Abstract:

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.

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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Abstract:

Purpose. Was to estimate the efficiency and sensitivity of X-ray-contrast (XRC), CT-angiography (CTAG) and colored duplex scanning (CDS) n diagnostics of patients with chronic abdominal ischemia (CAI)

Materials and methods. We have analyzed 1848 XRC, 436 CTAG and 181 CDS of patients with unpaired visceral artery branches of the abdominal aorta diseases, suffering from CAI.

Results. Due to CTAG, XRC and CDS we have revealed different levels of artery defeats, and also different types of stenotic and occlusion defeat.

Conclusions. CTAG is an effective screening method, and CDS - is an effective method of final diagnostics. Both of these methods should be included into algorithm CAI patients examination. 

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Abstract:

Article presents data of modern literature concerning diagnostic efficiency of computed tomography and CT-angiography in diagnostics of acute disorders of mesenterial blood circulation. Article describes various groups of instrumental diagnostic signs indicating directly or indirectly on acute thrombotic and thromboembolic occlusion of mesenterial.

According to huge ammount of authors, CT-angiography can be considered as the first step in instrumental diagnostics of acute disorder of mesenterial blood circulation, due to demonstrated sensitivity and specificity, comparable in comparison with a standard angiography. 

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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. 

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