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Results of 145 surgeries for direct myocardial revascularization without artificial circulation are presented. FC III and IV angina of effort was diagnosed in 80.6% and 13.5% of the patients respectively, acute coronary syndrome in 6.5%, past myocardial infarction in 63.8%. Mean left ventricular ejection fraction (EF) prior to surgery was 48.7 +/- 5.1%; it was below 40% in 28.8% of the patients. Three- and two-vessel coronary disease was documented in 54.7% and 35.3% of the patients respectively; 10% of them presented with the affected anterior interventricular branch, 14% with the stenotic trunk of the left coronary artery. Mean revascularization index increased from 22 to 76. The frequency of complete autoarterial revascularization amounted to 42.7%. Sequential and composite grafts were used in 93 and 257 cases respectively. No patient experienced perioperative myocardial infarction, acute disturbance of cerebral circulation, acute renal or cardiac insufficiency. Immediate postoperative hemorrhage requiring resternotomy developed in 0.9% of the patients, 1.2% with suppurative complications needed additional surgical treatment. It is concluded that myocardial revascularization on a beating heart is an efficacious and reliable method ensuring good results in the immediate and late postoperative period. Its success first and foremost depends on the previously gained experience that permits to operate patients with severe multi-vessel coronary artery disease and various concomitant disorders and thereby correct combined pathological conditions. The available data give reason to consider each patients in need of aortocoronary bypass as a candidate for myocardial revascularization on a beating heart regardless of the character and extent of coronary lesions and anatomical feature of the coronary bed.

The recovery of disturbed functions was followed up for 1 year after ischemic stroke in 85 patients with atherosclerotic stenosis of internal carotid arteries. Fifty patients underwent carotid endarterectomy and 35 patients refused surgery. Somatic signs, neurological status measured with the NIH-NINDS, functional state (Barthel index), quality of life and neuropsychological status were assessed. The Doppler ultrasound of precerebral arteries and neurovisualization were performed. The significant positive changes, including the reduction of focal neurological deficit, the improvement of cognitive functions and quality of life, the normalization of functional state, were noted after the carotid endarterectomy. In patients who refused surgery, these parameters did not change significantly compared to baseline. The number of the recorded ischemic events in the operated patients was much lower as well.

The degree and terms of recovery of the functional state of the myocardium after direct revascularization of the myocardium under conditions of extracorporeal circulation and on the working heart were studied in 58 patients with occlusion lesion of the arteries of lower extremities. In 30 patients (1st group) coronary artery bypass grafting (CABG) was fulfilled under conditions of extracorporeal circulation, in 28 (2nd group) revascularization of the myocardium was fulfilled on the beating heart. In patients with occlusion lesion of the abdominal aorta and arteries of lower extremities and IHD of the III-IV functional class we followed the strategy of stage-by-stage interventions in the arterial basins. CABG is indicated at the first stage. The optimal method of direct revascularization of the myocardium was proved to be operation on the beating heart which had a number of advantages: lower risk of the development of postoperative complications, quicker restoration of the myocardium function and rehabilitation of the patients, shorter time for the 2nd stage of operation-revascularization of lower extremities.

The possibility and use of prolonged epidural anesthesia in terms of preoperative care was studied in 78 patients. Patients with various stages of coronary arteries affection, central haemodynamics state and risk of reconstructive surgical treatment on lower limb arteries were marked out. Patient selection criteria for aortocoronary shunting or reconstructive operation on great lower limb vessels were worked out. It is proved, that prolonged epidural anesthesia allows not only to attain good analgesia but to minimize cardiac complications at reconstructive operations on abdominal aorta and its branches.

Thr experience in surgical treatment of 69 patients with rupture of abdominal aorto-aneurysm was analyzed. Multifactorial statistical analysis was carried out to determine detect influence of different parameters on postoperative lethality. The most significant parameters were initial blood loss (odds ratio (OR) -- 10.4, confidence interval (CI) -- 2.0-37.1, intraoperative hemorrhage (OR=8.5, CI 1.5-27.8), minute diuresis (OR=15,7, CI 1.8- 49.3), location of rupture (OR=12.1, CI 2.0-33.5). Combination of two and more factors led to the most unfavorable prognosis. The proposed algorithm allowed the authors to optimize treatment policy and improve significantly results of surgical treatment of patients with rupture of abdominal aorto-aneurysm: postoperative lethality has decreased from 71.4 to 28.5%.

Results of 136 femoro-tibial bypasses performed in 127 patients were analyzed. There were the following complications: lethal outcome (1.5%) due to myocardial infarction, thrombosis of shunts (10.3%). Surgery with "in situ" technique has demonstrated the best patency of femoro-tibial autovenous bypasses (68.7%). Combination of femoro-tibial bypass with lumbar sympathectomy and creation of arterio-venous fistula leads to improvement of bypasses function in long-term period after surgery.

Surgical treatment of abdominal aortic aneurysm (AAA) ruptures is a matter of great concern in current vascular surgery. The results of surgical treatment of patients presenting with such severe disease could have been improved due to the early and correct diagnosis. The present work is concerned with a study into the characteristic features and causes of the atypical clinical manifestations and the course of AAA ruptures as well as with the development of the classification accessible for practical uses. Later on it would allow to refine the treatment policy for an extremely severe patient group and to define a permissible algorithm of examination in the postoperative time and would favour the early diagnosis of disease. The study is based on an analysis of the clinical course of AAA rupture in 53 patients operated on at the Department of Vascular Surgery. MONIKI. The clinical manifestations were typical in 46 (86.8%) patients. The progressing course of AAA rupture was observed in 21 (39.6%) patients; the disease ran a wave-like course in 17 (32.1%) patients. Stabilization of the condition was marked in 15 (28.3%) cases. In 39 (73.6%) cases, AAA rupture affected the retro-peritoneal space, the free abdominal cavity was affected in 8 (15.1%), the duodenum in 2 (3.8%), the sigmoid intestine in 2 (3.8%), and the inferior vena cava in 2 (3.8%) of cases. The rupture of the posterior wall of the aortic aneurysm was identified in 29 (54.7%), of the lateral wall in 12 (22.6%), and of the anterior wall in 8 (15.1%) patients. Four (7.5%) patients demonstrated aneurysmal rupture of the iliac artery. The clinical manifestations of AAA rupture were marked by polymorphism whereas its course was often masked by other diseases making it difficult to establish the early and correct diagnosis. The difficulties in the diagnosis of AAA ruptures gave rise to a lot of diagnostic errors and late hospitalization to specialized unita.

Common carotic arteries, odd visceral branches of abdominal aorta were subgected to ultrasound Doppler examination and color duplex ultrasound in 100 vibration disease patients and 57 liquidators of Chernobyl power accident consequences. Stenosis of various degree and thickened vascular wall were revealed in 23.6 +/- 4.5% of vibration disease patients and in 46.2 +/- 7.98% of liquidators (p < 0.05). These data prove that the liquidators being younger (4 years average age difference) than the vibration disease patients demonstrate more significant atherosclerotic changes of vascular wall.

A comparative analysis of results of 70 operations fulfilled by the method of classical with autovein plasty of the internal carotid artery (ICA) and of 103 operations by the method of eversion carotid endarterectomy (CEAE) was made. The time of compression of the carotid artery during the eversion CEAE proved to be considerably less (22.5 +/- 6.5) min, than when using the "classical" method (32.5 +/- 5.3) min. In the nearest postoperative period no neurological complications of embologenic genesis or those associated with acute thrombosis of ICA after the eversion CEAE were noted while after the "classical" method they developed in 3 patients and 2 of them died. After the eversion CEAE 1 patients died of myocardial infarction. In remote periods after the "classical" CEAE the restenosis and reocclusions appeared in 6 patients, while after the eversion method--in 3 patients. CEAE fulfilled by the eversion technique is an effective operation reducing the amount of postoperative neurological complications as well as of late restenosis and reocclusions. It can be used without the applying of the internal bypass.

The work is based on an analysis of results of 70 carotid endarterectomies performed on 68 patients aged from 43 to 67 years. 53% of the patients were operated upon at the stage of a relative compensation of brain blood circulation. Multiple character of injuries of the brachiocephalic arteries took place in 70.5% of the cases. Plasty of the internal carotid artery is thought by the authors to be necessary by means of using a flap of lyophylized allopericardium, with the diameter of its orifice less than 8 mm.

The authors discuss their experience in surgical treatment of 37 patients with occlusive lesions of the subclavian arteries. Ten patients had isolated lesions of the subclavian arteries and 37 had combined affections of the carotid and subclavian arteries. Analysis of their own clinical material allowed the authors to put forth their point of view on the indications for surgical treatment, the tactics and order of surgical interventions, and the choice of the optimal method and plastic. material fro reconstructive operations. Sixty-seven reconstructive operations were carried out, in 11 of them one-stage reconstruction of the carotid and subclavian arteries was performed. Fatal outcomes were not encountered. The results of surgery were studied in 20 patients in follow-up periods of 6 months to 3 years. Complete regression of neurological symptomatology was found in 87.5% of patients with TIA and in 88.8% of those with encephalopathy and circulatory disorders. This confirms the effectiveness of surgical treatment of patients with occlusive lesions of the subclavian arteries.

The authors analyze their experience gained in prevention of embologenic complications and ischemic injuries to kidneys based on surgical treatment of 25 patients with abdominal aorta aneurysm. Original preventive methods are suggested. In ascending supra-aneurysmatic aortic thrombosis (in 4 patients) a left-side thoracophrenolumbotomic approach and open thrombectomy from the aorta were used and, if necessary, from visceral branches and renal arteries as well. If aortic clamping above renal arteries was needed (in 6 cases) and its time surpassed the permissible duration of thermal ischemia of the kidneys the authors resorted to autoarterial perfusion of the kidneys through an aortorenal shunt with which cannulation of the thoraco-abdominal segment of the aorta was made. No embologenic complications or postischemic renal insufficiency occurred after surgery, this indicating the efficacy of the suggested measures.

Based on diagnostic data in 35 patients with abdominal aortic aneurysm, which were obtained during ultrasonic scan echography, X-ray computed tomography and radioopaque angiography, and on their comparison with intraoperative findings, a diagnostic algorithm for examinations has been developed, which enables errors in the diagnosis to be excluded. The major diagnostic technique for abdominal aortic aneurysms has been found to be X-ray computed tomography which provided no errors in the assessment of the extent of aneurysms and the presence of their complicating components in all 35 patients. In high aneurysms of the abdominal aorta and suspected stenoses in the visceral, renal, and iliac arteries, X-ray computed tomography should be supplemented by radioopaque angiography to clarify the status of aortic branches.

Among 11 patients with traumatic aneurysms of the descending thoracic aorta, 2 had developmental anomalies of the branches of the arch of the aorta, in particular, independent origin of the right subclavian artery from the descending thoracic aorta. The anomalous right subclavian artery plays the role of a retaining ligament in trauma, and the forming posttraumatic false aneurysm is localized distal of the ostium of the right subclavian artery. The need for clamping the thoracic aorta and both subclavian arteries for the period of aneurysm reconstruction requires catheterization of the arch of the aorta for arterial pressure control. Surgical correction of aneurysm in anomalous origin of the right subclavian artery has peculiarities of its own in the formation of the proximal anastomosis.

In patients suffering from nonspecific aortoarteritis associated with impairment of the common carotid arteries, cerebral blood flow is compensated for at the expense of an increase of the volumetric blood flow in the vertebral arteries. During the first three years since the onset of the first disease symptoms, the blood content in the basin of the internal carotid arteries is reduced. Brain strokes occur most frequently within that period. They mostly develop without any preceding transitory ischemic attacks. The origin of neurological symptomatology depends to a considerable measure on the condition of the anterior and posterior communicating arteries.

During 1975-88 the staff of the Vishnevskiĭ+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.

The paper is concerned with analysis of the results of X-ray investigation of 45 patients with aneurysms of the distal part of the arch and descending part of the thoracic aorta. Errors were made in 16 of 35 patients (35.6%) before admittance to hospital. X-ray investigation helped to establish correct diagnosis of aneurysm of the aorta in 42 of 45 patients (93.3%) on the basis of the detection of intense additional shadow formation in left pulmonary field, inseparable from the aortic shadow. The use of a new method of ultrasound diagnosis--duplex scanning--made it possible to establish the presence of aneurysm and to determine its sizes as well as to visualize the relation of the left subclavicular artery to aneurysm in 17 of 21 patients. CT-semiotics of aneurysms of the descending part of the thoracic aorta consisted in its dilatation over 3.5 cm, wall calcification, thrombosis of the cavity and change of the adjacent structures. Basing on the analysis of these signs correct diagnosis was established in 34 of 35 examinees (97.1%).

The work presents data of 774 patients with occlusing injuries of the abdominal aorta and arteries of lower extremities subjected to aorto-femoral reconstructions. In 546 of these patients (70.5%) there were different variants of injuries of visceral branches. A detailed analysis of the clinical picture of injuries of the visceral branches is presented related with the injury volume, etiology of the occlusing process and coexistent arterial hypertension. The authors have an experience with 169 observations of revascularizations of visceral branches during aorto-femoral reconstructions. Reconstruction of the inferior mesenterial artery was made in 134 cases, that of the celiac trunk of the superior mesenterial artery-in 35 cases. A detailed description of indications to correction of the visceral branches blood flow in aorto-femoral reconstructions is presented as well as the methods of revascularization of the visceral arteries.

Possibilities of noninvasive radial diagnostics were studied in examination of 27 patients with dissecting aneurysms of the aorta. Classical X-ray examinations of chest organs have diagnosed aorta wall dissection in 2 of 24 patients. In 19 patients the diagnosis of aorta dissection was suspected. The ultrasound examination gave correct diagnosis in 3 of 4 patients examined. The non-contrast computed tomography has revealed dissecting aneurysms in 8 of 24 patients, an investigation with the intravenous injection of the contrast substance--in 13 of 15 patients. The diagnosis was based upon the detection of 2 canals of the aorta with the dissected intima between them, thrombosis of the false aorta canal and accumulation of the liquid in the pleura and pericardium cavity. When planning operative procedures it becomes necessary to perform aortography.

The authors, having studied the long-term results of the operation of creating the renoportal venous anastomoses in patients with severe and malignant course of arterial hypertension, revealed anastomotic thrombosis in presence of hypotensive effect. Developed in the experiment and employed in 7 patients was the technique of dosaged narrowing the central left adrenal vein with the aim of achieving its thrombosis, inclusion of the collateral routes of the left adrenal blood outflow into the system of the portal vein and inactivation of aldosterone in the liver.

The article analyses 303 cases with affection of the visceral branches of the abdominal aorta. In 210 cases it was caused by atherosclerosis, in 67 by nonspecific aorto-arteritis and in 26 by extravasal factors. In 190 cases there were no clinical manifestations of occlusive lesions. The abdominal syndrome was found in 113 patients. The main symptoms were abdominal pain (in 94 patients), intestinal dysfunction (in 84) associated with the intake of food, and in severe stages of ischemia, progressive loss of body weight (in 46 patients). On grounds of the case history, the presence of a murmur in the epigastrium, and symptoms of involvement of other arteries it may be assumed that the abdominal abnormalities are of vascular origin. The principal diagnostic method is angiography which makes it possible to identify and record the affection of visceral branches of the abdominal aorta.

Operations were performed on 48 patients with aneurysms of the thoracic aorta, one of them had a rupture of aneurysm of the noncoronary sinus followed by the formation of a fistula between the aorta and the right atrium. The fistula was ligated by an access through the right atrium with good nearest and long-term results.

Twenty-one patients with severe arterial hypertension were operated on using an original procedure, which consisted in creating a left-side renoportal venous anastomosis and right-side adrenalectomy. A considerable hypotensive effect was noted at both early and late follow-up. A drop in vascular peripheral resistance as a result of decreased blood aldosterone and cortisol levels as well as sodium elimination was found to be the principal mechanism of the hypotensive effect.

The authors have performed a complex ultrasonic angiographic and nephrological examination of 32 patients with associated occluding injuries of branches of the arch and renal arteries. The indications and tactics of reconstructive interventions on renal arteries in patients with pathology in question have been established which were not followed by neurological complications. All the patients who survived have shown substantial improvement of neurological symptoms.

The authors describe a male patient aged 22 years with primary infectious endocarditis which was marked by nonspecific manifestations in the form of tendovaginitis, myalgia and arthralgia. Early surgical treatment of the disease and its complications brought about an appreciable improvement in the patient's condition and restored his work fitness.

A total of 168 patients with aneurysms of the abdominal aorta and of its branches were examined, 117 of them were operated on. The leading method of surgery for abdominal aorta aneurysms consists in a resection of the aneurysm and its subsequent prosthetic repair. The choice of the operative technique for the aneurysms of the visceral branches and renal arteries depends on the localization and size of the aneurysm, on the importance of the diseased vessel in the blood supply to the digestive organs, as well as the organ which blood supply is impaired. The improvement of the operative technique and of the postoperative care of patients with abdominal aorta aneurysms helped to decrease the number of postoperative complications and the mortality in the recent years. Further improvement of the results of surgery for aneurysms of the abdominal aorta and its branches requires timely hospitalization of such patients in specialized vascular departments and further perfection of the operative technique.

Altogether 56 patients with occlusive abdominal aortic lesions and concomitant CHD were examined by radionuclide ventriculography on a nuclear stethoscope. Suppression of left ventricular systolic and diastolic function was noted in the patients with CHD and arterial hypertension. Investigations of cardiohemodynamics using the above method made it possible to identify patients with limited functional cardiac reserve, to predict possible myocardial complications, and to take preventive measures before, during and after reconstructive interventions on the abdominal aorta.

Under observation were 12 patients with traumatic aneurysms of the descending thoracic aorta, 11 of them were operated on. Diagnostic thoracotomy had been performed in the past in 4 patients. In 50% of the patients the course of the disease was asymptomatic. Resection of the aneurysm with alloplastic prosthesis under conditions of superficial hypothermia was performed in all of the patients. The average time of compression of the aorta for the period of reconstruction of the aneurysm was 40.1 min. One lethal outcome took place. There were no paraplegia, no complications of the operative and postoperative period.

Renal parenchyma, and the juxtaglomerular apparatus in particular, was studied in 23 patients with verified diagnosis of pheochromocytoma. Intraoperative renal biopsy was performed in 21 cases, and kidneys obtained at nephrectomy or autopsy were examined in 2 cases. Twenty-one patients were examined following the removal of pheochromocytoma (2 patients died). Arterial BP returned to normal in 86.4%, and residual hypertension due to continuous hyperfunction of the juxtaglomerular apparatus in the presence of hypertensive angiosclerosis was recorded in 13.6%. Tubular epithelial atrophy of varying markedness, associated with renal ischemia, was detected in all cases. The pathogenetic contribution of the renin-angiotensin system to pre- and postoperative hypertension in pheochromocytoma patients is discussed.

A review of the results of volume load tests, carried out in the presence of intracardiac hemodynamic monitoring in 19 patients with abdominal aortic diseases and attendant coronary heart disease, has demonstrated that the productivity curve slope and left-heart pumping coefficient are the most valuable criteria for the assessment of cardiac functional reserve. Volume load tests identified 12 patients with limited functional reserve of the heart as being in need of continuous intra- and postoperative inotropic support and pre- and poststress control in the presence of central hemodynamic monitoring.

Results of an examination of 39 patients are described and critically assessed. An analysis of the resolving power of the method of ultrasonic angiography in pathological formations of major vessels of the neck is given.

Fifteen patients with idiopathic hyperaldosteronism were examined. Ten patients were subjected to surgery with 9 of them having an operation of the "portalization" of the renal and adrenal venous blood flow in combination with contralateral adrenalectomy aimed at inactivating the hormone of the adrenal cortex in the liver. One patient had unilateral adrenalectomy in combination with the incision of the celiac ganglions. There were no lethal outcomes following surgery. Postoperationally, all patients were followed up from 3 months to 2.5 years. In 78% of the cases the results of surgery were assessed as good, in 22% the arterial pressure decreased insignificantly although it became more sensitive to hypotensive therapy. The results obtained indicate the efficacy of surgery for the "portalization" of the renal and adrenal venous blood flow in conjunction with contralateral adrenalectomy in patients with idiopathic hyperaldosteronism.

Ultrasonic echo-location (UEL) was used in 14 patients with nonspecific thoracoabdominal aortoarteritis before and after surgical treatment. Ultrasonic data were compared with aortographic and intraoperative findings. Patients with atherosclerosis of the abdominal aorta and congenital hypoplasia of the latter made up the control group. UEL is regarded as a fairly informative method of the diagnosis of nonspecific aortoarteritis, as thickened walls of the aorta and other affected vessels as well as irregular indurations involving aortic walls and para-aortic fat are pathognomonic signs of nonspecific aortoarteritis that differentiate it basically from other kinds of lesions. Besides, UEL is capable of early detection of the condition and the assessment of the routes of pathologic spread. After surgery, UEL might be used to control the state of the alloprosthesis.

Major hemodynamic and electrocardiographic parameters were examined in 47 patients with severe vasorenal hypertension at rest, and in 20 patients after stress exposure. Three (hyper-, eu- and hypokinetic) types of circulation were demonstrated, like the ones seen in essential hypertension. Hemodynamic values at rest were indicative of relative cardiovascular compensation in severe vasorenal hypertension. Stress testing demonstrated that exercise disrupted that compensation. Arterial blood pressure response to physical stress showed no correlation to baseline values of the parameters examined.