The carotid arteries stenting in patients suffering coronary atherosclerosis

There are depicted immediate results of treatment of the patients, suffering multifocal atherosclerosis, using endovascular methods. Of 21 patients, suffering atherosclerotic affection of carotid and coronary arteries, in 16 endovascular interventions were performed and in 5--combined endovascular and surgical interventions. In all the patients the stenting procedure was accomplished using mechanical neuroprotective devices. In the patients, to whom aorto-coronary shunting was indicated, as a first stage of treatment the interventions on extracranial basin was performed and in 3-4 weeks afterwards--the aorto-coronary shunting operation. The order of the procedures performance in the patients was dependent on the leading clinical symptoms severity. The total of 23 carotid and 46 coronary stents was implanted in the group observed. There were no mortality afer endovascular interventions performance. Non-Q myocardium infarction had occurred in a patient, suffering affection of several coronary arteries, and the transient disorder of the brain blood flow--in a patient during the carotid stenting performance.     

The role of revascularization in the foot salvage in patients suffering diabetes mellitus with occlusion-stenotic lesions of the shin arteries

There were examined 1363 patients suffering diabetes mellitus with trophic ulcer and purulent-necrotic affection of foot. Conservative treatment or operative intervention on the foot were conducted according to indications in 1176 (86.3%) patients, who no needed revascularization. Revascularization was done in 187 (13.7%) patients. Necessity of reconstruction for occlusion-stenotic affection of the shin arteries was established in 125 (66.8%) of them, shunting into the foot arteries was done in 52 (41.6%). High amputation of the limb was performed in 73 (58.4%) of patients in presence of contraindications for the foot revascularization. In 83.5% of patients suffering diabetes mellitus with occlusion-stenotic affection of the shin segment arteries there were two or one passable arteries of foot, fit for shunting operation.     

Surgical tactics in combined lesions of the aortic arch and its thoraco-abdominal segments in nonspecific aortoarteritis]

Seventy-one patients with unspecific aortoarteritis and affections of the aortic arch and its thoracoabdominal segment were treated in the period between 1984 and 1989. All the examined patients had different variants of affection of the brachiocephalic arteries, in 57 (80.3%) of them there was a coexistent affection of the thoracoabdominal segment of the aorta, and in 14 (18.7%) coexistent affection of the abdominal aorta and the lower limb arteries. Operations were conducted on 56 (78.8%) patients. Reconstruction of the brachiocephalic arteries was carried out in 12 (21.4%), of the thoracoabdominal segment of the aorta and the renal arteries in 30 (53.6%), and of the abdominal aorta and lower limb arteries in 9 (16.1%) cases. Five (8.9%) patients underwent two-stage correction of the blood flow in the branches of the arch of the aorta and its thoracoabdominal segment. The clinical picture, the volume of the affection, the methods of examination, and techniques and the results of reconstructive operations are described in detail. The authors present their point of view on the performance of surgical treatment in stages in coexistent lesions differing in volume.     

Peculiarities of regional hemodynamics and affection of arterial bed of the lower extremities in patients with diabetes mellitus

Peculiarities of the lower extremities blood circulation disorder in patients suffering diabetes mellitus, depending on the level of atherosclerotic affection of the femoro-popliteo-tibial segment arteries and the chronic ischemia severity, were studied. While equal ischemia severity, the chronic ischemia symptoms in patients, suffering diabetes mellitus, had revealed on earlier stages of regional hemodynamics disorder than in patients suffering atherosclerosis without diabetes mellitus. For the patients, suffering diabetes mellitus, characteristic are distal localization of arterial affection in form of frequent atherosclerotic lesion of popliteal artery bifurcation and total occlusion of tibial arteries, as well as tendency toward combined and bilateral affection.     

Surgical treatment of diseases of the brachiocephalic arteries

The authors have summarized the experience with surgical treatment of 147 patients with the brachiocephalic arterial pathology. Transient disorders in the cerebral circulation were noted in 54%, chronic vascular cerebral insufficiency--in 15%, ischemic insult and its sequelae--in 19% of the patients. Occlusive-stenotic lesions of the extracranial vessels, aneurysms, tortuosity of the brachiocephalic++ trunk, compression of the carotid arteries by chemodectoma were the indications for operative treatment. When choosing a method for operative intervention, the preference was given to extrathoracic techniques. The positive results were achieved in 90% of the patients.     

Peculiarities of the brain bioelectrical activity in patients with atherosclerotic lesions of extracranial branches of the aortal arch

Bioelectrical activity of the brain was studied in 12 patients with atherosclerotic affection of extracranial branches of aortal arch, using electroencephalography method, tests with hyperventilation and nitroglycerin loading. It was established that in lowering of the blood flow along extracranial vessels the brain functional state is not always disturbing. In 50% of patients the hypoxia signs were not revealed. While the blood flow lowering along extracranial vessels causes disorder of the brain bioelectric activity, strict dependence of the hypoxia severity from the blood flow disorder degree and the affection side was not established.     

Surgical treatment of extracranial internal carotid artery aneurysm

Aneurysms of the extracranial internal carotid artery are rare but can be responsible for severe complications such as rupture, thrombosis, or embolism. Between 1961 and 1985 we operated on 38 aneurysms of the extracranial internal carotid artery in 35 patients, 22 males and 13 females, whose ages ranged from 6 to 73 years. The underlying causes of aneurysm included atherosclerosis (12 cases), fibromuscular dysplasia (eight cases), a congenital defect (five cases), infection (one case), and trauma (six cases); in six cases aneurysm was secondary to spontaneous dissection. Signs of cerebral ischemia were present in 26 (74%) patients and a cervical mass was found in six. The aneurysm was proximal (i.e., below the angle of the mandible) in 16 patients and distal (i.e., above the angle of the mandible) in 22. After resection of the aneurysm, arterial continuity was restored in 37 patients by resection and grafting (12 cases), resection and anastomosis (11 cases), or arteriorrhaphy (14 cases). One death occurred 13 days after operation due to myocardial infarction. Two patients experienced a reversible neurologic event. Transient paresis of cranial nerves was observed in eight patients. During a follow-up period that ranged from 6 to 30 years, four patients were lost to follow-up and 25 patients remained asymptomatic. Three patients had asymptomatic thrombosis of the carotid artery detected at follow-up investigations. The potential risks of cerebral ischemia and rupture and the satisfactory long-term results achieved with surgery are strong arguments in favor of surgical treatment for aneurysms of the extracranial internal carotid artery.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Reims, France, June 19– 20, 1992.     

Diagnosis and treatment of the main arteries in the lower extremities of patients with diabetic foot syndrome]

Results of examination and treatment of 209 patients with diabetes mellitus (DM), complicated by purulent-necrotic affection of foot (PNAF), were analyzed. While choosing patients to determine indications for reconstructive operation performance segmentary pressure (SP) on posterior tibial artery on level of her low third was measured, shoulder-scapular index (SSI) and the PNAF stage (according to classification of Wagner) were determined. In 16% of patients with diabetic affection of III-IV stages, SP indexes ranging 9.3-12.0 kPa (70-90 mm Hg), SSI 0.6-0.9 stenosis or occlusion of the lower extremity main arteries, demanding surgical correction to be done, was revealed. Reconstructive operation on vessels was done in 26 patients with restricted stenosis of femoro-popliteal segment, according to ultrasonic Dopplerometry results, passability of the leg arteries, distance of more than 50 metres, which passes patient without painful sensations, value of SP in both arteries of leg ranging 9.3-12.0 kPa (70-90 mm Hg), SSI more than 0.6. Revascularization operation on arteries of lower extremity was successful in 46 (94%) of 49 patients with DM and PNAF.     

慢性肢体缺血的外科治疗：附75例报告

目的：探讨慢性肢体缺血的外科治疗方法及效果。方法：回顾性分析6年间收治的慢性肢体缺血经外科治疗的75例（78条肢体）的临床资料，其中上肢7条，下肢71条。手术方式包括传统外科手术65例、介入手术4例及干细胞移植术6例。结果：术后63例（66条肢体）获随访2～56个月，1年内8例患者9条下肢（13.6%）截肢;55条肢体（83.3%）临床症状减轻或消失;肢体溃疡愈合或截肢平面降低2条（3.0％），总有效率86.3％。结论：根据病情选用适当的手术方式治疗慢性肢体缺血，可取得较满意的效果。     

Analysis of complications and indices of cumulative preservation of the lower extremities in their chronic critical ischemia after direct, indirect and composite revascularization

Complications and indices of the lower extremities cumulative preservation in conditions of their chronic critical ischemia after doing the direct, indirect and composite revascularization were analyzed. Surgical treatment and postoperative follow-up was performed in 170 patients ageing 25-84 years. The priority role of a. fibularis in a blood supply of the extremity distal segment in obliterating diseases of the lower extremities arteries was established. After the direct revascularization performance there was noted the lowering of the extremities preservation indices during a follow-up period from 96%--in the first month down to 84%--in 24 months, and after composite revascularization--from 96 to 94%. The direct revascularization conduction, using automyelotransplantation, have permitted to secure the extremity in 95.1% of patients, suffering incurable affection of a nonrecontructable affection of the popliteo-crural segment arteries.     

Venous forms of the inborn vascular malformations of the lower extremities. Diagnosis and surgical treatment

Pathogenetically substantiated approach, using surgical, laser and echosclerosing methods, was applied for improvement of the treatment results in patients, suffering venous forms of the inborn vascular malformations of the lower extremities. The results of examination and treatment in 2006-2009 period were analyzed in 98 patients. The stem malformations with superficial venous system affection was diagnosed in 59 (60.2%) patients, the same with a deep venous system affection--in 27 (27.6%), the extrastem affections--in 7 (7.1%) and the combined malformations--in 5 (5.1%). There was differential tactics of the surgical treatment used together with combination of original surgical procedures, newest laser methods and sclerotherapy, which have permitted to achieve satisfactory late results in 73 (74.5%) patients. Poor results in 25 (25.5%) patients were caused by the pathological process spread and proliferative activity of malformation, what was confirmed by immunohistochemical and morphological investigations data.     

Repair of an Abdominal Aortic Aneurysm with a Remarkably Dilated Meandering Artery: Report of a Case

A 73-year-old man on dialysis for chronic renal dysfunction was referred to our hospital for surgical treatment of an abdominal aortic aneurysm (AAA). Preoperative angiography showed a remarkably developed meandering artery branching from the inferior mesenteric artery (IMA). The superior mesenteric and celiac arteries were occluded at the origin, and all blood flow to the abdominal organs was apparently supplied by collateral circulation from the IMA. Considering the risk of mesenteric ischemia after aortic clamping in conjunction during surgery, we used a perfusion catheter with a 12-F balloon to create a shunt to the IMA from the subclavian artery. The operation was successful and the patient recovered uneventfully. We describe this surgical procedure for its effectiveness in preventing postoperative mesenteric ischemia in a rare case of an AAA with complex branching lesions.     

Hyperbaric oxygenation for treatment of extremities major arteries

The results of hyperbaric oxygenation therapy in surgical treatment of 44 patients with traumatic injuries of major arteries of the extremities were analysed. Associated injuries of the veins were observed in 27 (61.4%) patients, damages to the nerves--in 32 (72.7%), to the bones and joints--in 5 (11.4%), and to the soft tissues--in all of the patients. The indications for the hyperbaric therapy were: severe acute ischemia, major soft tissue damages and bone fractures, wound infection (purulent, anaerobic) complications and emergency ligation procedures on arteries. The use of hyperbaric oxygenation procedure together with extracorporeal methods for detoxication and reconstructive operations on vessels gives us possibility to broaden the indications for reconstructive operations and to prevent and control ischemic and infectious complications, endotoxicosis, increase the effectiveness of surgical treatment in victims with the injuries of major arteries of the extremities.     

The volume and consistency of surgical intervention for the affected several extracranial vessels

The results of the cerebral hemodynamics investigation and of operative treatment of 94 patients with affection of several extracranial vessels were presented. It was established that along with the total arterial lumen narrowing stage increase the pronounced cerebral tissue hypoperfusion occurs. Therefore the reconstruction of several arteries is necessary. In patients with low cerebral perfusional reserve it is expedient to proceed with revascularization in stages.     

The natural history of carotid fibromuscular dysplasia

Although graduated internal dilatation has proved to be an effective, safe, and durable operation for the treatment of symptomatic patients with fibromuscular dysplasia of the extracranial internal carotid artery, the role of surgical treatment in this entity remains unclear because the natural history is not well defined. Forty-nine patients, aged 29 to 82 years (mean, 58.5 years), with angiographically proven fibromuscular dysplasia of 88 internal carotid arteries have been evaluated since 1969. Twenty patients showed symptoms of focal cerebral or retinal ischemia, 10 patients had nonlateralizing neurologic symptoms, three patients sustained intracerebral hemorrhage, five patients complained of nonischemic symptoms, and 11 patients were asymptomatic. The three patients with intracranial hemorrhage and one person who suffered a massive stroke after angiography died within weeks of admission; no surgical therapy was performed. Initial management of the other patients included four internal carotid endarterectomies in four patients for associated atherosclerosis, one with simultaneous graduated internal dilatation; seven graduated internal dilatations in five patients; and one extracranial-to-intracranial bypass in a patient with occlusion occurring after graduated internal dilatation. Seventy-three nondilated arteries in 42 patients have been followed for up to 16 years (mean, 6.8 years). During this time only three patients have undergone surgical therapy; one carotid endarterectomy was done for an asymptomatic atherosclerotic lesion and two graduated internal dilatations in patients with nonfocal ischemia. Through follow-up of all 49 patients, none has had a new neurologic deficit. Fourteen patients who initially presented with focal ischemia were not treated surgically and all but one are now asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)     

Revascularized osteo-trepanation in the treatment of chronic occlusion of the lower extremities arteries

The results of operation of revascularized osteotrepanation (ROT) in complex of treatment of 43 patients with chronic occlusion of the lower extremities arteries were analyzed. Stable clinical effect after application of ROT in patients with the ischemia II stage persisted during 40 months, III stage--25 months, "high" amputation of lower extremity in patients with IV stage ischemia was performed in 3.5-7 months. ROT is operation of choice in patients with distal form of ischemia of lower extremity, as well as while presence of contraindications for performance of reconstructive operation on main arteries.     

Management of kinked extracranial cerebral arteries

Kinked extracranial carotid and vertebral arteries are observed in 10% to 16% of cerebral angiograms. The hemodynamic significance of some kinked carotid arteries has been shown by investigators who documented oculoplethysmographic and angiographic differences accompanying flexion, extension, or rotation changes of the neck and head. In the 3-year period ending November 1985, we performed operations on seven patients to correct six kinked internal carotid arteries and one kinked vertebral artery at the C-2 level. The final decision regarding optimal operative technique was determined during operation, after observing the relative lengths of dissected arteries, envisioning the results of the procedures selected. We performed five segmental resections and end-to-end anastomoses (one vertebral, two common carotid, and two internal carotid arteries). Transection of the internal carotid artery with reimplantation into the side of the common carotid artery was performed twice. All patients became asymptomatic up to 4 years, irrespective of head and neck positions. There were no complications or deaths in these patients. This experience suggests that arterial kinks may constitute tenable indications for operative treatment in patients with transient cerebral ischemia who lack typical stenotic or ulcerative plaques to account for their symptoms. Kinked arteries can be corrected safely and effectively by appropriate surgical procedures.     

Application of lumbar sympathectomy for the lower extremities diabetic angiopathy in presence of purulent necrotic changes on the foot]

Immediate results of treatment of 63 patients with diabetes mellitus and occlusion of main arteries of lower extremity on different level in chronic ischemia and presence of limited purulent-necrotic changes of toes were adduced. Indications for the operation performance were substantiated and immediate results were analyzed. Favourable result was achieved in 48 (76%) patients, fair--in 8 (13%), in 7 (11%) patients high amputation of extremity was done.     

The correction of cerebrovascular insufficiency by transluminal dilatation: a preliminary report

Transluminal angioplasty is being extensively utilized to dilate arteriosclerotic lesions. However, this technique has not been widely used for the treatment of cerebrovascular insufficiency. This report describes the application of transluminal angioplasty to relieve cerebral ischemia secondary to extracranial arterial stenosis. A total of 10 patients presented with symptoms of vertebrobasilar insufficiency. Bilateral upper extremity pressures were measured prior to the performance of arteriography on all patients. Significant stenoses were found in the subclavian artery (9) and in the innominate artery (1). Dilating catheters were passed retrograde through surgically exposed brachial and common carotid arteries. Transluminal angioplasty under fluoroscopic control was attempted. Anatomic correction of all lesions was achieved without hemorrhagic or embolic complications. The mean increase in brachial systolic pressure was 38.2 mm Hg postdilatation. Initial symptomatic relief was total in seven patients, partial in two, and absent in one. It is believed that associated small vessel brain stem disease accounted for the less than total relief of symptoms of these three patients. Average follow-up for all patients was 13 months with one recurrent subclavian artery stenosis occurring at three months postangioplasty. Preliminary results suggest that some patients with cerebral ischemia secondary to extracranial arterial stenosis can be treated safely by transluminal angioplasty.     

Aneurysm of internal carotid artery. Clinical symptoms, surgical treatment, results

Aneurysms of the extracranial portion of the internal carotid artery is rare pathology - only 2.2% of all surgical procedures on this portion of the internal carotid artery are caused by this disease. Ten-year experience in surgical treatment of these aneurysms is presented in article. Symptoms and etiology of this disease are considered. It is demonstrated that fibromuscular dysplasia is one of the main causes of these aneurysms. Strategy and policy of surgical treatment, clinical cases are analyzed. Resection of the aneurysm with angioplasty or grafting is optimal. End-to-end anastomosis is possible in patients with kinking. Results of surgical treatment are positive, there is no hospital lethality.