Cerebrovascular disease ranks third after coronary artery disease and cancer among the causes of death in the Russian Federation. Currently, carotid endarterectomy is used for primary and secondary stroke prevention, and in brachiocephalic artery lesions. The authors of the article developed a new method of eversion carotid endarterectomy. Its immediate and long-term results are studied. The new method was compared with R. Kieny eversion carotid endarterectomy. The clinical safety and efficacy of the new method were demonstrated.

INTRODUCTION Critical lower limb ischemia is a widespread disease that occurs due to atherosclerotic lesions of the arteries with progressive narrowing of their lumen. Clinically critical ischemia is manifested by pain at rest, resistant to narcotic analgesics, and/or ulcerative necrotic process on the legs. In the absence of treatment, patients undergo amputation of the lower limb. Almost all patients die 10 years after amputation of the lower limb at the level of the thigh. Currently, there are following methods of treatment of critical ischemia: conservative therapy, direct revascularization, lumbar sympathectomy and neurostimulation.AIM OF STUDY To present the data of modern scientifi c literature on the use of lumbar sympathectomy and epidural spinal cord stimulation in the treatment of critical lower limb ischemia.MATERIAL AND METHODS This review presents the latest data obtained as a result of studying domestic and foreign literature on the treatment of critical lower limb ischemia with lumbar sympathectomy and epidural spinal cord stimulation. Currently, lumbar sympathectomy is performed by surgical (open, mini-access and endoscopic) and percutaneous (chemical or radiofrequency) methods. Percutaneous access is becoming widespread due to its minimally invasiveness, maximum accessibility, ease of performance and low cost. Epidural spinal cord stimulation is performed for resistant pain syndrome. The mechanism of action of spinal stimulation is to block the transmission of nerve impulses at the level of the gelatinous substance of the posterior horns of the spinal cord during stimulation of afferent fi bers of a larger diameter (type A-alpha and A-beta fi bers).CONCLUSION Spinal neurostimulation and lumbar sympathectomy are promising methods of treatment for critical lower limb ischemia in case of impossibility of direct revascularization. Lumbar sympathectomy can reduce the intensity of pain and improve the quality of life of patients. According to a number of studies, epidural spinal cord stimulation signifi cantly reduces the likelihood of amputation of the lower limb, and also reduces the intensity of pain in patients refractory to conservative therapy, as well as in those who are not indicated for direct revascularization of the arteries of the lower extremities. More large-scale studies are needed to determine the indications for the above methods.

The article presents a review of the literature on the topic of interventional treatment of pain in oncological practice. The epidemiology, classification and mechanism of oncological pain are presented. Aspects of the use of interventional methods of pain syndrome treatment, including neurolysis and blockade, are considered. The technique, indications, contraindications, complications are described for each minimally invasive intervention.

Metastasis of malignant tumors in the spine is a common problem of cancer patients. Modern neuroimaging methods make it possible to identify secondary lesions of the spinal column at an early stage. Currently, the approach to the treatment of metastatic spinal lesions is multidisciplinary and requires the approach of doctors of different specialties: neurosurgeon, radiologist, chemotherapist, neurologist and rehabilitologist. Currently, a combination of several treatment methods is optimal: surgery, radiation and drug therapy. Systemic drug therapy is an integral part of long-term control of spinal metastases and depends on the histological structure of the malignant neoplasm and its ability to respond to drug exposure. The article also describes modern methods of radiation therapy. To date, there is no unity of views and an unambiguous standardized, scientifically based approach to solving the existing problem, however, further study of it will be able to ensure the choice of the optimal algorithm for the curation of patients with metastatic spinal lesion. After all, proper treatment of secondary damage to the spinal column will allow the patient to prevent neurological deficit and persistent pain syndrome, to maintain an optimal quality of life.

The purpose of the study. To evaluate long-term results of a new method of eversion carotid endarterectomy and to study the structure of mortality in these patients in the postoperative period. Materials and methods. A retrospective analysis of medical records of 142 patients who underwent eversion carotid endarterectomy about ateroskleroticescoe lesions of carotid arteries. All patients depending on surgical intervention were divided into two groups. In the first group which included 60 patients was performed in eversion carotid endarterectomy according to the method of Sergeev V. L. technique of this method is the clipping of the internal carotid artery from common carotid artery with a wide grip. In the second group (82 patients) underwent eversion carotid endarterectomy according to Kieny R. the article described the results of surgical treatment in the immediate postoperative period. The mortality in first group was 1.7% (one patient died from intracerebral hemorrhage), the second of 3.7 (all three patients died from ischemic stroke). The main goal of our work was studying of the remote results of operative interventions. Results. The main cause of mortality in the postoperative period in these patients was myocardial infarction (3.6% in the first group and 2.9% in the second). Acute disorders of cerebral circulation in the postoperative period were more often registered in the second group (10.1 percent vs. 1.7 percent). Hemodynamically significant restenosis (>60%) was more common in the second group (7.7% versus 1.8 percent). Conclusion. 1. Eversion carotid endarterectomy, performed according to the method of Sergeev V. L., shows good consistent results in the postoperative period and can be recommended for widespread use.2. The main cause of mortality in the postoperative period is the progression of CHD. 3. Patients who underwent reconstruction of the carotid basin have control USDV SA from both sides.