The authors retrospectively analysed therapeutic results of treatment in a total of 749 patients of the Pyoseptic Surgery Unit with signs of lower limb critical ischaemia. Of these, 101 (13.5%) patients were found to have a pronounced septic process (successfully arrested in 88 patients). A further 86 (11.5%) patients were diagnosed with extended trophic alterations making revascularization unpromising. The incidence rate of "major" amputations in this group amounted to 34.2%, with a lethality rate of 5.9%. Severe somatic pathology was revealed in 106 (14.2%) patients, with the incidence of "major" amputation in this group equalling 27.4% and lethality rate - 10.4%. The neuropathic form of diabetic foot syndrome with no evidence of ischaemia was noted observed in 174 (23.2%) patients, "major" amputations in this group were performed in 3 (1.7%) patients, with a lethality rate of 0.6%. Impossibility of revascularization had previously been ascertained in 98 (13.1%) patients; "major" amputations in this group were performed in 38 (38.8%) patients, with a lethality rate of 6.1%. Sixty-nine (9.2%) patients were admitted for further treatment after previously performed reconstructive operations, including unsuccessful ones; the frequency of major amputations and lethality rate in this group amounted to 13.0 and 2.9%, respectively. Of the total number of the analyzed patients, 207 (27.1%) required considering the problem concerning possibility of revascularization. Surgical revascularization was performed later on in 34 (16.7%) patients in this group, and the incidence of "major" amputations amounted to 5.9% remaining at the same level in the remote period of follow up. In patients who were not subjected to revascularization, the incidence of "major" amputations during 3 months amounted to 9.5% reaching 27.2% by 42 months of follow up. The survival rate after 42 months in these groups amounted to 72.7 and 68.0 %, respectively.

The article presents the treatment results of 92 patients with critical limb ischemia for up to 12 months depending on the treatment strategy. In the 1 st group (72 patients) the revascularizing surgery was performed. In 42 cases open surgical operation were performed (29 femoro-poplitea-tibial reconstructions, in 6 aorto-femoral reconstructions and in 7 cases «double-stage» reconstructions). In 30 cases roentgen-endovascular surgeries were performed (in 22 cases reconstructions of crural arteries). The 2 nd group consisted of 20 patients who were not performed a reconstructive surgery for various reasons. One-year limb salvage was 95.8% in the 1 st group and 80.0% in the 2 nd group, the survival rates 97.2 and 70.0% respectively. Critical ischemia as a result of revascularization was eliminated in 87.8% of patients, and after 6 months of observation trophic defects had only 4.2%. In the 2 nd group critical limb ischemia remained at a period of 12 months in 85.7% of patients.

The hemodynamic estimation of leg arteries balloon angioplasty effect in 28 patients with ischemic form of diabetic foot using color duplex scanning (CDS) and laser Doppler flowmetry (LDF) was done. Average 72.2±1,7 year. All of them had tissues loss at the background of popliteal-tibial segment lesion. Anterior tibial artery angioplasty was performed in 19 patients, posterior in 4 people, popliteal artery lesion in 1 patient, peroneal artery in 10 patients. Macrohemodynamic parameters recorded by CDS in both tibial arteries were measured at foot before surgery and 1 day after. Increase of blood flow velocity (PSV) to 73,2% (p<0,01) in recanalized artery was revealed. In arteries with collateral revascularization increase PSV gain has made 26,9% (p<0,01) and resistivity index had increased (Ri) (p<0,01). LDF parameters recorded in two standard points on the foot, according to anterior and posterior tibial arteries angiosomes prior to surgery and daily for 5 days. No significant changes in microcirculation have been identified. The long-term results analysis (6 months) showed limb salvage in 96.2% of cases (1 large amputation), in 80.8% cases healing of trophic disorders.

The immediate results of 20 bilateral aortofemoral reconstructions performed through minimal retroperitoneal access for the period of 2002-2010 were analyzed. There were 3 ways of the abdominal wall dissection the median, subcostal and para/transrectal. In all cases the aorta exploration was possible only in the range of 2-3 cm above the mouth of the inferior mesenteric artery. The angle of operating action (AOA) at pararectal/transrectal mini-access to the proximal anastomosis was (longitudinal/transverse projection) 61,5°±2,7°/53,5°±3,2°; wound depth 8,8±0,3/7,8±0,4. In case of median retroperitoneal access of AOA to the proximal anastomosis accordingly was 55,0°±5,0°/46,7°±7,3°; wound depth 8,7±1,2/9,0±0,6 cm. At subcostal access in all cases AOA was less than 30° (26,3°±2,4/36,3°±5,5°; p

5000 extracranial arteries CDS protocols for the period from 2010 to 2012 were analyzed. The age ranged from 40 to 90 years old (average age 58,9±0,15 years). Among them there were 2550 men and 2450 women. 4104 patients (82,1%) had no stenotic disease, 445 (8,9%) patients had small, 329 (6,6%) moderate and 106 (2,1%) patients significant ICA stenoses. 16 (0,3%) patients had ICA occlusion. CCA IM-thickness of less than 0,1 cm had 29,7% of patients, CCA IMT 0,11-0,14 cm 50,6%; 0,15-0,19 cm had 16,9% patients, thickness of 0,2-0,24 cm had 2,5% of patients, and more than 0.25 cm CCA IMT had 0.2% of patients. There was revealed a significant positive correlation between the average thickness of CCA IMT and the degree of stenosis of the internal carotid artery (r=0,46; t=6,57; p

Cardiovascular diseases are the main cause of disability and mortality in developed countries. Identifying patients for primary prevention is not conducted in time today. Therefore, searching the methods that allow making a selection of patients for high-tech diagnostic methods seems to be very important. The authors conducted pathology screening of magistral arteries in an industrial organization. In total, were surveyed 991 patients of both sexes aged over 45 years (mean age — 55,6±0,16 years). As a result of screening, were identified 58 patients (5.8%) with a decrease of ankle-brachial index (ABI) (of them 42 people — 72,4% with subclinical course of disease), 7 patients (0,7%) with carotid stenosis or occlusion, and 3 patients (0,3%) with indications for coronary angiography.

Analysed herein are the results of the joint work of the Pyoseptic Surgery Department of the Centre "Diabetic Foot" with the Vascular Surgery Department based in various clinics over 2 periods - 2010 and 2011. During the first period, a total of 126 patients with critical ischaemia were treated without using revascularizing methods, during the second period, a total of 205 patients with critical ischaemia were examined by vascular surgeons deciding upon the problem concerning possibility of revascularization. In 148 cases (72.2%) revascularization was regarded impossible due to pronounced trophic disorders and/or severity of the general somatic status. Fifty-seven patients were subjected to angiography. Of these, five patients were found to have contraindications to vascular reconstruction, with the remaining 52 patients being subjected thereto (65 operations, of which 22 roentgen-endovascular ones). One (1.9%) patient died. Clinical improvement was achieved in 47 (90.3%) cases, and with no dynamics in four (7.7%) subjects. Using a multidisciplinary approach resulted in a decrease in the incidence rate of high amputations in patients with lower limb chronic ischaemia at the department of Pyoseptic Surgery from 51.6% in 2010 to 35.4% in 2011 (p=0.0000). Of these, the number of the above-the-knee amputations decreased from 41.3% to 15.1%, respectively (p=0.0000). The proportion of crural amputations increased from 20.0% to 46.6% (p=0.04).

An experimental model of various accesses to the infrarenal aorta with the modelling of the most traumatic stages of reparative operation at aorto-femoral segment was created. It was demonstrated that mini-access is followed by less vegetative reaction and parameter changes of central hemodynamics in comparison with the full laparotomy. The advantages of mini-access more frequently occur only at visceral injury of low intensity.

The immediate and long-term results of 500 reconstructive operations on the aorticfemoral segment using a miniaccess were analyzed. 443 patients suffered from the obliterative atherosclerosis and 57 were operated on the infrarenal aortic aneurism. The size of the surgical access was 5-12 sm (418 through laparotomy, 82 through the retroperitoneal access). The access enlargement was necessary in 5.0% of cases. The mean time of the operation was 166.6±7.8 min (90-255 min). Time of the aortic clamping was 26.2±1.5 min by the aortic by-pass and 32.3±4.5 min by the aortic resection. The postoperative leathality rate was 1.6%, the morbidity rate was 20.0% (local vascular complications 7.2%; local non-vascular complications 7.2%, systemic complication 7.6%). 5-year by-pass patency was 91.9±2.8%, the limb was preserved in 93.6±2.4%.

The article presents two clinical cases of successful bypass surgery for occlusion of the brachiocephalic veins in patients on hemo-dialysis.

The ankle-brachial index (ABI) was determined in a total of 1,751 employees of industrial enterprises of the Republic of Tatarstan aged from 45 to 84 years old (mean age 55,3 ± 0,14 years). An abnormal ABI was registered in 5,1% of the examined people (4,1% in the age group from 45 to 55 years, 5,4% in 56-65-year-old patients, and 12,1% in subjects over 65 years (p=0,001). An abnormal ABI was registered in 8.3% of men, and 3,1% of women (p=0,000), in 4,1% of rural population, 5,9% (p=0,138) of urban population, in 14,8% (p=0,000) of smokers, and in 45,4% (p = 0,000) of patients with a history of a cardiovascular event.

Несмотря на успехи трансплантологии, количество пациен-тов, которым требуется проведение программного гемодиали-за, с каждым годом растет, продолжительность их жизни повы-шается. В связи с этим обеспечение длительного и стабильного функционирования сосудистого доступа становится всё более актуальным [1]. Одной из основных причин, приводящих к несостоятель-ности сосудистого доступа, является локальная венозная ги-пертензия, вызванная нарушением проходимости центральных (брахиоцефальных) вен. По данным литературы, она развива-ется в 10-15% случаев у больных, находящихся на програм-мном гемодиализе [2, 3]. Её генез связывают как с наличием в анамнезе катетеризационной травмы вен [4], с локальными изменениями гемодинамики, так и с аутоиммунными и воспа-лительными процессами [5].Клинически венозная гипертензия может проявляться как дисфункцией доступа из-за нарушения венозного оттока, так и формированием хронической венозной 0недостаточности верхних конечностей. Этот синдром сам по себе может при-вести к несостоятельности доступа из-за технических слож-ностей с пункцией в связи с отеком мягких тканей. Интракра-ниальная венозная гипертензия значительно снижает качество жизни больных, причем её тяжесть усугубляется наличием артериовенозного кровотока. Поэтому обеспечение проходи-мости центральных вен является принципиальным фактором, определяющим качество и продолжительность жизни больных, находящихся на программном гемодиализе.Для коррекции окклюзирующей патологии центральных вен используются как эндоваскулярные, так открытые хирургиче-ские методы (экстра- и интраторакальные) [3, 4, 6]. Однако их опыт единичен и не обобщен. В данной статье мы приводим два клинических случая успешного хирургического лечения окклюзирующей патологии брахиоцефальных у больных, находящихся на программном гемодиализе.Пациентка И. 1935 года рождения, находилась на лечении в отделении сосудистой хирургии №1 Республиканской клини-ческой больницы МЗ РТ с 10.07.2011 г. по 05.08.2011 г. Посту-пила в экстренном порядке с жалобами на выраженный отек левой руки, подъем температуры до 40 С, общую слабостью, тошноту, рвоту. Анамнез заболевания: Сахарный диабет II типа в течение 32 лет, в течение последних 7 лет — инсулинозависимый. Диабе-тическая нефропатия. Хроническая почечная недостаточность, терминальная стадия.УДК

Prospective study of invasiveness of aortofemoral reconstructions carried through minilaparotomy and retroperitoneal miniaccess was done. Objective criteria of visceral injuries were more severe with minilaparotomy, and parietal with retroperitoneal miniaccess was revealed. The severity of postoperative pulmonary dysfunction was not significantly different.