JOURNAL «ANGIOLOGY AND VASCULAR SURGERY»

Despite significant advances in modern treatment of patients with peripheral artery disease, acute limb ischemia remains highly prevalent, limb-threatening, and potentially fatal, continuing to pose a challenge to vascular surgeons. Currently, there are various approaches to managing patients with acute limb ischemia. Selective intra-arterial thrombolysis is an acceptable alternative to surgical treatment. To date, the main indications, advantages and complications of thrombolysis have been identified. Searching for prognostic risk factors for the development of hemorrhagic complications and the likelihood of adverse outcomes after selective intra-arterial thrombolysis can help in choosing a treatment method for patients with this disease. However, despite the introduction of new thrombolytic drugs and improved infusion techniques of selective intra-arterial thrombolysis, the long-term results of vascular patency have not significantly improved and are in fact comparable to those in the urokinase era. Therefore, the prevention of reocclusion by means of additional pharmacological agents is an area that is under development and is being actively studied using numerous approaches, including the use of modern anticoagulant and antiplatelet drugs.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Kalinin R.E., Klimentova E.A., Pshennikov A.S., Egorov A.A., Suchkov I.A.; data collection and handling – Klimentova E.A., Egorov A.A.; draft manuscript preparation – Klimentova E.A.; manuscript revision – Kalinin R.E., Pshennikov A.S., Suchkov I.A

For citation: Kalinin R.E., Klimentova E.A., Pshennikov A.S., Egorov A.A., Suchkov I.A. Selective intra-arterial thrombolysis in acute limb ischemia. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 7–17. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-7-17

The incidence of diabetes mellitus is steadily increasing worldwide. The most frequent and severe complications of diabetes mellitus are micro- and macroangiopathies accompanied by endothelial dysfunction and leading to early disability and premature mortality. The problem of enhancing the efficacy of pharmacological correction of endothelial dysfunction in operated patients with critical lower limb ischemia on the background of diabetes mellitus remains currently important because of unsatisfactory results of standard pathogenetic therapy prescribed to patients in the pre- and postoperative periods. Discussed in this review are the mechanisms of development of endothelial dysfunction in patients with diabetes mellitus and obliterating atherosclerosis of the arteries of the lower extremities, methods for determining and identifying endotheliopathy, as well as possible pharmacological modalities of correcting endothelial dysfunction.

Funding. The review was prepared with the support of the grant No. 21-15-00192 dated 19.04.2021.

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

Authors’ contribution. Study conception and design – Frolov D.V., Dyachkova Yu.A.; data collection and handling – Dyachkova Yu.A., Obukhov A.D.; draft manuscript preparation – Dyachkova Yu.A.; manuscript revision – Tyurenkov I.N., Frolov D.V.

For citation: Tyurenkov I.N., Frolov D.V., Dyachkova Yu.A., Obukhov A.D. Pharmacological correction of endothelial dysfunction in patients with atherosclerotic lesions of peripheral arteries and diabetes mellitus (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 18–25. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-18-25

Objective. The aim of our investigation was to study the state of venous outflow from the lower extremities in patients with pelvic varicose veins (PVV) and the possibilities of compression treatment in correction of impaired evacuation function of the calf muscle pump (CMP).

Patients and methods. Our single-center prospective comparative cohort study included 90 female patients with symptomatic and asymptomatic forms of pelvic varicose veins and 10 women with varicose veins of the lower extremities (VVLE). All patients underwent duplex ultrasound of pelvic veins and lower-limb veins, radionuclide venography of the lower extremities and single-photon emission computed tomography (SPECT) of the pelvic veins with in vivo-labelled red blood cells. Using radionuclide methods, the evacuation function of the CMP was assessed based on determining the average time of isotope transport (T_average) in seconds in the tendinous (T_av.1), muscular (T_av.2) parts of the pump and the popliteal vein (T_av.3). An increase in T_av.1 more than 6–8 s, T_av.2 >10–12 s, T_av.3 >12–16 s indicated CMP dysfunction. A scintigraphic sign of pelvic venous congestion (PVC) was an increase in the coefficient of pelvic venous congestion (C_PVC) >0.5. Patients with CMP dysfunction were prescribed compression treatment (below-knee stockings or stockings of class 1 or 2). Repeat clinical and radionuclide examination with the assessment of the dynamics of symptoms and signs of chronic venous disease (CVD) and performance indicators of the CMP was carried out after ten days of using compression hosiery.

Results. CMP dysfunction was found in 78.7% of patients with symptomatic PVV and in 74.4% of those with asymptomatic PVV, which was characterized by a significant increase in T_average (T_av.1 – 18–30 s, T_av.2 – 27–45 s, T_av.3 – 20–40 s). Similar performance indicators of the CMP were noted in 90% of patients with VVLE, thus suggesting uniformity of impairments of the evacuation function of the CMP in patients with PVV and VVLE, regardless of the presence or absence of symptoms of CVD and the need for correction of these disorders. Class 1 compression below-knee stockings were used in 79.7% of patients with PVV. All patients with PVV and CMP dysfunction were found to have relief of symptoms of CVD and restoration of the evacuation function of the CMP (T_av.1 – 6–14 s, T_av.2 – 9–16 s, T_av.3 – 7–14 s) after compression treatment.

Conclusion. CMP dysfunction occurs in 76.7% of patients with PVV, regardless of the clinical course of the disease and the presence or absence of CVD of the lower extremities. Compression treatment using class 1 below-knee stockings is an effective method for restoring the evacuation function of the CMP in patients with PVV.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Gavrilov S.G.; data collection and handling – Gavrilov S.G., Karalkin A.V., Moskalenko E.P., Grishenkova A.S.; statistical processing – Moskalenko E.P., Grishenkova A.S.; draft manuscript preparation – Gavrilov S.G., Karalkin A.V., Moskalenko E.P., Grishenkova A.S.; manuscript revision – Gavrilov S.G., Karalkin A.V., Moskalenko E.P., Grishenkova A.S.

Acknowledgements. Acknowledgements for providing the compression knitwear used in this study: Venoteks Medical 18–21 mmHg and 23–32 mmHg below-knee stockings and Venoteks Medical 23–32 mmHg stockings (Rehard Technologies GmbH, Germany).

For citation: Gavrilov S.G., Karalkin A.V., Moskalenko E.P., Grishenkova A.S. Compression therapy in correction of impaired venous outflow from lower limbs for pelvic varicose veins. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 26–39 DOI: https://doi.org/10.33029/1027-6661-2024-30-1-26-39

Background. Currently, open operation of aortic prosthetic repair for abdominal aortic aneurysms remains one of the main methods of treatment, making it possible to achieve sustainable. However, the approaches to obligatorily performing separate stages of the perioperative management and separate stages of the operation itself seem far from being standardized.

Objective. The purpose of this study was to work out a specific, obligatory-to-perform technology of open prosthetic repair for an abdominal aortic aneurysm, to be associated with both a minimal rate of intraoperative complications and long-term favorable postoperative outcomes.

Patients and methods. Our single-center retrospective and prospective cohort study included a total of 284 elective patients presenting with an abdominal aortic aneurysm and subjected to open prosthetic repair. Depending on the technology of managing the perioperative period and the technical aspects of surgery, the patients were divided into two groups. Group 1 (retrospective) comprised 89 patients with abdominal aortic aneurysms treated by elective AAA repair according to the generally accepted intrasaccular method known as endoaneurysmorrhaphy. There was no unified strategy of the perioperative management and performing separate stages of the operation in patients of this group. Group 2 (prospective) was composed of 195 patients with abdominal aortic aneurysms, who underwent elective prosthetic repair according to the worked-out technique with aneurysmal sac reduction. The perioperative management and compulsory-to-perform separate stages of the operation were standardized.

Results. Statistically significant differences were obtained for the frequency of cardiac (p<0.001) and respiratory complications (p=0.009), as well as acute renal damage (p=0.007). Also, a statistically significant difference was observed between the two groups in the volume of intraoperative blood loss (p<0.001). The remote results were followed-up for 14 years. The frequency of reoperations amounted to 2.7%, accounting for either stent-branch thrombosis or the development of an aneurysm of the distal graft-femoral anastomosis. No aneurysms of the proximal anastomosis were revealed.

The operation of open repair for abdominal aortic aneurysms remains one of the main methods of treatment. Strictly complying with the clear-cut technology of the intraoperative management and performing the stages of the operation itself made it possible to statistically significantly decrease the volume of intraoperative blood loss, the amount of required transfusion of blood substitutes, postoperative complications, and to increase freedom from reoperation in the remote period.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Vachev A.N.; data collection and handling – Vachev A.N., Chernovalov D.A., Dmitriev O.V., Italiyantsev A.Yu., Kozin I.I., Gryaznova D.A., Kutsenko V.V., Andreeva Yu.V., Akhmedkhanova S.N.; statistical processing – Chernovalov D.A., Kozin I.I.; draft manuscript preparation – Chernovalov D.A., Kozin I.I.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Chernovalov D.A., Dmitriev O.V., Italiyantsev A.Yu., Kozin I.I., Gryaznova D.A., Kutsenko V.V., Andreeva Yu.V., Akhmedkhanova S.N. Open surgery for abdominal aortic aneurysms at the present stage. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 41–52. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-41-52

Background. Splenic artery aneurysm is a disease with a low incidence (0.1–2%), which is rarely diagnosed due to the paucity of clinical manifestations. At the same time, this pathology poses a great danger as a hidden source of internal bleeding in case of spontaneous or traumatic rupture. Giant true aneurysms larger than 5 cm (28%) and pseudoaneurysms of the splenic artery (37%) are more likely to rupture, the cause of which in most patients is pancreatic necrosis. Currently, there are no uniform clinical recommendations illustrating a clear-cut examination plan, indications and all the variety of surgical interventions for such patients, with endovascular technologies being at the research stage.

Objective. The aim of our study was to evaluate the efficacy of endovascular methods of treatment of patients with true and false splenic artery aneurysms.

Patients and methods. The study included a total of 18 patients diagnosed with a splenic artery aneurysm. Of these, true splenic artery aneurysms were diagnosed in 12 (66.7%) patients, and false ones in 6 (33.3%). The average age of the patients was 53±1.7 years, with 8 (44.4%) men and 10 (55.6%) women thereamong. The femoral access was used in nine patients. The following procedures were performed: 10 (55.6%) embolizations of splenic artery aneurysms, 1 (5.6%) stenting of the splenic artery aneurysm, 2 (11.1%) embolizations of the proximal portion of the splenic artery, 1 (5.6%) embolization of the anterior branch of the splenic artery and 4 (22.2%) diagnostic angiographies.

Results. 17 (94.4%) of the 18 patients had no complications in the early postoperative period. A fragmentary spleen infarction was detected in 1 patient after embolization of the proximal portion of the splenic artery according to the findings of computed tomography. The in-hospital mortality rate was 5.6%. The average number of bed-days for true and false splenic artery aneurysms amounted to 3±1 and 10±2, respectively.

Conclusion. Timely endovascular treatment of patients with splenic artery aneurysms is characterized by minimal postoperative complications and length of hospital stay.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Papoyan S.A., Gromov D.G., Mutaev M.M.; data collection and handling – Papoyan S.A., Mutaev M.M., Mishkina P.A.; statistical processing – Gromov D.G., Papoyan S.A., Mishkina P.A.; draft manuscript preparation – Mishkina P.A.; manuscript revision – Papoyan S.A.

For citation: Papoyan S.A., Gromov D.G., Shchegolev A.A., Markarov A.E., Mutaev M.M., Mishkina P.A. Endovascular treatment of patients with splenic artery aneurysm. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 53–61. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-53-61

Background. Choosing a revascularization method for multilevel lesions of the iliofemoral arteries is a difficult task.

Objective. The aim of this study was to compare the efficacy of a one-stage endovascular treatment for multilevel lesions of the iliac and femoropopliteal arteries versus a hybrid procedure (iliac artery stenting and femoropopliteal bypass).

Patients and methods. We conducted a retro-prospective study including patients with femoropopliteal TASC II C, D and ipsilateral iliac artery lesions. Patients in group 1 (MET – multilevel endovascular treatment) received stenting of the iliac and femoropopliteal arteries. Group 2 (Hybrid) patients were subjected to iliac artery stenting and femoropopliteal bypass. Propensity score matching was used to match the comparison groups for baseline characteristics. The data on the outcomes of surgical intervention were collected prospectively through face-to-face or remote contact with the patient.

Results. A total of 212 patients were enrolled into the study. Of these, 14 were excluded. After propensity score matching, 79 patients were assigned to the MET group and 83 patients to the Hybrid group. The two-year follow-up was completed by 62 patients from the MET group and 71 patients from the Hybrid group. The mean length of the stented femoropopliteal artery in the MET group was 185.6±67.2 mm. The mean length of the stented iliac arteries amounted to 71.3±33.5 mm and 75.6±29.3 mm (p=0.07) in the MET and Hybrid groups, respectively. A femoropopliteal bypass was performed with a prosthetic graft in 57 (68.7%) patients and an autologous vein was used in 26 (31.3%) cases. At 1 year, the primary and secondary patency for the MET group and Hybrid group was 69.6% versus 79.5% (p=0.10) and 83.5% versus 89.1% (p=0.20), respectively. The estimated hazard ratio for primary patency for MET versus Hybrid was 0.64 (95% CI 0.34–1.20), with the upper non-inferiority bound set at 1.6 corresponding to a 10% additive noninferiority margin for probabilities. The 2-year primary patency was 35.5% in the MET group and 54.9% in the Hybrid group (p=0.01). The 2-year secondary patency in the groups did not differ (61.3% and 70.4%, p=0.17). Target lesion revascularization accounted for 15.2% and 7.2% (p=0.08) in the MET and Hybrid groups, respectively. The primary sustained clinical improvement was 73.4% and 79.5% (p=0.23) in the MET and Hybrid groups, respectively. Clinical deterioration at 1 year was 12% in the Hybrid group versus 3.8% in the MET group (p=0.04), at 2 years of follow-up 29.5% and 14.5% (p=0.03), respectively. 1-year limb salvage in the MET and Hybrid groups was 100% and 92.8% (p=0.02), respectively. 2-year limb salvage was 96.82% and 84.5% (p=0.01) in the MET and Hybrid groups, respectively. 2-year survival in the MET and Hybrid groups was 100% and 95.7%, respectively.

Conclusion. Hybrid surgery for ilio-femoropopliteal lesions showed better 2-year primary patency than multilevel stenting. However, in the MET group, there was a higher rate of limb salvage and a lower rate of clinical deterioration at 1 and 2 years of follow-up. The rate of clinical improvement was comparable in both groups.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Karpenko A.A., Osipova O.S., Cheban A.V., Ignatenko P.V.; data collection and handling – Osipova O.S., Cheban A.V., Gostev A.A.; statistical processing – Osipova O.S., Gostev A.A.; draft manuscript preparation – Osipova O.S., Cheban A.V.; manuscript revision – Ignatenko P.V., Karpenko A.A.

For citation: Osipova O.S., Cheban A.V., Gostev A.A., Ignatenko P.V., Karpenko A.A. Two-year results of stenting vs hybrid operation for multilevel lesions of iliac and femoropopliteal arteries. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 62–72. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-62-72

Objective. The purpose of this study was to compare clinical results of using an original combined stent construction E-Luminexx + LifeStream and a Hanarostent graft for transjugular intrahepatic portosystemic shunting (TIPS).

Patients and methods. We retrospectively analyzed the results of treating a total of 89 patients after a TIPS procedure using either a combined stent construction E-Luminexx + LifeStream or a Hanarostent graft. The study included 44 men and 45 women, average age 54.4±10.1 years (range 33–71). The patients were divided into two groups: Group I consisted of 50 (56.2%) patients subjected to the TIPS procedure using the stent construction E-Luminexx + LifeStream and Group II comprised 39 (43.8%) patients treated with the Hanarostent graft.

Results. According to Kaplan-Meier analysis, cumulative primary patency in Group I and Group II patients at 1, 6, 24 and 48 months amounted to 93.9%, 91.8%, 81.5% and 73.1 vs 89.7, 81.8, 65,2 and 46.6%, respectively.

Conclusion. A comparative analysis of the short- and long-term results of TIPS created by means of the combined construction E-Luminexx + LifeStream and the Hanarostent revealed good comparable 12-month primary patency (85.3 vs 76.6%).

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh., Monakhov D.V., Zabadaeva O.B.; data collection and handling – Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh., Monakhov D.V., Zabadaeva O.B.; statistical processing – Zabadaeva O.B.; draft manuscript preparation – Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh., Monakhov D.V., Zabadaeva O.B.; manuscript revision – Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh., Monakhov D.V., Zabadaeva O.B.

For citation: Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh., Monakhov D.V., Zabadaeva O.B. Stent-grafts for transjugular intrahepatic portosystemic shunt creation. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 73–9. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-73-79

Objective. This study aimed to analyze and evaluate early postoperative outcomes obtained within 3 months after transjugular intrahepatic portosystemic shunting (TIPS) in patients with acute bleeding from gastroesophageal varices and portal hypertension on the background of hepatocirrhosis.

Patients and methods. From 2019 to 2023 inclusively, TIPS procedures were performed in sixty 33-to78-year-old patients (32 men and 28 women) with cirrhosis of the liver and acute bleeding from varicose veins of the esophagus and stomach.

The grades of cirrhosis severity in our patients according to the Child-Pugh classification were as follows: Child–Pugh A – 11 (18.3%), Child–Pugh B – 26 (43.3%), Child–Pugh C – 23 (38.4%). All endovascular surgical interventions were performed using Artiz Zeego and Philips Azurion 7 angiographs at the City Clinical Hospital № 15 named after O.M. Filatov. Statistical data processing was carried out using Microsoft Excel.

Results. The sixty patients underwent a total of 62 TIPS procedures. During the observation period of 3 months, the following changes were noted: two (3.3%) patients were found to have shunt thrombosis and one (1.7%) patient developed stenosis of the ostium of the right hepatic vein. These complications led to a relapse of portal hypertension. The overwhelming majority of the patients did not experience recurrent bleeding after the procedure. There were no cases of stent dislocation or signs of vessel perforation. Survival after surgery was 86.7% (52 patients), with mortality amounting to 13.3% (8 patients).

Conclusion. The creation of a transjugular intrahepatic portosystemic shunt is a minimally invasive, high-tech and reliable preventive operation in patients with esophageal variceal bleeding and portal hypertension on the background of liver cirrhosis.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Dzhurakulov Sh.R., Vechorko V.I., Severtsev A.N., Fakhriev J.A.; data collection and handling – Dzhurakulov Sh.R., Vechorko V.I., Fakhriev J.A..; statistical processing – Dzhurakulov Sh.R., Ibragimov S.A., Fakhriev J.A.; draft manuscript preparation – Dzhurakulov Sh.R., Ibragimov S.A., Fakhriev J.A.; manuscript revision – Dzhurakulov Sh.R., Severtsev A.N., Fakhriev J.A.

For citation: Dzhurakulov Sh.R., Vechorko V.I., Severtsev A.N., Anosov V.D., Ibragimov S.A., Fakhriev J.A. Early results of transjugular intrahepatic portosystemic shunting in patients with complications of portal hypertension. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 80–7. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-80-87

Background. The persistent primitive hypoglossal artery is an anastomosis between the internal carotid artery and the basilar artery, being a rarely encountered developmental anomaly of vessels supplying the brain. The presence of the persistent primitive hypoglossal artery in a combination with atherosclerotic stenosis of the internal carotid artery substantially increases the risk of developing vascular catastrophes and a lethal outcome. In this clinical case report, we describe a situation with successful open endarterectomy performed from the ostium of the internal carotid artery and the presence of the persistent primitive hypoglossal artery completely forming the basilar artery.

Objective. We herein present a rare clinical case concerning surgical management of a patient with significant stenosis of the internal carotid artery in a combination with the persistent primitive hypoglossal artery separately forming the basilar artery.

Patients and methods. The persistent primitive hypoglossal artery is a branch of the carotid artery, located in the canal of the hypoglossal nerve. In our patient, this artery was the only one forming the basilar artery, with both vertebral arteries being aplastic. The patient was operated on for significant stenosis of the internal carotid artery.

Conclusion. The presence of abnormal carotid-basilar anastomoses is a rare pathology most often found incidentally. Currently, there is no specific screening to identify this pathology, but once revealed, it requires thorough differential diagnosis for an appropriate therapeutic decision to be made.

A coronary artery fistula is an abnormal connection between one of the coronary arteries and a heart chamber or another blood vessel of the pulmonary or systemic circulation, with the formation of left-to-left or left-to-right shunt, bypassing the myocardial capillary bed. We herein describe a rare clinical case of a young man presenting with acute myocardial infarction caused by posttraumatic coronary artery arteriovenous fistula thrombosis. Treatment consisted in successful endovascular disconnection of the pathological arteriovenous junction by an original author method, i. e., implantation of a self-expanding antithrombotic stent CASPER from the side of the fistula venous collector (coronary sinus). This case demonstrates present-day opportunities of endovascular methods of diagnosis and treatment of coronary artery fistulas.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Semitko S.P., Analeev A.I.; data collection and handling – Akhramovich R.V., Analeev A.I., Kamolov I.Kh., Gyulmisaryan K.V.; draft manuscript preparation – Semitko S.P., Chernysheva I.E., Akhramovich R.V.; manuscript revision – Ioseliani D.G., Bayandin N.L., Chernysheva I.E.

For citation: Semitko S.P., Akhramovich R.V., Analeev A.I., Kamolov I.Kh., Gyulmisaryan K.V., Chernysheva I.E., Bayandin N.L., Ioseliani D.G. Long-term results of arteriovenous fistula endovascular disconnection by coronary venous sinus stenting (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 94–102. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-94-102

Described herein is a clinical case report regarding endovascular treatment of a female patient with a giant intraparenchymal aneurysm of the renal artery. During medical examination, she was diagnosed as having a giant renal artery aneurysm without pronounced clinical symptomatology. Her case history contained neither regular measurement of arterial pressure nor connective tissue diseases. The preoperative diagnosis revealed that blood from the aneurysmal sac drained directly into the efferent vein. A therapeutic decision to perform embolization of the branch of the renal artery was successfully implemented. The early and late postoperative periods were uneventful, with no complications.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Magammatov A.A., Ardavov A.M.; data collection and handling – Musalov A.Yu., Ibragimov I.I., Volchkova A.A., Aidamirova E.K., Gamzaev N.R.; draft manuscript preparation – Volchkova A.A.; manuscript revision – Magammatov A.A., Musaev M.K., Arakelyan V.S., Papitashvili V.G.

For citation: Magammatov A.A., Musaev M.K., Ardavov A.M., Musalov A.Yu., Ibragimov I.I., Arakelyan V.S., Papitashvili V.G., Gamzaev N.R.-Ogly, Volchkova A.A., Aidamirova E.K. Endovascular treatment of a patient with a giant intraparenchymal renal artery aneurysm (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 103–7. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-103-107

One of the main causes of acute arterial thrombosis of the lower extremity is an occlusive stenotic atherosclerotic vascular lesion. Thrombosis in this situation can develop on the background of the existing chronic limb ischemia, as well as in the absence thereof, manifesting as intense pain in the leg. The article presents a clinical case report regarding successful application of hybrid surgery for subacute thrombosis of the external iliac and common femoral arteries against the background of their atherosclerotic asymptomatic lesion. This method was chosen due to the exclusion of the embolic nature of ischemia and the impossibility of the isolated use of endovascular revascularization methods. The result was complete sustainable regression of clinical symptoms, achieved by combining thrombectomy, as an open stage of surgery, with endovascular stenting in the area of an unstable plaque.

Funding. The study had no financial support.

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

Authors’ contribution. Conception of the method of surgical treatment – Gavrilenko A.V.; participation in the operational procedure – Lisitsky D.A., Vaganov A.G., Nochnoy M.S.; data handling – 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. Hybrid surgery for acute iliofemoral artery thrombosis (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 108–12. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-108-112

Objective. The purpose of our study was to analyze the contribution of atherosclerosis the mesenteric arteries to the development of gastroduodenal zone diseases in patients with various-severity chronic ischemia of the lower extremities.

Patients and methods. The study included a total of 91 patients with atherosclerosis and chronic lower limb ischemia (CLLI), among them 71 (78.0%) men and 20 (22.0%) women. All patients underwent the following examinations: multislice computed tomoangiography of the abdominal aorta visceral branches and arteries of the lower extremities, esophagogastroduodenoscopy with histological examination of biopsy specimens according to the OLGA (Operative Link on Gastritis Assessment) staging system. Statistical parameters were calculated using IBM SPSS Statistics version 19.

Results. The incidence of atherosclerosis of the mesenteric arteries (MA) in the study group was 52.7%, with combined lesions of the celiac trunk (CT) and superior mesenteric artery (SMA) revealed in 52.1% of patients. A positive correlation was registered between the degree of SMA stenosis and the severity of CLLI (τ=0.193; p=0.036). In patients with hemodynamically significant MA stenosis, a higher incidence of erosive and ulcerative pathology of the gastroduodenal zone was recorded, primarily due to gastric ulcer in the acute stage. A positive correlation was revealed between the percentage of SMA stenosis and the severity of the erosive and ulcerative process in the gastroduodenal zone according to the Cryer scale (τ=0.337; p=0.031) and the modified Lanza scale (τ=0.405; p=0.010), as well as a positive relationship between the degree of CT stenosis and severity of atrophic gastritis according to the OLGA staging system (τ=0.264; p=0.020). Based on multiple logistic regression, the following factors were identified as associated with erosive-ulcerative gastroduodenopathy: the presence of MA atherosclerosis (OR 4.148; 95% CI 1.403–12.262; p=0.010), an increase in the total score of the Hospital Anxiety and Depression Scale (OR 1.340; 95% CI 1.118–1.606; p=0.002), and the level of alcohol consumption according to the Alcohol Use Disorders Identification Test (OR 1.166; 95% CI 1.017–1.337; p=0.028).

Conclusion. A positive correlation was revealed between the percentage of SMA stenosis and the severity of CLLI. In patients with hemodynamically significant MA stenosis, erosive and ulcerative lesions of the gastroduodenal zone are more common. The following factors associated with erosive and ulcerative gastroduodenopathy were identified: the presence of MA atherosclerosis, an increase in the total score of the HADS and the level of alcohol consumption according to the AUDIT questionnaire.

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., Dolgushina A.I.; data collection and handling – Fokin A.A., Dolgushina A.I., Saenko A.A.; statistical processing – Saenko A.A.; draft manuscript preparation – Fokin A.A., Dolgushina A.I., Saenko A.A.; manuscript revision – Fokin A.A.

For citation: Fokin A.A., Dolgushina A.I., Saenko A.A. Atherosclerosis of mesenteric arteries in patients with infrainguinal arterial disease. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 113–21. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-113-121

Treatment effectiveness among patients with carotid artery stenosis and acute visual impairment was studied. The 1^st surgical group (carotid endarterectomy) included 49 people, the 2^nd group of conservative treatment included 50 people. All patients underwent examination. Visual acuity was determined. Autorefractometry, ophthalmoscopy, and perimetry were performed. The functional state of the optic nerve and ultrasound duplex scanning of eye arteries and carotid arteries were assessed.

Control points: initial state of visual organ function, state 1 month and 1 year after surgery or a course of conservative treatment.

Results. The events of amaurosis, if such, disappeared in all patients after surgery and only in 3 after conservative therapy (p<0.001), the visual fields expanded in 16 after carotid artery reconstruction and in none after conservative treatment (p<0.001), the functional state of the optic nerve improved in 16 patients after surgery and did not undergo changes in those treated conservatively (p<0.001), the systolic blood flow rate in the arteries of the eye became 30% higher after surgery and remained the same after conservative treatment. In patients with occlusion of the central retinal artery and its branches, visual acuity improved in 8 vs 1, respectively (p=0.005), visual fields expanded in 6 vs 2 (p=0.112). Improvements in the functional state of the optic nerve were particularly meaningful: 14 vs 0 (p<0.001), in patients after surgery, there was a 40% increase in the systolic blood flow rate in the arteries of the eye, whereas after conservative therapy, no such effect was observed. In patients with acute ischemic neuropathy, an improvement in visual acuity was recorded in 9 cases of the surgical group and in 2 patients of the conservative-treatment group (p<0.001), expansion of visual fields was achieved in 9 patients of the surgical group versus 3 in the conservatively treated group (p=0.004), and the functional state of the optic nerve improved in 11 vs 0, respectively (p<0.001). After carotid endarterectomy the ratio of neurologically asymptomatic and symptomatic patients significantly changed – 22/27 vs 41/8 (p=0.0001), whereas after conservative therapy, no such changes in the neurological status were found – 23/27 vs 19/29 (p=0.6617). Only in 2^nd group there were 2 deaths from ischemic stroke.

Conclusion. Carotid endarterectomy not only effectively and safely helps to avoid cerebral ischemia, but also reliably improves visual functions in patients with carotid artery stenosis and acute visual impairment.

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., Kuklin A.V., Kiseleva T.N.; data collection and handling, statistical processing, draft manuscript preparation – Kiseleva T.N., Kuklin A.V.; manuscript revision – Kuklin A.V.

For citation: Gavrilenko A.V., Kuklin A.V., Kiseleva T.N. Carotid endarterectomy for acute ocular ischemia. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 122–30. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-122-130

Background. Cardiovascular diseases rank first in the annual structure of mortality, with the number of reconstructive operations for these diseases growing steadily. Thus, according to the data of A.V. Pokrovsky, approximately 70 thousand arterial reconstructions were performed over 2018 alone. The traditional open surgery by the number of arterial reconstructions continues to hold a leading position. One of the possible remote complications after laparotomy, a frequently performed access to the abdominal aorta, is the development of postoperative ventral hernias. Reducing the incidence of this complication remains a challenging task for several decades.

Objective. The purpose of this study was to assess the possibility of primary prevention of postoperative ventral hernias after various accesses to the abdominal aorta.

Material and methods. We analyzed the data published in the Russian and English languages – PubMed, Scopius, Web of Science, eLibrary.

Results and discussion. The article describes all possible types of accesses to the abdominal aorta, of laparotomic ones – the transverse and midline approaches. Based on Russian and international sources, discussed are advantages and disadvantages of each of them from the point of view of the biomechanics of the anterior abdominal wall, organization of the access, anesthesia, suture materials, postoperative wound suturing technique, use of meshes, and prevention of postoperative complications.

Conclusion. Continuous suture with a monofilament long-term absorbable thread used in the small-bite stitching technique with a suture length to wound length ratio of not less than 4:1 is currently a highly recommended method for closing the abdominal cavity. Among the transperitoneal accesses, the transverse one is less often complicated by hernia formation. In patients at high risk for developing postoperative ventral hernias, especially in a longitudinal access, a polypropylene mesh may be used.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Frolov D.V.; data collection and handling – Kovaleva Yu.S., Linchenko A.A.; statistical processing – Linchenko A.A.; draft manuscript preparation – Kovaleva Yu.S.; manuscript revision – Frolov D.V., Pletnev A.V.

For citation: Frolov D.V., Pletnev A.V., Kovaleva Yu.S., Linchenko A.A. Operative accesses to the abdominal aorta from the perspective of prevention of postoperative ventral hernias (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 131–7. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-131-137

Objective. The purpose of this study was to test a hypothesis about the diagnostic significance of changes in the levels of endothelial dysfunction markers for predicting the progression of atherosclerosis after using homografts in reconstruction of lower limb arteries.

Patients and methods. The study was conducted in accordance with the GCP (Good Clinical Practice) standards and principles of the Declaration of Helsinki. The protocol was approved by the Local Ethics Committee № 4 dated November 9, 2021. The study was registered on the platform ClinicalTrials.gov (identifier NCT05455138), being an independent, prospective, clinical, uncontrolled trial. The first “pilot” data were obtained in treating ten patients with stage III–IV obliterating atherosclerosis of lower limb arteries (according to the classification of A.V. Pokrovsky-Fontaine). The patients were operated on at the Department of Vascular Surgery of the Ryazan Regional Clinical Hospital. The inclusion criteria were as follows: use of a homograft (irrespective of the type) as a material for reconstruction of major arteries, the presence of atherosclerosis of the latter, males of females over 40 years of age, with the following exclusion criteria: another-etiology chronic lower limb ischemia (Buerger’s disease, aortoarteritis, etc.), active cancer or a period of remission less than 5 years, patients’ refusal to participate in clinical research.

The study enrolled a total of ten patients (7 men and 3 women), average age 62.6 (42–78) years. Arterial and venous homografts were used as a material for reconstructive and restorative intervention in all patients. We used 5 alloarteries and 5 alloveins. Blood serum levels of endothelin-1 (ET-1), interleukin-6 (IL-6), endothelial nitric oxide synthase (eNOS) and prostacyclin (PGI2) were measured at various time points (the day before surgery, after 7 days, 1 month, 3 months, 6 months, 1 year). The overall duration of postoperative follow-up amounted to 1 year.

Results. The obtained findings demonstrated an increase in the ET-1 level by 75% on POD 7 (p=0.004) and by 73% (p=0.05) at 3 months versus the baseline values, a 107% increase of the IL-6 level at 1 year (p=0.001), with a three-fold increase of the eNOS level at 3 months (p=0.006) and also a three-fold increase at 1 year (p=0.001). The PGI2 level in blood serum increased multiply at 1 year after surgery vs. the baseline level (p=0.024). Nine patients were discharged with saved extremities and relief of critical ischemia. The progression of atherosclerosis was observed in four patients. There were 2 thromboses of homografts in the position below the knee-joint fissure without development of acute limb ischemia. Two patients were found to have the progression of atherosclerosis on the contralateral extremity – a decrease of the pain-free walking distance to 200 m in one patient, and the appearance of rest pain in the other, thus requiring elective endovascular intervention. These patients were found to have a two-fold increase in the ET-1 (p=0.004) and IL-6 (p=0.02) levels at 1 year compared with those in patients without progression of atherosclerosis.

Conclusion. The levels of endothelin-1, interleukin-6, endothelial nitric oxide synthase and prostacyclin can be used for predicting the progression of atherosclerosis after operations using homografts. Elevated levels of ET-1 and IL-6 are predictors of thrombotic complications. The values of endothelial nitric oxide synthase and prostacyclin also increase in the remote postoperative period. Given the conclusive results of our research, further studies are warranted to confirm our findings in larger cohorts.

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Kalinin R.E., Suchkov I.A.; development of methodology – Suchkov I.A., Karpov V.V.; data collection and handling – Karpov V.V., Nikiforov A.А.; surgical intervention – Karpov V.V., Egorov A.A.; draft manuscript preparation – Karpov V.V., Suchkov I.A..; manuscript revision – Suchkov I.A., Kalinin R.E., Klimentova E.A.

For citation: Kalinin R.E., Suchkov I.A., Karpov V.V., Klimentova E.A., Egorov A.A., Nikiforov A.А. Biomarkers of endothelial dysfunction after operations using homografts for lower limb arterial reconstruction (a pilot study). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 138–45. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-138-145