BACKGROUND:In Russia and the world, there is an increase in the number of cancer patients with localization on the head and neck. According to the Global Cancer Observatory (GLOBOCAN), 890.000 new cases of head and neck cancer and 450.000 deaths were registered in 2018, with a forecast of a 30% increase in the incidence by 2030. Carotid chemodectomas (CC) account for 0.5% of all head and neck tumors. The frequency of occurrence is estimated as 1 per 30000-100000 people. CCS in most patients are benign, but 10% may be malignant. The aim to determine the rational surgical tactics in patients with carotid hemodectomas, from the standpoint of the radicality, effectiveness and safety of the operation. STUDY DESIGN:a retrospective, multicenter study. MATERIAL AND METHODS:An analysis was conducted of the medical records of 80 patients with CBTs who underwent treatment in the vascular surgery departments of Regional Clinical Hospital No. 3, City Clinical Hospital No. 8, Chelyabinsk Regional Clinical Hospital and Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in Chelyabinsk from 1985 to 2025. In particular, the results of instrumental research methods were assessed and a histological analysis of the obtained biopsy materials was performed. The literature search, as well as the systematization and analysis of information, was conducted from scientific literature sources located in the PubMed, Web of Science, and Elibrary databases. RESULTS:When writing the work, a literature search was conducted, as well as an analysis of the most significant clinical observations of patients with CС, including those with signs of malignancy, bilateral lesion, hereditary history, as well as a combination of tumors with atherosclerotic lesions of the internal carotid artery and the development of critical stenosis. CONCLUSION:To ensure the radicality, efficacy, and safety of carotid body tumor removal, the following principles should be considered: for type III tumors according to the Shamblin classification, as well as for tumors with malignant properties, en bloc resection followed by internal carotid artery reconstruction is advisable. The sequence of tumor removal in bilateral cases is determined by their size, Shamblin classification, and the presence of symptoms. Simultaneous bilateral tumor removal should not be performed due to the risk of fatal complications. Lymph node dissection should be performed in cases of enlarged lymph nodes in the surgical area, tumor recurrence, and aggressive or malignant tumor forms. Preoperative embolization of branches of the external carotid artery prior to surgical tumor removal has not proven its effectiveness. Patients with carotid body tumors, especially those with a family history or multiple tumors, are recommended to undergo genetic testing.
Subclavian artery aneurysm is rare. There are no recommendations for surgical treatment for this localization of aneurysms. Depending on the anatomy of the aneurysm itself and the surrounding tissues, treatment can be either open surgical or endovascular. The presented clinical case demonstrates successful surgical treatment in the amount of carotid-axillary prosthetics if the patient has contraindications to endovascular intervention.
Despite good immediate and remote results of endovascular treatment of patients with atherosclerotic lesions of the iliofemoral segment, involvement of the common femoral artery and the distal segment of the external iliac artery is often an argument in favor of open or hybrid surgery. Loop endarterectomy for this type of lesion has been successfully used for many years. However, unresolved problems remain that cause technical failure of the intervention and/or the development of intraoperative complications. The article presents an analysis of potential complications of the procedure and the causes of their occurrence, preventive measures and possible elimination from the perspective of various authors and our own experience. Besides, we herein describe two clinical cases accompanied by the development of such intraoperative complication as iliac artery perforation requiring immediate management.
BACKGROUND:Varicose vein disease of the lower extremities is a common vascular disorder associated with endothelial dysfunction, chronic inflammation, and venous wall remodeling. A promising therapeutic approach is pharmacotherapy aimed at modulating vein-specific biomarkers, including E-selectin, MCP- 1, VEGF, MMP-2, and MMP-9. OBJECTIVE:To evaluate the effects of micronized purified flavonoid fraction (MPFF), sulodexide, and their combination on key biomarker levels and quality of life in patients with VVDLE, depending on the clinical stage (C2-C6). MATERIAL AND METHODS:This prospective comparative study included 198 patients (68.2% female; mean age 43.0±8.72 years; BMI 22.0±2.9 kg/m ), allocated into four groups: compression therapy, MPFF 1000 mg/day, sulodexide 250 LSU twice daily, and MPFF plus sulodexide. Treatment duration was 2 months, with a follow-up period of 12 months. Biomarkers were assessed using the enzyme-linked immunosorbent assay method at visits V0, V2, and V3; quality of life was evaluated using the CIVIQ-20 and SF-36 questionnaires. RESULTS:In C2-C3 patients, MPFF showed the greatest efficacy, with sustained reductions in E-selectin ( 25.4%), MCP-1 (-24.5%), and VEGF (-20.8%) (p<0.001), accompanied by quality-of-life improvement. In C4-C6, sulodexide achieved pronounced and prolonged MMP-9 reduction (-53.8% at 2 months; -24.9% at 12 months) and quality-of-life enhancement. The combination therapy in C4-C6 patients reduced all biomarkers by month 1 and maintained decreases in MMP-2 (-18.2%) and MMP-9 (-24.3%) at 12 months, with persistent CIVIQ-20 and SF-36 improvement. In C2-C3, combination therapy provided no additional benefit and was associated with a higher adverse event rate (28%). CONCLUSION:Pharmacotherapy efficacy depends on the stage of VVDLE: MPFF is optimal at early stages, while sulodexide or its combination with MPFF is preferable for advanced disease. A personalized treatment approach enables maximal clinical and biochemical benefits with a comparable safety profile.
The aim of this study was to develop an algorithm for the prevention and treatment of venous thromboembolic complications (VTEC) during staged surgical interventions in wounded patients with gunshot fractures of the lower extremities (LE). MATERIAL AND METHODS:The treatment outcomes for VTEC were retrospectively assessed in 149 wounded patients with gunshot fractures of LE who were treated in a Level 5 military medical facility (MMF). All wounded were male, with an average age of 38.4 ± 8.8 years. Instrumental examination included ultrasound angioscanning of LE and computed tomography (as indicated). By localization, gunshot fractures were: femur in 80 (53.7%) wounded, tibia - in 33 (22.1%), fibula - in 1 (0.7%), femur and tibia - in 7 (4.7%), tibia and fibula - in 26 (17.4%), femur and fibula - in 1 (0.7%), femur, tibia and fibula - in 1 (0.7%). Deep vein thrombosis (DVT) of LE was detected in all the wounded. By the segments of damage, patients with DVT were distributed as follows: the iliofemoral segment was affected in 6 (4%) wounded, the femoropopliteal segment - in 53 (36%), the popliteal-tibial segment - in 67 (45%), and the distal segment - in 23 (15%). Short-term treatment outcomes were assessed based on mortality rates, secondary amputation rates, recurrence and/or progression of venous thromboembolism, and hemorrhagic complications. RESULTS:Indications for lower musculoskeletal surgery were delayed in most patients (123, 82.5%). The median duration of preoperative anticoagulant therapy (ACT) with low-molecular-weight heparins was 7 days (Q1 - 5, Q3 - 11). A total of 247 (53.2%) interventions were performed with a high risk of hemorrhagic complications, while 217 (46.8%) had a low risk of bleeding. A postoperative break from ACT of up to 24 hours was most often used (353 interventions, 76.1%). A 24-48 hours break in ACT was performed after 97 (20.9%) operations, while a 48-72 hour break was performed only after 14 (3%) operations. Surgical prophylaxis of massive PE was performed in 24 (16.1%) patients, with the most common procedure being superficial femoral vein ligation (21 wounded) performed during the previous stages of medical evacuation. The median hospital stay in a MMF was 8 days (Q1 - 6, Q3 - 15). There were no fatal outcomes. Secondary LE amputations were performed in 12 (8%) wounded. DVT progression was noted in 9 (6%) patients. Development of massive PE and major bleeding were not noted. Performing femoral vein ligation before one or more high-risk interventions in wounded patients with gunshot fractures of LE was not associated with lower complication rates compared with isolated anticoagulant therapy with low-molecular-weight heparins in the perioperative period. CONCLUSION:A rational combination of perioperative anticoagulant therapy with short-term withdrawal before and immediately after surgery, as well as its resumption in most patients within 24 hours after surgery, with or without surgical pulmonary embolism prophylaxis, helps prevent both massive venous thromboembolic and hemorrhagic complications.
Despite significant advances in angiosurgery, the treatment of acute limb ischemia remains a challenging clinical problem. Historically, the mainstay of therapy consisted of open thrombectomy and bypass surgery, later supplemented by selective thrombolysis and percutaneous angioplasty techniques. However, even with these approaches, there remains a high risk of adverse outcomes, including amputations and mortality. A breakthrough in the treatment of occlusive-stenotic lesions in the femoropopliteal segment has been the advent of modern endovascular technologies. Numerous studies confirm their clinical efficacy and promise in acute ischemia. Particular importance has been given to a multidisciplinary approach combining advancements in vascular surgery, interventional radiology, and intensive care. Among innovative methods, rotational atherectomy deserves special attention as a technology demonstrating excellent results in treating acute occlusions of the femoropopliteal zone. The article presents clinical cases of successful treatment of femoral-popliteal lesions in acute ischemia of the lower extremities using rotational atherectomy devices.
Described herein is a clinical case of successful prosthetic repair of the aortic valve, ascending aorta and aortic arch according to the hemiarch technique from the left-sided thoracotomy. A 69-year-old female patient presented with an aneurysm of the ascending aorta and proximal aortic arch, a combined defect of the aortic valve and pronounced displacement of the mediastinal organs due to pulmonectomy performed in 2001. The classical procedure of the operation from the median sternotomy would be associated with technical difficulties and a high risk of lung injury owing to displacement of the mediastinum to the left, therefore left-sided lateral thoracotomy was chosen, thus making it possible to perform full-scope surgical treatment without exposure deterioration. The woman was discharged with no complications on POD 7 and rapidly rehabilitated. Precise knowledge of the anatomical location of the aorta and cardiac structures plays a large part in planning of the operation. That is why it is necessary to underline the importance of thorough preoperative CT planning prior to interventions on the thoracic portion of the aorta, with the use of alternative approaches in non-standard anatomy making it possible to avoid unexpected difficulties and complications during interventions on the thoracic aorta.
INTRODUCTION:Currently, for extensive occlusive lesions of the superficial femoral artery, the treatment of choice is femoropopliteal bypass grafting above the knee joint space. In the absence of a suitable autogenous vein or xenograft, synthetic grafts are used. One of the causes of thrombosis in the reconstruction zone after using synthetic grafts for femoropopliteal bypass grafting is the high incidence of restenosis in the anastomotic zone of arterial reconstruction due to endothelial dysfunction. One agent that normalizes endothelial function is a complex of bovine vascular regulatory polypeptides. STUDY OBJECTIVE:To evaluate the effectiveness of using a complex of regulatory polypeptides of bovine vessels after femoropopliteal bypass above the knee joint space with a synthetic prosthesis. MATERIAL AND METHODS:The study included 60 patients with stage III-IV lower extremity arterial atherosclerosis according to the Fontaine-Pokrovsky classification. They were divided into two groups of 30 patients each. All patients underwent surgery: femoropopliteal bypass grafting above the knee joint space using a synthetic prosthesis made of polytetrafluoroethylene diameter 8 мм. After surgery, patients in Group I, in addition to standard therapy, received one course of a drug based on a complex of bovine vascular regulatory polypeptides according to the instructions for use of Slavinorm® (intramuscular injections of the drug twice a week for 5 weeks, No. 10). Patients in Group II received only standard therapy according to clinical guidelines. To evaluate the effectiveness of treatment of patients, the following were used: measurement of the ankle-brachial index (ABI), ultrasound examination of the zones of the proximal and distal anastomoses of the femoropopliteal bypass, as well as measurement of the pain-free walking distance (PFWD) on the first day, 1, 3, 6, 9, 12 months after surgery. RESULTS:In groups I and II, the average ABI value before treatment was 0.46 and 0.44; 1 month after surgery 0.76 and 0.74; 3 months 0.77 and 0.71; 6 months 0.78 and 0.7; 9 months 0.785 and 0.7; 12 months 0.8 and 0.65, respectively. In groups I and II, the average DBH value before treatment was 31.5 m and 23 m; 1 month after surgery 118.5 m and 88 m; 3 months 128.5 m and 87 m; 6 months 128 m and 84 m; 9 months 134 m and 71 m; 12 months 138 m and 66 m, respectively. Changes in ABI and DBH in both groups throughout the entire follow-up period were statistically significant (p<0.001). Twelve months after surgery, the incidence of restenosis in Group I was 7 (11.6%) cases, while in Group II it was 15 (50%) cases. Postoperatively, at various follow-up periods, cases of BPS thrombosis were recorded: 1 (3.3%) case in Group I and 4 cases in Group II (13.3%). According to logistic regression data, in Group II patients who did not receive the bovine vascular polypeptide-based drug, the odds of developing restenosis in the arterial reconstruction zone were 3.25 times higher (OR 0.325, 95% CI 0.108-0.976, p=0.045) than in Group I patients. CONCLUSION:The use of regulatory polypeptides of bovine vessels after femoropopliteal bypass grafting above the knee joint space using a synthetic prosthesis reduced the incidence of restenosis of arterial reconstruction anastomosis zones by 3.25 times and, as a consequence, reduced the incidence of thrombosis of femoropopliteal bypass grafts.
Endovascular treatment of patients with abdominal aortic aneurysm is a minimally invasive alternative to open surgery with lower hospital mortality and rapid postoperative recovery. The maximum benefits are achieved in the elderly and comorbid patients with high surgical risk. However, long-term complications such as endolics and stent graft infection may require repeated interventions. The article presents a clinical observation of the occurrence of type I endolycosis 10 years after endovascular correction of an aortic aneurysm (EVAR) with suspected infection of the prosthesis. Stent graft explantation and aorto-femoral bifurcation prosthetics with a synthetic prosthesis were performed. The described case demonstrates the importance of a multidisciplinary approach and the use of modern imaging techniques for timely diagnosis and selection of optimal treatment tactics.
The modern direction of treatment of deep vein thrombosis of the lower extremities is endovascular interventions. Regional catheter thrombolysis and percutaneous mechanical thrombectomy are used to restore the lumen of a thrombosed vein. The results of these methods have been well studied. Venous stenting is used to eliminate residual venous obstruction. This endovascular technology has not yet been widely used in medical practice. The article summarizes the literature data reflecting the efficacy and safety of venous stenting. The emphasis is placed on the indications for endovascular intervention in the acute period of deep vein thrombosis. It is emphasized that the method of restoring the patency of thrombosed veins should be selected individually for each patient. The technology of venous stenting to eliminate iliac vein obstruction is described in detail. The results of using this technology and the factors negatively affecting the success of treatment are presented.
An abdominal aortic aneurysm in combination with a horseshoe kidney occurs in 0.12 to 0.7% of all abdominal aneurysms, according to various authors. This combination presents certain challenges for surgical repair. With the current level of development of surgery and imaging techniques, with the proper experience, it is possible to install a fenestrated aortic endoprosthesis with minimal surgical aggression and complete preservation of the function of the horseshoe kidney.
The aim was to evaluate the efficacy and safety of primary retrograde endovascular intervention in patients with necrotic lesions of the foot caused by chronic limb threatening ischemia. OBJECTIVE:The analysis of the results of 68 primary retrograde interventions in 64 patients with ischemic necrosis of the foot was performed. The average age was 69.2±9.7. Occlusion of the femoropopliteal segment occurred in 72.1% of observations. At least one crural artery was occluded in 79.4% of cases. There was a two-level occlusive lesion in 58.8% of observations, a three-level occlusion in 2.9%. Access was performed at the distal third of the crural arteries in 95.6% of cases. Access was performed through the sole patent crural artery in 25% of observations. The sole patent vessel was also feeding artery for affected angiosome in 14.7% of cases. Antegrade recanalization and angioplasty of the 'adjacent' crural artery were performed using primary retrograde distal access in 35 (51.5%) observations. The lesion of the 'adjacent' artery was represented by occlusion in 68.6% of cases. In addition, due to the presence of hemodynamically significant lesion of the proximal segment of the punctured vessel, in 27 (77.1%) observations angioplasty of two crural arteries was performed through the single access. RESULTS:Direct revascularization of the affected angiosome was achieved in 82.4% of observations. Blood supply to the ulcer was restored through the foot collaterals from the non-angiosome artery in 17.6% of cases. Angioplasty of the 'adjacent' crural artery was successful in 100% of observations. It was possible to perform intraluminal recanalization in 41.7% of cases of 'adjacent' artery occlusion (the average lesion length was 3 cm). In 58.3% of cases subintimal angioplasty was performed (the average occlusion length was 11 cm). Femoral access was required to successfully complete intervention in 5.9% of observations. Access site complications (7.4%) were local, occurred without any symptoms and in most cases (4 out of 5) were eliminated without loss of patency of the punctured artery. In one case active measures were not carried out due to good blood supply to the foot from other crural arteries. CONCLUSION:Primary retrograde endovascular intervention in patients with chronic limb threatening ischemia is effective and safe, including when performing through a sole patent crural vessel and/or when recanalization of the 'adjacent' artery through the distal single access is necessary.
OBJECTIVE:To study, summarize, and conduct a comparative analysis of four currently used methods for harvesting the great saphenous vein during coronary artery bypass grafting surgery. MATERIAL AND METHODS:A literature search was conducted using the electronic databases PubMed, eLibrary, and CNKI with specific keywords and inclusion criteria to select articles focused on evaluating the outcomes of different autologous vein graft harvesting techniques. RESULTS:Data from 22 selected scientific publications were analyzed. It was found that, in terms of long-term patency, the no-touch technique showed the best results; the traditional open technique is characterized by the highest number of complications; the endoscopic method provides the best cosmetic appearance of the postoperative scar but is somewhat inferior in terms of long-term graft patency. CONCLUSION:Currently, the choice of great saphenous vein harvesting technique largely depends on the technical equipment of the operating room and the personal experience of the surgeon. The development of autologous vein graft harvesting techniques reflects key trends in modern medicine aimed at achieving minimal invasiveness, precision, and treatment personalization. Each technique has unique clinical value and areas of application. In the future, with further progress in medical technology, these surgical methods are expected to continue improving, further reducing risks and improving patients' quality of life.
RELEVANCE:Currently, only one method of spinal cord protection-cerebrospinal fluid (CSF) drainage - has been rated as level 1 evidence in international guidelines for thoracoabdominal aortic aneurysm surgery. However, in recent years, there has been increased attention to complications of CSF drainage, such as intracranial hemorrhage. The aim determination of the frequency and risk factors of complications of CSF drainage during operations for thoracoabdominal aortic aneurysms. MATERIAL AND METHODS:A search of publications in the PubMed (Medline), Google Scholar, and Russian Science Citation Index (eLibrary) databases was conducted according to the PRISMA criteria. The ROBINS1 and ROBINS2 scales were used to assess the methodological quality of the studies. The pooled complication rate was calculated using a random-effects model (DerSimonian-Laird). Univariate (subgroup analysis) and meta-regression analyses were performed to assess the influence of the following parameters on the complication rate of CSF drainage: study type, article publication date, surgical approach, target CSF threshold pressure, CSF drainage rate, and CSF drainage method. RESULTS:The final analysis included 71 articles (10.798 patients) published from 1991 to 2024. In general, the methodological quality of the studies was acceptable, the risk of systematic error remained moderate. According to the meta-analysis, the incidence of all complications of CSF drainage was 11.9% (95% CI 9.7-14.1), the incidence of severe complications was 1.7% (95% CI 1.3-2.0), intracranial symptomatic hemorrhage was 1.3% (95% CI 1.0-1.7), and associated mortality was 1.1% (95% CI 0.1-3.1). High heterogeneity of studies and the absence of significant publication bias were noted. A significant increase in the incidence of complications was revealed in later publications. No differences were found in the incidence of CSF drainage complications depending on the type of publication, type of procedure, CSF pressure threshold used, drainage rate, and drainage technique. CONCLUSION:Due to the high complication rate, a careful assessment of the benefits and risks of CSF drainage is necessary. This study highlights the limitations of the available data, the high prevalence of complications associated with CSF drainage, and the need for further research to determine the true complication rate and evaluate various CSF drainage protocols.
The review presents and summarizes current knowledge about endothelial dysfunction in atherosclerosis and chronic venous disease. The data on various biomarkers and methods of studying endothelial damage are analyzed, as well as modern drugs affecting its function.
OBJECTIVE:To study the state of tissues of the aortic wall in the area of the proximal neck of an aneurysm in patients with lethal outcomes due to aneurysmal rupture. MATERIALS AND METHODS:A fragment of the aortic wall for histological examination was procured from the area of the proximal neck of aneurysms in 16 patients who died from ruptured aneurysms of the abdominal and thoracic aorta. The fragment of the aortic wall to study was taken at a distance from 1 to 4 cm above the upper pole of the aneurysm. The specimens after being treated with phosphotungstic acid were stained with hematoxylin and eosin, aniline blue. RESULTS:Damage to all layers of the aortic wall was revealed at a distance of 1 cm from the upper pole of the aneurysm. The most pronounced changes were observed in the medial layer. At a distance of 2 cm from the upper pole of the aneurysm, the aortic wall was found to contain atherosclerotic plaques circumscribed by a thick, dense layer of collagen fibers with diffuse hyalinosis. At a distance of 3 cm from the upper pole of the aneurysm, there was a decrease in the severity of the lesion of the aortic wall. At a distance of 4 cm from the upper pole of the aneurysm, in the media predominated foam cells, visualizing pronounced medial atrophy, with replacement of elastic fibers by coarse collagen fibers. CONCLUSION:In patients with ruptured aortic aneurysms, the structural integrity of the aortic wall begins at a distance of 4 cm above the upper pole of the aneurysm, which should be taken into consideration when performing surgical treatment.
BACKGROUND:Abdominal aortic aneurysms (AAA) occupy the first place by the incidence amongst all aortic aneurysms and are found in 0.1-1.6% of all autopsies. The natural outcome of the AAA course is rupture occurring, according to literature data, in 50-80% of patients Amongst AAAs, there are forms posing great challenges in diagnosis and surgical management due to rarity of the disease and diversity of clinical manifestations. OBJECTIVE:The purpose of this study was to determine the leading clinical signs of rare forms of AAA rupture and develop optimal surgical tactics of treating them. PATIENTS AND METHODS:At the Department of Vascular Surgery of the 'Institute of Emergency and Restorative Surgery named after V.K. Gusak', we operated on a total of 633 patients with AAAs, of these, 285 (45%) for a ruptured aneurysm. Amongst the latter, there were 22 (7.7%) patients presenting with rare forms of rupture defined as: chronic contained rupture in 7 (2.5%) patients, aneurysmal rupture into the gastrointestinal tract with the formation of an aortoenteric fistula in 6 (2.1%) patients, rupture into the inferior vena cava with the formation of an aortocaval fistula in 6 (2.1%) patients, and a combination of AAA rupture with abdominal aortic dissection in 3 (1%) cases. The main methods of examination included duplex and triplex scanning, Doppler ultrasonography, and in insufficient information, spiral computed tomography (SCT) and SCT-angiography. RESULTS:All 22 patients were operated on. Of these, 9 (40.9%) patients died. The diagnostic peculiarities were as follows: 1. Chronic contained rupture turned out to be difficult to differentiate from a retroperitoneal tumor, both before and during surgery. Two-phase nature of clinical manifestations was characteristic of the clinical course of this variant of rupture. 2. Aortoenteric fistulas were characterized by symptoms of a pulsatile mass in the abdominal cavity, relapsing gastrointestinal bleeding, with negative results of fibrogastroduodenoscopy. 3. Aortocaval fistulas were characterized by systolic-diastolic murmur above the aneurysm and acute right ventricular cardiovascular insufficiency. CONCLUSION:Diagnosis of rare forms of AAA rupture is a difficult task, the clinical course of the disease is characterized by a wide variety of symptoms, thus leading to delayed rendering of emergency specialized care. Surgical tactics in rare forms of abdominal aneurysm rupture has not yet been standardized and solving this problem requires further accumulation of experience.
AIM:The aim of our study was to estimate initial and long-term outcomes of ascending aortic and root replacement with either xenograft or allograft in patients with chronic aortic aneurysm. MATERIAL AND METHODS:Forty-five patients were enrolled in the study from January 2017 to May 2023. In 23 patients a Medtronic Freestyle xenograft was applied, while 22 patients underwent allograft implantation. Early safety, clinical efficacy were analyzed using VARC-3 and ICHOM criteria at exact time points using non-parametric statistics. Time-to-event survival analysis was performed using log-rank test and Kaplan-Meier curves. RESULTS:Patients from both groups demonstrated excellent early results with zero 30-day mortality. There were no incidence of myocardial infarction, deep sternal wound infection and pacemaker implantation. One patient after xenograft implantation was complicated with ischemic stroke. Resternotomy for bleeding was required in one patient from both groups. Patients with either allograft or xenograft demonstrated 100% freedom from structural deterioration, redo surgery, endocarditis and pacemaker implantation during the whole follow-up period. Allograft implantation was associated with significantly better survival compared with xenograft (100 vs 78.3%, OR 10.53; 95% CI 0.0128-0.3839; р=0,036) and better quality of life (95% CI -22.76, -2.244; р<0.05) two years after surgery. The number of patients with left ventricle hypertrophy was significantly higher after xenograft implantation regardless the overall reduction in left ventricle hypertrophy in both groups compared with preoperative variables (р=0.03). The maximum and average pressure gradient at the aortic root after surgery and one year after surgery was statistically significantly lower after allograft implantation [16.0 (11.8-21.0) and 7.0 (5.0-10.0) vs 7.0 (6.0-10.0) and 3.0 (3.0-5.0); 95% CI (4.326-13.67) and 95% CI (1,844-6,156); p<0.05]. The analysis of survival to the endpoints was carried out in 6-, 12-, 18-, 24-, 36-, 48- the monthly period after surgery. Expected survival in the allograft group through 6, 12, 18, 24, 36, 48 for a month and beyond, it was 100%. Survival rate in the xenograft group over the same time periods - 82,6; 82,6; 82,6; 77,7; 77,7; 77.7% (log-rank test, p=0.02). CONCLUSION:Ascending aortic and root replacement with either xenograft or allograft demonstrated excellent early results with zero 30-day mortality and lower rate of complications in selected patients. Clinical efficacy, quality of life and time-to-event analysis may justify in favor of allograft ascending and root replacement, although it should be studied further. Allograft aortic replacement showed better hemodynamic profile with regard to significantly lower number of patients with LV hypertrophy and lower peak and mean pressure gradients on aortic root.
RELEVANCE:Arterial disease of the lower extremities is a common form of atherosclerosis associated with an increased risk of cardiovascular disease and mortality. Arterial disease of the lower extremities tends to progress from asymptomatic forms to intermittent claudication and critical ischemia. Sulodexide therapy in patients with PH allows for increased pain-free walking distance. At the same time, the scientific literature has not fully documented how long-term sulodexide therapy affects the quality of life of patients with arterial disease of the lower extremities. The aim of the study was to evaluate the effect of sulodexide on the quality of life of patients with arterial disease of the lower extremities. MATERIAL AND METHODS:The multicenter prospective observational study of ANDANTE included patients with PH stage IIa-IIb according to the classification of A.V. Pokrovsky receiving sulodexide therapy. During the 6-month follow-up, 4 visits were conducted, during which the quality of life was analyzed based on a subjective assessment of physical and mental health using the SF-36 questionnaire. Pain-free walking distance, ankle-shoulder index, self-assessment of erection retention, WELCH walking ability scale scores, and Hasegawa dementia scale scores were also evaluated for men. In this article, we have considered only the dynamics of patients' quality of life in terms of physical and mental health on the SF-36 scale as the primary endpoint of the study. In the future, data on other criteria for the treatment of patients will be presented. RESULTS:The study included 229 patients aged 37 to 90 years (on average, 65.0±9.9 years). Men prevailed among the patients - 159 (69.4%) patients. There were 118 (51.5%) smokers and 111 (48.5%) non-smokers. The average duration of the disease from the moment of diagnosis of arterial disease of the lower extremities to inclusion in the study was 6.0±6.3 years. In addition to OCD, 72.5% of patients were diagnosed with hypertension, 28.4% with cerebrovascular disease, 26.6% with coronary heart disease, 25.3% with diabetes mellitus, and 19.7% with erectile dysfunction. At the time of inclusion in the study, 61.6% of patients were taking antiplatelet agents, 10.9% were taking direct oral anticoagulants, and 46.3% of patients were taking lipid-lowering therapy. At the time of inclusion in the study, 147 (64.2%) patients followed the recommendations on physical activity. Revascularization before inclusion in the study was performed in 19.2%, and 80.8% were treated conservatively. The study did not record any adverse events during sulodexide therapy. Compliance with therapy was high and averaged 4.6 points on a 5-point scale. The indicators of the physical aspect of the quality of life on the SF-36 scale significantly increased (p<0.01) after 6 months of treatment with sulodexide from 35.7±8.3 points on the first visit, to 44.6±7.2 points on the fourth. At the same time, the indicator increased by 8.9 (24.9%) points. The mental aspect of the quality of life during treatment also significantly improved from 45.4±9.9 to 51.6±6.7 points, an increase of 6.2 (13.6%) points. CONCLUSION:ANDANTE's study showed an improvement in subjective physical by 24.9% and mental by 13.6% aspects of quality of life on the background of sulodexide therapy in patients with ZANK.
The article presents a clinical case of staged surgical treatment of a patient with acute complicated aortic dissection of the B type on the background of symptomatic abdominal aortic aneurysm with risk of rupture and the presence of HIV infection. Surgical intervention was performed: left-sided thoracophrenolumbotomy through the eighth intercostal space, elimination of abdominal aortic dissection with surgical correction of visceral and renal arteries, resection of abdominal aortic aneurysm with aorto-femoral bifurcation prosthetics. The patient was discharged on the 14th day after surgery. A control MSCT angiography of the aorta revealed the formation of a descending thoracic aortic aneurysm, which required a number of staged endovascular surgical interventions. Further follow-up showed no complications up to 5 years. This article considers the problem of choosing the optimal treatment strategy for the complicated course of aortic dissection, which requires a collegial discussion and dynamic postoperative follow-up.
