Use of plasma-free autologous platelet lysate in treatment of inoperable patients with critical limb ischemia
Objective. The aim of the study was to determine efficacy of using plasma-free autologous platelet lysate in inoperable patients with stage IV critical limb ischemia.
Patients and methods. We analyzed the results of treating a total of 127 inoperable patients presenting with grade IV critical limb ischemia. The inclusion criteria were as follows: the presence of necrotic defects on toes, impossibility to perform lower limb revascularization, and no history of reconstructions on the extremity concerned. The patients were divided into two groups. Group 1 (n=57) comprised patients who underwent the standard course of conservative therapy supplemented by administration of plasma-free autologous platelet lysate according to an original technique. Group 2 (n=70) was composed of patients whose treatment was limited to the standard course of conservative therapy alone. There were no statistically significant between-group differences in the clinical and demographic characteristics (p>0.05). The duration of follow-up amounted to 6 months. Therapeutic efficacy of treatment was assessed by means of a radionuclide method (three-phase scintigraphy with 99mТс-pyrfotech) used to evaluate alterations in tissue blood flow on the background of treatment.
Results. Complete healing of necrotic defects was observed in 52.6% patients of Group 1 and in 30.0% of Group 2 patients, with the rest pain relieved in 56.1 and 34.3% of patients, respectively. The mean value of the ankle-brachial index increased from 0.38 [0.31; 0.44] to 0.61 [0.52; 0.67] in Group 1 (p=0.003609) and decreased from 0.43 [0.38; 0.46] to 0.37 [0.33; 0.42] in Group 2 (p=0.02585). Clinical improvement in all patients was associated with improved microcirculation (uniform distribution of the radiopharmaceutical, a decrease of hypoperfusion zones, involution of necrotic foci as judged by no increase of the coefficient of relative accumulation of the radiopharmaceutical in the bone phase compared with the tissue one on the scintigrams). Based on the clinical and instrumental findings at six-month follow-up, we managed to achieve improvement in 61.4% of Group 1 patients and 41.4% of Group 2 patients (p<0.0001). The amputation rate amounted to 5.2% and 14.3% in Groups 1 and 2, respectively (p=0.0023). There was one lethal outcome in Group 2.
Conclusion. The use of plasma-free autologous platelet lysate in comprehensive treatment of patients with critical lower limb ischemia made it possible to improve therapeutic results in this patient cohort.
Clinical comparison of incidence of side effects of cilostazol analogs in treatment of diabetic foot syndrome
The purpose of our study was to test the assumptions about possible side effects of two brand names of cilostazol. It included a total of 165 patients presenting with neuroischemic form of diabetic foot syndrome, stage IIA–IIB lower-limb chronic ischemia, moderate-to-severe distal sensorimotor neuropathy, as well as tissue damage according to the W (W1–W3) scale, with no urgent indications for limb amputation. The patients were willing to comply with the requirements for examination and treatment performed according to the algorithm at the “Diabetic Foot” Center of Kazan after obtaining written informed consent. Two trade names of cilostazol analogs, i. e., “Aducyl” and “Pletax”, were compared. The patients were divided into 2 groups, representative by the baseline data, in accordance with the received analog. The frequency of side effects, as well as the frequency of favorable and unfavorable outcomes were compared.
The side effects encountered in both groups were as follows: headache, edematous syndrome in the lower extremities, destabilization of blood pressure, dermatitis in the lower extremities, tachycardia, shortness of breath, nausea, and general malaise. Also, the frequency of complications and the frequency of refusal to take the drug were compared. When analyzing the data obtained, it was found that the group of patients receiving Aducyl® included in the complex therapy regimen had significantly more favorable outcomes. Taking Pletax® was associated with a higher level of clinically verified complications. The chance of an unfavorable outcome during treatment with Pletax® was 2.43 times higher than that with Aducyl®.
Efficacy and safety of a drug based on regulatory polypeptides of vessels for treatment of intermittent claudication (results of a multicenter, double-blind, placebo-controlled randomized trial)
Objective. To evaluate efficacy and safety of various dosage regimens of Slavinorm® compared with placebo in patients with stage IIB chronic obliterating diseases of lower-limb arteries according to the Fontaine-Pokrovsky classification.
Patients and methods. The study was planned as a multicenter (7 centers), double-blind, placebo-controlled, comparative trial in parallel groups. It included a total of 108 patients with confirmed atherosclerotic lesions of lower-limb arteries and symptoms of intermittent claudication. The diagnosis was verified by duplex scanning of vessels, treadmill test, and the ankle-brachial index.
The overall duration of participation in the study for each patient was not more than 91 days, with the period of drug administration ranging from 22 to 33 days.
The patients were randomized into one of four treatment groups:
Group A (n=36): patients received the studied drug Slavinorm® intramuscularly at a dose of 5 mg two times a week.
Group B (n=36): patients received the studied drug Slavinorm® intramuscularly at a dose of 5 mg three times a week.
Group C (n=18): patients received placebo intramuscularly twice a week.
Group D (n=18); patients received placebo intramuscularly three times a week.
Each patient during the study received 10 doses of the drug or placebo.
Slavonirm® is a complex of polypeptides derived from vessels of cattle. The technology of production of the drug envisages that the finished dosage form should contain only polypeptides having molecular weights not exceeding 10 kDa, with complete absence of proteins, lipids, hormones and pyrogens.
The main criterion for efficacy was the proportion of patients demonstrating a therapeutic response at the time of the final visit as a 50% and more increase in the pain-free walking distance as compared with the baseline level. Additional criteria for efficacy assessment were the average alteration in the maximal pain-free walking distance and maximal walking distance at various stages of treatment, change in the total score of the Walking Impairment Questionnaire (WIQ) at various stages of treatment, general assessment of efficacy of treatment, made by the patient/investigator at various visits, frequency of taking analgesics to relieve pain, the number of patients withdrawing from the study for the reason of ineffective treatment.
The measures to assess safety included changes in physical and laboratory parameters, as well as the frequency of unfavorable and adverse events.
The groups of patients formed according to the study design were comparable by the main parameters.
Results. Using Slavinorm® turned out to result in a statistically significant increase in the pain-free walking distance (by 46.2 and 31.4% in Groups A and B, respectively) as compared with the placebo group (+6.5%). A 50% increase in the pain-free walking distance was observed in 28 and 26% of patients in the Slavinorm® Groups as compared with 3% of patients in the placebo group. The use of Slavinorm® improved the assessment by the patients of their general condition, walking distance and speed according to the WIQ scale. According to the general assessment of treatment efficacy, 95.7% of patients and 94.2% of investigators noted improvement of the patients’ state on the background of therapy with Slavinorm®. The frequency of adverse events in the Slavinorm group did not statistically significantly differ from the placebo group (p=0.55983). The effect of the drug persisted after discontinuation of the drug administration (9–25 days after the last injection of Slavinorm).
Conclusion. Slavinorm® used according to the dosage regimens A (at a dose of 5 mg twice weekly, 10 injections) and B (at a dose of 5 mg thrice weekly, 10 injections) possesses clinical efficacy and increases the pain-free walking distance in patients with stage IIB chronic obliterating disease of lower-limb arteries according to the Fontaine–Pokrovsky classification.
Slavinorm® has a favorable safety profile, with the frequency of adverse events not differing statistically significantly from the placebo group.
Combined intraoperative neuromonitoring during carotid endarterectomy
Background. Carotid endarterectomy belongs to the most common vascular operations performed in atherosclerotic lesions of brachiocephalic arteries for prevention of ischemic stroke. One of intraoperative complications of this intervention is ischemic stroke, therefore, currently important remains the task of choosing an optimal technique of intraoperative monitoring and improving methods of preventing the development of ischemic stroke.
Objective. The purpose of this study was to determine an optimal combination of methods of comprehensive intraoperative neuromonitoring during carotid endarterectomy.
Patients and methods. We analyzed the results of treating a total of 206 patients subjected to carotid endarterectomy. The mean age of the patients was 63.9±8.7 years. Depending on the method of intraoperative control over the development of cerebral ischemia, the patients were divided into 2 groups. Group One comprised 97 patients in whom the method of control was the measurement of the retrograde arterial pressure in the internal carotid artery with the calculation of the retrograde arterial pressure index. Group Two was composed of 109 patients in whom the control method consisted in measuring the retrograde arterial pressure and comprehensive intraoperative monitoring.
Results. By the main parameters, the patient groups were comparable (p>0.05). The frequency of developing ischemic stroke amounted to 4.1 and 0.9% in Group One and Group Two, respectively (p=0.048). An intraluminal shunt was used significantly more often in Group Two (with intraoperative monitoring), i. e., in 26.5% (28 patients) vs 12.4% (12 patients) in Group One (without intraoperative monitoring) (p=0.025).
The predictive model of reposition of an intraluminal shunt based on the data of intraoperative monitoring: somatosensory evoked potentials + transcranial dopplerography + electroencephalography and intraoperative monitoring: somatosensory evoked potentials + transcranial dopplerography was assessed by means of the ROC analysis and demonstrated comparable parameters of sensitivity and specificity (83%). Therefore, the protocol of intraoperative monitoring with the use of an intraluminal shunt was reduced to assessing alterations in 2 diagnostic parameters (somatosensory evoked potentials + transcranial dopplerography).
Conclusion. Combined neuromonitoring during carotid endarterectomy under conditions of general anesthesia makes it possible to verify critically decreased cerebral perfusion and to determine intraoperative indications for placing an intraluminal shunt and assess its condition during the main stage of surgery, thus resulting in a decrease in the frequency of neurological complications.
Volumetric-myocardial indices for predicting the course of the early postoperative period in patients with ischemic cardiomyopathy
Background. The number of published studies exploring risk factors for the development of early postoperative complications predicted based on the findings of magnetic resonance imaging in patients with left ventricular dysfunction is limited.
Objective. Our study was aimed at searching for predictors of a complicated course of the postoperative period in patients with ischemic cardiomyopathy.
Patients and methods. In a total of 44 patients prior to comprehensive surgical treatment of ischemic cardiomyopathy, we analyzed volumetric and linear parameters of the left ventricular myocardium by means of contrast-enhanced cardiac magnetic resonance imaging. For prognostic purposes, we proposed volumetric-myocardial indices: the ratio of the end-diastolic volume to the viable myocardium mass (DVM) and the ratio of the end-systolic volume to the viable myocardium mass (SVM).
Results. It was found that the ratio of the end-systolic volume to the viable myocardium mass was the only independent risk factor for the development of postoperative complications and that an increase of the SVM index by one unit increased the risk of developing complications in the early postoperative period 6.68-fold.
Conclusion. The assessment of the proposed index at the preoperative stage may contribute to optimization of selection of patients for surgery.
Histological confirmation of biodegradation of «Sulfacrylate» glue after cyanoacrylate vein ablation according to the VAGOV technique at different periods
Background. One of the reasons for limited use of cyanoacrylate obliteration of veins is the lack of the knowledge of what happens to the glue inside the vein at different follow-up periods.
Objective. The purpose of our study was to assess the possibility and degree of biodegradation of the cyanoacrylate glue “Sulfacrylate” after endovenous ablation according to the method of vacuum-assisted glue obliteration of veins (VAGOV) at various terms of follow up.
Patients and methods. Since 2018, we performed a total of 52 procedures of cyanoacrylate vein ablation according to the VAGOV technique. After obtaining voluntary consent, surgical biopsy of the target large saphenous vein was performed 1, 6, 12 and 24 months after the procedure. The comparison was carried out with the control vein procured after classical phlebectomy. Biological samples were stained with hematoxylin-eosin and by the Mallory method. The micro-preparations were examined using conventional light microscopy on an Axioskop 40 FL microscope (Carl Zeiss, Germany).
Results. Comparing histological sections of the great saphenous vein (GSV) harvested before surgery and 1 and 6 months after the operation according to the VAGOV technique demonstrated sequential processes of granulation tissue first, then connective tissue bearing a large number of collagen fibers inside the lumen of the GSV. At 12 and 24 months, no signs of histological recanalization of target veins were revealed. By the end of the 2-year follow-up, the replacement connective tissue completely sprouted the adhesive composition and had a typical structure (a mixture of connective tissue fibers and fibroblast cells). There was a decrease in the intensity of lymphocytic infiltration and its residual presence in the area of the former vein wall by the end of the 2-year follow-up.
Conclusion. After cyanoacrylate vein ablation according to the VAGOV technique, the adhesive composition “Sulfacrylate” almost completely biodegraded and was replaced by connective tissue within a period of up to 24 months.
Adverse events and complications following cyanoacrylate adhesive closure of varicose veins
Background. Cyanoacrylate adhesive closure is currently considered to be an alternative to thermal ablation of varicose veins. It emerged as a natural step towards minimally invasive surgical treatment of incompetent saphenous veins.
Objective. The purpose of this study was to assess the safety of cyanoacrylate adhesive closure in treatment of patients with varicose veins based on two-year experience.
Patients and methods. Between July 2019 and July 2021, cyanoacrylate adhesive closure was performed in a total of 457 patients (634 limbs and 725 venous trunks). The inclusion criteria were as follows: CEAP clinical classes C2–C6, junctional and truncal valve incompetence with reflux >0.5 sec, saphenous vein diameter > 6 mm, presence of varicosities. Cyanoacrylate adhesive closure was carried out according to the standard VenaSeal protocol. In 76.2% of cases, the procedure was performed selectively without tributary treatment. Duplex ultrasound follow-up examinations were carried out on POD 3, as well as at 1, 3, 6 and 12 months following the procedure.
Results. Partial recanalization occurred in 4 (0.8%) cases between 6 and 15 months post-procedure. Glue migration and propagation into the deep vein was detected in 7 (1.5%) patients and asymptomatic sural vein thrombosis was found in 2 (0.4%) cases. Phlebitis-like skin reaction developed in 50 (11%) cases, superficial thrombophlebitis – in 20 (4.3%) patients. In 6 (1.3%) cases, the procedure was complicated by soft tissue foreign body granuloma. There were no cases of either pulmonary embolism or peripheral neuropathy.
Conclusion. The procedure of cyanoacrylate adhesive closure proved highly effective and safe in treating patients with superficial venous insufficiency and was associated with minimal incidence of adverse events during the two-year follow-up. Further studies are needed to assess the long-term safety of the method.
Frequency, severity and possible risks of development of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins
Objective. The aim of this study was to determine the frequency, degree of severity and possible risk factors of the development of phlebitis-like abnormal reaction (PLAR) after cyanoacrylate obliteration of varicose veins.
Patients and methods. We analyzed the results of cyanoacrylate obliteration of CEAP class C2–C3 varicose veins in a total of 175 patients operated on from 2017 to 2022. Cyanoacrylate obliteration of varicose veins was performed with the help of a foreign adhesive used in the “VenaSeal” system and the Russian-made adhesive compound “Sulfacrylate” (VenoGlue) according to the standardized techniques. All patients underwent ultrasound duplex scanning prior to surgery and at various stages of follow-up. The frequency and severity of PLAR after manipulations at various terms were evaluated in accordance with the developed Visual Analog Phlebitis Scale (VAPS) based on the scoring principle of assessing severity of pain and itching, hyperemia and infiltration of soft tissues along the occluded veins, as well as a systemic allergic reaction.
Results. It turned out that various-degree PLAR developed following cyanoacrylate obliteration of varicose veins averagely in 36% of patients after 24 hours, irrespective of the adhesive used. The duration of cyanoacrylate obliteration appeared to be a statistically significant factor of the development of PLAR observed in 56% of cases of cyanoacrylate obliteration of the entire main trunk of the great saphenous vein, in 28% – within the femur, and only in 7% of cases of cyanoacrylate obliteration limited to the proximal portion of the GSV, with the degree of PLAR according to the VAPS scoring 2.27±1.85, 1.44±0.16 and 0.63±0.12, respectively. The highest degree of PLAR among patients with extended cyanoacrylate obliteration in 100% of cases was observed on the crus, where the main trunk of the great saphenous vein was located in 50% of cases suprafascially, being maximally close to the skin. Also in 100% of cases, PLAR developed during isolated cyanoacrylate obliteration of veins in the basin of the anterior accessory (arch) vein on the crus, amongst whom in 63.6 and 36.4%, the severity score of PLAR amounted to 4–6 points and 6–7 points, respectively. In all these cases, the occluded segments were located suprafascially, adhering immediately to the skin, i. e., the thickness of the fat layer between the vein and skin amounted to only several millimeters. All patients with PLAR were treated with nonsteroidal anti-inflammatory drugs at the standard dose, with all adverse events resolving by day 7–10. There were no statistically significant differences in the incidence of PLAR depending on the diameter of the great saphenous vein. Development of PLAR regardless of the degree of severity did not influence the completeness of occlusion of the target veins, averagely amounting to 96% during 3 years.
Conclusion. PLAR after cyanoacrylate obliteration of varicose veins occurred in more than one third of patients but the degree of severity requiring active anti-inflammatory treatment was encountered in 3–5% of cases. The main factors influencing the risk of developing PLAR were found to be “local” factors such as the length of occlusion, cyanoacrylate obliteration performed on the crus, subfascial location of veins and proximity of veins to the skin.
Short- and medium-term results of open and endovascular treatment of steno-occlusive lesions of the iliac segment (TASC II C, D) in a randomized clinical trial
Background. Endovascular treatment of iliac occlusive lesions (TASC II C, D) is an alternative method of open surgical reconstruction which is the “gold standard”. However, currently there are only few randomized trials comparing both treatment modalities, with a number of remaining issues especially concerning therapeutic policy depending on morphology of damage of target arteries.
Objective. The purpose of this randomized trial was to compare the short- and mid-term outcomes of endovascular and open surgical treatment in patients with lesions of the iliac segment (TASC II C, D) by criteria of safety and efficacy.
Patients and methods. This randomized trial was approved by the Local Ethics Committee of the “National Medical Research Center named after Academician E.N. Meshalkin” of the Ministry of Health of the Russian Federation,and registered in the ClinicalTrials.gov register (identifier: NCT02209350). From June 2014 to March 2020, we treated a total of 202 patients with occlusive lesions of the iliac segment (TASC II C, D). Group 1 patients (n=101) underwent endovascular recanalization of iliac arteries and Group 2 patients (n=101) endured open reconstructions, i. e., aortofemoral bypass (AFB). All patients prior to surgery underwent duplex scanning of lower-limb arteries, ankle-brachial index (ABI) testing and multidetector computed tomographic angiography. The postoperative follow-up visits at 1, 6, 12 and 24 months consisted of physical examination, ABI measurement and duplex scanning or of the aortofemoral graft or stented iliac segment.
Results. The average hospital length of stay in the stenting group was 6.1±4.2 days vs 14.1±6.9 days in the AFB group (p<0.001). The technical success in the stenting group and ABI group patients amounted to 97% and 100%, respectively. The 30-day perioperative morbidity rate was 5% in the stenting group vs 17% in the AFB group (p=0.01). The cumulative primary patency rates at 24 months was 82% in the stenting group and 94% in the AFB group (p=0.01). Secondary and assisted primary patency rates at 24 months were 97% and 96% in the stenting group and 99% and 98% in the AFB group, respectively (p=0.32 and p=0.33). The limb salvage rate was 97% (stenting group) vs 98% (AFB group) at 24 months (p=0.64). The 2-year survival rate was 98% in the stenting group versus 94% in the AFB group (р=0.15).
Conclusion. Endovascular interventions in patients with stenotic-occlusive lesions of the iliac segment (TASC II C, D) were associated with a significantly lower rate of nosocomial systemic complications and significantly shorter hospital length of stay, however, by efficacy, endovascular revascularizations turned out to be significantly inferior to open surgery during the mentioned follow-up period.
Choice of method of revascularization of lower extremities for occlusive lesions of femoropopliteal arteries
Objective. The purpose of our study was to assess the results of using a modified technique of blood flow restoration in patients with lesions of the femoropopliteal arterial segment in the absence of an autovein suitable for a reconstructive operation and the impossibility of endovascular recanalization.
Patients and methods. The study included a total of 91 patients with lesions of femoropopliteal segment. The patients were divided into three groups: Group 1 comprised patients who underwent a modified procedure in the form of semiclosed loop endarterectomy from the superficial femoral artery in a combination with popliteal-distal autovenous bypass grafting (n=21), Group 2 consisted of patients subjected to femoral-distal autovenous bypass grafting (n=33) and Group 3 was composed of patients who endured roentgenosurgical operations (balloon angioplasty with stenting of the superficial femoral and popliteal arteries) (n=37).
Results. In the early postoperative period, thrombosis of the femoropopliteal segment developed in 1 (4.7%) patient of Group 1, shunt thrombosis in 2 (6.1%) patients of Group 2, and in Group 3 thrombosis occurred in 1 (3.7%) patient. The primary patency of the arterial channel at 12 months amounted to 80.9, 81.8 and 83.7% in Groups 1, 2 and 3, respectively. The limb salvage rates at 1 year were 90.4, 87.87 and 89.1% in Groups 1, 2 and 3, respectively.
Conclusion. The obtained results demonstrated efficacy of the developed technique of operative treatment of patients with femoropopliteal lesions in the absence of an autovenous graft and the impossibility of endovascular correction.
New method of performing operation for thoracic aortic aneurysm complicated by primary aortoesophageal fistula
Presented herein is a new method of the operation for a thoracic aortic aneurysm complicated by an aortoesophageal fistula and hemorrhage. The technology of performing the procedure was aimed first of all at preventing mediastinitis. The patient underwent prosthetic repair of the thoracic artery with reduction of the aneurysmal sac in the zone of the aortoesophageal fistula according to the developed technique, with no surgical manipulations performed on the esophagus. On POD 16, sutures were removed, with the patient discharged in a satisfactory condition. There was no evidence of esophageal dysfunction. A total of 3 patients were operated on according to the presented technology.
Hybrid surgical treatment of false aneurysm of proximal anastomosis after aortobifemoral bypass grafting (case report)
One of formidable complications of aortobifemoral bypass grafting or prosthetic repair is a false aneurysm of a proximal anastomosis. Clinical guidelines propose treatment using relaparotomy.
We describe herein a clinical case report regarding a 66-year-old male patient primarily operated on for lower-limb critical ischaemia in 2011, undergoing aortobifemoral bypass surgery and femoropopliteal bypass grafting on the right. In 2018, he again presented to our Clinic, complaining of acute abdominal pain. Examination revealed a false aneurysm of the proximal aortobifemoral bypass graft, followed by operative intervention, i. e., endoprosthetic repair of the defect of the proximal anastomosis, reconstruction of the right distal anastomosis of the aortobifemoral bypass graft. The shunt has been functioning for 4 years, with no evidence of either paraprosthetic infection or critical ischaemia.
Giant abdominal aortic aneurysm combined with horseshoe kidney (case report)
A horseshoe kidney is one of the most common anomalies of renal structure. This pathology combined with an abdominal aortic aneurysm is of special interest because surgical policy for the patient cohort concerned is not standardized and depends on a plurality of individual anatomical peculiarities.
Described herein is a clinical case report regarding successful surgical treatment of a patient presenting with a giant abdominal aortic aneurysm and a coexisting horseshoe kidney. Through a laparotomic access, we performed resection of the juxtarenal abdominal aortic aneurysm, aortic-common-iliac bifurcation prosthetic repair using a synthetic bifurcated graft with reimplantation of the right renal artery into the aorta. At the stage of aneurysm resection, perfusion of the kidney with autologous blood was performed through the right renal artery. The postoperative period proved uneventful. The levels of blood urea and creatinine did not exceed the admissible values. The patient was discharged home on POD 10 in a satisfactory condition.
Bleeding from an aberrant right subclavian artery (case report)
Background. The aberrant right subclavian artery (arteria lusoria) is the most common anomaly of aortic arch vessels. A rare but potentially life-threatening complication of this anomaly is the formation of an arterioesophageal fistula with the development of hemorrhage. Due to rarity of the disease, no unified therapeutic and diagnostic algorithm has been worked out as yet.
Objective. The purpose of this article is to demonstrate the present-day possibilities of diagnosis and treatment of developing hemorrhage from a fistula formed between the aberrant right subclavian artery and esophagus.
Patients and methods. We retrospectively analyzed the case history of a 6-year-old girl after endured acute cerebral ischemia. During 107 days, she was on artificial pulmonary ventilation and and fed through a nasogastric tube, which resulted in formation of a fistula between the aberrant subclavian artery and esophagus, complicated by profuse bleeding.
Results and discussion. In patients with the aberrant right subclavian artery, long-term tube feeding may contribute to formation of an arterioesophagel fistula with the development of profuse hemorrhage. In this clinical case, endoscopic methods of hemostasis turned out to be ineffective. Bleeding was temporarily stopped using the Sengstaken-Blackmore tube. The girl underwent occlusion of the fistula by means of implantation of endovascular stents and endoscopic clipping of the defect in the esophagus.
Conclusion. Prolonged tube feeding and tracheostomy can cause the formation of an arterioesophagel fistula complicated by profuse bleeding which should temporarily be stopped using the Sengstaken-Blackmore tube. A combination of roentgen-endovascular methods of treatment and endoscopic techniques may be a possible variant of treating patients with this pathology.
Acute mesenteric ischemia after cardiac surgery. Management of patients undergoing endovascular treatment (case report)
In the structure of abdominal complications after cardiac surgical interventions, cases of acute mesenteric ischemia are rare, but are accompanied by high mortality. Early revascularization of the intestine before the development of irreversible changes in the intestinal wall is the key to successful treatment of this patient cohort. However, endovascular revascularization of the intestine may be followed by a relapse of acute mesenteric ischemia. Dynamic follow-up with control of the state of the stent and an individual therapeutic approach can reduce high mortality characteristic of this complication.
Extracranial internal carotid artery aneurysms (literature review)
Extracranial internal carotid artery aneurysms are uncommon, accounting for approximately 1% of all peripheral arterial aneurysms. This nosology is associated with the development of such formidable complications as thromboembolism of the intracranial arteries and compression of the cranial nerves.
This article is a review of the current literature data on the clinical course, diagnosis and treatment of aneurysms of the extracranial carotid arteries. Currently, due to the lack of randomized clinical trials, the question of choosing appropriate surgical policy for the pathology involved remains open.
The purpose of the present study was to analyze the available literature data concerning the clinical course, diagnosis and treatment of aneurysms of the extracranial carotid arteries. Scientific publications were retrieved using such databases as PubMed, Scopus, Google Scholar, Web of Science and Russian Science Citation Index.
May–Thurner syndrome: a modern view on the problem
May–Thurner syndrome belongs to venous compression syndromes with predominant hemodynamic and morphological lesions of the left common iliac vein. Despite sufficient knowledge of the anatomical and pathomorphological components of this condition, there is significant variability in revealing the incidence of its symptomatic and asymptomatic manifestations.
Our current understanding of this pathology does not allow us to explain the mechanisms of many pathophysiological and clinical processes, serving as its indicators. Scattered data of the known studies turn out to be largely incomparable and contradictory by the studied parameters. Presently, there are no answers to the key questions concerning the criteria of hemodynamic significance of stenosis of the common iliac vein and consequential indications for performing an operation.
This article covers the history of studying May–Thurner syndrome, discussing problems of variant anatomy and pathophysiology, diagnostic arsenal of assessing the disease, modern methods of surgical and endovascular treatment.
Venous stenting as a method of choice in treatment of May–Thurner syndrome is broadly justified by high frequency of technical success and low complication rates.
Further studies are warranted to get a deeper insight into the pathophysiological mechanisms of extravasal compression of the left iliac vein, to be followed by the development of clear-cut diagnostic parameters making it possible to define this condition as pathological and implying surgery, as well as to distinguish it from other variants of the course, not requiring invasive methods of treatment.
Effect of coronary artery disease on incidence of major adverse cardiovascular events after surgical treatment of patients with peripheral arterial disease (literature review)
This review article describes the current trends in surgical treatment of patients with critical and chronic lower-limb ischemia combined with coronary artery disease, taking a close look at the problems concerning the necessity of performing myocardial revascularization (percutaneous coronary intervention and coronary artery bypass grafting) in patients with critical and chronic lower-limb ischemia. Globally, more than 202 million people were living with peripheral artery disease in 2010; of these, 20–40 million people had intermittent claudication, with a further 45 (22.5%) million people diagnosed with coronary artery disease and acute cerebral ischemia known to be the leading cause of lethal outcomes. It is concluded that further studies are warranted in this direction in order to work out clear-cut recommendations on treatment of patients with critical and chronic lower-limb ischemia combined with coronary artery disease.