Abstract:

Introduction: treatment of patients with bilobar metastatic liver disease remains an unsolved problem. Among methods of regional chemotherapy, the least studied is isolated liver chemoperfusion, which is an unpopular technique due to its high trauma and difficult reproducibility.

Aim: was to demonstrate the method of endovascular isolated liver chemoperfusion (EILHP) developed by us.

Case report: EILCP was performed using a heart-lung machine (HLM) in a patient with cancer of the rectum, stage 2 (pT3N0M0), after combined treatment (radiation therapy (SOD 60 Gy) + anterior resection of the rectum in 2007). Disease progression. Isolated metastatic liver disease (01.2021). Isolated chemoperfusion was performed endovascularly using 2-balloon catheters, which provided vascular isolation of the liver and its isolated perfusion during the procedure. Posi- tioning of balloon catheters was performed in an open way through femoral artery and vein. Perfusion was carried out for 30 minutes with chemotherapy drugs (CtD) oxaliplatin 42,5 mg/m² and irinotecan 82,5 mg/m² injected directly into the circuit.

Results: the duration of intervention was 160 minutes, intraoperative blood loss was 50 ml. During insertion and positioning of aortic balloon, a limited dissection of the aorta developed in area of left common iliac artery deviation, which did not require any intervention in postoperative period. Duration of intensive care unit stay was 1 day. There were no complications associated with aortic dissection during 3-month follow-up. Level of ALT and AST remained within reference values during entire postoperative period. No hematological toxicity was observed. Patient was discharged on the 7th day after operation in satisfactory condition.

Patient underwent control CT scan of abdominal organs, 30 days after endovascular isolated chemoperfusion of the liver. According to the RECIST scale, stabilization of tumor process was noted.

Conclusions: proposed technique of endovascular isolated liver chemoperfusion is technically feasible and safe. The use of this method may be appropriate in treatment of patients with isolated liver metastases who require dose reduction of chemotherapeutic agents due to their severe toxicity or high patient comorbidity.

Abstract:

Introduction: it is well known that magnetic resonance imaging (MRI) has superiority above computed tomography (CT) in identification of epileptogenic substrates due to higher resolution of images and the best differentiation between white and gray matter. But in some peculiar cases, CT can be the method of choice.

Aim: was to illustrate the role of CT in presurgical examination in children with drug-resistant focal epilepsy.

Materials and methods: results of CT of 65 patients with focal epilepsy had been analyzed. All patients underwent multimodal presurgical examination with followed antiepileptic surgical operation and morphological analysis.  CT was performed on GE Lightspeed and Philips Ingenity Elite scanners.

Results: in presurgical period, native CT was performed in 11 (16,9%) patients and in 6 patients, structural brain changes responsible for epilepsy were identified. In 13 patients (20%) we’ve used CT angiography for estimation of angio-architectonic environment in the area of potential surgical intervention and in case of suspicion on arteriovenous malformation (AVM). CT on the 1st day of post-operative period was made in 48 (73,8%) of patients, and in 2 cases CT revealed structural changes that influenced further treatment tactics. At the background of exacerbation in 3 patients, repeated CT revealed sings of acute disorders of cerebrospinal fluid cirdulation.

Conclusion: computed tomography can be an effective diagnostic method in examination of patients with epilepsy, especially when verifying bone and vascular (CT-angiography) changes, is used for neuronavigation to control the position of invasive electrodes and exclude post-implantation hemorrhages, and also helps to identify early postoperative complications, thus influencing tactics and outcomes of surgical treatment of epilepsy. In children with focal epilepsy undergoing surgical treatment, computed tomography and magnetic resonance imaging are complementary studies that provide adequate neuroradiological support.

References

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6.     Полянская М.В., Демушкина А.А., Костылев Ф.А. и др. Возможности режима SWI в магнитно-резонансной нейровизуализации у детей с фокальной эпилепсией. Эпилепсия и пароксизмальные состояния. 2020; 12(2): 105-116.

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https://doi.org/10.1016/j.wneu.2017.11.063

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https://doi.org/10.1016/j.wneu.2018.11.079

22.   Fontes RB, Smith AP, Munoz LF, et al. Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center. J Neurosurg. 2014; 121: 307-312.

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Abstract:

Aim: was to estimate long-term results of vertebral artery (VA) stenting in patients with vertebrobasilar insufficiency (VBI).

Material and methods: study included 194 patients with VBI caused by lesion of V1 segment of VA. All patients received the best course of drug therapy before admission to the clinic. In all these patients, atherosclerotic stenosis of 70% or more of VA was revealed in V1 sergment. All patients underwent surgical correction of V1 segment of VA. Open surgery was performed in «A» group – with a tortuosity of VA – 129(66,5%), in group «B» – without tortuosity of a VA – 65(33,5%) performed stenting of V1 segment of PA.

Bare-metal stents were implanted in 44 patients, drug-eluted stents - 14, renal stents – 7. Distal protection was used in 14 patients. In remaining patients, stenting was performed without embolic protection devices.

Main criteria for evaluating of results were: patency of the reconstruction zone and clinical improvement in the patient after surgery. Statistical processing of results was carried out by calculating ?2, the exact Fisher test (EFT) and constructing of Kaplan-Meier survival curves.

Results: it was determined that in «hopeless» patients, from the point of view of drug treatment, it is possible to achieve a significant clinical effect by surgical methods. Of 194 patients, clinical improvement in the early postoperative period was achieved in 189(97,4%) patients, after 1 year in 177 (91,2%) patients, and after 3 years in 156(80.2%) patients.

In case of stenting of V1 segment of VA – we received excellent immediate results – 100% of technical and clinical success. However, in the long term, results of open operations were better than results of stenting. 3 years after operation, a higher clinical efficacy of open methods was determined – 79,8%, in contrast to stenting – 73,8%. Although, differences were not statistically significant (p> 0,05). 3 years after operation, in case of open operations, a significantly smaller number of restenosis of the reconstruction zone was 1.6%, than with stenting – 15,4% (p <0.05). However, in patients with open operations, more thrombosis of the reconstruction zone were revealed – 5,5% than in patients with stenting – 1.5% (p>0,05). When performing open operations on V1 segment of VA, strokes were fewer – 2.3%, than in group of V1 stenting segment of VA – 3.1% (p> 0.05). When comparing Kaplan-Meyer curves, the median during open surgeries on VA is not achieved after 18 years, and in group of stenting of VA, it occurs after 7 years.

Conclusion: stenting of V1 segment of vertebral arteries in patients with VBI is not the operation of choice in terms of long-term results. However, this operation can be considered as the first stage of brain revascularization in the presence of significant stenosis of V1 segment of vertebral artery and low brain tolerance to ischemia in patients with multiple lesions of brachiocephalic arteries.

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15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240.

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Abstract

Background: ongoing abdominal and pelvic bleeding is one of main causes of deaths among patients with penetrating and blunt trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary patient's stabilization and reducing blood loss.

Aim: was to present result of work of 1st-level trauma-center: to describe experience of application of methodics of REBOA in center, to estimate its efficacy on the base of retrospective analysis of hospital charts of injured and heavy damaged patients.

Materials and methods: during the period between April 2013 and November 2017, 14 REBOA procedures to patients with abdominal (thoracic aorta occlusion) and pelvic (occlusion of the aortic bifurcation) bleeding were performed at the War Surgery Department of the «KirovMilitaryMedicalAcademy». A decision to do REBOA was made upon admission according to significant hypotension (systolic blood pressure [sBP] less than 70 mm Hg.) or cardiac arrest, abdominal free fluid and/or mechanically unstable pelvic fractures.

Results: mean time from admission to REBOA was 27,5 [10,0-52,5] minutes. The procedure took 10 [5-13] minutes. Average BP elevation after balloon inflation was 43±16 mm Hg. Survival in acute phase of trauma (first 12 hours) was 57.1%, while total survival rate was only 14.3% (2/14 patients). One REBOA-associated major complication was registered - development of irreversible ischemia due to long sheath dwell time in the femoral artery.

Conclusion: REBOA is effective for temporary hemodynamic stabilization and internal hemorrhage control, it allows increasing early survival in severe trauma. Factors to improve short- and long-term outcome, total survival warrant to be additionally investigated, especially in terms of intensive care improvement.

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Abstract

This study presents an overview of modern methods of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery

Aim: was to analyze the state of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery according to the modern literature in the field of vascular surgery

Results: this review analyzes more than 30 relevant publications presented in both domestic anc foreign press over the past 20 years, taking into account a variety of meta-analyses.

Conclusions: this topic is very relevant today, as the increase in the number of surgical and endovascular interventions in lesions of the superficial femoral artery dictates new research to develop optimal tactics of treatment of this category of patients.

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37.   Liistro F, Porto I, Angioli P, et al: Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation. 2013.

38.   Bays S. The use of scoring balloons in the superficial femoral artery. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):504-511.

39.   Saxon rubles. Heparin bonded stent grafts in SFA: VIPER annual results. The report is presented at the International Symposium on Endovascular Therapy; January 18, 2012; Miami, Fla, USA.

40.   Ansel G. 3-year vivid results. The document is available at: Vascular InterVentional Advances; October 2011; Las Vegas, Nev, USA.

41.   Vermassen F. Bouckenooghe I, Morel N Goverde P. Schroe N. The role of biodegradable stents in the superficial femoral artery. Journal of Cardiovascular Surgery. 2013; 54 (2): 225-234.

Abstract:

Aim: was to evaluate the efficacy of MSCT in assessment of long-term graft patency after coronary artery bypass graft surgery (CABG).

Material and methods: 25 patients with multi-vessel coronary artery disease were included in the research. To assess the 5-year graft patency, MSCT arteriography was performed.

Results: a total of 96 grafts (22 left internal thoracic artery (LITA) and 74 saphenous venous grafts (SVG)) were analyzed using MSCT There were 12 venous sequential grafts and 19 venous Y-shaped grafts determined. During the assessment of graft patency, 13 occlusions of venous grafts and 1 hemodynamically significant stenosis were detected. Occlusion and hemodynamically significant stenosis of mammary grafts were not observed.

Conclusion: MSCT arteriography, allows to determine occlusive and hemodynamically significant stenoses of SVG. Results of study shows the prevalence of SVG occlusions and stenosis over arterial grafts. CT angiography can be highly informative for assessing the patency of grafts in late periods after CABG. 

References

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3.      Ropers D, Pohle FK, Kuettner A, Pflederer T, Anders K, Daniel WG, Bautz W, Baum U, Achenbach S. Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation. Circulation. 2006;114: 2334-2341.

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5.      Lee R, Lim J, Kaw G, Wan G, Ng K, Ho KT. Comprehensive noninvasive evaluation of bypass grafts and native coronary arteries in patients after coronary bypass surgery: accuracy of 64-slice multidetector computed tomography compared to invasive coronary angiography. J Cardiovasc Med (Hagerstown). 2010; 11(2): 81-90.

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Abstract:

Aim: was to analyze long-term results of carotid endarterectomy (CEA) in patients with unilateral lesion of the internal carotid artery (ICA), the lack of/or insignificant lesion on the contralateral side on statin therapy.

Materials and methods: for the period January 2009-December 2010, 262 CEA performed in 262 patients. Evaluated results of survival rate, stroke and myocardial infarction, condition of carotid arteries, effect of various factors on features of atherosclerotic lesions and effect of statin therapy on these processes.

Results: in late follow-up period - 245(93,5%) survivors. Patients were divided into groups: simvastatin - 60(24,5%) patients, atorvastatin - 134(54,7%) observations, rosuvastatin - 51(20,8%) cases. 14 patients died, data were obtained on the 13, average loss of 6.06%. The frequency of cardiovascular events leading to death is seven cases. Non-fatal stroke of any location - 5(1,9%) observations. The influence of hypertension (p=0,019), smoking (p=0,004), type 2 diabetes (p=0,03), dyslipidemia: hypercholesterolemia (p=0,05), hypertriglyceridemia (p=0,02), low-density lipoprotein (LDL) level is higher than normal (p=0,015), high-density lipoprotein (HDL) is below normal (p = 0,03) and other factors. Lowering cholesterol by 5,9% is marked in the atorvastatin group, maintaining at recommended values throughout the period from the initial selection in the rosuvastatin group (p = 0,0001). LDL cholesterol decreased by 19,1% in the mean value in the atorvastatin group (p = 0,0001), the increase of HDL level of 3,4% in the rosuvastatin group (p=0,02). Achievement of recommended levels of cholesterol was more often observed in the rosuvastatin group at 64,7% compared with simvastatin (p = 0,03). Risk factors influenced the incidence of restenosis ipsilateral side in 3 patients (1,2%). The greatest influence of risk factors was determined in the atorvastatin group (4,1%, p=0,001). Atorvastatin therapy stabilized the wall of the ICA 17,6% more often (p=0,05) and contralateral common carotid artery, leaving it intact at 84,6% (p=0,002) compared with other groups of statins.

Conclusion: the purpose of statin therapy depends on the severity of the atherosclerotic process the characteristics of the lipid profile and the need correction of risk factors. The most effect is provided by the group of synthetic statin above semisynthetic. Atorvastatin therapy is effective with moderate hypercholesterolemia; rosuvastatin prescribed with severe dyslipidemia.

References

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2.      AbuRahma A.F., Srivastava M., Stone P.A. Effects of Statins on Early and Late Clinical Outcomes of Carotid Endarterectomy and the Rate of Post-Carotid Endarterectomy Restenosis. J Am Coll Surg. 2015;220:481-488.

3.      Sillesen H., Amarenco P., Hennerici M.G., Callahan A., Goldstein L.B., Zivin J. et al. Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2008; 39: 3297-3302.

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Abstract:

Open surgery is a basis of treatment of major vascular injuries, although some of injuries can be treated by means of endovascular surgery

Aim: was to investigate the possibility of endovascular treatment of full transection of major arteries. Material and methods: а retrospective analysis of patients histories of 52 patients with limbs' vascular injuries was performed. Opinions of physicians of different surgical specialties about practicability of endovascular technologies use in trauma surgery were investigated. Using a created stand-desk, consisted with container filled with gelatin mass, simulating a hematoma in a zone of vascular rupture, plunged into gelatin ends of silicone tubes 6 mm in internal diameter, and a web-camera fixed above the stand, comparative analysis of efficacy of 6 different methods of vessel recanalization was done.

Results: еndovascular methods of treatment can be performed in 42,3% of patients with major arterial injuries. Of those, 13,5% of patients may need to undergo recanalization of full vascular transection followed by stent-graft implantation. Our study demonstrated the possibility of through-and-through recanalization of the full major vascular transection, and most effective methods of recanalization - methods with use of a special endovascular loop, a retrieval device, and a standard folded guidewire. Preliminary balloon inflation inside a proximal part of the artery should be considered in case of unstable hemodynamics of a patient.

The questionnaire showed that integration of endovascular surgical methods is perspective for the future of trauma surgery; however, there are some retaining obstacles such as organizational and fiscal issues. It is likely that training of general surgeons in basic endovascular skills is practical. 

References

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13.   Reva V.A., Petrov A.N., Samokhvalov I.M. Stentirovanie poverhnostnoj bedrennoj arterii pri ee bokovom povrezhdenii. [Stenting of superficial femoral artery in correction of its side damage]. Diagn. Intern Radiol. 2014; 8(3):105-108 [In Russ].

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21.   Gilani R., Tsai PI., Wall M.J. Jr., Mattox K.L. Overcoming challenges of endovascular treatment of complex subclavian and axillary artery injuries in hypotensive patients. J. Trauma Acute Care Surg. 2012; 73(3): 771-773. 

Abstract:

122 cases of gastroesophageal bleeding due to portal hypertension are analyzed in the article. It is shown that transcatheter interventions, as a part of the complex hemostasis strategy, can significantly improve the results. Keeping to algorithms and acting in accordance with protocols developed for any diagnostic procedure or intervention are declared to be crucial to success. The complex approach to profuse bleeding management, that included transcatheter procedures, decreased mortality rate from 72,2% to 22,1% and reduced rebleeding rate from 47,2% to 31,4%. 

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27.   Борисов А.Е., Рыжков В.К., Кащенко В.А. идр. Малоинвазивные операции в лечениипищеводно-желудочных кровотечений портального генеза. Анналы хирургической гепатологии. 2006; 5 (2): 214.

28.   Зубрицкий В.Ф. Регионарная внутриартериальная перфузия и малоинвазивная рентгенохирургия локальных патологических процессов. Автореф. дис. д-ра мед. наук. С.-Пб., 2000; 43.

29.   Ханевич М.Д., Зубрицкий В.Ф., Овчинников А.А. Эндоваскулярные вмешательства при кровотечениях из варикозно-расширенных вен пищевода и кардиального отдела желудка у больных портальной гипертензией. В кн.: Актуальные вопросы малоинвазивной хирургии. Владимир, 2004; 49-55.

30.   Овчинников А.А. Эндоваскулярный гемостаз при кровотечениях из варикозно-расширенных вен пищевода и желудка у больных портальной гипертензией. Автореф. дис. канд. мед. наук. М., 2004; 25.

31.   Шерцингер А.Г., Жигалова С.Б., Мусин РА. и др. Осложнения после эндоскопических вмешательств у больных с портальной гипертензией. Анналы хирургической гепатологии. 2007; 12 (2): 16-21.

32.   Братусь В.Д. Дифференциальная диагностика и лечение острых желудочно-кишечных кровотечений. Киев: Здоровье. 1991; 272.

33.   Авдосьев Ю.В., Бойко В.В., Лазирский В.А. Рентгенэндоваскулярные методы гемостаза в комплексе хирургического лечения кровотечений из флебэктазий пищевода и кардии, развившиеся на фоне внутрипеченочной и допеченочной портальной гипертензии. Врачебная практика. 2006; 6: 21-30.

34.   Ninoi Т., Nishida N., Kaminou Т. et al. Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR. 2005; 184:1340-1346.

35.   Sugimori K., Morimoto M., Shirato K. et al. Retrograde transvenous obliteration of gastric varices associated with large collateral veins or a large gastrorenal shunt.J. Vasc. Interv. Radiol. 2005; 16: 113-118.

Abstract:

Aim: was to show possibilities of endovascular methods of treatment in patients with acute ischemic stroke in endovascular operation-room of cardiovascular surgical department.

Materials and methods: we present two case reports of treatment of patients with acute ischemic stroke, who were admitted to neurological department during first hours from onset.

Patients underwent CT perfusion, CT angiography of cerebral arteries. For blood-flow restoration, patients underwent thrombectomy

Results: thrombectomy from occluded artery was successful in both cases, that leaded to better recovery of neurological status.

Conclusions: wide application of endovascular techniques for restoration of cerebral blood flow in patients with ischemic stroke in the early hours of the onset of the disease, can lead to a more prosperous clinical outcomes, more rapid and complete recovery of the patient. Important is the presence of specialized personnel with appropriate skills and a wide spectrum of endovascular instruments.  

References 

1.    Feigin V.L., Lawes C.M.M., Bennet D.A., Anderson C.A. (Stroke epidemiology: a review of population-based studies of incidence, prevalence, and casefatality in the late 20th century. Lancet Neurol. 2003;2:43-53.

2.    Stulin I.D., Musin R.S., Belousov Ju.B. Insul't s tochki zrenija dokazatel'noj mediciny. [Stroke from viewpoint of evidence-based medicine]. Kachestvennaja klinicheskaja praktika. 2003; 4: 10-18 [In Russ].

3.    Varakin Ju.A. Jepidemiologicheskie aspekty profilaktiki narushenij mozgovogo krovoobrashhenija. [Epidemiological aspects of the stroke prevention]. Nervnye bolezni. 2005; 2: 4-9 [In Russ].

4.    Hripun A.V., Malevannyj M.V. i soavt. Pervyj opyt oblastnogo sosudistogo centra ROKB po jendovaskuljarnomu lecheniju ostorogo narushenija mozgovogo krovoobrashhenija po ishemicheskomu tipu [First Experience of Regional Vascular Center ROKB in Endovascular Treatment of ischemic stroke]. Mezhdunarodnyj zhurnal intentencionnoj kardiologii. 2010; 23: 32-42 [In Russ].

5.    Gusev E.I., Skvorcova V.I., Martynov M.Ju. Vedenie bol'nyh v ostrom periode mozgovogo insul'ta [The treatment of the acute phase of the stroke]. Vrach. 2003; 3: 8-24 [In Russ].

6.    Nakano S., Iseda T., Yoneyama T., et. Al. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombollysis. Stroke. 2002; 33: 2872-2876.

7.    White J., Cates Ch., Cowley M. et. al. Interventional stroke therapy: current state of the art and needs assessment. Catheterization and Cardiovascular Intervention. 2007; DOI 10.1002/ccd: 1-7.

8.    Suzuki S., et al. Access to intra-arterial therapies for acute ischemic stroke: an analysis of the US population. AJNR Am. J. Neuroradiol. 2004; 25: 1802-1806.

9.    Wholey M.H, et.al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc. Interv. 2000; 50: 160-167

Abstract:

Aim: was to estimate possibilities of the CT in patients with anomalies of dental system and asymmetric jaws and to offer a protocol analysis of CT data.

Materials and Methods: 100 patients with anomalies of dental system were examined. They were divided into 4 groups:

- 22 patients with II class without asymmetry of jaws (22%)

- 8 patients with II class with the asymmetry of jaws (8%)

- 52 patients with III class without asymmetry of jaws (52%)

- 18 patients with III class with asymmetry of jaws (18%)

At the stage of preoperative planning, computed tomography was performed. CT protocol of jaws symmetry estimation was developed.

Results: with the help of developed СТ protocol, asymmetry of the maxilla was determined in 11 patients (11.0%): 5 patents (5.0%) with II class, 6 patients (6.0%) with III class. The number of patients with signs of asymmetry of the mandible of II class was 9 patients (9.0%), III class — 13 patients (13.0%). Obtained measurements allowed to analyze degree of asymmetry and calculate required excision and moving of jaws. For planning of surgical stage, CT data of all patients was uploaded into special program «Surgicase CMF».

Conclusions: CT gives possibilities to estimate the anatomy of the facial skeleton and its symmetry; that allows to make plan of further orthognathic surgery.  

References 

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3.    Proffit U.R. Sovremennaja ortodontija. Perevod s anglijskogo pod redakciej prof. L.S. Persina[Modern orthodontics. Under editio of prof. L.S. Persina]. M.: Medpress-inform, 2006; S559 [In Russ].

4.    Дробышев А.Ю., Анастассов Г. Основы ортогнатической хирургии. М.: Печатный город, 2007; С 55. Drobyshev A.Ju., Anastassov G. Osnovy ortognaticheskoj hirurgii[Basics of orthognathic surgery]. M.: Pechatnyj gorod, 2007; S55 [In Russ]

5.    Mani V. Surgical correction of facial deformities. JP Medical Ltd, 2010; 290 p.

6.    Ko E.W.C., Huang C.S., Chen YR.J. Characteristics and corrective outcome of face asymmetry by orthognathic surgery. J. Oral. Maxillofac. Surg. 2009; 67: 2201-2209.

7.    Bishara S.E., Burkey PS., Kharouf J.G. Dental and facial asymmetries: A review. Angle Orthod. 1994; 64: 89-98.

8.    Gordina G.S., Glushko A.V., Klipa I.A., Drobyshev A.Ju., Serova N.S., Fominyh E.V. Primenenie dannyh kompjuternoj tomografii v diagnostike i lechenii pacientov s anomalijami zubocheljustnoj sistemy, soprovozhdajushhimisja suzheniem verhnej cheljusti [The use of computed tomography data in the diagnosis and treatment of patients with anomalies of dental system, accompanied by a narrowing maxilla.]. Medicinskaja vizualizacija. 2014; 3: 104-113 [In Russ].

9.    Gateno J., Xia J.J., Teichgraeber J.F. A New ThreeDimensional Cephalometric Analysis for Orthognathic Surgery. J. Oral Maxillofac. Surg. 2012; 69: 606-622.

10.  Kau C. H., Richmond S. Three-dimensional imaging for orthodontics and maxillofacial surgery. Blackwell Publisheng Ltd., 2010; 320 p.

11.  Olszewski R., Zech F., Cosnard G. et al. Threedimensional computed tomography cephalometric craniofacial analysis: experimental validation in vitro. Int. J. Oral Maxillofac. Surg. 2007; 36: 828-833.

12.  Rooppakhun S., Piyasin S., Sitthiseriprati K., Ruangsitt C., Khongkankong W. 3D CT Cephalometric: A Method to Study Cranio-Maxillofacial Deformities. Papers of Technical Meeting on Medical and Biological Engineering. 2006; 6: 75-94, 85-89.

13.&

Abstract:

A case report of successful treatment of a penetrating stab injury of the superficial femoral artery ir the adductor canal using uncovered stent. While stenting is usually used in major arteries for an intimal defeat and/or dissection due to blunt trauma, sometimes this type of penetrating injury pattern allows performing uncovered stent implantation. In this case report, it was a small side injury of vessel with the impression of the arterial wall inside the lumen resulting less than 50% stenosis and the absence of active extravasation during angiography Prior to stenting, balloon angioplasty was not effective to affect the intimal tear completely Good final angiographic and functional outcome with fast complete recovery let us draw a conclusion of the possibility of usage of uncovered stents Г certain cases with specific penetrating injury pattern.

Refernces

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2.     Rasmussen T.E., Clouse W.D., Peck M.A. et al. Development and implementation of endovascular capabilities in wartime. J. Trauma. 2008; 64 (5): 1169-1176.

3.     Teixeira P.G., Inaba K., Hadjizacharia P. et al. Preventable or potentially preventable mortality at a mature trauma center. J. Trauma. 2007; 63 (6): 1338-1347.

4.     Bocharov S.M. Angiograficheskaja diagnostika i jendovaskuljarnoe lechenie pri travme arterij. Diss. kand. med. nauk [Angiographic diagnosis and endovascular treatment in arterial trauma. Cand. med. sci. diss.]. Moscow. 2008: 103 [In Russ].

5.     Sin'kov M.A., Murashkovski A.L., Pogorelov E.A. et al. Endovaskulyarnoe zakrytie jatrogennogo arteriovenoznogo soust'ja podvzdoshnoj arterii i veny. [Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein]. Angiologiya i sosudistaya khirurgiya. 2014; 20 (1): 80-84. [In Russ].

6.     Chernyavskiy A.M., Osiev A.G., Grankin D.S. et al. Endovaskulyarniy metod lecheniya anevrizmy podkluchichnoi arterii s pomoschiu stent-graphta. [Endovascular method of treatment of subclavian artery aneurysm with stent-graft implantation]. Angiologiya i sosudistaya khirurgiya. 2003; 3: 122-123. [In Russ].

7.     Cynamon J., Lautin J.L., Wahl S.I. Covered stents for vascular injuries. Emerg. Radiol. 1999; 6: 244-248.

8.     Nicholson A.A. Vascular radiology in trauma. Cardiovasc. Intervent. Radiol. 2004; 27 (2): 105-120.

9.     Assali A.R., Sdringola S., Moustapha A. et al. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity. Catheter. Cardiovasc. Interv. 2001; 53 (2): 253-258.

10.   Fox N., Rajani R.R., Bokhari F. et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J. Trauma Acute Care Surg. 2012; 73 (5, Suppl. 4): S315-S320.

11.   Sofue K., Sugimoto K., Mori T. et al. Endovascular uncovered Wallstent placement for life-threatening isolated iliac vein injury caused by blunt pelvic trauma. Jpn. J. Radiol. 2012; 30 (8): 680-683.

Abstract:

The review presents literature data on the heparin-induced thrombocytopenia, its forms, the pathogenesis of condition and its clinical manifestations. Consideration of options for treatment of this complication and provisions recommendations of the American College of specialist doctors in diseases of the chest (ACCP), adopted at the IX Conference on antithrombotic therapy and prevention of thrombosis in 2012. 

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2.     Weismann R.E., Tobin R.W. Arterial embolism occurring during systemic heparin therapy. AMA Arch. Surg. 1958; 76 (2): 219-25; discussion 225-7.

3.     Natelson E.A., Lynch E.C., Alfrey C.P., Gross J.B. Heparin-induced thrombocytopenia. An unexpected response to treatment of consumption coagulopathy. Ann. Intern. Med. 1969; 71 (6): 1121-5.

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6.     Greinacher A., Warkentin T.E. Heparin-induced thrombocytopenia.New York, N.Y: Marcel Dekker, 2004; 627 р.

7.     Prechel М.М., Walenga М^ Emphasis on the Role of PF4 in the Incidence, Pathophysiology and Treatment of Heparin Induced Thrombocytopenia. Thrombosis Journal. 2013; 11:7.

8.     Martel N., Lee J., Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005; 106 (8): 2710-15.

9.     Warkentin T.E., Greinacher A. So, does low-molecular-weight heparin cause less heparin-induced thrombocytopenia than unfractionated heparin or not? Chest. 2007; 132 (4): 1108-10.

10.   Warkentin T.E., Sheppard J.A., Sigouin C.S., et al. Gender imbalance and risk factor interaction in heparin-induced thrombocytopenia. Blood. 2006; 108 (9): 293741.

11.   Brieger D.B., Mak K.H., Kottke-Marchant K., Topol E.J. Heparin-induced thrombocytopenia. J. Am. Coll. Cardiol. 1998; 31 (7): 1449-59.

12.   Franchini M. Heparin-induced thrombocytopenia: an update. Thromb. J. 2005; 3: 14.

13.   Warkentin T.E., Kelton J.G.. Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann. Intern. Med. 2001; 135 (7): 502-6.

14.   Warkentin T.E., Kelton J.G. Temporal aspects of heparin-induced thrombocytopenia. N. Engl. J. Med. 2001; 344 (17): 1286-92.

15.   Greinacher A., P^zsch B., Amiral J., Dummel V.. Eichner A., Mueller-Eckhardt C. Heparin-associated thrombocytopenia: isolation of the antibody and characterization of a multimolecular PF4-heparin complex as the major antigen. Thromb. Haemost. 1994; 71 (2): 247-51.

16.   Warkentin T.E., Kelton J.G. A 14-year study of heparin-induced thrombocytopenia. Am. J. Med. 1996; 101 (5): 502-7.

17.   Warkentin T.E., Greinacher A., Koster A., Lincoff A.M. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133 (6 Suppl.): 340-80.

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20.   Warkentin T.E., Roberts T.S., Hirsch J., Kelton J.G. Heparininduced skin lesions and other unusual sequelae of the heparininduced-thrombocytopenia syndrome: a nested cohort study. Chest. 2005; 127 (5): 1857-61.

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23.   Warkentin T.E., Sheppard J.A.Testing for heparin-induced thrombocytopenia antibodies. Transfus. Med. Rev. 2006; 20 (4): 259-72.

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28.   Lewis B.E., Matthai W.H., Cohen M., Moses J.W., Hursting M.J., Leya F. Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Catheter Cardiovasc. Interv. 2002; 57 (2): 177-84.

29.   Campbell K.R., Mahaffey K.W., Lewis B.E. et al. Bivalirudin in patients with heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. J. Invasive Cardiol. 2000; 12 Suppl. F: 14F-9.

30.   Warkentin T.E., Cook R.J., Marder V.J. et al. Anti-platelet factor 4/heparin antibodies in orthopedic surgery patients receiving antithrombotic prophylaxis with fondaparinux or enoxaparin. Blood. 2005; 106 (12): 3791-6.

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Abstract:

Surgical treatment of aortic valve pathology is an actual problem of modern medicine. Aortic valve pathology is widely spread in population on a stable high level. Due to a large amount of patients with no possibility of open surgical treatment of aortic valve pathology modern hybrid methods of treatment, such as transcatheter aortic valve implantation are being actively proposed and modified.

MSCT angiography before transcatheter aortic valve implantation is obligatory procedure. Data obtained by MSCT is extremely necessary to define the possibility and the access path of transcatheter aortic valve implantation. MSCT allows to select the size and type of aortic valve prosthesis.

Appearance of modern MSCT scanners with 320-640 row of detectors will increase the leading role of MSCT in preoperative inquiry of patients with planned transcatheter aortic valve implantation.

References

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Abstract:

Aim: was to study influence of surgical reconstruction of left ventricular (LV) in patients with postinfarction LV aneurysm, on dynamics of stroke volume (SV) and determine basic predictors of its decreasement.

Materials and Methods: retrospective study included patients with various types of surgical reconstruction of post-infarction LV aneurysm who underwent cardiac MRI before surgery, and subsequent control study by the same method in the postoperative period (mean 17,6 ± 4,7 days ) from March 2010 to February 2014. For statistical analysis, patients were divided into 2 groups according to the postoperative increase or decrease of SV Performed statistical analysis of baseline and post-operative structure - geometric and functional parameters of LV A mathematical model, based on which the multivariate analysis was performed using an automated method of linear modeling tc identify the most important predictor of subsequent risk assessment and its impact on postoperative decrease SV

Results: the left ventricular reconstruction surgery in the early postoperative period leads to reduce of left ventricular end diastolic (LVED) and end-systolic volume (LVES), respectively 22,41% and 21,85% (p <0,001), and an increase in ejection fraction (EF) at 21,76% (p <0,001), that seemingly indicates improvement in the pumping function of the heart. But, however, pointed out that the stroke volume, which more accurately reflects the feature after reconstruction LV increases less than half of patients (42.6%), an average of 11,2±1,6%, (p <0,001) and the majority (57,4%) decreases in average 21,0 ± 1,6%. (p <0,001). Groups with a postoperative increase or decrease in the value of SV differed except its dynamics (p <0,001), for the volume reduction of LVES (p = 0.25) increase in EF (p <0,001), a decrease INLS (p = 0.006). Found that the most important predictor of postoperative dynamics affecting the SV is the surgical reduction of LV volume (LVED). With a decrease in LV volume more than 25% of the original LVED risk reduction SV becomes high (OR 0,53; 95% CI 0,35, 0,79). When surgical volume reduction ratio greater than 35% chance of postoperative improvement SV maximally reduced (RR 4,74; 95% CI 1,27; 17,73; p = 0,042).

Conclusion: after surgical reconstruction of postinfarction LV aneurysms in the early postoperative period increase SV occurs in less than half of patients (42.6%), despite an increase in ejection fraction and decreased LVED. Leading predictor of postoperative determining the dynamics of the SV, is surgical reduction of left ventricular volume. Reduction of the volume of the left ventricle during the operation of surgical correction of left ventricular aneurysm more than 25% of the original LVED increases the risk of postoperative decrease in stroke volume, and more than 35% reduces chances of his promotion. 

References

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7.     Di Donato M., Fantini F., Toso A., Castelvecchio S., Menicanti L., Annest L., Burkhoff D. Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2010; 140:1325-1331

8.     Menicanti L., Castelvecchio S., Ranucci M., et al. Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration. J. Thorac. Сardiovasc. Surg. 2007; 134: 433-441.

9.     Annest L., Burkhoff D., JordeU., Wechsler A.S. Stroke volume alterations in patients undergoing left ventricular reconstructive surgery: a meta-analysis of 2131 cases. J. Card. Fail. 2007; 3:118.

10.   Cirillo M., Amaducci A., Brunelli F., et al. Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2004; 127:1648-1656.

11.   Di Donato M., Toso A., Dor V., et al. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy. Circulation. 2004; 109:2536-2543.

12.   Menicanti L., Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J. Thorac. Cardiovasc. Surg. 2002; 124:886-890.

13.   O’Neill J.O., Starling R.C., McCarthy P.M., et al. The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy. Eur. J. Cardiothorac. Surg. 2006; 30:753-759.

14.   Patel N.D., Williams J.A., Nwakanma L.U., et al. Impact of lateral wall myocardial infarction on outcomes after surgical ventricular restoration. Ann.Thorac. Surg. 2007; 83:2017-2027.

15.   Tulner     S.A., Bax J.J., Bleeker G.B., et al. Beneficial hemodynamic and clinical effects of surgical ventricular restoration in patients with ischemic dilated cardiomyopathy. Ann. Thorac. Surg. 2006; 82:1721-1727.

16.   Athanasuleas C.L., Stanley A.W. Jr., Buckberg G.D., et al. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. RESTORE group. Reconstructive Endoventricular Surgery, returning Torsion Original Radius Elliptical Shape to the LV. J. Am. Coll. Cardiol. 2001; 37:1199-1209.

17.   Dor V., Sabatier M., Montiglio F., Coste P., Di D.M. Endoventricular patch reconstruction in large ischemic wall-motion abnormalities. J. Card .Surg. 1999;14:46-52.

18.   Patel N.D., Williams J.A., Barreiro C.J., et al. Surgical ventricular remodeling for multiterritory myocardial infarction: defining a new patient population. J. Thorac. Cardiovasc. Surg. 2005; 130:1698-1706.

19.   Ribeiro G.A., da Costa C.E., Lopes M.M., et al. Left ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium. Eur. J. Cardiothorac. Surg. 2006; 29: 196-201.

20.   Suma H., Isomura T., Horii T., et al. Nontransplant cardiac surgery for end-stage cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2000; 119:1233-1244.

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22.   Yu H.Y, Chen YS., Tseng W.Y, et al. Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis withmagnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration. J. Thorac. Cardiovasc. Surg. 2009; 137:887-894.

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30.   Dor V., Civaia F., Alexandrescu C., Sabatier M., Montiglio F. Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J. Thorac. Cardiovasc. Surg. 2011; 141:905-9164.

31.   Bokerija L.A., Fedorov G.G. Hirurgicheskoe lechenie bol'nyh s postinfarktnymi anevrizmami serdca i soputstvujushhimi tahiaritmijam [Surgical treatment of patients with postinfarction aneurysms accompanying tachyarrhythmia.]. Grudnaja i serd.-sosud.hirurgija. 1994; 4:4-8 [In Russ].

32.   Cooley D.A. Repair of post-infarction aneurysm of the left ventricle. Cardiac surgery: state of the art reviews, Vol. 4, No. 2. Philadelphia: Hanley and Belfus, 1990; P. 309

33.   Dor V. Clinical, Sabatier M., Montiglio F., et al. Hemodynamic, and electrophysiologic results of 207 left ventricular patch reconstructions for infarction left ventricular aneurysm. l. Presented at the 72nd Annual Meeting of the American Association for Thoracic Surgery, Los Angeles, CA, April. 1992; 26-29.

34.   Artrip J.H., Oz M., Burkhoff D. Left ventricular volume reduction surgery for heart failure: a physiologic perspective. J. Thorac. Cardiovasc. Surg. 2001;122: 75-82.

35.   Burkhoff D., Wechsler A.S. Surgical ventricular remodeling: a balancing act on systolic and diastolic properties. J. Thorac. Cardiovasc. Surg. 2006;132:459-63.

36.   Ratcliffe M.B., Guy T.S. The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling. J. Thorac. Cardiovasc. Surg. 2007; 134:280-283

37.   Jones R.H., Velazquez E.J. Michler R.E., et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N. Engl. J .Med. 2009;360:1705-17.

38.   Chernjavskij A.M., Marchenko A.V., Karas'kov A.M. Raschet ploshhadi vykljuchenija postinfarktnoj anevrizmy levogo zheludochka [Calculation of area of postinfarction aneurism dismiss]. (Grudnaja i serdechnososudistaja hirurgija. 2002; 6. 54-58 [In Russ]. 

Abstract:

Aim: was to show the role and possibilities of 128-slice computed tomography (MSCT) iirfhe dynamic observation of patients; after open and endovascular surgery of lower limb's arteries;

Material and methods: 1st group - 36 patients (30,5%) who (underwent endovascular procedures;, 2nd group - 51 patients; (44,2%) who underwent open reconstructive operations;, 3rd group - 31 patients; (26,3%) after hybrid operations;. 108 patients; were examined in post-operative period (7 women, 101 men), average age was 57,28±15,08. All patients underwent MSCT-angiography on the background of the contrast bolus;. 55 patients; had standard procedure, other patients; underwent examination with low-close protocol.

Results: obtained images of low-close protocol had satisfactory condition of information: arterial walls were visualized well, inner lumen and para-prosthesis space, atherosclerotic lesions were also visualized. Obtained results of MSCT-angiography during low-dose protocol were confirmed ntraoperatively Obtained data of MSCT-angiography: all patients; of 1st group had passable stents; but 2 patients; who had hernodynarnically non-significant stenosis. In 2nd group 5 patents; had restenosis of prosthesis and grafts;, 20 patients; had thrombosis. In 3rd group, 2 patients; had restenosis of prosthesism femoral-popliteal segment, 13 patient had thrombosis of prosthesis/grafts, 6 patients; had restenosis of stents;, 1 patient had stent thrombosis in femoral-popliteal segment, n case of hernodynarnically significant stenosis (50%) of the stent or prosthesis in the absence of clinical manifestations; we made correction of drug therapy. If the patent had a detected boundary stenosis (50-74%) with the absence of complaints;, the patient had correction of drug therapy, with the appointment of a dynamic MSCT-angiography in 3-6 months. Patents; with occlusion of the prosthesis, or a stent with a satisfactory distal vessels clue to good collaterals; we performed thrombectomy or repeated prosthetics. Patients who according to the MDCT-angiography, had identified thrombosis of prosthesis/grafts with poor distal vessels, absence of good collaterals; and the presence of clinical manifestations; of critical ischemia - amputation of the affected limb.

Conclusion: MSCT-angiography is a highly informative method of nornnvasive imaging of patency of stent, prosthesis/graft of mam arteries; of lower limbs;. Our study showed that using of a low-close protocol is; possible for the dynamic monitoring of patents; for the detection of postoperative complications;, early diagnosis and prevention of restenosis and thrombosis of prosthesis/grafts and stents Timely diagnosis of stenosis of stents; or grafts/prostheses of mam arteries; of lower limbs can determine tactics; and stages; of surgery (endovascular treatment, and re-open reconstructive vascular surgery, thrombectomy), not leading to the patient’s; disability. 

References

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2.     Pokrovskij A.V., Doguzhieva R.M., BogatovJu.P., i dr. Otdalennye rezul'taty aorto-bedrennyh rekonstrukcij u bol'nyh saharnym diabetom 2 tipa[Late outcomes of aorto-femoral reconstructions in patients with diabetes mellitus type 2]. Angiologija i sosudistajahirurgija. 2010; 16 (1): 48-52[In Russ].

3.     Poljancev A.A., Mozgovoi P.V., Frolov D.V., i dr. Trombofilicheskie sostojanija v patogeneze pozdnih tromboticheskih reokkljuzij u bol'nyh obliterirujushhim aterosklerozom arterii nizhnih konechnostej [Thrombofillic conditions in pathogenesis of late thrombotic occlusions in patients with atherosclerosis of lower limbs]. Vestnik jeksperimental'noj i klinicheskoj hirurgii. 2011; 2 (4): 208-211[ In Russ].

4.     Kokov L.S. Luchevaja diagnostika bolezni serdca i sosudov: nacional'noe rukovodstvo. [Radiodiagnostics of heart and vessels pathology. National guide-book] M.: GJeOTAR- Media. 2011; 688 [In Russ].

5.     Bokerija, L.A., AlekjanB.G. Rukovodstvo rentgenjendovaskuljarnoj hirurgii serdca i sosudov 3t [Guide-book of endovascular surgery of heart and vessels. Volume 3]. M: NCSSH im. A.N. Bakuleva RAMN. M. 2013; 598 [In Russ].

6.     Diagnosticheskajaj effektivnost' mul'tisrezovoj komp'juternoj tomografii-angiografii v dinamicheskom nabljudenii pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterij nizhnih konechnostej [Diagnostic efficacy of multislice computed tomographic angiography in dynamic post-operative supervision after reconstrictive procedures on main arteries of lower limbs]. MedicinskijvestnikMVD. 2014; 6 (73): 47-49[In Russ].

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13.   Mizuno A., Nishi Y, Niwa K. Total bowel ischemia after carbon dioxide angiography in a patient with inferior mesenteric artery occlusion. Cardiovasc. Interv. Ther. 2014; 6(3): 642-650. 

Abstract:

Aim: was to evaluate the influence of factors on the development of diaphragmatic dysfunction ir early periods after cardiac surgery

Materials and methods: study included 830 patients after various cardiac surgery in Federal National Center of Cardiovascular Surgery (Penza, Russian Federation). In the early postoperative period (3,9 ± 0,9 days) all patients underwent chest x-ray while transporting from intensive care unit. We evaluated differences between diaphragm contors in two consecutive shots - with a deep breath and exhale fully In the early postoperative period diaphragmatic dysfunction was detected in 172 cases (20.7%). Patients were divided into 4 groups depending on the presence or absence of a violation of the diaphragm function. The criterion of selection into the group with diaphragmatic dysfunction was size of amplitude motion, less than 10 mm. 1st group with normal mobility of the diaphragm included 658 patients (79.3%). 2nd group with dysfunction of the left dome of the diaphragm - 85 patients(10.2%). 3rd group with dysfunction of the right dome - 58 patients (7%). 4th group with bilateral diaphragmatic dysfunction - 29 patients (3.5%). Logistic regression model included 4 variables, the significance of which is reflected by the published data: preparation of internal thoracic artery (ITA) for graft, valve surgery, the use of radiofrequency ablation, the use of cardiopulmonary bypass. We made a multiple logistic regressive analysis of predictors for the development of diaphragmatic dysfunction.

Results: we have found that under the influence of complex predictors, greatest chance of dysfunction was observed in the group with bilateral violation of diaphragm mobility after two-sidec separation of ITA (OR 3.4; CI 1.60, 7.25). High chances of dysfunction were observed in groups with unilateral violation of diaphragm mobility after unilateral separation of ITA. Separation of left ITA had higher chances for diaphragmal dysfunction (OR 2.7; CI 1.36; 5.37) than in case of separation of right ITA (OR 2.0; CI 1.16, 3.47). After valve operations, radiofrequency ablation, and cardiopulmonary bypass chances of diaphragmatic dysfunction was statistically insignificant (p>0.05) in all study groups.

Conclusions: diaphragmatic dysfunction develops in 3.4 times greater in case of bilateral separation of ITA. Unilateral dysfunction of the diaphragm has a great chance in case of separation of ITA: left up to 2.7 times and right up to 2 times. Influence of cardiopulmonary bypass, valve operations and radiofrequency ablation for the development of diaphragmatic dysfunction is statistically insignificant.

References

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Abstract:

Ischemic strokes are still the worldwide problem with high mortality and morbidity. Carotid endarterectomy that is used for revascularization of changed artery required precise visualization of carotid arteries at extra- and intracranial level, assessment of intracranial circulation.

References

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8.     John J. Ricotta, MD,a Ali AbuRahma, MD, FACS,b Enrico Ascher, MD,c Mark Eskandari, MD,d Peter Faries, MD,e and Brajesh K. Lal MD,f Washington, DC; Charleston, WV; Brooklyn, NY; Chicago, Ill; New York, NY; and Baltimore, Md Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011 Sep; 54(3): 1-31.

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Abstract:

Aim: was to estimate the importance of restoring blood flow in vertebral arteries in the segment V1 by stenting in patients with multivessel lesions of extracranial arteries and vertebrobasilar insufficiency (VBI).

Material and methods: study include 59 patients with a dominant, long-existing clinic of vertebrobasilar insufficiency, with multivessel lesions of brachiocephalic arteries, lower brain tolerance to ischemia, with the presence of stenosis of segment V1 of vertebral artery more than 70%, which is regarded by neurologists, as the main reason for VBI. All patients should have been undergone carotid revascularization. However, due to multivessel lesions and low perfusion reserve, all patients as the first stage of treatment - underwent stenting of V1 segment of vertebral artery. In 38 patients bare-metal stent were used, in 14 - drug-eluting stents, in 7 - renal stents. Distal protection was used in 12 patients. In remaining patients - stenting was performed without protection.

Results: in immediate postoperative period, technical, angiographic success and clinical improvement were noticed in 100% of patients. All 59 patients underwent the second and subsequent stages of cerebral revascularization without ischemic episodes. The duration of follow-up was from 6 months to 6 years. After 3 months, 55(93,2%) patients sustained clinical improvement, with no restenosis in stents. 4 patients (6,8%) had no clinical improvement: in one patient after 3 months developed ischemic stroke (IS) in vertebrobasilar system(VBS), due to the occlusion of the stent. 1 patients had stent restenosis with the increase of clinical manifestations of VBI, which required additional stenting. After 14 months, 1 patient after stenting had IS in VBS due to stent fractures caused by bone compression.

Conclusion: stenting of V1 segment of vertebral artery in patients with multivessel lesions of brachiocephalic arteries and clinic of VBI, can be considered as the first stage of cerebral revascularization in case of significant stenosis segment V1 vertebral artery and low tolerance to cerebral ischemia.

References

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