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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.



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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.



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The aim of this research was to perform preoperative examination of distal arterial flow in patients with popliteal artery aneurysms. We performed 47 open surgery procedures in 38 patients with popliteal artery aneurysms. Patients underwent duplex scanning, CT and angiography Duplex scanning was performed in all cases while CT only in 14 (36,8%) cases. Angiography was performed in 29 (76,3%) cases (43 aneurysms).

We revealed that with the increasing duration of the disease increases the number of aneurysms with thrombus (71,8% vs 28,2%, p<0,05). Accordingly increases the number of patients with distal embolisation: 81,6% diseased shin arteries in patients with popliteal aneurysm vs 46,7% in patients without aneurysm (p<0,05). Therefore the longer aneurysm exists the more cases are complicated. In conclusion angiography still plays important role in diagnostics of popliteal aneurysms and helps to make decision for type of revascularization procedure.



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