The article is based on the materials of a representative sociological survey conducted in 2016 in Yaroslavl. Based on the analysis of the standardized survey data, it is revealed that the reasons for the weakening of the consolidation potential of the society are: changes in the social structure of society; violation of intergroup and interpersonal contacts; weakening the feeling of empathy towards our fellow citizens; erosion of social identities; changes in the system of norms of social morality. It is proved that in the transitive society the influence of the level of social consolidation of the society on the process of forming social solidarity is great. At this time, society is experiencing a crisis of social solidarity. It is shown that the consolidation potential looks different in different social groups in different ways, that most of all consolidation is destroyed in the relations of people with the state. The disintegration of institutions actualized the dangerous for the future development of Russian society trend: people leave the public space in a personal-family, they rely only on their own strength, close in the family. In society, the process of adaptation to cash prevails, a short-term reaction to what is happening, which leads to a narrowing of the scope of publicity, to the curtailment of institutions that promote the maturity of civil society and the competitiveness of the political system.

Рассмотрены результаты морфологической изменчивости Tulipa tarda Stapf в интродукционных популяциях ботанических садов трех стран: Казахстана (г. Алматы), Кыргызстана (г. Бишкек) и Украины(г. Харьков). На основании многолетних наблюдений доказано, что он является наиболее перспективным представителем дикорастущих тюльпанов Казахстана для культивирования в различных зонах Северного полушария. Выявлено, что морфологические параметры генеративных особей зависят от географического положения местности, климатических условий и типа почв. Достоверность результатов подтверждается тем, что наблюдения проводились в один и тот же год по единой методике и на достаточном для сравнения количестве материала. Наиболее оригинальные данные получены в Ботаническом саду Харьковского университета, где под наблюдением находятся три популяции разного происхождения, отличающиеся условиями выращивания. По количеству цветков и листьев генеративных особей самое мощное развитие отмечено в популяции с периодическим выкапыванием луковиц и стабильным агротехническим уходом. Здесь же на заброшенном участке те же морфологические показатели сходны с таковыми в коллекциях гг. Алматы и Бишкека. Установлено, что исследуемый вид отличается высоким уровнем адаптации, успешно натурализуется, образует самосевные популяции на газонах путем самопроизвольного заноса семян. Доказано, что температура, влажность воздуха, сумма осадков и долгота дня в разных регионах выращивания меньше влияют на морфологию вида, чем периодическое выкапывание и агротехнический уход.

According to the data of various statistical studies, 76% of patients with occlusion of the aortoiliac arterial bed are found to have lesions of the femoropopliteal segment. Surgical treatment of patients presenting with multi-layered atherosclerotic lesions still remains one of the most complicated problems of vascular surgery, since adequate revascularization of lower limbs requires correction of the inflow and outflow pathways. In the early postoperative period in patients with lower limb ischemia with multilevel lesions, as well as while performing conventional open reconstructions on the aortoiliac segment, the complication rates still remain high. Presented in the article are the results of a single-center randomized study comparing a hybrid procedure and aortofemoral bypass grafting for lesions of iliac arteries and the common femoral artery. All patients were enrolled into the study according to inclusion and exclusion criteria. The duration of follow up amounted to 24 months. The obtained findings demonstrated safety of the hybrid procedure in the early postoperative period, as well as a shorter length of hospital stay. High efficacy of hybrid operative interventions: clinical improvement in 92-98% of cases with low incidence of postoperative complications make promising the development of this direction of reconstructive vascular surgery in this cohort of patients as compared with aortofemoral bypass grafting. Our study was aimed at revising the guidelines on endovascular treatment of TASC II type C/D lesions of the aortoiliac segment, as well as implementing hybrid techniques in treatment of this cohort of patients.

AIM:The study was aimed at assessing efficacy and safety of endovascular treatment of abdominal aortic aneurysms based on 11-year experience with implantation of stent grafts.PATIENTS AND METHODS:We retrospectively analysed outcomes of treatment of 242 patients with abdominal aortic aneurysm during the period from 2008 to 2019. Of these, 210 (86.78%) were males, mean age 69.32±7.36 years. Diagnosis was made using colour duplex scanning and contrast-enhanced multislice spiral computed tomography, with implanting the following stent grafts: Ella - 44, Ovation Prime - 33, Anaconda - 13, Endurand - 77, Aortix - 2, Zenith - 33, Seal - 39, with one endoprosthesis placement failed. Assessing safety of the operation, we took into consideration lethality due to aortic rupture/thrombosis. Efficacy was taken to mean technical success of the operation (implantation of all components of the endograft without switch to open surgery), the number of reoperations.RESULTS:Technical success of the operation was achieved in 98.35% of cases. In 1 case due to pronounced arterial calcification for technical reasons we failed to position the stent graft and in another case - the contralateral leg of the Ella prosthesis. The early postoperative period revealed: type A1 endoleak - 3.7%, type IB - 4.13%, type IIA - 6.6%, type IIB - 4.54%, type III - 0.83%, type IV - 0.83%. Repeat operations were performed in 20 (8.2%) patients within 30 days after the intervention and in 32 (13.22%) in the remote period. In the early postoperative period two conversions were performed: 1) iliorenal bypass grafting for restoration of blood flow through the renal artery occluded by endoprosthesis wall; 2) evacuation of retroperitoneal haematoma due to rupture of the common femoral artery. Lethality during the whole period of follow up amounted to 32 (13.22%) cases. Of these, due to aortic complications 4.54% (n=11) and due to accompanying pathology 8.67% (n=21). A direct correlation was revealed between the aortic diameter and duration of the operation which in turn increases the risk of complications requiring re-operation or resulting in a lethal outcome (RR - 1; 95% CD 1- 1; p=0.026).CONCLUSION:Our experience showed high safety and efficacy of stent graft implantation in treatment of patients with abdominal aortic aneurysms and high surgical risk.

It is assumed that the characteristics of stents including design of device may be predictors of adverse outcomes in carotid stenting. New stent designs enter the market and the stent manufacturers declare their ability to prevent periprocedural and postprocedural embolisms. The article provides an overview of clinical trials comparing the incidence rates of restenosis and ischemic complications in carotid artery stenting with various stent designs. In theory, the closed-cell stents and doublelayer stents are superior to the open-cell stents in preventing the postprocedural cerebral embolisms. However, the clinical significance of this phenomenon has not been proven, and the data on the effect of various carotid stent types on the stenting results remain controversial. In many cases, the choice of stent depends on the anatomy of the target vessel. The results of new randomized controlled clinical trials may clarify the clinical relevance of various stent designs.

Endovascular management of femoropopliteal lesions has proven effective. A large number of publications indicates the relevance and prospects of this method. The article presents an analysis of studies over the past 5 years about different treatment techniques, the use of cytostatics coated balloons and stents. Ways to improve the outcomes of femoro-popliteal bypass surgery are proposed.

Aim . To compare the effectiveness of superficial femoral artery (SFA) stenting with/without lamina vastoadductoria dissection. Material and methods . The study included are 70 patients with TASCII type C and D lesions. All patients were divided onto 2 groups: group 1 (n=35) — conventional SFA stenting, group 2 (n=35) — SFA stenting with lamina vastoadductoria dissection. The average lesion length in group 1 was 22,92±5,62 cm, in group 2 — 21,2±5,42 cm. The primary endpoint was the absence of binary restenosis and reocclusion. Secondary composite endpoint was procedural success, limb salvage, secondary patency of the operated segment, intraoperative complications. The groups were comparable in age, sex, risk factors and comorbidities. Results . The procedural success in both groups was 100%. Primary patency after 24 months was 28,5% in group 1 and 60% in group 2. During the 24-month follow-up period, we recorded 1 death in group 2 due to myocardial infarction. In group 1, 2 deaths due to myocardial infarction and pancreatic cancer metastasis were recorded. Limb salvage was 100% in both groups. There were no intraoperative complications in both groups. Conclusion . Lamina vastoadductoria dissection is safe and does not lead to limb functional limitations. Biomechanical changes in the distal SFA segment contribute to the improvement of primary patency after stenting of SFA long lesions. Preliminary results of the single-center pilot study demonstrate the safety and efficacy of SFA stenting with lamina vastoadductoria dissection, emphasizing the need for further larger studies to compare it with conventional stenting and to assess the effectiveness during the long-term follow-up.

AIM:The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system.PATIENTS AND METHODS:Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta.RESULTS:Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed.CONCLUSION:From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.

Aim. To compare a novel technique of carotid endarterectomy (CEA) with autoarterial remodeling (AAR) of carotid bifurcation and the conventional patch angioplasty in relation to effect on 24-hour blood pressure (BP) and heart rate (HR) in the short- and long-term postoperative periods.Material and methods. This prospective, randomized, comparative trial included 200 patients which were divided into 2 groups: group 1 (n=100) — patients after CEA with AAR, group 2 (n=100) — patients after conventional xeno-pericardial patch repair. Twenty four-hour monitoring of BP and HR was performed before and after surgical treatment, both in short- and long-term postoperative periods in both groups. The follow-up period was 3 years.Results. Surgery in both groups was associated with an increase in HR, systolic and diastolic hypertension time index. Damage to carotid sinus enhances sympathetic innervation and disrupts the baroreflex regulation. Conclusion. The study did not reveal a significant difference in the incidence of postoperative hypertension and the dependence of HR on sel ected surgical technique. Thus, the proposed novel method of CEA with AAR of carotid bifurcation does not increase the risk of preexisting hypertension.

Aim. To compare the effectiveness of superficial femoral artery (SFA) stenting with/without lamina vastoadductoria dissection.Material and methods. The study included are 70 patients with TASCII type C and D lesions. All patients were divided onto 2 groups: group 1 (n=35) — conventional SFA stenting, group 2 (n=35) — SFA stenting with lamina vastoadductoria dissection. The average lesion length in group 1 was 22,92±5,62 cm, in group 2 — 21,2±5,42 cm. The primary endpoint was the absence of binary restenosis and reocclusion. Secondary composite endpoint was procedural success, limb salvage, secondary patency of the operated segment, intraoperative complications. The groups were comparable in age, sex, risk factors and comorbidities.Results. The procedural success in both groups was 100%. Primary patency after 24 months was 28,5% in group 1 and 60% in group 2. During the 24-month follow-up period, we recorded 1 death in group 2 due to myocardial infarction. In group 1, 2 deaths due to myocardial infarction and pancreatic cancer metastasis were recorded. Limb salvage was 100% in both groups. There were no intraoperative complications in both groups.Conclusion. Lamina vastoadductoria dissection is safe and does not lead to limb functional limitations. Biomechanical changes in the distal SFA segment contribute to the improvement of primary patency after stenting of SFA long lesions. Preliminary results of the single-center pilot study demonstrate the safety and efficacy of SFA stenting with lamina vastoadductoria dissection, emphasizing the need for further larger studies to compare it with conventional stenting and to assess the effectiveness during the long-term follow-up.

AIM The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.

Клинический случай успешного оперативного лечения пациента с гигантской аневризмой подвздошной артерии типа Е и подковообразной почкой.

Described herein is a clinical case report regarding successful endovascular treatment of a patient presenting with an abdominal aortic aneurysm combined with occlusion of one of the iliac arteries. Cases concerning elimination of such pathology appear to be reported only sporadically in the available literature. The patient underwent reconstructive repair in two stages. The first stage comprised recanalization with stenting of the occluded iliac artery on the right and implantation of the Zenith stent graft. The findings of intraoperative check angiography showed no evidence of endoleak, with the preserved patency of both the stent graft and iliac arteries on the right. The second stage consisted of balloon angioplasty of stenosis of the external iliac artery on the left. The results of the follow-up examination at 3 years showed that the iliac arteries on both sides and the aortic endograft were free from significant stenoses, with no evidence of endoleaks.

Endovascular interventions have proved efficacy in the treatment of the shin arteries lesion management. Lots of published works witness on the significance and future perspective of the field. The article is focused on the analysis of studies for previous 5 years, on various treatment approaches, balloons and cytostatics coated stents usage. The ways for interventions relsults improvement are sketched on tibial arteries with drug eluting stents.

The article deals with a case report regarding successful surgical management of late type IB endoleak caused by dislocation of the leg of the stent graft, occurring three years after endoprosthetic repair of an aneurysm of the aortic infrarenal portion with the COOK stent graft, aneurysmectomy with prosthetic repair of the right common femoral artery using the linear vascular graft Intergard 8Ч20. The patient underwent surgical treatment: endoprosthetic repair of the iliac branch ZSLE-24-90-90 ZT of the Zenith Spiral AAA stent graft. The findings of the check-up angiography and ultrasonographic examination revealed no evidence of endoleak, with the stent graft's patency preserved. The early postoperative period was marked with moderate manifestations of asthenic syndrome. The patient was discharged in a satisfactory condition. Cases concerning removal of similar complication in the remote period following endoprosthetic repair of the aorta are mentioned sporadically in the available literature.