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Introduction: all over the world, the number of patients with peripheral arterial lesions is growing, the progression of the disease leads to the chronic limb-threatening ischemia (CLTI) with an increasement in mortality. To carry out revascularization, it is required to accurately determine the degree and length of lesions of arteries of limbs, with the creation of a «road map» of lesions and the choice of the least affected artery ˗ the target arterial pathway.

Aim: was to determine the effectiveness of CT angiography in diagnosing lesions of shin arteries in patients with critical lower limb ischemia (CLI) by calculating its sensitivity and specificity in comparison with digital subtraction angiography.

Materials and methods: the study included 26 patients (15 men and 11 women, average age of patients 69,3 ± 10,8 years) with critical lower limb ischemia, against the background of lesions of the femoro-popliteal segment of arteries, class D TASC II. All patients underwent CT angiography on a 64-spiral computed tomography scanner. Obtained data was compared with results of catheter angiography (digital subtraction angiography), used as a reference method.

Results: the sensitivity of CT angiography in determining the degree of lesion (stenosis or occlusion) of leg arteries was 100% and 94%, the specificity was 83% and 96%, respectively. The overall accuracy of CT angiography in the tibial segment was 87% for stenoses and 94% for occlusions. According to results of CTA, massive calcification was detected in 13% of cases from the total number of analyzed arteries. When evaluating these arteries according to DSA data, most of arteries (11 of 12) were occluded, and the length of occlusions in 8 cases was maximum according to the GLASS classification (the length was more than 1/3 of the artery length). The presence of strong correlations between CT angiography and digital angiography on the presence of occlusions, stenoses> 50% and their length was determined.

Conclusions: CT angiography is a highly informative method for diagnosing the degree and length of lesions of shin arteries in patients with critical lower limb ischemia.



1.     GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1789-1858.

2.     Reinecke H, Unrath, M, Freisinger E, et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. European heart journal. 2015; 36(15), 932-938.

3.     National guidelines for the diagnosis and treatment of lower limb arterial diseases. Expert group for the preparation of recommendations: chairmen of the expert group Academician of the Russian Academy of Sciences Bokeria LA, Academician of the Russian Academy of Sciences Pokrovsky AV. Moscow, 2019 [In Russ].

4.     Aboyans V, Ricco JB, Bartelink M, et al. ESC Scientific Document Group (2018). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European heart journal. 2018; 39(9): 763-816.

5.     Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33 (1): 1-75.

6.     Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019; 69(6S): 3-125.

7.     Pokrovsky AV, Yakhontov DI. The value of assessing the outflow tract in femoral-tibial reconstructions. Rossijskij Mediko-biologicheskij vestnik im. akademika I.P. Pavlova. 2013; 4: 104-112 [In Russ].

8.     Hamburg NM, Creager MA. Pathophysiology of Intermittent Claudication in Peripheral Artery Disease. Circulation journal: official journal of the Japanese Circulation Society. 2017; 81(3): 281-289.

9.     Bollinger A, Breddin K, Hess H, et al. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis. 1981; 38(3-4): 339-346.

10.   Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26(3): 517-538.

11.   Graziani L, Silvestro A, Bertone V, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg. 2007; 33(4): 453-460.

12.   Radiation diagnostics of diseases of the heart and blood vessels. National leadership. (Ed. by LS Kokov; SK Ternovoj.) Moscow, GEOTAR-Media, 2011; 688 [In Russ].

13.   Đurović Sarajlić V, Totić D, Bičo Osmanagić A, et al. Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia? Psychiatr Danub. 2019; 31(5): 814-820.

14.   Al-Rudaini HEA, Han P, Liang H. Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia. Curr Med Imaging Rev. 2019; 15(5): 496-503.

15.   Lim JC, Ranatunga D, Owen A, et al. Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease: Assessment of Image Quality and Accuracy in a Tertiary Care Setting. J Comput Assist Tomogr. 2017; 41(2): 327-333.

16.   Mohler ER, Jaff MR Peripheral Artery Disease 2nd Edition. Wiley-Blackwell. 2017; 208.

17.   Ayubova NL, Bondarenko ON, Galstyan GR, et al. Peculiarities of lesions of the arteries of the lower extremities and clinical outcomes of endovascular interventions in patients with diabetes mellitus with critical ischemia of the lower extremities and chronic kidney disease. Saharnyj diabet. 2013; (4): 85-94 [In Russ].

18.   Molitvoslovova NA, Manchenko OV, Jaroslavceva MV, et al. The relationship of calcification of the arteries of the lower extremities with the severity of distal neuropathy in patients with diabetes mellitus. Problemy jendokrinologii. 2013; 59(2): 7-11 [In Russ].

19.   Konijn LCD, Takx RAP, de Jong PA, et al. Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients. Eur J Radiol. 2020; 132: 109305.



Introduction: congenital portosystemic venous shunts (CPVS) are rare vascular abnormalities that occur secondary to abnormal development or involution of fetal vasculature. They allow intestinal blood to enter the systemic circulation, bypassing the liver, which in the long term leads to various symptoms and complications. Today, thanks to advanced imaging techniques, the number of reported cases of CPVS is increasing, although for the most part these are single clinical cases or reports summarizing small series of cases. The overall incidence of CPVS is estimated at 1:30 000 births and 1:50 000 for those persisting beyond early childhood.

Material and methods: article consists of 44 foreign literature sources, that  highlight pathogenesis, classification, clinical picture, diagnosis and treatment of CPVS.

Conclusion: early diagnosis and correction of this anomaly using any (endovascular or surgical) occlusion regresses symptoms and prevents long-term complications. At present, given the rarity of this pathology, there is no large statistical analysis and no standards, developed for the management of this category of patients. However, further collection of material, an emphasis on the pathophysiology and anatomy of these lesions, will help to provide more effective care for patients with congenital portosystemic venous shunts.





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Olkhova EB, Tumanyan GT, Hungarian GV, et al. Abernathy malformation in newborns. Echographic diagnostics. Radiology-practice. 2015; 5 (54): 46-58 [In Russ].

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Malysheva EB, Zakharova EM, Rykhtik PI, Zhulina NI. Abernetty's malformation is a rare cause of hemodynamic cirrhosis of the liver. Russian journal of gastroenterology, hepatology, coloproctology. Application. 2017; 27(1) S49; 48 [In Russ].

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According to American Cancer Society lung cancer is the main "killer" among all types of cancer, five year survival rate of these patients in less than 15%. Thorough staging is necessary to make prognosis of disease and choose the way of treatment. In 2009 International Association for the Study of Lung Cancer ( IASLC) published the 7th system of lung cancer staging based on TNM classification data. Defining of lung cancer and its staging is an interdisciplinary process. Moreover clinical, endoscopic and radiological data are used for this purpose. Among them, the multislice computed tomography is a leading method for lung cancer staging. 



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Aim: was to evaluate possibilities of using of ultrasound classification of subcutaneous rupture of the Achilles tendon (AT) for hospital clinical practice.

Materials and methods: we examined 11 patients (9 men and 2 women). Clinical and X-ray examinations were done. Ultrasound examination was done by the standard method; modern sonographic classification of the rupture of AT was done with functional probe

Results: clinical signs of subcutaneous rupture of AT were obtained in each patient. According to sonographic classification, complete AT rupture was found in 27,2% patients (3 of 11), incomplete rupture was found in 72,8% (8 of 11). Tendinosis signs were found in 37,5% patients (3 of 8) with incomplete rupture.

Conclusions: obtained data prove the effectiveness of ultrasound method of diagnosis of subcutaneous rupture of AT, in detection various variants of its trauma. It is important for optimization of treatment strategy. 



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Aim: was to develop a classification of osteonecrosis of the midface, based on clinical and radiological examinations. Such classification can allow to make detailed planning of surgical intervention tactics and develop criteria for surgical intervention basing on the bone division of the facial skeleton, as well as to assess dynamics of changes in bones of the facial skull.

Materials and methods: the study included 87 drug-addicted patients with a diagnosis of «toxic phosphate osteonecrosis». All patients underwent clinical and radiological examination. Basing on MSCT data, tactics of surgical treatment was determined.

Results: basing on results of clinical and radiological methods of examination in 29 cases (33%) we observed toxic phosphate osteonecrosis of the upper and lower jaw. In 18 patients (21%) the disease occurred only in the upper jaw. Lesion of the upper jaw within the I and II parts below the infraorbital foramen was observed in 39 cases (45%). Lesion of the maxilla above the infraorbital foramen was determined in 8 cases (9%). In case of diffuse lesions of the maxilla in 23 cases (26%), different patterns of midface were involved in pathologic process.

Conclusion: creation and application in clinical practice of this classification of osteonecrosis of the midface bone in patients with drug-addiction on desomorphine and pervitin, based on the data of MSCT, allowed to pinpoint boundaries and the nature of the defeat of facial bones and choose the best tactics of surgical treatment in all patients. 



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