khamitov F.F., Gadzhimuradov R.U., Bobylev A.A., Shimanko A.I.

For citation: Khamitov F.F., Matochkin E.A., Gadzhimuradov R.U., Shimanko A.I., Bobylev A.A., Kuzubova E.A., Gergedava G.K. Surgical policy and peculiarities of management of patients with infection of an aortofemoral bifurcation synthetic prosthesis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 97–105. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-97-105

Editor’s comment

The Editorial Council draws the reader’ attention to the fact that this work is a continuation of a multi-year study of surgical treatment of patients with suppuration of a synthetic bifurcation prosthesis in the aortoiliac position, analyzing the results of operations performed using the same technique.

Objective. This study was aimed at improving the results of surgical treatment of patients with infected synthetic prostheses in the aortoiliac zone by replacing them with an autovenous graft using in situ technique.

Patients and methods. Analyzed herein are therapeutic outcomes in a total of 78 patients who underwent redo surgery for infection of aortofemoral bifurcation allografts over the period from 2001 to 2023. These patients were initially operated on for atherosclerotic occlusion of the terminal aorta and its branches (Leriche syndrome) or aneurysms of the infrarenal aorta. Prosthetic infection was observed both in the immediate and long-term postoperative periods. After confirmation of the diagnosis and preoperative preparation, all patients were re-operated in the scope of aortofemoral bifurcation autovenous prosthetic repair according to in situ technique. Femoral and internal jugular veins were used as autografts.

Results. In the immediate postoperative period, the following complications were encountered: acute renal failure (ARF), multiple organ system failure (MOSF), and arrosive bleeding. Thrombosis of one of the branches of the autovenous prosthesis developed in two (2.5%) patients, one (1.3%) of whom was subjected to high-level hip amputation. Arrosive bleeding was observed in five (6.4%) cases. Perioperative mortality amounted to 15.3% (12 patients).

The remote results were evaluated in 62 patients during a 1-to-12-year follow-up period. Only one patient developed false aneurysms of distal anastomoses, which were operated on successfully. There was no long-term mortality.

Conclusion. Thus, the method of removing an infected synthetic bifurcation graft in the aortoiliac position with simultaneous autovenous redo prosthetic repair using femoral and internal jugular veins can be considered as a method of choice of surgical treatment in patients with suppuration of bifurcation prostheses.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Khamitov F.F.; data collection and handling – Khamitov F.F., Matochkin E.A., Kuzubova E.A.; draft manuscript preparation – Khamitov F.F., Gergedava G.K., Gadzhimuradov R.U.; manuscript revision – Khamitov F.F., Gadzhimuradov R.U., Bobylev A.A., Shimanko A.I.

For citation: Khamitov F.F., Matochkin E.A., Gadzhimuradov R.U., Shimanko A.I., Bobylev A.A., Kuzubova E.A., Gergedava G.K. Surgical policy and peculiarities of management of patients with infection of an aortofemoral bifurcation synthetic prosthesis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 97–105. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-97-105

Editor’s comment

The Editorial Council draws the reader’ attention to the fact that this work is a continuation of a multi-year study of surgical treatment of patients with suppuration of a synthetic bifurcation prosthesis in the aortoiliac position, analyzing the results of operations performed using the same technique.

According to the national guidelines for the diagnosis and treatment of diseases of the lower extremity arteries of 2019, extended occlusion of the aorto-submandibular segment on both sides is an indication for aorto-femoral bifurcation bypass surgery. The current level of development of vascular surgery and endovascular methods of surgical treatment allows the use of a minimally invasive hybrid approach in the treatment of such a group of patients.

This clinical case describes a minimally invasive hybrid approach in the treatment of a patient with extended occlusion of the aorto-iliac segments on both sides, with hemodynamically significant damage to the common femoral arteries and the formation of critical ischemia of the left lower limb.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Syromyatnikov D.D., Papoyan S.A., Shchegolev A.A.; data collection and handling – Syromyatnikov D.D., Papoyan S.A.; statistical processing – Papoyan S.A.; draft manuscript preparation – Syromyatnikov D.D.; manuscript revision – Shchegolev A.A., Markarov A.E., Abramov I.S.

For citation: Syromyatnikov D.D., Markarov A.E., Shchegolev A.A., Papoyan S.A., Abramov I.S. Hybrid intervention in occlusion of the terminal aorta. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2). 106–11. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-106-111

Even with the current pace of development of medicine, and cardiovascular surgery in particular, we regularly encounter untypical clinical situations when therapeutic decision-making poses a significant challenge.

Presented herein is a clinical case concerning surgical treatment of a patient with an infrarenal aortic aneurysm and left pelvic kidney.

The difficulty of the situation is that ischemia due to cross-clamping of the aorta may damage the kidney, with further transition to renal insufficiency. We proposed a modified methodology of the procedure, during which for the purpose of nephroprotection, the first stage consisted in prosthetic repair of the renal artery, to be only thereafter followed by aortic cross-clamping.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Marchenko A.V., Belov V.A.; data collection and handling – Myalyuk P.A., Kadyraliev B.K.; statistical processing – Porodikov A.A.; draft manuscript preparation – Samoshina F.B.; manuscript revision – Myalyuk P.A., Samoshina F.B.

Approaches to myocardial revascularization in patients with acute ST-segment elevation myocardial infarction remain controversial, both from the point of view of disaggregant therapy and from endovascular approaches to restoring the lumen of the affected vessels.

We herein present the result of treating a 64-year-old male patient admitted to the Regional Vascular Center of the Aleksandrovskaya Hospital with a preliminary diagnosis of “Acute coronary syndrome with ST segment elevation. Acute heart failure class IV according to Killip”.

The findings of angiography revealed acute occlusions of the proximal segments of the right coronary artery and the anterior interventricular branch of the left coronary artery. Given a combination of prognostically unfavorable factors, a decision was made intraoperatively on preventive administration of eptifi batide, followed by manual thromboaspiration and implantation of stents without predilation, which, in our opinion, had a beneficial effect on the further course of the disease. This clinical case demonstrates the importance of risk stratification and an individual approach to myocardial revascularization in patients with the pathology concerned.

In addition, this clinical example underlines an important role of preventive administration of IIb/IIIa glycoprotein receptor blockers and thrombus aspiration in relation to the development of reperfusion complications and the no-refl ow phenomenon in a patient with an extremely high risk of their occurrence.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Shishkevich A.N., Bessonov E.Yu.; data collection and handling – Bessonov E.Yu., Bogomolov A.N., Dyuzhilov A.V., Kachesov E.Yu.; draft manuscript preparation – Bessonov E.Yu., Bogomolov A.N., Mikhailov S.S., Fedorov A.S.

For citation: Bessonov E.Yu., Bogomolov A.N., Dyuzhilov A.V., Shishkevich A.N., Kachesov E.Yu., Mikhailov S.S., Fedorov A.S. Prevention of the no-reflow phenomenon in emergency coronary artery stenting in a patient with ST-segment elevation myocardial infarction (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 117–23. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-117-123

A secondary aortoduodenal fistula is a rare, difficult-to-diagnose and often fatal complication in aortic surgery.

We herein describe a clinical case concerning surgical treatment of a male patient presenting with an aortoduodenal fistula manifesting as relapsing gastrointestinal bleeding 7 years after abdominal aortic aneurysm repair. Comparing the findings of a comprehensive examination (endoscopic and roentgenological) with the clinical picture and anamnestic data made it possible to avoid mistakes at the diagnostic stage, as well as to choose an appropriate method of surgical treatment, i. e., performing repeat prosthetic repair of the aorta via a thoracoabdominal approach using a synthetic graft (silver-impregnated) with duodenal resection.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Ananyev D.P., Kalinin A.A.; data collection and handling – Salnikov P.S., Osminskaya E.D., Kutyrev O.E., Kruchkova O.V., Yadykov O.A.; statistical processing – Kutyrev O.E., Osminskaya E.D.; draft manuscript preparation – Ananyev D.P., Kalinin A.A., Osminskaya E.D.; manuscript revision – Kalinin A.A., Ananyev D.P., Matveev D.A., Kutyrev O.E.

For citation: Ananyev D.P., Kalinin A.A., Matveev D.A., Yadykov O.A., Kutyrev O.E., Kruchkova O.V., Salnikov P.S., Osminskaya E.D. Secondary aortoduodenal fistula. Repeat aortic prosthetic repair with duodenal resection (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 124–30. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-124-130

In early 2024, the updated ESVS guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries were published.

A total of 160 recommendations were presented on the following topics: service standards, including surgical volume and training; epidemiology, diagnosis and screening; management of patients with small abdominal aortic aneurysms (AAA), including surveillance, cardiovascular risk reduction, and indications for treatment; elective AAA repair, including surgical risk assessment, open and endovascular surgery, as well as early complications; ruptured and symptomatic AAA, including perioperative management, such as permissive hypotension and use of aortic balloon occlusion, open and endovascular repair, as well as early complications; long-term results and follow-up after AAA surgery, including graft infection, endoleaks and subsequent procedures; management of complex AAA, including open and endovascular repair; treatment of iliac artery aneurysm, including indications for surgery; miscellaneous aortic problems, including mycotic, inflammatory and saccular aortic aneurysms. In addition, shared decision making is addressed, with supporting information for patients, and unresolved issues are discussed.

Conclusion. The ESVS Clinical Practice Guidelines provide the most comprehensive, up-to-date, and unbiased advice to clinicians and patients on the management of AAA and iliac aneurysms.

This article is an attempt to compare approaches to the treatment of patients with AAA under modern conditions in the Russian Federation to the concept proposed by the ESVS, with the aim of accelerating the development of domestic stent grafts.

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

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

Authors’ contribution. Study conception and design – Svetlikov A.V.; data collection and handling – Svetlikov A.V., Galkin P.A., Gurevich V.S., Yablonsky P.P.; statistical processing – Svetlikov A.V., Ratnikov V.A.; draft manuscript preparation – Svetlikov A.V., Gurevich V.S., Yablonsky P.P.; manuscript revision – Ratnikov V.A., Gurevich V.S.

For citation: Svetlikov A.V., Galkin P.A., Yablonsky P.P., Gurevich V.S., Ratnikov V.A. Review of the European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms: what is new and prospects for development. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 131–6. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-131-136

Presented herein is a clinical case concerning successful treatment of varicose veins of the lower extremities in a patient with moderate severe hemophilia A. The patient underwent endovenous laser ablation of the great saphenous vein. According to the recommendation of a hematologist, correction of hemophilia was performed by means of infusion of blood coagulation factor VIII. Delayed sclerotherapy of the dilated tributaries was managed. Good results were achieved with neither intra- nor postoperative complications. The duration of follow-up and ultrasonographic assessment amounted to 1 year.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Borsuk D.A., Fokin A.A.; data collection and handling – Zabelinskaya D.A.; draft manuscript preparation – Borsuk D.A., Zabelinskaya D.A.; manuscript revision – Fokin A.A.

For citation: Borsuk D.A., Zabelinskaya D.A., Fokin A.A. Minimally invasive treatment of varicose veins of lower extremities in a patient with hemophilia A (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 137–42. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-137-142

Objective – to conduct a retrospective analysis of the frequency and structure of combat gunshot vascular injury in wounded people admitted to an advanced level 3 medical organization in the context of a modern armed conflict.

Material and methods. The medical histories of the wounded with combat gunshot vascular trauma who were admitted to a separate medical battalion deployed at the Central District Hospital of the Ministry of Health of the Russian Federation for 45 days (March–April 2023) were analyzed. In addition, the medical histories of the same wounded from the subsequent stage of medical evacuation were analyzed. All the wounded were men, whose average age was 30.7±4.8 years. The time elapsed from the moment of receiving a combat gunshot vascular injury to the moment of admission to the stage of providing specialized medical care averaged 2.20±1.24 hours. Statistical processing was carried out using Graphpad prism software.

Results and discussion. Combat gunshot vascular injuries were identified in 21 (7%) of 300 consecutively admitted wounded patients. In 15 (71%) of them, vascular injuries were combined, and in 6 (28%) – isolated. The most common injuries were to the vessels of the lower extremities – 9 (43%) victims. It is also necessary to note the diversity of clinical forms and types of combat gunshot vascular injury in different vascular areas. The most severe complications and deaths occurred in those wounded for whom 3 or more hours passed from the moment of injury to admission to the stage of specialized medical care. All wounded with combat gunshot vascular trauma underwent reconstructive vascular operations, which amounted to 17.4% of the total number of operations performed on 300 wounded. All operations were performed no more than 6 hours from the moment of injury. In the postoperative period, the following complications developed: hemorrhagic shock of III and IV degrees [3 (14%) and 1 (5%) wounded, respectively], acute respiratory failure [2 (9%) wounded], acute kidney injury [2 (9%) wounded], disseminated intravascular coagulation syndrome [2 (9%) wounded]. There were 2 (9%) deaths. At the next stage of evacuation, 3 (15%) wounded from this group underwent secondary amputation of the lower limb at the level of the middle third of the thigh.

Conclusion. Considering the high percentage of combat vascular trauma in the overall structure of injuries in a modern large-scale armed conflict, the strengthening of medical teams with narrow specialists (vascular surgeons) at the stage of an advanced medical organization of level 3 leads to a significant reduction in the number of limb amputations and mortality.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Gavrilov E.K.; data collection and handling – Ramazanov A.Y., Lyabah D.D.; statistical processing – Khasanov A.R.; draft manuscript preparation – Ramazanov A.Y.; manuscript revision – Gavrilov E.K., Goncharov A.V.

For citation: Gavrilov E.K., Ramazanov A.Y., Goncharov A.V., Lyabah D.D., Khasanov A.R. Frequency and structure of combat gunshot vascular injury in an advanced third-medical organization in a modern armed conflict. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 143–50. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-143-150