OBJECTIVE:The purpose of the study was to determine clinical and laboratory predictors suggesting an unfavorable outcome of acute limb ischemia. PATIENTS AND METHODS:The work was based on retrospective assessment of treatment of 556 patients with confirmed acute limb ischemia, undergoing treatment in 2000-2018. All patients were operated on. The mean age amounted to 69.9±12.8 years. Women accounted for 51.3%. According to the classification of I.I. Zatevakhin, degree I ischemia was in 36.1% of patients, degree II in 59.2%, and degree III in 4.7%. In the majority of patients, acute ischemia was caused by arterial embolism. The patients were divided into two groups: Group 1 included those discharged with the saved limb after restoration of arterial blood flow and Group 2 comprised patients discharged after amputation. RESULTS:The time from the onset of the disease to the moment of surgical intervention in Group 2 was 10.3-fold longer (p=0.0001). Arterial thrombosis was 2.5 times more associated with the risk of major amputation (p=0.002). The chance of amputation in acute ischemia of upper extremities was 6.8 times less than in lesions of lower limbs (p=0.003). Distal lesions of lower-limb arteries increased 3.6-fold the risk of amputation (p=0.001). The chance of limb loss directly depended on the ischemia degree (p<0.024). In Group 2 patients, the neutrophil-to-lymphocyte ratio was 1.5-fold higher (p=0.001). CONCLUSION:The duration prior to revascularization, limb ischemia degree, etiology and the level of the arterial bed lesion remain the most significant predictors of an unfavorable outcome in acute limb ischemia. Elevated values of the neutrophil-to-lymphocyte ratio appeared to directly associated with the necessity to perform amputation.

BACKGROUND:In the structure of surgical events, acute limb ischemia is a cause of death in 25-30% of patients. OBJECTIVE:The present study was aimed at examining the structure of patients with lower and upper limb acute ischemia in the Barnaul urban agglomeration. PATIENTS AND METHODS:We analyzed a total of 1,366 patients presenting with arterial embolism or limb thrombosis within 14 days after the onset of the acute event and hospitalized to the Department of Vascular Surgery during 2000-2018. The epidemiological index of acute limb ischemia amounted to 10.1 per 100 thousand people per year, being comparable with the data of the international statistics. Of these, 865 patients were hospitalized during 2000-2010, and 501 during 2011-2018. RESULTS:Comparing the groups demonstrated an increased number of hospitalizations of women (from 4.6 to 5.3 per 100 thousand/year) in the structure of all patients with acute ischemia, a statistically significant decrease in the number of patients with arterial thromboses, and an increase in the number of those admitted with arterial embolisms. We revealed a tendency to a decrease in the overall number of hospitalized patients and an increase in the number of patients with stage II-III arterial ischemia, with upper limb ischemia diagnosed significantly more often (from 1.4. to 3.2 per 100 thousand/year). CONCLUSION:Along with a trend towards a decrease in the total number of hospitalized patients with acute limb ischemia, we revealed an increase in the number of patients with acute limb ischemia in the presence of arterial embolism and a decreased number of patients with acute arterial thrombosis.

Research objective. To study the structure of VTEC hospitalization and changes in this structure over the last 10 years.Materials and methods. The retrospective analysis of hospitalization of 2327 patients with VTEC for a 10-year period (2010–2019). Depending on the period of admission, patients were divided into 2 groups: the first group (1104 patients) included people hospitalized in the period of 2010–2014; the second group (1223 patients) – admitted to the hospital in the period of 2015–2019. The structure of hospitalization was analyzed. The dynamics of the number of hospitalizations of VTEC nosological forms was studied.Results and conclusions. No statistically significant difference was found in the frequency of VTEC hospitalization, but there is a tendency to an increase in the total number of VTEC. According to the data, the annual frequency of VTEC was 65.5 cases per 100 000 population. The significant increase in frequency of hospitalization of PATE patients was found. This fact may be related not only to the improvement of diagnosis, but also to the increase in the intensity of the thrombotic process. The study presented took into account VTEC requiring treatment in a specialized unit, without regard to VTEC recommended for the outpatient stage of treatment.

The authors carried out a retrospective analysis of clinical efficacy of streptokinase and alteplase (actilyse®) in patients presenting with high- and intermediate-to-high risk pulmonary artery thromboembolism (PATE) who were discharged from hospital after appropriate treatment performed. Of the total number of the treated patients, we formed 2 groups comprising 20 patients each, receiving alteplase (group 1) and streptokinase (group 2). The patients were comparable by the main clinical characteristics, predisposing factors, severity of pulmonary artery thromboembolism (PATE) and duration of treatment. Efficacy of thrombolytic therapy assessed clinically and instrumentally did not differ. However, by the stratified risk and frequency of PATE relapses, the condition of patients receiving alteplase turned out to be more severe. Based on the obtained results, a conclusion was made that actilyse is a drug of choice for treatment of patients with PATE.

The purpose of the study was to optimize the technique of removing the trunk of the great saphenous vein (GSV) in patients over 60 years. The study included a total of eighty-five patients aged over 60 years and presenting with primary varicose veins of the lower limbs and undergoing operations performed on the superficial venous system, including all stages of classical phlebectomy - crossectomy, stripping of the GSV, removal of tributaries and ligation of incompetent perforant veins. The patients were divided into two groups: the Study Group (n=44) patients endured removal of the GSV with the use of the technique of temporal tamponing of the canal, while in Group Two patients, composing a comparison group (n=41), the GSV was removed without the use of a tampon. The groups of the patients were comparable by the main characteristics, as well as by the CEAP class and the types of the operations performed. The results of treatment were studied clinically with the use of the Venous Clinical Severity Score (VCSS). In the Study Group patients, the average VCSS score decreased from 1.52±0.11 to 0.47±0.05 (p=0.007) and in the Comparison Group from 1.21±0.11 to 0.85±0.06 (p=0.028). In the remote terms after the operation, in the Study Group patients the average VCSS score appeared to be 2 times lower than in the control group, amounting to 0.47±0.05 and 0.85±0.06, respectively (p=0.007). A conclusion was drawn that in surgical treatment of varicose veins in elderly and aged patients while removing the grate saphenous vein, it is appropriate to use the technique of temporary tamponing of the canal, which is associated with better results in the remote period as compared to the traditional stripping.

The authors studied dilatation of a biological prosthesis (a specially treated xenograft made of bovine arteries) used as a femoropopliteal bypass in patients presenting with diseases of peripheral arteries. Structural alterations (ectasia) were examined in a total of 15 patients within the terms varying from 1 year to 7 years after the operation, resulting in working out a methodology of calculating structural changes of the conduit with characteristics of the composite index of dilatation of the conduit. The presence of aneurysmatically dilated portions whose dimension exceeded the initial size of the xenograft 3-4-fold did not influence the long-term patency of the shunt with preserved blood flow approximated to the major one. This made it possible to avoid a repeat surgical intervention.

The present study enrolling a total of eighty-eight 4-to-16-year-old children and adolescents was aimed at detailed elaboration and formalization of clinical signs of the internal carotid artery pathological kinking syndrome. To achieve these objectives, the authors carried out a comparative analysis of clinical manifestations of the disease in the surgically treated subjects (constituting the Surgery Group comprising 43 children and adolescents) and non-operated patients (making up the Comparison Group consisting of 45 age- and gender-matched subjects). There were no baseline differences in the incidence rate of clinical syndromes and symptoms between the groups of the would-be operated and conservatively treated patients. Also studied were the remote outcomes (1-to-12-year follow up) of surgical correction for pathological tortuosity of the internal carotid artery. The incidence rate of regression of neurological symptomatology along different clinical signs after surgery was shown to vary within a wide range from 11.6% to 96.3%. Resection of the proximal portion of the internal carotid artery with re-implantation into the old ostium turned out to be clinically effective in 90.0% of cases, with the haemodynamic efficacy amounting to 83.3%. Arteriolysis of the internal carotid artery rendered a clinical effect in 75% of cases, with a haemodynamical effect thereof equalling 25.0%. The decision as to the type of a surgical intervention to perform was primarily made based on the findings of angiography of the internal carotid artery. The operation of arteriolysis did not lead to deterioration of the child's condition.