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Introduction: pathological tortuosity of internal carotid arteries (ICA) is widespread; its frequency in population varies within 18-34%. Currently, there are several approaches for the determination of indications for surgical intervention in pathological ICA tortuosity. The main criteria are hemodynamic changes in the arterial flow and the presence of neurological symptoms, so an informative preoperative examination is an integral part in treatment strategy determination in patients' subsequent treatment.

Aim: was to estimate the condition of carotid arteries and substance of the brain in isolated pathological tortuosity and in combination with stenotic lesions, based on results of CT angiography.

Materials and methods: we analyzed results of examination and treatment of 70 patients. Ultrasound and CT angiography of brachiocephalic arteries were performed on a Philips iCT 256-slice multislice computed tomograph. During CT angiography, a non-contrast study, arterial and venous phases of contrast enhancement were performed with an intravenous bolus injection of 50.0 ml of isoosmolar iodinated contrast-agent at 4-5 ml/sec.

Patients were divided into two groups: patients with isolated pathological carotid tortuosity (28 pts) and patients with a combination of carotid tortuosity and stenotic lesions (42 pts). We assessed the effect of carotid tortuosity on the severity of the brain tissue alterations using statistical analysis.

Results: a lesser severity of changes in the substance of the brain was noted in patients in the group with isolated pathological tortuosity of ICA. In 9 cases, we did not detect focal lesions; in 15 cases, small foci of microangiopathy and individual cerebrospinal fluid cysts were noted, in 4 patients, we noted areas and zones of cystic-glial changes. S- and C-shaped deformation became the most frequent variants of tortuosity; the formation of 3 saccular aneurysms (two true and one false) was revealed.

Manifestations of ischemic damage of the brain substance in the group of patients with a combination of ICA tortuosity and stenotic lesion were more pronounced. Thus, in 11 cases, zones and areas of cystic-glial changes were determined within the framework of past cerebrovascular accidents; in 20 patients, foci of microangiopathy expressed in varying degrees, as well as individual cerebrospinal fluid cysts, were noted. In 11 cases, no focal lesions were detected in the brain.

Statistical processing showed a correlation between the condition of carotid arteries and the presence of focal brain damage - in the group with combination of pathological tortuosity and stenosis of ICA, more pronounced chronic ischemic brain damage was detected (p=0,012).

Conclusion: CT-angiography was noted to be highly informative in assessment of condition of carotid arteries and brain substance in patients with isolated pathological tortuosity, as well as in combination with a stenotic lesion of internal carotid arteries. With a combination of pathological tortuosity and a stenosis in internal carotid arteries, data were obtained on a more pronounced damage of the brain substance. According to computed tomography, clinical manifestations of chronic cerebrovascular insufficiency were generally more pronounced compared to changes in the brain substance. However, there was a correlation between the increase in the degree of chronic cerebrovascular insufficiency and the aggravation of the state of the brain substance.



Aim: was to define possibilities of multispiral computed tomography (MSCT) in assessment of condition of aorta and it's branches, during preparation for reconstructive surgery in patients with horseshoe kidney.

Material and methods: for the period 2015-2018, 415 patients were examined during preparation for aortic reconstructive surgery. Patient underwent target ultrasonic diagnostics, followed by computed tomography made on 256-slice Philips iCT, before and after injection of contrast agent. We used a special program for comparing various phases of the study ("Fusion") for better visualization of arterial vessels of kidney, aorta and renal excretory system. In 5 cases, a combination of aortic pathology with abnormal horseshoe kidney was revealed.

Results: in all cases we revealed branched type of blood supply of abnormal kidney A total of 5 patients had 25 renal arteries. In 4 cases we revealed branched type of renal veins, its total ammount was 20. Duplication of upper urinary tract was found in 1 case. From the surveyed group, 3 patients out of 5 were operated. Intraoperatively all data detected by CT scan regarding the condition of the aorta, the position of the kidney, the number of renal vessels were confirmed.

Conclusion: MSCT allows detailly assessment of anatomical features of abnormal horseshoe kidney and facilitates subsequent surgical intervention in patients with a rare combination of aortic pathology and a horseshoe kidney.



1.       Kirkpatrick J.J., Leslie S.W. Horseshoe Kidney. In: StatPearls [Internet], 2018.

2.       Gianfagna F., Veronesi G., Bertu L, et al. Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study. BMC Cardiovasc Disord. 2016;16(1):243. Published 2016 Nov 29. doi:10.1186/s12872-016-0420-2.

3.       Joanna Mikolajczyk-Stecyna, Aleksandra Korcz, Marcin Gabriel et al. Risk factors in abdominal aortic aneurysm and aortoiliac occlusive disease and differences between them in the Polish population. Scientific Reports (2013) volume3: 3528.

4.       Davidovic L Markovic M, Ilic N et al. Repair of abdominal aortic aneurysms in the presence of the horseshoe kidney. IntAngiol. 2011 Dec;30(6):534-40.

5.       Kumar Y, Hooda K, L.i S., Goyal P, et al. Abdominal aortic aneurysm: pictorial review of common appearances and complications. Ann TranslMed. 2017;5(12):256.

6.       Stephen P Reis, Bill S. Majdalany, Ali F. AbuRahma et al., ACR Appropriateness Criteria Pulsatile Abdominal Mass Suspected Abdominal Aortic Aneurysm. J Am Coll Radiol 2017;14:S258-S265

7.       CHekhoeva O.A., Buryakina S.A., Alimurzaeva M.Z., Gontarenko V.N. Aneurysm of the infrarenal aorta in combination with a horseshoe-shaped kidney: case report. Medicinskaya vizualizaciya №3 2016. C.: 63-70. [In Russ.] 

8.       B.V. Fadin, A.B. Mal'gin, S.V. Berdnikov i dr. Aneurysm of the abdominal aorta in combination with a horseshoe-shaped kidney. ZHurnal angiologiya i sosudistaya hirurgiya . 2002 TOM 8 №3 Str. 113-119. [In Russ.]

9.       Ignat'ev I.M., Volodyuhin M.YU., Zanochkin A.V. Endoprosthetics of the abdominal aortic aneurysm in a patient with a horseshoe-shaped kidney. Arhitektura zdorov'ya. [Internet souce] tekushchee-izdanie/zdorove-i-meditsina/klinicheskie- issledovaniya/11-endoprotezirovanie-anevrizmy-bryush- noj-aorty-u-patsienta-s-podkovoobraznoj-pochkoj

10.     Troickij V.I., Habazov R.I., Lysenko E.R. i dr. Surgical treatment of abdominal aortic aneurysm in a patient with a horseshoe-shaped kidney. Angiologiya i sosudistaya hirurgiya. 2003; 9 (2): 122-125. [In Russ.]



Aim: was to assess computed tomography angiography (CTA) abilities in analysis of internal carotid artery (ICA) critical atherosclerotic lesions.

Material and method: for the period 2014-2016 - 321 patients underwent examination (ultrasound and CTA of brachiocephalic arteries) prior to surgical treatment of ICA occlusive disease. CTA was made on Philips iCT 256-slice (noncontrast examination, arterial and venous phases), 50 ml on nonionic contrast agent was injected (4-4,5 ml/sec). We distinguished several types of ICA changes: stenosis more than 60% and 70%, critical stenosis, subocclusion (also with distal collapse), local occlusion.

Results: CTitical ICA stenosis was detected in 82 patients (26% of all observed cases); ICA changes with diffuse decrease of upper segments - in 20 cases (6,2% of cases). Among group of decreased diameter we saw subocclusion (18 patients) and local occlusion (2 patients). In the setting of local occlusion ICA contrast-enchanced through atypical ascending pharyngeal artery In patients with diffuse decrease of upper ICA segments all elements of circle of Wills were detected in 70% of cases. During surgery CTA results were confirmed, but atherosclerotic plaque extension was higher than observed at CT approximately at 10 mm.

Conclusion: we can refer critical stenosis, subocclusion and local occlusion to critical atherosclerotic ICA changes. The one should consider CTA limitations in differentiation of upper part of atherosclerotic plaque. In majority of cases decrease in ICA diameter was associated with severe atherosclerotic involvement and not with congenital changes CTA is necessary for preoperative assessment of carotid occlusive disease, especially in critical ICA changes.



1.     John J. Ricotta, Ali AbuRahma, Enrico Ascher, Mark Eskandari, Peter Faries and Brajesh K. Lal. 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.

2.     Nacional'nye rekomendacii po vedeniyu pacientov s zabolevaniyami brahiocefal'nyh arterij [National recommendations on treatment of brachicephalic arteries disease]. Rossijskij soglasitel'nyj dokument. 2013; 72S [ In Russ].

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b)  Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami brahiocefal'nyh arteriT [National recommendations on treatment of brachicephalic arteries disease]. M.2013 [In Russ].

3.     Johansson E. and A.J. Fox., Carotid Near-Occlusion: A Comprehensive Review, Part 2-Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement. American Journal of Neuroradiology 2016; 37(2):200-204.

4.     Johansson E. and A.J. Fox., Carotid Near-Occlusion: A Comprehensive Review, Part 1- Definition, Terminology, and Diagnosis. American Journal of Neuroradiology Jan 2016; 37(1):2-10.

5.     Vishnyakova M.V., Pronin I.N., Lar'kov R.N., Zagarov S.S. Komp'yuterno-tomograficheskaya angiografiya v planirovanii rekonstruktivnyh operacij na vnutrennih sonnyh arteriyah [CT-angiography in planning of reconstructive operations on internal carotid arteries]. Diagnosticheskaya i intervencionnaya radiologiya. 2016; 10(3):11-19 [In Russ].

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11.   Johansson E., Chman K., Wester P.. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 2015; 277:615-623.


Article exists only in Russian.




Aim: was to evaluate possibilities and advantages of endovascular treatment of intracranial aneurysms (IA) and arteriovenous malformations (AVM) using three-dimensional navigation (3D-roadmapping).

Materials and methods: during 2010-2013 years 103 embolizations of IA and AVM ir 88 patients were performed in our angiography department. Embolizations of IA were managed by metallic detachable coils, embolizations of AVM - by Histoacryl : Lipiodol glue composition. 3D-roadmapping technique was applied for guidance of endovascular tools in cerebral arteries anc catheterization the IA cavity and AVM-feeding arteries during the procedure. 3D-roadmapping technique is based on creation of composite images that consist of two-dimensional fluoroscopic views superimposed on virtual three-dimensional model of the vessel.

Results: endovascular interventions with 3D-roadmapping were performed in 65(63%) cases. In 49 (75%) cases we used 3DRA data to create three-dimensional model of cerebral vessels and in 16 (25%) cases - CT-angiography data. Complex algorithm of diagnosis and endovascular treatment of IA and AVM using 3D-roadmapping was introduced.

Conclusion: our experience of the endovascular embolization of IA and AVM with 3D-roadmapping convincingly showed that usage of this technique is possible and effective. In comparison with two-dimensional navigation there was a tendency in reduction of the effective exposure dose, also there was a statistically significant decrease of amount of contrast material , and of time for superselective catheterization of AVM-feeding arteries and IA cavity. 



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3.     Методические Указания «Контроль эффективных доз облучения пациентов при проведении медицинских рентгенологических исследований». Metodicheskie Ukazanija «Kontrol jeffektivnyh doz obluchenija pacientov pri provedenii medicinskih rentgenologicheskih issledovanij»[«Control of effective patient dose in medical X-ray examinations»] [In Russ].

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7.     Fernandez Zubillaga A., Guglielmi G., Vinuela F.. Duckwiler G.R. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am. J. Neuroradiol. 1994;15: 815-820.

8.     Svistov D.V., Pavlov O.A., Kandyba D.V., Nikitin A.I., Savello A.V., Landik S.A., Arshinov B.V.. Znachenie vnutrisosudistogo metoda v lechenii pacientov s anevrizmaticheskoj bolezn'ju golovnogo mozga [Meaning of intravascular method in patients with aneurysmal disease brain.]. Nejrohirurgija. 2011; 1: 21-28 [In Russ].

9.     Gallas S., Januel A.C., Pasco A., Drouineau J., Gabrillargeus J., Gaston A., Cognard C., Herbreteau D. Long-term follow-up of 1036 cerebral aneurysms treated by bare coils: a multicentric cohort treated between 1988 and 2003. J. Amer. J. Neuroradiol. 2009; 30(10): 1986-1992. 



Malignant otitis externa is a rare but potentially fatal disease, that occurs mostly among elderly diabetic or immunocompromised patients.

Aim: was is to report the experience of the diagnosis of malignant otitis externa.

Materials and methods: we examined 5 patients with diagnosed malignant otitis externa with the help of computed tomography (CT) and magnetic resonance imaging (MRI). In both diagnostic methods, contrast enhancement was used.

Results: causative pathogen is mainly Pseudomonas Aeruginosa. The disease spreads rapidly to skull base region, inducting osteomyelitis and involving the cranial nerves. The diagnosis is based on the radiology methods, anamnesis, and biopsy

Conclusions: CT is a first-line method, which allows to detect the presence of bone erosion, which is critical for the diagnosis. Exact borders of a pathological infiltration, distribution on cranial nerves, brain covers and in a skull were defined on MRI. 



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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.



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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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Anatomical variants of abdominal and retroperitoneal veins are characterized by a great diversity Mostly anomalies are asymptomatic, in some cases they may have clinical manifestations. Information about features of the venous anatomy is necessary when planning surgical operations and interventional procedures in the abdomen and retroperitoneum

Aim: was to increase efficacy of diagnostics of abdomen and retroperitoneal veins' anomalies by evaluating clinical significance of observed changes of veins and analysis of incidence of venous anomalies at MSCT of the abdomen.

Materials and methods: 440 patients with different diseases of the abdomen and retroperitoneum underwent MSCT Anomalies of the inferior vena cava (IVC) and its tributaries were classified by Huntington G.S. and C.F.W. McLure. As the normal anatomy of the portal vein (PV) was taken a «classic» variant of the division into two branches. Normal type of hepatic veins (HV) anatomy meant the presence of three venous trunks independently flowing into the IVC Results: venous malformations were detected in 67% cases, combined with each other in many cases. Most common were aberrations of renal veins (43%), followed by variants of HV (31%), PV (18%) and IVC (1,6%).

Conclusion: our results show the necessity of detailed assessment of venous anatomy during abdominal MSCT for selecting the optimal treatment strategy, planning and the success of surgery.



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