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The last decade has seen distinct dynamics of the worldwide growth of the number of endovascular interventions and a decrease in the number of 'open' surgical operations for pathology of the aorta and peripheral arteries. The world trends of treatment of patients presenting with pathology of the aorta and peripheral arteries are indicative of a steadily growing amount of operations, most of which are performed in an endovascular manner. In the Russian Federation, the past decade has also witnessed a noticeable jump of the amounts of endovascular interventions. Thus, the number of operations from 2008 to 2017 increased from 15 094 to 37 109 (2.5-fold). Nevertheless, in Russia there is a significant lag in both the total amount and the ratio of the performed surgical and endovascular operations in patients with pathology of the aorta and peripheral arteries. The article analyses the world and Russian trends in the development of surgical and endovascular treatment of patients with pathology of the aorta and peripheral arteries.

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.

Objective: The purpose of the study was to assess the immediate and remote results of endovascular treatment of obstructive lesions of the veins of the iliofemoral segment., Patients and Methods: We performed balloon angioplasty and stenting for iliofemoral venous thrombosis in a total of 75 patients. Of these, 60 patients were subjected to stenting of post-thrombotic obstructions and 15 patients underwent stenting of non-thrombotic obstructive lesions of the iliac veins (for May-Thurner syndrome - in 11, for extravasal tumour-induced compression and cicatricial stenosis - in 4). Stenting was performed using self-expanding stents Wallstent (Boston Scientific, n=84) or S.M.A.R.T. (Cordis, Johnson & Johnson, n=16). The stent diameter varied from 12 to 18 mm depending on the venous segment to be stented. The average number of the implanted stents amounted to 1.3 per patient. Efficacy of endovascular intervention was evaluated by measuring the pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS)., Results: Technical success of endovascular intervention amounted to 92%. Stent thrombosis in the immediate postoperative period occurred in 7 (9.3%) patients. Of these, three patients were subjected to catheter-directed thrombolysis with restoration of patency of the stented venous segment of the limb. Stent occlusion within 48 postoperative months was diagnosed in 4 cases. Two patients underwent successful repeat angioplasty and stenting. Stent restenosis of not less than 50% at 36 months of follow up was observed in 5 (16%) patients. Repeat stenting was performed in 1 case. Dynamic control of stent patency was carried out by means of ultrasonographic duplex scanning. Also performed were control multispiral computed tomography-phlebography and roentgen contrast-enhanced phlebography. Cumulative primary and secondary patency at 60 months in post-thrombotic lesions amounted to 72 and 81%, respectively, in non-thrombotic lesions to 85% (primary patency). The VCSS values demonstrated a significant decrease in manifestations of chronic venous insufficiency. The mean value of the composite parameter decreased from 14.2±4.2 to 7.5±2.6 (p<0.001), the malleolar circumference decreased from 272.3±6.7 to 250.6±6.1 mm (p<0.01). Permanent healing of trophic ulcers was noted in 5 (71%) patients., Conclusion: The method of endovascular angioplasty and stenting for obstructive lesions of the veins of the iliofemoral segment is a minimally invasive, safe, and highly effective therapeutic modality, which is confirmed by significant improvement of the limb's condition and good remote results of patency of the venous segments restored. Endovascular methods should be wider implemented into the clinical practice.

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.

Background: Severity of endothelial dysfunction and impairments of the vasomotor function of arteries correlate with the degree of the development of atherosclerosis and the risk of cardiovascular complications. To date, poorly studied still remains the problem concerning alteration of the regulatory function of the endothelium in patients diagnosed with pronounced atherosclerotic lesions of peripheral arteries, as well as the impact of a surgical intervention on indices of endothelial dysfunction., Patients and Methods: Presented in the article are the results of preoperative study of the endothelial function by means of peripheral arterial tonometry (PAT) using the Endo PATTM 2000 device (Itamar Medical Ltd.) in a total of 74 patients undergoing surgical treatment at the Institute of Surgery named after A.V. Vishnevsky. The male-to-female ratio in the studied group was 1:2.52, with the patients' average age amounting to 67Ѓ}8 years. Of the 74 patients, 21 were subjected to a repeat examination performed at terms varying from 2 to 23 months postoperatively. Of these, 17 (80.95%) patients took statins. Fourteen (66.7%) patients had endured an operative intervention on carotid arteries and seven (33.3%) had been operated on for lesions of lower-limb arteries., Results: The statistical analysis of the obtained findings revealed no significant differences of the indices of the endothelial function in the studied group between the genders, depending on age, smoking or taking statins. Neither were there statistically significant differences in the reactive hyperaemia index (RHI) amongst the patients with the involvement of one or several arterial basins. We did not reveal a direct relationship or regularity of the effect of a surgical intervention on the RHI values in the operated patients. This might be explained by the fact that the method of PAT to a greater degree assesses the state of the microvascular bed rather than that of large arteries.

Aim: The study was aimed at assessing efficacy of open thrombectomy in acute iliofemoral venous thrombosis., Patients and Methods: From January 2012 to December 2016, a total of 37 patients underwent transfemoral thrombectomy for acute iliofemoral venous thrombosis. The Control Group consisted of 24 patients receiving standard anticoagulant therapy. Six patients were subjected to a hybrid operation consisting in thrombectomy supplemented with stenting of the residual compression stenosis of the left common iliac vein (CIV). The outcomes of the operations were controlled by means of duplex scanning. Clinical efficacy of the operations was evaluated with the help of the Venous Clinical Severity Score (VCSS) and CEAP classification., Results: Patency of the iliofemoral segment at 6 months of follow up after thrombectomy was observed in 92% of patients. At the same time, in patients receiving anticoagulant therapy recanalization of the iliofemoral segment was observed in only 21% (5/24; χ2=31, p<0.01) of cases. Recanalization of the femoropopliteal segment 6 months after thrombectomy was noted to occur in 70% (23/33) of patients. The median of the composite index by the VCSS after 6 months decreased from 7 to 2 (p=0.002). The cumulative patency of the iliofemoral segment 36 months after surgery amounted to 86%. Clinical assessment of the remote results of thrombectomy according to the CEAP classification demonstrated that 90% (19/21) of patients were either free from or had weakly pronounced symptoms of post-thrombotic syndrome., Conclusion: Performing thrombectomy for iliofemoral thrombosis by selective indications using modern methods of restoring patency of deep veins significantly increases efficacy of treating patients presenting with this severe pathology and prevents the development of pronounced manifestations of post-thrombotic syndrome.

The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD). Hybrid operations [open endovenectomy from the common femoral vein (CFV) with creation of an arteriovenous fistula + stenting of iliac veins] were performed carried out in a total of eleven patients with PTD. Of these, there were 7 men and 4 women aged from 34 to 52 years (mean age - 42.8±7 years). All patients had severe-degree chronic venous insufficiency (CVI). The distribution of patients according to the CEAP classification was as follows: C4a - 2 patients, C4b - 4 patients, C5 - 4 subjects, C6 - 1 patient. The time having elapsed since a newly onset episode of acute iliac-femoral venous thrombosis varied from 2 to 12 years (averagely - 7.1±3.3 years). The degree of manifestation of PTD was determined by means of the Villalta-Pradoni scale before and 6 months after the operation. Instrumental methods of study included ultrasound duplex scanning (USDS), magnetic resonance and/or multispiral computed venography, and contrast-enhanced X-ray venography. The technical success of the procedure amounted to 91%. In one patient with occlusion of the common and external iliac veins we failed to perform recanalization and stenting. A further one patient developed in-stent and CFV thrombosis on the second postoperative day. An attempt of catheter thrombolysis turned out unsuccessful. There were no wound complications in the postoperative period. Neither was pulmonary artery thromboembolism registered. The dynamic control was carried out by means of USDS before discharge from hospital and at 1, 3 and 6 months after the intervention. The outcomes of hybrid operations after 6 months were followed up in five patients. Secondary patency rate of the stented iliac veins amounted to 100%. No relapses of trophic ulcers were observed. According to the Villalta-Prandoni scale the value of the median of the composite index decreased from 15 to 7 (p=0.012). The first experience with hybrid operations for obstructive lesions of veins of the iliac-femoral segment demonstrated their high efficacy and safety. Efficiency of the operation was confirmed by significant clinical improvement and good results of patency of the restored-repaired segments of veins.

Presented in the article are clinical cases of successful totally percutaneous endovascular repair of the infrarenal portion of the abdominal aorta using the Ovation Prime ultra-low profile stent graft in high-surgical-risk patients, yielding good immediate and short-term results, thus demonstrating new possibilities in endovascular treatment of aneurysms of the infrarenal portion of the abdominal aorta.

Open surgical intervention is an operation of choice in lesions of coronary arteries. In some cases, however, performing reconstructive surgery is either impossible or associated with high risk of both intra- and postoperative complications. In such cases it is possible to perform an endovascular intervention, including endoprosthetic repair. The Russian and foreign literature contains either sporadic or small-in-number case reports concerning the use of stent grafts in carotid arteries aneurysms. The article describes cases of successful use of self-expandable stent grafts in three patients with a true aneurysm and pseudoaneurysms of internal carotid arteries.

The article describes the most significant for Russian surgery personalities, facts, and events of the last 180years. An emphasis is placed upon those works, discoveries or operations made by Russians for the first timein the world's practice. To such we refer N.J. Pirogov's topographical anatomy of vessels (1837), N. V. Ekk's portocaval anastomosis (1877), A.A. Yanovsky's lateral arterial suture (1889), S.S. Bryukhonenko's artificial circulation unit (1923-1924), Yu. Yu. Voronoy's renal replantation onto femoral vessels (1933), V.P. Demikhov'stransplantation of vital organs (1946-1959), V.I. Kolesov's mammary-coronary anastomosis (1964),F.A. Serbinenko's endovascular neurosurgery ( 1979), E. I. Chasov's intracoronary thrombolysis by E.I. Chazov( 1974), endovascular prosthetic repair of the thoracic aorta by N.L. Volodos ( 1985) and a series of other facts.

The authors share herein their experience with composite bypass grafts and PTFE synthetic prostheses used for treatment of obliterating diseases of the infrainguinal-segment arteries. The data of the study were based on the outcomes obtained in 92 patients. The authors assessed the condition of the outflow pathways and their effect on patency of composite bypass grafts in the immediate and remote postoperative periods, followed by comparative analysis of the short- and long-term therapeutic outcomes after using composite bypass grafts and PTFE synthetic prostheses in the infragenicular position for femoropopliteal and femorotibial reconstructions, also assessing the effect of the localization of the distal anastomosis on the immediate and remote therapeutic outcomes. Based on the obtained findings it was determined that the immediate results of patency depended upon the state of the outflow pathways and localization of the distal anastomosis. Thus, by the 1st, 3rd and 5th year of follow up patency of transplants in patients with the runoff score less than 7.0 amounted to 78.3, 21.7 and 4.3%, respectively. Analogous indices of patency in patients with the runoff score equalling or greater than 7.0 amounted to 60.7 and 3.6% for the 1st and 3rd year, respectively. The remote results of patency turned out to depend on the type of a vascular transplant and the state of the outflow pathways and did not depend on the localization of the distal anastomosis. Thus, the remote results of patency for the composite bypass graft for the 1st, 3rd and 5th year of follow up amounted to 74.5, 19.6 and 5.9%, respectively, versus 60.8 and 8.6% by the first and third year for the PTFE prosthesis. The limb salvage rate at the same terms for the composite bypass graft amounted to 94.1, 84.3 and 78.4% versus 73.9, 56.5 and 52.2% for the PTFE prosthesis.

Analysed herein are remote results of surgical management of patients presenting with atherosclerotic stenoses of carotid arteries by means of eversion carotid endarterectomy. Over the period from 2002 to 2007 specialists of the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health carried out a total of 393 eversion carotid endarterectomies in 356 patients. We assessed the remote results of 338 (86%) operations in 303 (85%) patients, analysing survival, freedom from stroke, patency of the reconstructed internal carotid artery and effects of risk factors on these indices. The average duration of follow-up amounted to 84 ± 31 months (max - 146 mos). A total of 242 (71.2%) patients survived. The cumulative 5-year survival rate amounted to 84%, with 10-year survival equalling 63%. Severity of the initial atherosclerotic lesion of the arterial bed, progression of atherosclerosis, and control over risk factors for atherosclerosis exerted a statistically significant influence on total survival. Acute disorders of cerebral circulation (of any localization) at a median follow-up of 81 ± 33 months (max - 146 mos) developed in 38 (12.1%) patients, of whom in 15 (4.8%) it terminated with a lethal outcome. Five-year cumulative freedom from stroke amounted to 92%, equalling 80% 10 years after. The risk factors which influenced the freedom from stroke included a history of acute impairments of cerebral circulation, restenoses of the reconstructed ipsilateral internal carotid artery (>70%), and diabetes mellitus. Amongst the examined by means of ultrasonography 164 patients, patency of the reconstructed ipsilateral internal carotid artery at an average follow-up of 75 ± 28 months (max - 135 mos) amounted to 95%. Haemodynamically significant restenoses (≥ 70%) were revealed in eight (5%) cases. Of these, three (2%) patients had narrowing of 70-89% and the remaining five (3%) patients had narrowing of ≥ 90% (including 2 occlusions of the reconstructed ipsilateral internal carotid artery). We revealed no risk factors influencing the development of restenosis of the reconstructed ipsilateral internal carotid artery after eversion carotid endarterectomy. The obtained findings give grounds to consider eversion carotid endarterectomy as a safe and reliable method for treatment of atherosclerotic lesions of carotid arteries and, consequently, for prevention of stroke. Control of risk factors may improve remote results of surgical treatment.

The article deals with the analysis of the results of randomized placebo-controlled studies of various therapeutic agents currently available in Russia, as well as the results of meta-analyses and Cochrane reviews of medicamentous treatment of patients with intermittent claudication. The results of these studies gave grounds to recommend the most efficient agents in the new edition of the "National Guidelines on management of patients with lower-limb arterial disease" (2013).

The present work was based on analysing the results of a complex examination and surgical treatment of 16-to-78-year-old patients presenting with varicose disease during the period from 2006 to 2010. A total of 1,095 limbs were examined and operated on in 1,070 patients. Of these, 298 (29.6 %) were men, and 709 (70.4 %) women. The distribution of the patients according to the CEAP clinical classification was as follows: C1 - 3 patients, C2 - 215, C3 - 566, C4 - 203, C5 - 29, and C6 - 79 subjects. All patients underwent ultrasonic duplex scanning, with retrograde phlebography performed in 21 cases. 51.2% of patients were diagnosed as having pathological deep venous reflux. In the group of patients with valvular insufficiency of deep veins, a total of 93 operations aimed at correcting deep reflux were performed, including 12 interventions for congenital avalvulation of veins. The indications for restorative operations on the valvular apparatus of deep veins were determined in severe forms of chronic venous insufficiency combined with axial reflux along deep veins in cases of inefficiency of conventional methods of surgical and conservative treatment. The long-term outcomes of surgery were assessed after 18-48 months. The results were evaluated by means of clinical and instrumental methods of examination: the disease severity scale, patients quality of life questionnaire, ultrasonographic and roentgen contrast methods of examination, and legometry. The operations aimed at restoring the valvular function of the femoral veins turned out to be effective methods of correcting venous reflux and made it possible to restore the valvular function in 84% of cases. In the remote postoperative period valvular competence was observed in 74.6% of patients. Carrying out such operations significantly improve the course of the disease due to decreasing the malleolar volume (p<0.001), manifestations of symptoms of chronic venous insufficiency (p<0.001), and improving quality of life (p<0.001).

Objective: The study was aimed at assessing efficacy and safety of administering the generic alprostadil VAP in patients presenting with lower limb critical ischaemia., Material and Methods: We carried out a prospective study including a total of 30 patients with lower limb critical ischaemia. The patients' mean age was 67.7±7.8 years, with men predominating - 60%. Trophic ulcers were observed in 40% of patients. The proximal level of the lesion was localized in the arteries below the inguinal ligament in 19 (63.3%) patients, in the aortofemoral segment - in 9 (30%) patients, and in the popliteal-crural-plantar segment - in 2 (6.6%) subjects. The average ankle-brachial index amounted to 0.49±0.4. The studied agent was used at a dose of 40 mcg once a day in patients with stage III ischaemia and a dose of 40 mcg twice daily in patients with stage IV ischaemia. The drug was administered for 14 days followed by a 14-day follow-up period., Results: The pain syndrome score over the 14 days of treatment decreased twofold from 6.1±2.5 to 3.5±2.6 and within the subsequent 14 days it did not increase - 2.4±3.1 (p< 0.05). The number of patients in whom the pain syndrome decreased by 50% amounted to 19 (63.3%). The consumption of analgesic agents decreased from 60% (at the beginning of treatment) to 12 (40%) (14 days after treatment) and to 8 (26.6%) (at the end of the follow-up period). In patients with trophic ulcers, the average size of the ulcers during treatment decreased from 3.3±3.7 cm to 2.8±3.8 after 14 days, and at the end of the follow-up period the size of the ulcers amounted to 2.1±2.8 cm (p >0.05). The number of patients responding to treatment amounted to 22 (77.3%). The ABI during treatment did not change, being 0.49 ± 0.4 at the beginning of treatment, 0.53±0.4 after 14 days of treatment, and 0.47±0.3 at the end of the follow-up period. There were no amputations either during treatment or within the follow-up period. Only one lethal outcome occurred which was related to acute coronary insufficiency. The "response to treatment" was significantly influenced only by the level of the proximal lesion and age (p<0.05)., Conclusion: VAP 20® demonstrated good efficacy and tolerability comparable to those of the original preparations.

Widespread use of various present-day visual methods of study has made it possible to increase the frequency of revealing penetrating atherosclerotic ulcers, known to be ulcerations of an atherosclerotic plaque thorough the intimal elastic lamina into the medial layer of the aortic wall. The review deals with the literature data regarding the clinical picture, pathogenesis, diagnosis, policy of management and treatment of complications of penetrating atherosclerotic ulcers. The problem concerning the choice between surgical and endovascular treatment of penetrating atherosclerotic ulcers has been elucidated insufficiently in the present-day literature.

We analyzed long-term results of vascular surgery in 199 patients with diabetes and chronic limb ischemia. At the time of the study mean age of patients was 64.7+1.2 years. They all had severe course of disease. Results showed that in the majority of patients good clinical effect after aorto-femoral reconstructions persisted over a long period of time. Patency of aorto-femoral bypass and limb salvage rate after 9 years equaled 72 and 79%, respectively. This was associated with improved quality of life. Surgery for severe limb ischemia (50 % of patients had critical ischemia) helped to preserve the limb and achieve sustainable increase of pain-free walking distance in 85 % of patients. However 5-year survival rate was 75%. The leading cause of death was myocardial infarction. This was indicative of the lack of prevention of progression of coronary artery disease. Thus, despite the presence of diabetes aorto-femoral reconstructions in most patients reliably and continuously prevented development of critical ischemia and preserved lower limbs. Active prophylaxis of cardiac complications is necessary for improvement of long-term survival of patients after vascular reconstructive surgery.

This article is dedicated to diagnostics, prevention and surgical treatment of vascular complications of diabetes mellitus, particularly prevention of ischemic strokes and treatment of critical ischemia of lower limbs. The main tendency in treatment of brachiocephalic artery lesions nowadays is a surgical intervention in the latent stage of the disease. X-ray endovascular surgical techniques are being increasingly used to treat lesions of lower limbs arteries. Limb preservation is impossible without cooperation of many specialists. It's essential to perform careful out-patient follow up of the patient after vascular reconstructive surgery.

Aim: to carry out comparative assessment of the immediate outcomes of eversion carotid endarterectomy, classical carotid endarterectomy and prosthetic repair of the internal carotid artery in atherosclerotic-genesis stenoses thereof., Material and Methods: the study was based on a retrospective analysis of the immediate results of 630 isolated primary open interventions on the bifurcation of the common carotid artery in atherosclerosis, performed at the Department of Vascular Surgery of the A.V. Vishnevsky Institute of Surgery over the period from January 2008 to December 2010. The choice of the method of intervention was based on the indications developed worked out at our Department with due regard for the clinical and morphological peculiarities of the lesion of the carotid bifurcation., Results: the incidence of performing eversion carotid endarterectomy (416; 66%) in the entire group was significantly higher than that of classical carotid endarterectomy (127; 20%) and that of prosthetic repair of the internal carotid artery (87; 14%) (p=0.000). Thrombosis of the reconstructed internal carotid artery developed significantly more often (p<0.05) after prosthetic repair (4.6%) and classical carotid endarterectomy (3.9%) as compared with the eversion technique (0.7%). Frequency of the development of homolateral stroke after prosthetic repair of the internal carotid artery (4.6%) was higher than after eversion carotid endarterectomy (1.2%) and classical carotid endarterectomy (2.36%), however, these differences were statistically significant only when compared with the group of the eversion technique (p=0.000). All techniques were accompanied by low mortality from stroke (the eversion technique - 0.24%, classical carotid endarterectomy (0%), prosthetic repair of the internal carotid artery - 1.15%), and the groups did not differ significantly by this parameter (p>0.05)., Conclusion: the choice of the method of carotid endarterectomy should be determined by the character of lesions of the carotid bifurcation, anatomical interrelationships in the operation wound, and tolerance of the brain to clamping of carotid arteries. Eversion carotid endarterectomy, once possible to perform, is the most preferable method of reconstruction in atherosclerotic lesions of the carotid bifurcation.

Objective: to study remote results of surgical treatment of patients presenting with a pathological deformity of the internal carotid artery., Methods: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (ICA), who underwent a total of 166 reconstructive operations., Results: 7% of patients were operated on at the asymptomatic stage, more than half (56%) of the patients were found to have transient (21%) or persistent neurological deficit (35%), 37% of patients had stage III cerebrovascular insufficiency. Twenty-five (15%) operations were performed for C- and S-shape tortuosity, ninety-seven (58%) procedures for kinking of the internal carotid artery, and forty-four (27%) interventions for coiling. The operation of choice was resection with redressation of the internal carotid artery and reimplantation into the old ostium (74%). Analysing the results of surgical treatment showed its high neurological efficiency in prevention of cerebral circulation impairments (93% of patients at terms up to 25 years had no such complications), as well as clinical efficacy (relief of cerebrovascular insufficiency symptoms in 91.1% of patients). The effect obtained appeared to preserve during 2 and 5 years in 96% and 92% of patients, respectively, and at terms up to 25 years in 83%. The 3-, 5- and up- to-25-year survival amounted to 95%, 92% and 75%, respectively. Restenosis of the internal carotid artery was significantly more often observed after prosthetic repair of the artery (p <0.05) as compared with other methods of reconstruction employed. Thromboses of the internal carotid artery were encountered with similar frequency (8%) only after prosthetic repair and resection of the internal carotid artery with an «end-to-end» anastomosis, which was significantly more often than in resection with redressation (p <0.05). Stroke incidence in the remote postoperative period amounted to 0.8% and the «stroke + stroke-related mortality» parameter equalled 1.6%., Conclusion: the remote results of surgical treatment for pathological deformity of the internal carotid artery are strongly suggestive of high efficacy of this method of prevention of impairments of cerebral circulation and treatment of cerebrovascular insufficiency in patients with the pathology concerned. The operation of choice in pathological deformity of the internal carotid artery is resection with redressation of the internal carotid artery and reimplantation into the original ostium.

The article contains a review of the literature regarding the use of low-molecular-weight heparins (LMWHs) exemplified by dalteparin in the hitherto insufficiently explored area of their implementation, i. e., during the intraoperative period in patients suff ering from atherothrombosis. Presented herein is analysis of alterations in the parameters of the plasmatic and thrombocytic links of haemostatis during intraoperative administration of various molecular-weight fractions of heparin. The obtained findings make it possible to conclude that LMWHs do off er certain advantages when used during surgical interventions in patients with atherosclerotic lesions of the arterial bed.

Presented in the article are the findings of a multicenter prospective clinical trial assessing quality of life of patients with chronic diseases of lower limb veins on the background of administration of nonmicronized diosmin (Vasocet). Specialized questionnaires (CIVIQ-2) appeared to be the most optimal evaluating tools, more precisely catching alterations in patients' quality of life on the background of drug therapy.

Objective: to study clinical and morphological aspects of pathologically deformed pathological deformity of the internal carotid artery., Methods: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (1СA), who underwent a total of 166 reconstructive operations., Results: more than half (58%) of the patients were operated on for 1С A kinking, 27% for coiling and only 15% were found to have C- and S-shape tortuosity. The patients were predominantly women, with a male-to-female ratio of 1:1.6 (Р<0.01). The majority of the patients (61%) were operated on at the age varying from 51 to 70 years (P<0.01). Patients under 40 years appeared to more often (92%) suffer bilateral lesions (P<0.01). 56% of patients had a history of acute cerebral circulation impairment (P<0.05). A symptom-free course of the disease was more frequently encountered in unilateral lesions (P<0.01). Patients under 30 years were more often operated on at the pre-stroke stage of the disease (P<0.05). Patients with kinking of the internal carotid artery had a significantly higher risk (63%) of acute cerebral ischaemia (p<0.01). Arterial hypertension was revealed in 74% of patients. Incidence of acute cerebral ischaemia events was significantly higher in hypertensive patients (P<0.01). Pronounced haemodynamic impairments (bloodflow turbulence) were significantly more often (92%) detected in patients with kinking of the internal carotid artery (P<0.05)., Conclusion: patients with clinical signs of cerebrovascular insufficiency, being relatively young and having concomitant arterial hypertension even with no objective signs of a stenotic lesion of coronary arteries should be referred to duplex scanning of brachiocephalic arteries in order to verify a pathological deformity of the internal carotid artery at the pre-stroke stage of the disease. An algorithm of examination including duplex scanning of brachiocephalic arteries and comprehensive magnetic resonance imaging made it possible to in short time obtain the in-depth information about the anatomical and topographical peculiarities of the pathological deformity of the internal carotid artery and to assess its haemodynamic significance, which in turn makes it possible to clearly and timely determine the treatment policy for the patient concerned.

Objective: To investigate the immediate outcomes of surgical treatment of patients presenting with pathological deformity of the internal carotid artery., Methods: The study was based on retrospective analysis of the outcomes of surgical management of 142 patients with isolated pathological deformity of the internal carotid artery who underwent a total of 166 reconstructive procedures., Results: Resection with redressing of the internal carotid artery and reimplantation into the old bed was a method of choice of repairing the deformed artery (74%). More often it was possible to have performed it in kinking, C- and S-shape tortuosity of the internal carotid artery, whereas prosthetic repair was more often in coiling (P < 0.05). A positive clinical effect of the operation was achieved in 97% of the patients. Neurological efficacy of the performed interventions depended upon the baseline degree of cerebrovascular insufficiency and the duration of clamping of carotid arteries (P < 0.05). The incidence of the development of thrombosis of the reconstructed internal carotid artery (1.2%) did not depend on either the form of pathological deformity or the method of reconstruction thereof. Cerebral circulation impairments in two (1.2%) cases were transitory and in three (1.8%) resulted in ischaemic stroke, one of which having become the cause of the patient's death. The index "stroke + lethality from stroke" amounted to 2.4%. Neurological complications had been caused by rheological impairments, instability of haemodynamics and inadequate redressing of the internal carotid artery., Conclusion: Analysing the immediate outcomes confirmed that surgical treatment of pathological deformity of the internal carotid artery is an effective method aimed at preventing cerebral circulation impairments and removal of cerebrovascular insufficiency in patients with the disease concerned.

Interdependence between the level of homocysteine and acute-phase proteins was assessed in patients presenting with a severe course of atherosclerosis. We examined a total of 67 patients aged 62.3 +/- 1.03 years. Of these, 34 patients had type 2 diabetes mellitus and 35 were non-diabetic. The diabetic patients were found to suffer a severe course of the disease, with 65.6% having a decompensated form. We carried out a comparative analysis of the level of homocysteine, C-reactive protein, and that of fibrinogen. It was noted that diabetic patients significantly more often showed high levels of blood-plasma total homocysteine, C-reactive protein, and that of fibrinogen as compared to nondiabetic patients. Hyperhomocysteinemia appeared to correlate with elevated levels of C-reactive protein (r = 0.37, p = 0.04) and that of fibrinogen (r = 0.36, p = 0.04) at HbA1c > or = 7%. The obtained findings strongly suggest interrelationship of high levels of blood-plasma homocysteine and an elevation in acute-phase proteins in a decompensated form of diabetes mellitus and the presence of sluggish chronic inflammation in all patients, either with or without diabetes mellitus. Inclusion of homocysteine measuring and a highly sensitive method for determining C-reactive protein into the standard of examining patients with atherosclerosis improves diagnosis of the pathological condition, while timely correction of the impairments revealed promotes a decrease in the risk of the development of complications.

Systematised herein are the results of large-scale randomized studies, as well as own findings regarding the use of beta-adrenoblockers and statins in vascular patients. Administration of selective beta-adrenoblockers and statins appeared to decrease the cardiac-complication rate in this cohort of patients.

Efficacy of out-hospital treatment of coagulation disorders in patients with diabetes mellitus type II (DMII) in comparison with non-diabetic patients after aortic-femoral reconstruction was studied. Long-term results were obtained within 65,1±3,95 months after surgery. Data of 67 patients were obtained, of them 32 had severe DMII, 35 patients had no diabetic disorders. 94% of patients had various hypercoagulation disorders and thrombophilia stage I-II. Desagregant therapy was noneffective in 70,1% of patients. Patients with atherosclerosis after reconstructive vascular surgery showed disorders of both thrombocytic and plasma links of coagulation, which requires combined (anticoagulant and desagregant) therapy. Patients with DMII require also blood glucose and HbA1c control postoperatively.

Studied herein are long-term outcomes of aortofemoral reconstructions in a total of 469 patients presenting with atherosclerosis. Of these, 201 (42.8%) patients were diagnosed as suffered from type 2 diabetes mellitus (DM). By the time of the survey, the age of the patients in this group averaged 64.7 +/- 1.2 years. The remaining 268 (57.2%) patients (mean age 62.5 +/- 1.7 years) turned out to be non-diabetic. Surgical interventions performed on the background of pronounced limb ischaemia (50% of the patients had critical ischaemia) had made it possible to save the limb affected and for a long time to increase the distance of pain-free walk in 85.9% of diabetic patients and in 93.1% of non-diabetic subjects. Nine years after the vascular reconstruction of the aortoiliac zone, the indices of the cumulative patency of the bypass grafts (72% for diabetic patients and 81% for non-diabetics) and the limb-salvage rate (78.9% for those with DM and 88.5% for those without DM) remained sufficiently high. The cumulative survival rate amongst the diabetic patients after 3 and 6 years was significantly lower (74.0% and 58.0%, respectively) as compared with that in the non-diabetic patients (93.0% and 72.0%), P < 0.01, whereas by the 9-year period of follow-up it turned out to be similarly low in the both groups of patients (amounting to 26.0% and 29.0%, respectively). In diabetic patients, the mortality rate was significantly higher, with deaths occurring earlier, than in those from the comparison group (43.1% at 56.0 +/- 2.4 months and 28.9% at 62.4 +/- 1.9 months, respectively). The underlying causes of death regardless of the presence of diabetes mellitus chiefly comprised cardiac complications which in diabetic patients were observed significantly more often and occurring at earlier terms (52.9% at 49.5 +/- 1.7 months and 31.1% at 62.1 +/- 1.5 months, respectively, P = 0.04). Hence, despite the presence of DM, aortofemoral reconstructions in the majority of cases (up to 80%) make it possible to reliably and for a long time prevent the development of critical ischaemia and to save the lower limbs.

The present retrospective study was carried out to analyse clinical outcomes of 56 surgical interventions performed on renal arteries in a total of 48 patients suffering from atherosclerotic- aetiology vasorenal hypertension (VRH). Of these, 14 patients were subjected to stenting of renal vessels, 19 underwent aortorenal prosthetic repair, 11 patients endured transaortic endarterectomy (TEA), and four cases were treated by resection of the renal artery with reimplantation. The immediate postoperative outcomes turned out positive in 81% of the patients, to have remained so within an average follow-up period of up to 5 years in 72% of the patients. Most often good results were observed after renal artery prosthetic repair (in 85% of patients) and stenting (in 78% of patients). Good results were observed in 26% of patients with a history of VRH over 5 years, with its duration of less than that surgical renal revascularization being accompanied by positive outcomes in 58% of patients.

The nature of arterial occlusive lesions in young smokers is an object of continuous debate commencing from 1879 when Winiwarter for the first time described a vascular syndrome which he called «obliterating endarteritis». However, in 1908 Buerger published his works hav.' lg become classical and then his monograph (1924) dedicated to this disease for which he used a new name «obliterating thromboangiitis» which further on became a generally accepted term. Diagnosis of obliterating thromboangiitis was made very often in the past. The occurrence of this disease is considerably lower nowadays than 20 or 30 years ago; therefore, the last 10-15 years have witnessed no publication of serious works on this subject. It should be underlined that obliterating thromboangiitis is an independent disease differing fundamentally from atherosclerosis with considerably less frequent occurrence.

The present study was aimed at optimizing the algorithm of examination and indications for operation in patients with a pathological deformity of the internal carotid artery. The work was based on a retrospective analysis of the therapeutic outcomes in 142 patients with an isolated pathological deformity of the internal carotid artery, who underwent a total of 166 reconstructive operations. Based on assessment of the diagnostic accuracy of the employed methods of diagnosis, we proposed an optimal algorithm of patient's examination including coloured duplex scanning and magnetic resonance angiography of the brachiocephalic arteries with simultaneous magnetic resonance tomography of the brain, followed by determining due indications for surgical treatment, depending on the baseline degree of cerebrovascular insufficiency and haemodynamiс significance of the pathological deformity of the internal carotid artery. The developed algorithm of examination makes it possible to timely and efficiently diagnose the disease and to determine due indications for surgical treatment of patients presenting with a pathological deformity of the internal carotid artery.

Presented in the article is a case report concerning successful dissociation of an arterio-arterial anastomosis between the circumflex branch of the left coronary artery and bronchial artery using a stent graft in a 72-year-old patient.

Current concepts of etiology and pathogenesis of nonspecific aortoarteritis (Takayasu's disease) are considered. A.V. Pokrovsky and his team gained the largest experience with diagnostics and treatment of patients suffering this disease. In this paper, the authors describe results of the treatment of more than 200 patients including 118 operated for isolated reconstruction of aortic arch branches (n = 43), restoration of blood flow only in thoracoabdominal aorta and its branches (n = 63), reconstruction of both brachiocephalic arteries and thoracoabdominal aorta (n = 12). The authors present their view of diagnostics and treatment strategy in patients with lesioned brachiocephalic arteries, abdominal and thoracoabdominal aorta. The necessity of following up patients in the postoperative period is emphasized.

Presented herein is the authors' experience gained in employing a method of prosthetic repair of the internal carotid artery in patients suffering from atherosclerotic stenosis. Special attention is paid to intraoperative factors having led to arterial prosthetic reconstruction. Also analysed are the remote results of treatment in 81 of 97 operated patients. The mean duration of follow-up amounted to 28 +/- 3 months. All the patients in the remote period were subjected to colour duplex scanning of the reconstructed tone and that of the contralateral internal carotid artery (ICA), immediately followed by assessing the neurological status. Two patients were found to have developed single transient ischaemic attacks, with their grafts remaining patent. A further three patients had developed thrombosis of the graft, with restenosis of the anastomosis zone being revealed in four patients more. All complications were symptom-free. The obtained findings showed that, taking into consideration the remote results and in certain indications, prosthetic repair of carotid arteries is an efficient method of treatment for atherosclerotic lesions of the ICA and in this relation is at least not inferior to the conventional techniques of carotid endarterectomy.

Presented herein is the authors' experience with surgical treatment of 85 lower extremities by means of endovasal laser coagulation. Shown are the energy-related characteristics of coagulation, followed by analysing the causes of unsatisfactory poor outcomes therapeutic as exemplified on their own experience. Proposed is an adequate selection of energy-related parameters of laser radiation in order to obtain stable occlusion. Given are the literature data on using the method concerned, with a detailed discussion of various points of view on the problem concerning selection of an efficient dose of the laser energy in order to attain adequate occlusion.

The article is dedicated to assessment of quality of ambulatory management of patients suffering from type 2 diabetes mellitus in remote terms following reconstructive operations on the aortoiliac segment. The aspects investigated included the frequency of the of patients' visiting the district polyclinic, as well as frequency and quality of planned examinations and conservative treatment. Presented herein are the results of questioning and comprehensive examination of fifty-six patients suffering from type 2 diabetes mellitus (mean age 62.3 +/- 1. 7years) performed averagely 61.9 +/- 2.1 months after surgical treatment. Fifty percent of these patients appeared to have prior to the operation had critical ischaemia of the lower extremities. By the time of the check up examination, 62.5% of these preserved stage 1 or 2A ischaemia and 37.5% had stage 2B ischaemia, which on the whole was indicative of a long-term positive outcome of surgical interventions in this severely ill cohort of patients. During this time period, in 23 (41.1%) patients with baseline critical ischaemia it turned out possible to avoid limb amputation, and 62.5% were found to have considerably increased the distance of pain-free walking (stage 1 or 2A). Together with it, the obtained findings suggested virtually total lack of adequate angiological care for the postoperative patients at the ambulatory-polyclinic level. First of all, there are neither correctly organized dispensary follow up of patients nor continuity between the clinical hospital and the polyclinic. Analysing the check-up clinical evidence showed that 83.9% of patients required correction of blood glucose level, 96.4% that of lipid profile, and 73.2% that of the haemocoagulation system. Twenty-five (44.6%) patients required stagewise reconstructions due to an atherosclerotic lesion of the previously intact arteries of the lower limbs (21), prosthesis-leg thrombosis (1) and anastomotic restenosis (3). Hence, the clinical effect of a clinical intervention in diabetic patients is apparently evident. Correct and adequate organization of therapeutic and preventive care at the ambulatory and polyclinic level may substantially improve the remote results of vascular operations in this cohort of patients.

Literature review is dedicated to the 100th anniversary of the first case presentation for nonspecific aortoarteritis. The review covers the history of the disease concept development, current knowledge on its etiology and pathogenesis, unresolved problems of management strategy for patients with this pathology.

The authors studied structural-and-functional properties of the arterial wall, also assessing elastic properties of the common femoral artery and the brachial artery flow-dependent dilatation (FDD) index in a total of thirty-six patients presenting with nonspecific aortoarteritis (NAA). The overwhelming majority of the patients, i. e., twenty-four (89%), showed a statistically significant decrease in the FDD as compared with the control-group patients (P<0.05). We revealed a statistically reliable (P=0.0005) inverse correlation between the level of systolic arterial pressure and an increase in the rigidity index of the common femoral artery wall. Also determined was a correlation of the femoral artery wall rigidity (systolic AP equalling 140 mm Hg and higher) and the brachial artery flow-dependent dilatation index (r=-0.61). All the patients suffering from non-specific aortoarteritis were diagnosed as having a decrease in the elasticity values, accompanied by an increase in systolic arterial pressure (r=0.36; P=0.07). Comparing the level of systolic arterial pressure with the values of the distensibility coefficient and compliance coefficient revealed a weak inverse correlation (r=-0.28 and 0.21, respectively). Evaluating the impact of duration of the disease on the distensibility coefficient, compliance coefficient and the rigidity index made it possible to detect a statistically significant (P=0.0039) direct correlation between the rigidity index and the duration of non-specific aortoarteritis. To a leaser degree, the duration of the inflammatory process influenced the distensibility coefficient and compliance coefficient (r=-0.28; r=-0.30, respectively; P=0.06).

The authors carried out a comparative analysis of the level of homocysteine and the state of haemostasis in patients with and without type 2 diabetes mellitus in the remote terms after endured reconstructive operations on the aorto-iliac segment. They examined a total of eighty-eight patients who had endured reconstructive operations on the aorto-iliac segment at various terms. Of these, forty-two patients were found to have a severe course of type 2 diabetes mellitus (59.9% with decompensation) and forty-six subjects without diabetes constituted the group of comparison. The average age of the patients amounted to 61.9 +/- 1.25 years, with all being smokers. The following parameters were assessed: patency of the bypasses and major arteries of the lower limbs (LL), homocysteine (Hey), fibrinolytic activity, fibrinogen, activated partial thromboplastin time (aPTT), factor XIII, thrombin time, prothrombin index, activity of antithrombin III (AIII), platelet aggregation with ADP, and glycosylated haemoglobin (Hb Aic).

The purpose of this study was to determine the frequency with which atherosclerotic lesions of renal arteries are detected during diagnostic angiography in patients presenting with peripheral arterial disease. To this was added the assessment of the risk factors for the development of atherosclerotic renal artery lesions (i. e., gender, age, and the level of a concomitant lesion of the lower-limb arteries). The findings obtained in our study revealed that each fourth patient with Leriche's syndrome appeared to have a significant lesion of the renal artery. Female sex was found to be a predictor of renal artery lesions in patients with peripheral arterial disease. Patients presenting with pathology of renal arteries proved significantly older than those having no lesions of renal arteries.

The article deals with a review of the present-day literature data regarding administration of lipid-decreasing agents--statins in clinical practice of cardiologists and heart surgeons. In the context of the constantly accumulating evidence-based findings concerning efficacy of administration of statins in patients suffering from cardiovascular diseases, the authors describe the importance of therapy with statins in order to prevent complications after atherothrombosis.

Analysed herein are the consensus documents concerning angiology and vascular surgery worked out and adopted in Russia. This is followed by a detailed description of the methodology used while their development, underlying their significance for medical practice and pointing out their strict compliance with the principles of evidence-based medicine. Emphasis is laid on the thesis that the consensus guidelines worked out by the leading specialists, like any rules and norms, contribute favourably to making appropriate decisions by the practicing clinical physicians and may serve as a basis for creation of the branch standards. Also shown are advantages and shortcomings of the adopted documents in angiology, including phlebology, and finally announced is a forthcoming meeting of the Russian experts, devoted to the development of the consensus document entitled "Russian Clinical Guidelines on Diagnosis and Treatment of Chronic Venous Diseases".

The article deals with the findings of studying the use of rosuvastatin in patients after endured reconstructive operations on the brachiocephalic arteries and aortofemoral segment in order to prevent cardiac atherothrombotic complications. A total of thirty patients were given "Crestors" at a daily dose of 10 mg for two weeks prior to surgery and for two weeks postoperatively and were found to have a significant decrease in the average levels of total cholesterol and low-density lipoproteins, which was accompanied and followed by certain improvement in the functional state of the vascular wall, with no cardiac complications being observed in either case.

The paper presents the results of 80 femoro-popliteal bypasses above popliteal fossa for patients with lower limb atherosclerotic lesions that were fulfilled with the use of polytetrafluoroethylene (PTFE) graft in the Department of Vascular Surgery, AV Vishnevsky Institute of Surgery, from February 1992 till December 2005. 50% of patients had lower limb ischemia grade IIb, 13.7% - grade III and 36.3% - grade IV. Distal circulation was good in 41.2%, satisfactory - in 48.5% and unsatisfactory - in 10.3% of patients. The technique of surgical reconstruction was conventional. In 50% of cases the diameter of PTFE grafts was 8 mm, in another 50% - 6 mm. A statistically significant difference in bypass patency was revealed between prostheses with different diameter in late postoperative period. For the 8-mm grafts the patency rate was 93%, 64% and 51% in 12, 30 and 60 months, respectively, while for the 6-mm grafts the same rate was 62%, 44% and 31%, respectively (p=0.004).

The article deals with analysing the outcomes of administering low-molecular-weight heparins (LMWH) by the example of nadroparin ("Fraxiparin") during the intraoperative period in patients diagnosed with atherosclerotic lesions of femoropoplietal-crural segment of the lower-limb arteries as compared with non-fractionated heparin (NFH). Studied were the alterations in the parameters of the plasmatic and thrombocytic links of haemostasis on the background of administering various molecular-weight fractions of heparin. A conclusion was drawn on advantageous use of LMWH in the cohort of the patients involved. Also presented herein is an analysis of the literature data concerning appropriate usage of LMWH during the intraoperative period.

Nonspecific aortoarteritis (NAA) is a chronic inflammatory disease that affects the aorta and its branches. The clinical manifestations of this disease are of a great variety and depend on the site of a lesion and the stage of the disease. A wide range of highly informative noninvasive imaging techniques, such as duplex scanning (DS), magnetic resonance imaging (MRI), and computed tomography (CT) of the aorta and its branches, are used to make a more accurate diagnosis and to determine the site and extent of a vascular bed lesion. The given clinical example suggests that CT angiography of the aorta and its branches is a high-precision technique in determining the site of vascular bed lesion in patients with NAA and the pattern and extent of arterial involvement and that it may be used for both the diagnosis of the disease at its developmental stages and the monitoring of the vessels during pathogenetic therapy.

The authors present herein a case report of a patient presenting with a posttraumatic arterio-venous aneurysm between the aorta and left renal vein, which is an extremely rarely occurring disease. A method of choice in treatment of an arterio-venous aneurysm is an open operation. The clinical example presented demonstrates a possibility of using roentgenoendovascular occlusion for closing the aorto-venous fistula. We report our own experience in treatment of the diseases by means of the occluders PLUG and Amplatzer ASD, followed by a surgical intervention.

The article is dedicated to analyzing the outcomes of an open prospective study of efficacy of Liprimai administered in the postoperative period. The study comprised a total of 30 patients presenting with atherosclerotic lesions of the arteries of the carotid bed and aorto-femoral segment, who were subjected to reconstructive vascular operations. The aim of the present study was to look into a possibility of preventing cardiac complications in patients after endured reconstructive vascular surgery. Liprimar was administered at a daily dose of 10 mg seven days prior to the operation, and for eight days thereafter.

The paper analyzes outcomes of 12 internal carotid artery (ICA) graftings for repeat stenosis after carotid endarterectomy (CEA) in 11 patients. In 6 cases restenosis occurred after eversion CEA, in 5 - after conventional patch CEA, and in 1 case - after ICA patch angioplasty for post-CEA restenosis. Critical restenosis >75% in reconstruction area was an indication for surgical intervention. There was 1 case of graft thrombosis in early postoperative period with hemispherical stroke and lethal outcome. Eight patients were examined in late postoperative period. Mean follow-up was 34?+/-?8.44 months (from 16 to 48 months). No cerebrovascular disturbances in operated ICA feeding area were detected. In 6 patients graft patency was good, while 2 smoking patients with diabetes mellitus and hyperlipidemia demonstrated repeat restenosis of proximal anastomosis >70%.