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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.




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.



1.     Fitsiori A, Hiremath SB, Boto J, et al. Morphological and Advanced Imaging of Epilepsy: Beyond the Basics. Children. 2019; 6(3): 43.

2.     Baumgartner C, Koren JP, Britto-Arias M, et al. Presurgical epilepsy evaluation and epilepsy surgery. F1000Research. 2019; 8.

3.     Skjei KL, Dlugos DJ. The evaluation of treatment-resistant epilepsy. Semin Pediatr Neurol. 2011; 18: 150-170.

4.     Middlebrooks EH, Ver Hoef L, Szaflarski JP. Neuroimaging in Epilepsy. Curr Neurol Neurosci Rep. 2017; 17(4): 32.

5.     Takanashi J. MRI and CT in the diagnosis of epilepsy. Nihon Rinsho. 2014; 72(5): 819-26.

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.

Polyanskaya MV, Demushkina AA, Kostylev FA, et al. The role of susceptibility-weighted imaging (SWI) in neuroimaging in children with focal epilepsy. Epilepsy and paroxysmal conditions. 2020; 12(2): 105-116 [In Russ].

7.     Cendes F, Theodore WH, Brinkmann BH, et al. Neuroimaging of epilepsy. Handbook of Clin. Neurol. 2016; 136: 985-1014.

8.     Roy T, Pandit A. Neuroimaging in epilepsy. Annals of Indian Academy of Neurology. 2011; 14(2): 78.

9.     Lapalme-Remis S, Cascino GD. Imaging for Adults With Seizures and Epilepsy. Continuum. 2016; 22(5): 1451-1479.

10.   Duncan JS. Brain imaging in epilepsy. Practical Neurology. 2018: 002180.

11.   Tranvinh E, Lanzman B, Provenzale J, Wintermark M. Imaging Evaluation of the Adult Presenting With New-Onset Seizure. Am J Roentgenol. 2019; 212(1): 15-25.

12.   Lompo DL, Diallo O, Dao BA, et al. Etiologies of non-genetic epilepsies of child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso. Pan African Medical Journal. 2019; 31.

13.   Goel D, Dhanai JS, Agarwal A, et al. Neurocysticercosis and its impact on crude prevalence rate of epilepsy in an Indian community. Neurol India. 2011; 59(1): 37-40.

14.   Mengistu G, Ewunetu BD, Johnston JC, Metaferia GZ. Neuroimaging of Ethiopian patients with epilepsy: a retrospective review. Ethiop Med J. 2014; 52(2): 57-66.

15.   Patel N, Jain A, Iyer V, et al. Clinico - diagnostic and therapeutic relevance of computed tomography scan of brain in children with partial seizures. Annals of Indian Academy of Neurology. 2013; 16(3): 352.

16.   Cherian A, Syam UK, Sreevidya D, et al. Low seroprevalence of systemic cysticercosis among patients with epilepsy in Kerala, South India. J Infect Public Health. 2014; 7(4): 271-6.

17.   Panov F, Li Y, Chang EF, et al. Epilepsy with temporal encephalocele: Characteristics of electrocorticography and surgical outcome. Epilepsia. 2015; 57(2): 33-38.

18.   Van Rooijen BD, Backes WH, Schijns OEMG, et al. Brain Imaging in Chronic Epilepsy Patients After Depth Electrode (Stereoelectroencephalography) Implantation. Neurosurgery. 2013; 73(3): 543-549.

19.   Lee DJ, Zwienenberg-Lee M, Seyal M, Shahlaie K. Intraoperative computed tomography for intracranial electrode implantation surgery in medically refractory epilepsy. Journal of Neurosurgery. 2015; 122(3): 526-531.

20.   Schmidt RF, Lang MJ, Hoelscher CM, et al. Flat-Detector Computed Tomography for Evaluation of Intracerebral Vasculature for Planning of Stereoelectroencephalography Electrode Implantation. World Neurosurg. 2018; 110: 585-592.

21.   Freyschlag CF, Gruber R, Bauer M, et al. Routine postoperative CT is not helpful after elective craniotomy. World Neurosurgery. 2018.

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.

23.   Almohiy H. Paediatric computed tomography radiation dose: A review of the global dilemma. World J. Radiol. 2014; 6: 1-6.



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.



1.     Savitz SI, Caplan LR: Vertebrobasilar disease. N Engl J Med. 2005; 352:2618-2626.

2.     Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS: New England Medical Center Posterior Circulation registry. Ann Neurol. 2004; 56:389-398.

3.     Vereschagin NV. Pathology of vertebrobasilar system and cerebrovascular accidents. M. 1980; 312. [In Russ].

4.     Puzin MN, Zinoveva GA, МеtelkinaLP. Aspects of medical treatment of patients with vertebrobasilar insufficiency. Klinicheskaya farmakologiya i terapia, 2006; 2: 23-26. [In Russ].

5.     Berguer R, Morasch M, Kline R. A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease. J Vasc Surg. 1998; 27 (5): 852-859.

6.     Pokrovskii AV, Belojarcev DF. Long-term results of operations subclavian-carotid transposition. Angiologiya i sosudistaya khirurgiya 2002; 8 (2): 84 - 91. [In Russ].

7.     He Y, Bai W, Li T et al. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar arteryocclusion. Ann Vasc Surg. 2014 Feb; 28 (2):386-393.

8.     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). Eur Heart J. 2018 Mar 1; 39(9): 763-816.

9.     National guidelines on the management of patients with brachiocephalic artery disease. Angiologiya i sosudistaya khirurgiya. 2013; 19 (2), appendix: 70 [In Russ].

10.   Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ. Outcome in patients with basilar artery occlusiontreated conventionally. J Neurol Neurosurg Psychiatry. 2005; 76:1238-1241.

11.   Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM: Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke. 2007; 38:1526-1530.

12.   Compter A, van der Worp HB, Schonewille WJ, Vos JA, Algra A, Lo TH, Mali WPThM, Moll FL and Kappelle LJ. VAST: Vertebral Artery Stenting Trial. Protocol for a randomized safety and feasibility trial. Trials 2008; 9: 65.

13.   Clifton A, Markus H, Kuker W, Rothwell P.E-050. The Rationale for the Vertebral artery Ischaemia Stenting trial (VIST): NeuroIntervent Surg 2013; 5. Suppl 2 A56.

14.   Compter A et al. VAST investigators. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol. 2015 Jun; 14(6): 606-614.

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

16.   Markus HS, Harshfield EL, Compter A. et al. Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis. Lancet Neurol. 2019 Jul; 18(7): 666-673.

17.   Markus HS, Larsson SC, Dennis J et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: the VIST RCT. Health Technol Assess. 2019 Aug; 23(41): 1-30.



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.



1.     Stannard A., Eliason J.L., Rasmussen T.E. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J. Trauma. 2011; 71(6): 1869-1872.

2.     Barnard E.B.G., Morrison J.J., Madureira R.M. et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Emerg. Med. J. 2015; 32 (12): 926-932.

3.     Brenner M.L., Moore L.J., DuBose J.J. et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J. Trauma Acute Care Surg. 2013; 75 (3): 506-511.

4.     Moore L.J., Brenner M., Kozar R.A. et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for resuscitative balloon occlusion of the aorta (REBOA). J. Trauma Acute Care Surg. 2016; 81 (3): 409-419.

5.     Zavrazhnov A.A. Damage of large vessels of the abdomen: ways to improve diagnosis and treatment: Diss. kand. med. Nauk. St.Petersburg. 1996; 201 [In Russ].

6.     Sadeghi M., Nilsson K.F., Larzon T. et al. The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry. Eur. J. Trauma Emerg. Surg. 2018; 44 (4): 491-501.

7.     Hughes C.W. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954; 36 (1): 65-68.

8.     DuBose J.J., Scalea T.M., Brenner M. et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J. Trauma Acute Care Surg. 2016; 81 (3): 409-419.

9.     Martinelli T., Thoni F., Declety P. et al. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. J. Trauma. 2010; 68 (4): 942-948.

10.   Brenner M., Hoehn M., Pasley J. et al. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J. Trauma Acute Care Surg. 2014; 77 (2): 286-291.

11.   DuBose J., Fabian T., Bee T. et al. Contemporary utilization of resuscitative thoracotomy: results from the AAST aortic occlusion for resuscitation in trauma and acute care surgery (AORTA) multicenter registry. Shock. 2018; 50 (4): 414-420.

12.   Gumanenko E.K. An objective assessment of the severity of injuries. Voenno-medicinskij zhurnal. 1996; 317 (10): 25-34 [In Russ].

13.   Samokhvalov I.M., Reva V.A., Pronchenko A.A., Agliulin V.F. Comparison of the effectiveness of emergency thoracotomy in wounded and injured. Zdorov'e. Medicinskaja jekologija. Nauka. 2012; 1-2 (47-48): 43 [In Russ].

14.   White J.M., Cannon J.W., Stannard A. et al. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery. 2011; 150 (3): 400-409.

15.     Ogura T., Lefor A.T., Nakano M. et al. Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta. J. Trauma Acute Care Surg. 2015; 78 (1): 132-135



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.



1.     Pokrovskij A.V. The state of vascular surgery in 2017. Moskva 2018. [In Russ.]

2.     Pokrovskij A.V. Clinical angiology. Guide-book for physicians. M.: Medicina. 2004; 2: 184 [In Russ.]

3.     Diamantopoulos A, Katsanos K. Treating femoropopliteal disease: established and emerging technologies. Semin Intervent Radiol. 2014 Dec; 31(4):345-52.

4.     Dominguez A, Bahadorani J, Reeves R, et al. Endovascular therapy for critical limb ischemia. Expert Rev Cardiovasc Ther. 2015 Apr; 13(4): 429-44.

5.     Bokeriya L.A., Temrezov M.B., Kovalenko V.I., i dr. Actual problems of surgical treatment of patients with critical ischemia of lower limbs - solutions (state of the problem). Annalyhirurgii. 2011; 1: 5-9. [In Russ.]

6.     Norgen 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; 3(1): 1-75.

7.     Cotroneo AR, Iezzi R, Marano G. Hybryd therapy in patients with complex peripheral ultifocal steno-obstructive vascular disease: two-year results. Cardiovasc. Intervent. Radiol. 2007; 30: 355-361.

8.     Bokeriya L.A. Endovascular surgery of diseases of great vessels. M.:NCSSKH im. A.N. Bakuleva RAMN, 2008;291-310. [In Russ.]

9.     Gavrilenko A.V., Kotov A.E., Murav'eva YA.YU. The effect of tactical errors on results of surgical treatment in patients with critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2010; 16(1):138-143. [In Russ.]

10.   Marston WA, Davies SW, Armstrong В, Farber MA, Mendes RC, Fulton JJ, Keagy BA. Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. J Vase Surg. 2006 Jul; 44(1): 108-114.

11.   Kazakov YU. I., Lukin I. B., Kazakov A. YU. The choice of vascular reconstruction method for critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 2015;21(2):152-8.

12.   Bied Dzh. D. Amputation or reconstruction for critical lower limb ischemia. Angiologiya i sosudistaya hirurgiya. 1998;4(1): 72-78. [In Russ.]

13.   Pokrovskij A.V. Russian consensus. Diagnosis and treatment of patients with critical lower limb ischemia. M., Shwarz Pharma, 2002; 40 s. [In Russ.]

14.   Linkert P. et al. Saphenous Vein Versus PTFE for Above-Knee Femoropopliteal Bypass. A Review of the Literature. Eur. J. Vasc. Endovasc. Surg. Elsevier BV. 2004; 27(4): 357-362.

15.   Abramov S.I., Majtesyan D.A., Lazaryan T.A. Longterm results with a semi-closed endarterectomy loop from the superficial femoral artery and femoral-popliteal bypass grafting. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 147-151 [In Russ.]

16.   Beard JD: which revascularization is best for critical limb ischemia: endovascular or open surgery? J Vasc Surg. 2008, 48: 112-116S. 10.1016 / j.jvs.2008.01.065.

17.   Blevins WA, Schneider PA: Endovascular treatment of critical limb ischemia. Eur J Vasc Endovasc Surg. 2010; 39 (6): 756-761. 10.1016 / j.ejvs.2010.02.008.

18.   Adam DJ, Beard JD, Cleveland T, et al: BASIL trial participants. Shunting and angioplasty in severe ischemia of the foot (basil): a multicenter, randomized controlled trial. Lancet. 2005, 366 (9501): 1925-1934.

19.   Bradbury AW, Adam DJ, Bell J, et al. Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial: An intention-to-treat analisys of amputation-free and overall survival in patients randomized to a bypass surgery-first or a ballon angioplasty-first revascularization strategy. J. Vasc. Surg. 2010; 51: 5-17.

20.   Lindgren H, Qvarfordt P, Ekesson M, et al Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg. 2017        May; 53(5):686-694.

21.   Grimme FA., Goverde PA., Van Oostayen JA., et al. Covered stents for aortoiliac reconstruction of chronic occlusive lesions. J. Cardiovasc. Surg. (Torino). 2012; 53 (3):279-89.

22.   Gandini R, Fabiano S, Chiocchi M, et al. Percutaneous treatment in iliac artery occlusion: long-term results. Cardiovasc. Intervent. Radiol. 2008; 31 (6): 1069-76.

23.   Yokoi Y How should recent endovascular trials for femoropopliteal artery disease be interpreted. Cardiovasc Interv Ther. 2017 Apr; 32(2):106-113.

24.   Deloose K, Callaert J. Less is more: the "As Less As Reasonably Achievable Stenting" (ALARAS) strategy in the femoropopliteal area. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):495-503.

25.   Chalmers n Walker PT, Belly AM et al. A randomized study of a smart stent versus balloon angioplasty for long superficial lesions of the femoral artery: a super-study. Cardiovascular and Interventional Radiology. 2013; 36 (2): 353-361

26.   Dake MD. et al. Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal ArteryCLINICAL PERSPECTIVE. Circulation. Ovid Technologies (Wolters Kluwer Health), 2016;133(15): 1472-1483.

27.   Muradin GSR, Bosch Denpasar, Stainen T, Hunink MGM. Balloon dilatation and stent implantation for the treatment of arterial disease of the femur: Meta-analysis. Radiology. 2001; 221 (1): 137-145.

28.   Acin F, de Haro J, Bleda S,et al Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther. 2012 Oct;19(5):585-95. doi: 10.1583/JEVT-12-3898R.1.

29.   Zatevahin         I.I., SHipovskij V.N., Tursunov S.B. i dr. Longterm results of angioplasty using drug-coated balloons for lesions of the femoral-popliteal segment. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 64-68. [In Russ.]

30.   Katsanos to Karnabatidis D. Kitrou P Spiliopoulos with Christeas H Siablis D. Paclitaxel-coated balloon angioplasty and a conventional dilatation balloon for treatment of non-dialysis access: 6-month interim results from a prospective randomized controlled trial. Journal of Endovascular Therapy. 2012; 19 (2): 263-272.

31.   Werk M, Albrecht T, Dirk-Roelfs Meyer D-R, et al. Paklitaxel-Coated Balloons Reduse Restenosis After Femoropopliteal Angioplasty. Circ. Cardivasc. Interv. 2012; 5:831-840.

32.   Fanelli F, Cannavale A, Boatta E, et al. Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19: 571-580.

33.   Diamantopoulos A, Gupta Y, Zayed H. et al Paclitaxel-coated balloons and aneurysm formation in peripheral vessels. J Vasc Surg 2014; epub ahead of print.

34.   Pastromas G, Katsanos K, Krokidis M, et al Emerging stent and balloon technologies in the femoropopliteal arteries. Scientific World Journal. 2014; 2014:695402.

35.   Schmidt A, Piorkowski M, Werner M, et al: First experience with drug-eluting balloons in infrapopliteal arteries: restenosis rate and clinical outcome. J Am Coll Cardiol. 2011; 58 (11): 1105-1109. 10.1016/j.jacc. 2011.05.034.

36.   Fanelli F, Cannavale A, Boatta E, et al: Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19 (5): 571-580. 10.1583/JEVT-12-3926MR.1.

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.



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. 



1.      Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1, 388 patients during 25 years. J Am Coll Cardiol. 1996; 28: 616-626.

2.      Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC. Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med 1986; 314: 1-6.

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.

4.      Dikkers R, Willems TP, Tio RA, Anthonio RL, Zijlstra F, Oudkerk M. The benefit of 64-MDCT prior to invasive coronary angiography in symptomatic post-CABG patients. Int J Cardiovasc Imaging. 2007; 23(3): 369-377.

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.

6.      Laynez-Carnicero A, Estornell-Erill J, Trigo-Bautista A, Valle-Mutz A, Nadal-Barangй M, Romaguera-Torres R, Planas del Viejo A, Corb-Pascual M, Payб-Ser- rano R, Ridocci-Soriano F. Non-invasive assessment of coronary artery bypasss grafts and native coronary arteries using 64-slice computed tomography: comparison with invasive coronary angiography. Revista espanola de cardiologia. 2010; 63(2): 161-169.

7.      Heye T, Kauczor HU, Szabo G, Hosch W. Computed tomography angiography of coronary artery bypass grafts: robustness in emergency and clinical routine settings. Acta Radiol. 2014; 55(2): 161-170.

8.      Bourassa MG. Fate of venous grafts: the past, the present and the future. J Am Coll Cardiol. 1991; 5: 1081-1083.

9.      Nikonov ME. Possibilities of multispiral computed tomography in assessing the patency of coronary grafts in early and late periods in patients undergoing aortic and mammarocoronary bypass graft surgery. REJR. 2013; 3 (1): 18-27 [In Russ].

10.    ACC/AHA/ACP — ASIM Practice guidlines. ACC/AHA/ACP — ASIM Guidelines for the management of patients with chronic stable angina. Am Coll Cardiac. 1999; 33(7): 2092-2097.

11.    Tochii M, Takagi Y Anno H, Hoshino R, Akita K, Kondo H, Ando M. Accuracy of 64-slice multidetector computed tomography for diseased coronary artery graft detection. Annals of Thoracic Surgery. 2010; 89(6): 1906-1911.

12.    Shimanovsky NL. Safety of iodine-containing radiopaque agents in the light of new recommendations from international associations of experts and clinicians. REJR. 2012; 2 (1): 12-19 [In Russ].

13.    Campbell PG, Teo KS, Worthley SG, Kearney MT, Tarique A, Natarajan A, Zaman AG. Non-invasive assessment of saphenous vein graft patency in asymptomatic patients. Br J Radiol. 2009 Apr; 82(976):291-5. doi: 10.1259/bjr/19829466.

14.    Frazier AA, Qureshi F, Read KM, Gilkeson RC, Poston RS, White CS. Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics. 2005 Jul-Aug; 25(4): 881-896. Review.

15.    Tinica G, Chistol RO, Enache M, Leon Constantin MM, Ciocoiu M, Furnica C. Long-term graft patency after coronary artery bypass grafting: Effects of morphological and pathophysiological factors. Anatol J Cardiol. 2018 Nov;20(5):275-282. doi: 10.14744/AnatolJCardiol.2018. 51447.

16.    Drouin A, Noiseux N, Chartrand-Lefebvre C, Soulez G, Mansour S, Tremblay JA, Basile F, Prieto I, Stevens LM. Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial. Trials. 2013 Aug 26; 14: 270. doi: 10.1186/1745-6215-14270.

17.    Deb S, Cohen EA, Singh SK, Une D, Laupacis A, Fremes SE RAPS Investigators. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol. 2012 Jul 3;60(1):28-35. doi: 10.1016/j.jacc.2012.03.037.



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.



1.      Rothwell P.M., Eliasziw M., Gutnikov S.A., Fox A.J., Taylor D.W., Mayberg M.R. et al. Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003; 361: 107-116.

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.

4.      O'Regan C., Wu P., Arora P., Perri D., and Mills E.J. Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients. Am J Med. 2008; 21: 24-33.

5.      Perler B.A. The effect of statin medications on perioperative and long-term outcomes following carotid endarterectomy or stenting. Semin Vasc Surg. 2007; 20: 252-258.

6.      McGirt M.J., Perler B.A., Brooke B.S., Woodworth G.F., Coon A., Jain S. et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J. Vasc Surg. 2005; 42: 829-836.

7.      Paraskevas K.I., Athyros V.G., Briana D.D., Kakafika A.I., Karagiannis A., and Mikhailidis, D.P. Statins exert multiple beneficial effects on patients undergoing percutaneous revascularization procedures. Curr Drug Targets. 2007; 8: 942-951.

8.      Koh K.K. Effects of statins on vascular wall (vasomotor function, inflammation, and plaque stability). Cardiovasc Res. 2000; 47: 648-657.

9.      Amarenco P., Labreuche J., Lavallee P., and Touboul, P.J. Statins in stroke prevention and carotid atherosclerosis (systematic review and up-to-date meta-analysis). Stroke. 2004; 35: 2902-2909.

10.    Amarenco P. and Labreuche J. Lipid management in the prevention of stroke: review and updated metaanalysis of statins for stroke prevention. Lancet Neurol. 2009; 8: 453-463.

11.    Pokrovsky A.V., Beloyartsev D. F., Talibli O. L. Analysis of long-term results of eversion carotid endarterectomy. Angiology and vascular surgery. 2014; 20 (4): 100-108 [In Russ].

12.    Efthymios D. Avgerinos Rabih A., Abdallah Naddaf, Omar M. El-Shazly, Luke Marone, Michel S. Makaroun. Primary closure after carotid endarterectomy is not inferior to other closure techniques. Presented at the Vascular and Endovascular Surgery Society 2015 Summer Meeting, Chicago, Ill, June 17-20, 2015.

13.    Taylor A.J., Kent S.M., Flaherty P.J., Coyle L.C., Markwood T.T., and Vernalis, M.N. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002; 106: 2055-2060.

14.    Taylor A.J., Sullenberger L.E., and Lee H.Y ARBITER 3: Atherosclerosis regression during open-label continuation of extended-release niacin following ARBITER 2. Circulation. 2005; 112: II-179.

15.    Jones P., Davidson M., Stein E. et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR  Trial). Am. J. Cardiol. 2003; 92(2): 152-160.

16.    Crouse J.R. III, Raichlen J.S., Riley W.A. et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007;297:1344-1353.

17.    Radak D., Tanaskovic S., Matic P., et al. Eversion Carotid Endarterectomy - Our Experience After 20 Years of Carotid Surgery and 9897 Carotid Endarterectomy Procedures. Ann. Vasc. Surg. 2012; 26(7): 924-928.

18.    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995; 273: 1421-1428.

19.    Sever P.S., Poulter N.R., Dahlof B. et al. Different Time Course for Prevention of Coronary and Stroke Events by Atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Am J Cardiol. 2005; 96: 39-44.

20.    Paraskevas K.I., Hamilton G., Mikhailidis D.P. Statins: an essential component in the management of carotid artery disease. J Vasc Surg. 2007; 46: 373-386.



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. 



1.     Soroka V.V. Neotlozhnye serdechno-sosudistye operatsii v praktike obshhego khirurga [Emergency cardiovascular operations in practice of a general surgeon]. Volgograd: Izd-vo VolGU. 2001; 204 [In Russ].

2.    Samokhvalov I.M. Boevye povrezhdeniya magistral'nykh sosudov: diagnostika i lechenie na etapakh meditsinskoj evakuatsii. Diss. doct. med. nauk [Wartime major vascular injuries: diagnosis and treatment on echelons of care. Doct. med. sci. diss.]. St.Petersburg. 1994; 389 [In Russ].

3.     White J.M., Stannard A., Burkhardt G.E. et al. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann. Surg. 2011; 263(6):1184-1189. 

4.     Eastridge B.J., Mabry R.L., Seguin P et al. Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J. Trauma Acute Care Surg. 2012; 73(6):431-437.

5.     Holcomb J.B., Fox E.E., Scalea T.M. et al. Current opinion on catheter-based hemorrhage control in trauma patients. J. Trauma Acute Care Surg. 2013; 76(3): 888-893.

6.     Lumsden A.B. Commentary on «Endovascular management of vascular trauma». Perspect. Vasc. Surg. Endovasc. Ther. 2006; 18(2):130-131.

7.     Rasmussen T.E., Woodson J., Rich N.M. et al. Vascular trauma at a crossroads. J. Trauma. 2011; 70(5): 1291-1293.

8.     Reva V.A., Samokhvalov I.M. Endovaskulyarnaya khirurgiya na vojne. [Endovascular surgery in the war]. Angiologiya i sosudistaya khirurgiya. 2015; 21(2):166-175 [In Russ].

9.     Reva V.A., Semenov E.A., Petrov A.N. et al. Endovaskulyarnaya ballonnaya okklyuziya aorty: primenenie na statsionarnom i dogospital'nom ehtapakh skoroj meditsinskoj pomoshhi. [Endovascular balloon occlusion of the aorta: the use at in-hospital and pre-hospital stages of emergency medical care]. Skoraya meditsinskayapomoshh,'. 2016; 3:30-38.

10.   Reva V.A., Kiselev M.A., Platonov S.A. et al. Selektivnaja embolizacija vetvej glubokoj arterii bedra pri koloto-rezanom ranenii. [Selective angioembolization of the branches of the deep femoral artery in its stab injury]. Vestn. chir. irn. Grekova. 2015; 174(3):67-69 [In Russ].

11.   Bocharov S.M. Angiograficheskaya diagnostika i endovaskulyarnoe 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].

12.   Chernaya N.R., Muslimov R.Sh., Selina I.E. et al. Endovaskulyarnoe i khirurgicheskoe lechenie bol'nogo s travmaticheskim razryvom aorty i pechenochnoj arterii. [Endovascular and surgical treatment of a patient with traumatic rupture of the aorta and the hepatic artery]. Angiologiya i sosudistaya khirurgiya. 2016; 22(1):176-181 [In Russ].

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].

14.   Villamaria C.Y, Eliason J.L., Napolitano L.M. et al. Endovascular Skills for Trauma and Resuscitative Surgery (ESTARS) course: curriculum development, content validation, and program assessment. J. Trauma Acute Care Surg. 2014; 76(4):929-935.

15.   Brenner M., Hoehn M., Pasley J. et al. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J. Trauma Acute Care Surg. 2014; 77(2):286-291.

16.   Reva V.A. Obuchajushhie kursy po hirurgii povrezhdenij i endovaskuljarnoj hirurgii pri travmah v Jerebru (Shvecija). [Educational course on trauma surgery and endovascular surgery for trauma in Orebro (Sweden)] . Voen.-med. Jowrn. 2015; 336(12):78-81 [In Russ].

17.   Tsurukiri J., Ohta S., Mishima S. et al. Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists: A single-emergency center experience. J. Trauma Acute Care Surg. 2017; 82(1):126-132.

18.   Julien M., Emilie L., Dominique M. et al. Evaluation of femoro-popliteal angioplasties with the need for retrograde approach in a twin center series of 26 consecutive cases. J. Vasc. Endovasc. Surg. 2016; 1(4):1-10.

19.   Rohlffs F., Larena-Avellaneda A.A., Petersen J.P et al. Through-and-through wire technique for endovascular damage control in traumatic proximal axillary artery transection. Vascular. 2015; 23 (1): 99-101.

20.   Shalhub S., Starnes B.W., Tran N.T. Endovascular treatment of axillosubclavian arterial transection in patients with blunt traumatic injury. J. Vasc. Surg. 2011; 53(4): 1141-1144.

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. 



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%. 






1.     Хрупкин В.И., Ханевич М.Д., Зубрицкий В.Ф., Теканадзе А.Н. Неотложная эндоваскулярная хирургия гастродуоденальных кровотечений. Петрозаводск, 2002; 90.

2.     Бабенков Г.Д., Усов С.Н., Глазунов В.К. и др.Результаты лечения больных циррозом печени, осложненного кровотечением. Анналыхирургической гепатологии. 2000; 5 (2): 210-211.

3.     Ерамишанцев А.К., Щерцингер А.Г., Китенко Е.А. и др. Консервативная терапия острых пищеводно-желудочных кровотеченийу больных портальной гипертензией. Клиническая медицина. 1998; 7: 33—37.

4.     Оноприев В.И., Дурлештер В.М., УсоваО.А., Ключников О.Ю. Хирургическое лечение кровотечений из варикозно-расширенных вен пищевода и желудка. Хирургия. 2005; 1: 38-42.

5.     Прокубовский В.И., Черкасов В.А. Результаты эндоваскулярной эмболизации венжелудка у больных с портальной гипертензией. Вестник хирургии. 1993; 712: 16-19.

6.     Акилов Х.А., Хашимов Ш.Х., Девятов А.В.Роль отдельных факторов в патогенезе ВРВП и кровотечений из них у больных циррозом печени. Анналы хирургической гепатологии. 1998; 3 (3): 130.

7.     Пациора М.Д. Хирургия портальной гипертензии. Ташкент. Медицина. 1984; 319.

8.     Петров В.П., Ерюхин И.А., Шемякин И.С. Кровотечения при заболеваниях пищеварительного тракта. М.: Медицина. 1987; 256.

9.     Шалімов О.О., Каліта М.Я., Буланов К.І. таінші. Лікування хворих з ускладненнями цирозу печінки в стадії декомпенсації. Клінічна хірургія. 1997; 3 (4): 4-8.

10.   Ерамишанцев А.К. Развитие проблемы хирургического лечения кровотечений из варикозно-расширенных вен пищевода и желудка. Анналы хирургической гепатологии. 2007; 12 (2): 8-15.

11.   Любинский В.Л., Андреев Г.Н., Оспанов А., Турмаханов СТ. Агрегатное состояние крови и значение его нарушений при кровотечениях портального генеза. Вестник хирургии. 2005; 164 (3): 65-69.

12.   Бойко В.В., Васильев Д.В. Профилактика рецидивов кровотечения из варикозно-расширенных вен пищевода и желудка при циррозе печени. Хірургія України. 2007; 2: 108-113.

13.   Горбузенко Д.В. Лечебная тактика при кровотечениях из варикозно-расширенных вен желудка. Анналы хирургической гепатологии. 2007; 12 (1): 96-101.


14.   Щеголев А.А., Шиповский В.Н., Аль-Самбунчи О.А., Шагинян А.К. Эндоскопический и эндоваскулярный гемостаз при кровотечениях из варикозно-расширенных вен пищевода. М.: РГМУ. 2003; 238.


15.   Stiegmann G. Update of endoscopic band lig ation therapy for treatment of esophageal varices. Endoscopy. 2003; 35: 5-8.


16.   Каримов Ш.И., Ким В.Ф., Ахтаев А.Р. Эндоваскулярная диагностика и катетерная хирургия профузных пищеводных кровотечений у больных с портальной гипертензией. Ташкент. Изд-во Ибн Сина. 1992; 124.



17.   Kiyosue H., Matsumoto S., Yamada Y. et al.Transportal intravariceal sclerotherapy withN-Butyl-2-Cyanoacrylate for Gastric Varices. J. Vasc. Interv. Radiol. 2004; 15 (5): 505-509.



18.   Ninoi T., Nakamura K., Kaminou T. et al.TIPS versus transcatheter sclerotherapy forgastric varices. AJR. 2004; 183: 3693-3776.



19.   Tripathi D., Therapondos G., Jackson E., 29.Redhead D.N., Hayes P.C. The role of thetransjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations. Gut. 2002; 51: 270-274.



20.   Vidal V., Joly L., Perreault P. et al. Usefulnessof transjugular portosystemic shunt in themanagement of bleeding ectopic varices in cirrhotic patients. Cardiovasc. Intervent. Radiol. 2006; 29: 216-219.



21.   Haciyali M., Genc H., Halici H. et al. Resultsof modifickend sugiura operation in varicealbleeding in cirrhotic and noncirrhotic patients. Hepatogastroenterology. 2003; 50 (51):748-788.



22.   Wolff M., Hirner A. Current state of portosystemic shunt surgery. Langenbecks. Arch. Surg. 2003; 388 (3): 141-149.



23.   Hert C., Fisher L., Broering D. et al. Livertransplantation in patients with liver cirrhosisand esophageal bleeding. Langenbecks. Arch. Surg. 2003; 388 (3): 150-154.



24.   Li M.K., Sunf J.J., Woo K.S. et al. Somatostatinreduces gastric mucosal blood flow in patientswith portal hypertensive gastropathy: a randomized, doubl-blind crossover study. Dig.Dis. Sci. 1996; 41: 2440-2446.


25.   Калита Н.Я., Буланов К.И., Весненко А.И.Прогнозирование исхода полостной операции у больных с декомпенсированным пиррозом печени. Клінічна хірургія. 1995; 1: 4—6.

26.   Зубарев П.Н., Котив Б.Н., Хохлов А.В. и др.Выбор способа портокавального шунтирования. Анналы хирургической гепатологии..2000; 3 (3): 23-27.

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.




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.  



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, Global experience in cervical carotid artery stent placement. Catheter Cardiovasc. Interv. 2000; 50: 160-167



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.  



1.    Posnick J.C. Orthognathic surgery: principles and practice. Elsevier. 2014; 1864 p.

2.    Persin L.S. Ortodontija. Sovremennye metody diagnostiki zubocheljustno-licevyh anomalij [Orthodontics. Modern methods of diagnosis maxillodental-facial anomalies.]. Moskva: OOO «IZPC «Informkniga». 2007; 248 s [In Russ].

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.




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.



1.     Compton C., Rhee R. Peripheral vascular trauma. Perspect. Vasc. Surg. Endovasc. Ther. 2005; 17 (4): 297-307.

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.MAngiograficheskaja 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.



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. 



1.     Kelton J.G., Warkentin T.E. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008; 112 (7): 2607-16.

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.

4.     Rhodes G.R., Dixon R.H., Silver D. Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg. Gynecol. Obstet. 1973; 136 (3): 409-16.

5.     Jang I.K., Hursting M.J. When heparins promote thrombosis: review of heparin-induced thrombocytopenia. Circulation. 2005; 111 (20): 2671-83.

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.

18.   Warkentin T.E. Heparin-induced thrombocytopenia: pathogenesis and management. Br. J. Haematol. 2003; 121 (4): 535-55.

19.   Linkins L., Dans A.L., Moores L.K., et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice Guidelines. Chest. 2012; 141 (2 suppl.): 495-530.

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.

21.   Bleasel J.F., Rasko J.E., Rickard K.A., Richards G. Acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome. Med. J. Aust. 1992; 157 (3): 192-3.

22.   Greinacher A., Juhl D., Strobel U. et al. Heparin-induced thrombocytopenia: a prospective study on the incidence, platelet-activating capacity and clinical significance of antiplatelet factor 4/heparin antibodies of the IgG, IgM, and IgA classes. J. Thromb. Haemost. 2007; 5 (8): 1666-73.

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

24.   Tomer A., Masalunga C., Abshire T.C. Determination of heparin-induced thrombocytopenia: a rapid flow cytometric assay for direct demonstration of antibody-mediated platelet activation. Am. J. Hematol. 1999; 61 (1): 53-61.

25.   Meyer O., Salama A., Pittet N., Schwind P. Rapid detection of heparin-induced platelet antibodies with particle gel immunoassay (ID-HPF4). Lancet. 1999; 354 (9189): 1525-6.

26.   Warkentin T.E., Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126 (3 Suppl.): 311-337.

27.   Greinacher A., Lubenow N., Eichler P. Anaphylactic and anaphylactoid reactions associated with lepirudin in patients with heparin-induced thrombocytopenia. Circulation. 2003; 108 (17): 2062-5.

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.

31.   Walenga J.M., Prechel M., Jeske W.P. et al. Rivaroxaban an oral, direct Factor Xa inhibitor has potential for the management of patients with heparin-induced thrombocytopenia. Br. J. Haematol. 2008; 143 (1): 92-9.

32.   Shantsila E., Lip G.Y, Chong B.H. Heparin-induced thrombocytopenia. A contemporary clinical approach to diagnosis and management. Chest. 2009; 135 (6): 1651-64.

33.   Bokerija L.A., Chigerin I.N. Geparininducirovannaja trombocitopenija (sovremennoe sostojanie problemy) [Heparin-induced thrombocitopenia (modern condition of problem)]. M. Izd. NCSSH im. A.N. Bakuleva. 2007; 96 s [In Russ].

34.   Potzsch B., K^vekorn W.P., Madlener K. Use of heparin during cardiopulmonary bypass in patients with a history of heparin-induced thrombocytopenia. N. Engl. J. Med. 2000; 343 (7): 515. 

35.  Warkentin T.E., Greinacher A. Heparin-induced thrombocytopenia and cardiac surgery. Ann. Thorac. Surg. 2003; 76 (6): 2121-31.



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.



1.     Nkomo V.T., Gardin J.M., Skelton T.N. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005-1011.

2.     Charlson E., Legedza A.T.R., Hamel M.B. Decisionmaking and outcomes in severesymptomatic aortic stenosis. J. Heart Valve Dis. 2006; 15: 312-321.

3.     Iung B., Baron G., Butchart E.G., Delahaye F.. Gohlke-Barwolf C., Levang O.W., Tornos P., Vanoverschelde J.L., Vermeer F., Boersma E., Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur. Heart J. 2003; 24: 1231-1243. 

4.     Varadarajan P., Kapoor N., Bansal R.C., Pai R.G. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann. Thorac. Surg. 2006; 82: 2111-2115.

5.     Andersen H.R., Knudsen L.L., Hasenkam J.M. Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur. Heart J. 1992; 13:704-708.

6.     Cribier A., Eltchaninoff H., Bash A., Borenstein N., Tron C., Bauer F., Derumeaux G., Anselme F., Laborde F., Leon M.B. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002; 106: 3006-3008.

7.     Webb J.G., Pasupati S., Humphries K., Thompson C., Altwegg L., Moss R., Sinhal A., Carere R.G., Munt B., Ricci D., Ye J., Cheung A., Lichtenstein S.V. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007; 116: 755-763.

8.     Callander V. Computed tomography. M. Technosphere, 2006. C-17-23 [In Russ.]

9.     Ternovoy S.K., Sinitsyn V.E. Spiral CT and cathode ray angiography. M. Vidar, 1998. C-23-47 [In Russ.]

10.   Sinitsyn V.E., Achenbach S. Electron Beam Computed Tomography. In: M.Oudkerk (ed). Coronary Radiology. Berlin: Springer, 2004.

11.   Bridgewater B., Keogh B., Kinsman R., Walton P Sixth national adult cardiac surgical database report. 2008 [cited 2011 Feb 9].

12.   Ludman PF. British Cardiovascular Intervention Society audit returns: adult interventional procedures Jan 2009 to Dec 2009. BCIS Meeting; 2010 Oct: Cardiff, Wales. Рр17-34.



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. 



1.     Borisov N.A., Popov L.V., Bletkin A.N. Hirurgicheskoe lechenie postinfakrtnoj anevrizmy levogo zheludochka [Surgical treatment of postinfarction aneurysm of left ventricular]. Annaly hirurgii. 2002; 3:14-19 [ in Russ].

2.     Cooley D.A. Surgical restoration of left ventricular aneurysm. Oper. Tech. Cardiac. Thorac. Surg. 1997; 2:151-161.

3.     Otsuji Y, Handschumacher M.D., Liel-Choen N., et al Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: Three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J. Am. Coll. Cardiol. 2001; 37:641-648.

4.     Kalon K., Ho. L., Pinsky J.L., Karmd W.B., Levy D. The epidemiology of heart failure: the Framingham Study. J. of AmericanCollege of Cardiology. 1993; 22:6A-13A.

5.     Grigioni F., regurgitationEnriquez-Sarano M., Zehr K.J. et al. Ischaemic mitral. Circulation. 2001; 103: 1759-1764.

6.     Athanasuleas C.L., Buckberg G.D., Stanley A.W., et al. RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J. Am.Coll. Cardiol. 2004; 44:1439-1445.

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.

21.   Yamaguchi A., Adachi H., Kawahito K., et al Left ventricular reconstruction benefits patients with dilated ischemic cardiomyopathy. Ann. Thorac. Surg. 2005; 79:456-461.

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.

23.   Rossejkin E.V., Kobzev E. E., Bazylev V. V. Neposredstvennye rezul'taty hirurgicheskoj rekonstrukcii levogo zheludochka [Immediate results of surgical reconstruction of left ventricular]. XIX Vserossijskij s#ezd serdechno-sosudistyh hirurgov. 2013. _rezultaty_khirurgi_cheskoy_rekonstruktsii_ levogo_ zheludochka/[In Russ].

24.   Shabalkin B.V., Rabkin I.H., Belov Ju.V. i dr. Prognozirovanie posleoperacionnoj serdechnoj nedostatochnosti pri hirurgicheskom lechenii anevrizm serdca. Krovosnabzhenie, metabolizm i funkcija organov pri reko struktivnyh operacijah. [Prognosis of post-operative heart insufficiency on surgical treatment of heart aneurysms. Blood circulation, metabolism and functioning of organs during reconstruction operations.] Erevan 1984; 166-168 [In Russ].

25.   Komeda M., David T.E., Malik A., Ivanov J., Sun Z. Operative risks and long-term results of operation for left ventricular aneurysm. Ann. Thorac. Surg. 1992; 53:22-29.

26.   Van         der Wall E.E., Bax J.J. Different imaging approaches in the assessment of left ventricular dysfunction: all things equal? Eur. Heart J. 2000; 21:1295-1297.

27.   Lorenz C.H., Walker E.S., Morgan V. L., Klein, S.S., Graham T.P. Jr. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 1999; 1:7-21.

28.   Belov Ju.V. Postinfarktnoe remodelirovanie levogo zheludochka serdca: ot koncepcii k hirurgicheskomu lecheniju [Postinfarction remodeling of left ventricular: from concept to surgical treatment.]. M., izd. De-Novo. 2002; S:194 [In Russ].

29.   Dor V., Sbatier M., DiDonato M., et al. Efficacy of endoventricular patchplasty in large post-infarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J. Thorac. Cardiovasc. Surg. 1998;116:50-59.

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]. 



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. 



1.     Bokerija, L. A., Gudkova R.G. Serdechno-sosudistaja hirurgija - 2010. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija: Prakticheskoe rukovodstvo[Pathology and congenital anomalies of circulatory system. Practical guide-book]. M.: NCSSH im. A. N. Bakuleva RAMN. 2011; 191 c [In Russ].

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].

7.     Kayhan A., Palab y k F., Serinsoz S. et а!. Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetectorCT a valuable screening tool? Eur. J. Radiol. 2012; 81(3): 542-546.

8.     Mamet'eva I.A., Miheev N.N. Diagnosticheskajaj effektivnost' mul'tisrezovoj komp'juternoj tomografii-angiografii v dinamicheskom nabljudenii pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterijah nizhnih konechnostej [Diagnostic efficacy of multislice computed tomographic angiography in dynamic post-operative supervision after reconstrictive procedures on main arteries of lower limbs]. Medicinskij vestnik MVD. M. 2015; 78 (5): 42-47[ In Russ].

9.     lezzi R., Santoro M., Dattesi R., et al. Diagnostic accuracy of CT angiography in the evaluation of stenosis in lower limbs: comparison between visual score and quantitative analysis using a semiautomated 3D software. J. Comput. Assist. Tomogr. 2013; 37 (3): 419-425.

10.   Pomposelli F. Arterial imaging in patients with lower-extremity ischemia and diabetes mellitus. J. Am. Podiatr. Med. Assoc. 2010; 100 (5): 412-23.

11.   Mamet'eva I.A., Miheev N.N., Obel'chak I.S. i dr. Primenenie nizkodozovogo protokola u pacientov posle rekonstruktivnyh vmeshatel'stv na magistral'nyh arterijah nizhnih konechnostej. Nash opyt[Low-dose protocol in patients after reconstructive procedures on main arteries of lower limbs]. REJR. Materialy IX Vserossijskogo kongressa luchevyh diagnostov i terapevtov «Radiologija 2015».M. 2015; 5 (2): 69 [ In Russ]

12.   Mahnken A.H., Bruners P., Mommertz G. Et al. Carbon dioxide contrast agent for CT arteriography: results in a porcine model. J. Vasc.Interv. Radiol. 2008; 19 (7):1055-1064.

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. 




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.



1.     Berrizbeitia L.D., Tessler S., Jacobowitz I.J., et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics. Chest. 1989, 96(4):873-876.

2.     Deng Y, Byth K., Paterson H.S. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann. Thorac. Surg. 2003; 76(2):459-463.

3.     Mazzoni M., Solinas C., Sisillo E., et al. Intraoperative phrenic nerve monitoring in cardiac surgery. Chest. 1996, 109(6):1455-1460.

4.     O'Brien J.W., Johnson S.H., VanSteyn S.J., et al. Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann.Thorac. Surg. 1991, 52(2):182-188.

5.     Tripp H.F., Sees D.W., Lisagor P.G., et al. Is phrenic nerve dysfunction after cardiac surgery related to internal mammary harvesting? J. Card. Surg. 2001, 16(3): 228-231.

6.     Canbaz S., Turgut N., Halici U., et al. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery - a prospective, controlled, clinical study. BMC Surgery. 2004, 4:2.

7.     Merino-Ramirez M.A., Juan G., Rair^n M., et al. Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors. J. Thorac. Cardiovasc. Surg. 2006; 132:530-536.

8.     Metzner A., Rausch P, Lemes C., et al. The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J. Cardiovasc. Electrophysiol. 2014; 25(5):466-470.

9.     Diehl J.L., Lofaso F., Deleuze P, et al. Clinically relevant diaphragmatic dysfunction after cardiac operations. J. Thorac. Cardiovasc. Surg. 1994; 107:487-498.

10.   Efthimiou J., Butler J., Woodham C., et al. Diaphragm paralysis following cardiac surgery: role of phrenic nerve cold injury. Ann. Thorac. Surg. 1991; 52:1005-1008.

11.   Smith B.M., Ezeokoli N.J., Kipps A.K., et al. Course, Predictors of Diaphragm Recovery After Phrenic Nerve Injury During Pediatric Cardiac Surgery. Ann. Thorac. Surg. 2013; 96:938-42.

12.   Kim W. Y; Suh H. J.; Hong S.-B.; Koh Y; Lim C.-M. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Critical Care Medicine. 2011; 12:2627-2630.

13.   Davison A., Mulvey D. Idiopathic diaphragmatic weakness. BMJ. 1992; 304:492-494.

14.   McCool F.D., Tzelepis G.E. Dysfunction of the Diaphragm. N. Engl. J. Med. 2012; 366:932-942.

15.   McCool F.D., Mead J. Dyspnea on immersion: mechanisms in patients with bilateral dia-phragm paralysis. Am. Rev. Respir Dis. 1989; 139:275-276.

16.   Steier J., Jolley C.J., Seymour J., et al. Sleep-disordered breathing in unilateral diaphragm paralysis or severe weakness. Eur. Respir. J. 2008; 32:1479-1487.

17.   Wang C.S., Josenhaus W.T. Contribution of the diaphragmatic-abdominal displacement to ventilation in supine man. J. Appl. Physiol. 1971; 31:576-80.

18.   Stradling J.R., Warley A.R. Bilateral diaphragm paralysis and sleep apnoea without diurnal respiratory failure. Thorax. 1988; 43:75-77

19.   Summerhill E.M., El-Sameed YA., Glidden T.J. Monitoring recovery from diaphragm paralysis with ultrasound. Chest. 2008; 133:737-743.

20.   El-Sobkey S.B., Salem N.A. Can lung volumes and capacities be used as an outcome measure for phrenic nerve recovery after cardiac surgeries? J. Saudi. Heart Assoc. 2011; 23:23-30.

21.   Laroche C.M., Mier A.K., Moxham J., Green M. Diaphragm strength in patients with recent hemidiaphragm paralysis. Thorax. 1988; 43:170-174.

22.   Линденбратен Л.Д. Лучевая диагностика поражений диафрагмы. Радиология и практика. 2001; 2:6-21. Lindenbraten L.D. Luchevaja diagnostika porazhenij diafragmy[Beam diagnostics of diaphragm lesions]. Radiologija ipraktika. 2001; 2:6-21[In Russ].

23.     Suwatanapongched T., Gierada D.S., Slone R.M. et al. Variation in Diaphragm Position and Shape in Adults With Normal Pulmonary Function. Chest. 2003; 123(6): 2019-2027. 



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.



1.     Insul't: Rukovodstvo dlja vrachei. Pod red. L.V. Stahovskoi, S.V. Kotova. [Stroke: guide for physicians. Under edition of L.V.Stakhovsky, V.Kotov] M.: OOO «Medicinskoe informacionnoe agentstvo», 2013;400S [In Russ].

2.     Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami brahiocefal'nyh arterii. [National recommendations for treatment of patients with pathology of brachiocephalic arteries.] ]2013; S 70 [In Russ].

3.     Vereshhagin N.V. Rol' porazhenij jekstrakranial'nyh otdelov magistral'nyh otdelov golovy v patogeneze narushenij mozgovogo krovoobrashhenija. Sosudistye zabolevanija nervnoj sistemy. [Role of extracranial arteries’ lesion in pathogenesis of disorders of cerebral circulation] Smolensk. 1980; 23-26 [In Russ].

4.     Gusev E.I., Skvorcova V.I. Ishemija golovnogo mozga. [Ischemia of brain]. Zhurn.nevropat. i psihiatr. 2003;9:66- 70 [In Russ].

5.     Harbaugh R.E., Schlusselberg D.S., Jeffery R., Hayden S., Cromwell L.D., Pluta D. Threedimensional computerized tomography angiography in the diagnosis of сerebrovascular disease. J. Neurosurg 1992; 76: 408-414.

6.     Heiserman J.E., Dean B.L., Hodak J.A. et al. Neurologic complications of cerebral angiography. AJNR Am Neuroradiol. 1994; 15: 1401-1407.

7.     Dzhibladze D.N. Patologija sonnyh arterii i problema ishemicheskogo insul'ta (klinicheskie, ul'trazvukovye i gemodinamicheskie aspekty). [ Pathology of carotid arteries and problem of ischemic stroke (clinical, ultrasonic and hemodynamic aspects)] Moskva. 2002; 208S [In Russ].

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.

9.     Buskens E., Nederkoorn P.J., Buijs-Van Der Woude T., Mali W.P., Kappelle L.J., Eikelboom B.C., Van Der Graaf Y, Hunink M.G. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology. 2004;233:101-112.

10.   Edward C. Jauch et al., Guidelines for the Early Management of Patient With Acute Ischemic Stroke. Stroke. 2013;44: 870-947.

11.   Gladstone D.J., Kapral M.K., Fang J., Laupacis A., Tu J.V. Management and outcomes of transient ischemic attacks in Ontario. CMAJ. 2004;170:1099-1104.

12.   North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med. 1991;325:445-453.

13.   Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998 May 9; 351 (9113): 1379-87.

14.   Osborn A.G.; Diagnostic Cerebral Angiography. 2nd edition Philadelphia, PA: Williams and Wilkins; 1999.

15.   Choi YJ., JungS.C., Lee D.H. Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries. Journal of Stroke. 2015; 17(3):238-255.

16.   Extracranial vascular-interventional: E. Johansson and A.J. Fox Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis. AJNR Am. J Neuroradiol 2016 37: 2-10.

17.   The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: risk of rupture and risks of surgical intervention. N Engl J Med. 1998; 339: 1725-1733

18.   Krylov V.V. Jepidemiologija i jetiopatogenez anevrizm i subarahnoidal'nyh krovoizlijanii. [Epidemiology and ethiopathogenesis of aneurysms and subarachnoid hemorrhage] Krylov V.V., Godkov I.M. Hirurgija anevrizm golovnogo mozga: v 3-h t. Pod red. V.V. Krylova. Tom 1. M.: Izd-vo T.A. Alekseeva. 2011; tom.I, Gl. 1: 12-41 [In Russ]. 



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.



1.     Savitz S.I., Caplan L.R. Vertebrobasilar disease. N Engl J Med. 2005, 352: 2618-2626.

2.     Caplan L.R., Wityk R.J., Glass T.A., Tapia J., Pazdera L., Chang H.M., Teal P, Dashe J.F., Chaves C.J., Breen J.C., Vemmos K., Amarenco P, Tettenborn B., Leary M., Estol C., Dewitt L.D., Pessin M.S. New England Medical

Center Posterior Circulation registry. Ann Neurol. 2004, 56: 389-398.

3.     Vereshhagin N.V. Patologija vertebral'no-baziljarnoj sistemy i narushenija mozgovogo krovoobrashhenija[Pathology of vertebrobasilar system and cerebral blood flow disorders]. M. 1980; S 28 [In Russ].

4.     Puzin M.N., Zinov'eva G.A., Metelkina L.P. Aspekty medikamentoznogo lechenija bol'nyh s vertebral'no-baziljarnoj nedostatochnost'ju [Aspects of pharmacotherapy in treatment of patients with vertebrobasilar insufficiency]. Klinicheskaja farmakologija i terapija. 2006; 2: 23-26 [In Russ].

5.     Berguer R., Morasch M., Kline R. A review of 100 consecutive reconstructions of the distal vertebraf artery for embolic and hemodynamic disease. J Vasc Surg. 1998, 27 (5): 852-859.

6.     Pokrovskiy A.V., Beloyartsev D.F., Otdalemmie rezultati operatsiy podkluchichno-sonnoi transpozitsii. [Longterm results of operations of the subclavian-carotid transposition.] Angiologia I sosudistaya khirurgia. 2002; 8(2): 84-91.

7.     He Y, Bai W., Li T. et al. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar arteryocclusion. Ann Vasc Surg. 2014 Feb; 28 (2): 386-393.

8.     European Stroke Organisation et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011 Nov; 32 (22): 2851-906.

9.     Natsionalnie rekomendacii po vedeniyu patsientov s zabolevaniyami brakhiotsefal’nikh arteriy. [National guidelines on the management of patients with diseases of brachiocephalic arteries.] Angiologia I sosudistaya khirurgia. 2013; 19 (2): attachment 70.

10.   Schonewille W.J., Algra A., Serena J., Molina C.A., Kappelle L.J. Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry. 2005, 76:1238-1241.

11.   Coward L.J., McCabe D.J., Ederle J., Featherstone R.L., Clifton A., Brown M.M. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke. 2007, 38: 1526-1530.

12.   Compter A., van der Worp H.B., Schonewille W.J., Vos J.A., Algra .A., Lo T.H., Mali WPThM, Moll FL. and Kappelle L.J. VAST: Vertebral Artery Stenting Trial. Protocol for a randomised safety and feasibility trial. Trials 2008, 9: 65.

13.   Clifton A., Markus H., Kuker W., Rothwell P. E-050. The Rationale for the Vertebral artery Ischaemia Stenting trial (VIST): NeuroIntervent Surg 2013; 5. Suppl 2 A56.

14.   Compter A., et al. VAST investigators. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol. 2015 Jun; 14(6): 606-614.

15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240. (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы