The objective was to assess the prognostic value of D-dimer level in peripheral venous blood and arterial blood to the risk of developing complications in the short-term period after open reconstructive surgery on the aortoiliac segment.Methods and materials. The study included 89 patients who were determined the D-dimer level in peripheral venous blood, as well as arterial blood intraoperatively.Results. Statistically significant differences in the D-dimer level were established depending on the presence or absence of early postoperative complications.Conclusions. The intraoperative D-dimer level in arterial blood has a predictive ability in relation to the development of early postoperative complications.

Цель. Оценка прогностической значимости уровня D-димера крови в диагностике аневризм и злокачественных новообразований (ЗНО) в отдаленном периоде после открытого хирургического лечения аневризмы брюшной аорты.

Введение. Рост заболеваемости атеросклерозом как мужчин, так и женщин обусловливает интерес к факторам риска этого заболевания. У мужчин и женщин болезнь протекает по-разному. Более тяжелое течение атеросклероза у женщин после менопаузы многие авторы связывают со снижением образования эстрогенов.

Введение. Нарушения системы гемостаза у пациентов с аневризмой аорты обусловливают необходимость изучения механизмов их развития и оптимальных подходов к лечению. Одним из таких состояний является синдром хронического диссеминированного внутрисосудистого свертывания крови, негативно влияющий на результаты хирургического лечения.

Введение. Неуклонный рост заболеваемости атеросклерозом как мужчин, так и женщин обусловливает внимание к факторам риска его возникновения, в том числе к гипергомоцистеинемии, которая связана с низким уровнем фолиевой кислоты и цианокобаламина. В литературе содержится недостаточно сведений о различиях в уровне фолиевой кислоты, витамина В12 и показателей липидного спектра в зависимости от пола у больных с атеросклеротическим поражением аорты и подвздошных артерий.

Abdominal aortic aneurysm was detected in 269 patients and 26 (9.6%) of them had a coincidental malignancy. There were 25 (96.2%) men and 1 (3.8%) woman of age from 46 to 88 years (on the average 67.9 +/- 1.7 years old). All of them had different accompanying diseases, influencing the choice of treatment strategy. More than half of patients (16 (61.5%) had the advanced stage III or IV (3H) of cancer and three of them occupied the first place due to their wide occurrence: tumors of lung--42.3%, of stomach--19.2%, of large intestine--11.5%. The operations were performed in 8 patients with malignancy and in 2 patients with abdominal aortic aneurysm. Two-step operations were performed in 4 patients, the simultant operation--in one patient.

The  OBJECTIVE   is  to  assess the  patency  of  the  inferior  mesenteric artery   and   internal   iliac  arteries in  the  remote period  after  resection of the  aneurysm of the  infrarenal  aortic  segment. MATERIAL AND METHODS.  The  study  included 33  patients who  underwent resection  of  the  abdominal aortic  aneurysm with  reconstruction of  the  inferior  mesenteric artery  and  (or)  internal  iliac  arteries from  1998  to  2017.   All patients were  examined with  computed  tomography scan with  contrast to  assess the  patency of  inferior  mesenteric artery  and   internal  iliac  arteries. RESULTS.   Patients  were observed from  0.5  to  15  years. Among  30  patients with  inferior  mesenteric artery   implanted  into  the  prosthesis,  23 (76  %)  patients had  a  passable inferior  mesenteric artery  and  7  patients had  an  occluded inferior  mesenteric artery. The  implanted  inferior  mesenteric artery   maintained its  patency for  3  years in  100%   of  cases, from  3  to  5  years  – in  86%,  after  5  years and   more   –  in  62%.  In  one   patient   who  underwent  reconstruction  of  the  internal   iliac  artery, thrombosis  of  the  prosthetic-internal  iliac  shunt   was   found  out  in  1.5  years  after  the  operation,  without  any  clinical manifestations. One  patient,  underwent the  reconstruction of the  internal  iliac artery,  was  diagnosed with thrombosis of the prosthetic-internal iliac  shunt   in  1.5  years after  the  operation, which  was   not  accompanied by  clinical  manifestations. CONCLUSION.  The  high  remote patency of the  inferior mesenteric artery  and  internal  iliac arteries reconstructed during resection of the aneurysm of the infrarenal aortic segment indicates the need for this procedure in order to prevent ischemic disorders of the digestive organs and pelvis.

A retrospective analysis of data of 188 patients, who underwent a selective surgery for abdominal aortic aneurism showed, that all the patients had a cardiac pathology. Ischemic heart disease and arterial hypertension had 175 (93.0%) and 177 (94.1%) of patients, respectively. Chronic nonspecific lung disease was noted in 65.4% patients and kidney disease--in 48.9%. Different complications developed in early postoperative period in 47 (25%) patients, that resulted in fatal outcome in 20(10,6%). The most frequent complication was an acute renal insufficiency, which led to fatal outcome in 40% patients. Myocardial infarction and pneumonia took the second place in the structure of postoperative complications, one half of the fatal cases was due to these. Retrospective risk stratification assessment of the development of early postoperative complications and lethality was made by Glasgow Aneurysm Score (GAS) and angiosurgical model scale V-POSSUM. It was stated, that score was up to 84 according to GAS scale and up to 28 (V-POSSUM). That fact is the evidence of high risk of the operation. On the basis of ROC curves building, the conclusion was made about greater predictive ability of V-POSSUM scoring system.

Retrospective analysis of data in 188 patients showed, that chronic nonspecific pulmonary disease was diagnosed in 65.4% of all. Disorders of bronchial patency of different degrees of manifestation were noted in 61.2% and 19.7% of patients had a hypoxemia. Renal diseases were found in 59% of patients, resulting in the development of chronic renal insufficiency in 17%. The data obtained indicate, that the presence of coexisting pulmonary pathology directly influences the frequency and severity of respiratory complications after surgery, which can be the cause of fatal outcome. The presence of renal diseases results in three times higher risk of the development of postoperative renal complications.

A retrospective analysis of the data of 188 patients with the infrarenal segment of the aortic aneurysm (ISAA) showed, that ischemic heart disease and arterial hypertension were diagnosed practically in all patients--175 (93.0%) and 177 (94.1%) patients respectively. A decreased retractor function of the myocardium was noted in 88 (46.8%) of patients. According to the findings of echocardiography 134 (71.3%) patients had the arterial hypertension of third degree. For the assessment of the influence of the accompanying cardiac pathology on the results of planned surgical treatment and systematization of postoperative cardiac complications the classification, which was proposed by R. B. Rutherford et al. and modified by A. V. Pokrovsky et al. was used. The obtained data point at a direct proportional relationship between the degree of the initial cardiac status, frequency and severity of postoperative cardiac complications in patients after resection of ISAA in 1.6-2.3 times.

Mycotoc aneurysms (MA)--a rare and extremely dangerous lesion of the aorta. CT, MRA and aortography were used to diagnose MA of the thoracoabdominal areas in 2 men of 64 and 67 years of age. The clinical picture included: fever with shivering with the temperature 38-39 degrees C and increasing pains in the inferiothoracic and lumbar areas of the spine. Hemoculture was positive in 1 patient only. The patients were operated on. Shunting of the aorta from the inferiothoracic to infrarenal segments was performed in one patient with the exclusion of the involved portion and resection of MA. Metalloosteosynthesis of the spine due to destruction of LI-LII and compression of the spine were performed in the second patient followed by analogous shunting of the aorta and visceral arteries with the resection of the aneurysm. To prevent infection of the prostheses the shunts were wrapped up with a piece of the greater omentum. One patient died two months later from recurrent sepsis. The other one is alive, within 28 months the shunts are patent, there are no signs of a reinfection.

An analysis of 72 reconstructive operations on the abdominal aorta (in 5 cases shunts of the celiac trunk and superior mesenteric arteries were performed) fulfilled by the authors has shown that in order to prevent the development of the aorto(prosthetic)-intestinal erosions and fistulas and possible extension of the inflammatory process to the synthetic prostheses from the adjacent organs it is necessary to use the corresponding technical means and the following methods of protection of anastomoses and vascular transplants: protection of the prosthesis by local tissues or greater omentum flaps, selection of the corresponding diameter and length of the prosthesis.