Surgical tactics in occlusive lesions of the brachiocephalic and coronary arteries]

Surgical management of combined arterial occlusions is a difficult problem. Combined lesions of the coronary arteries and brachiocephalic trunk are marked by significant mutual aggravation. The authors examined 48 patients with this pathological condition in the last 4 years, 32 of them underwent restorative surgical interventions. The direct effect was positive in 87% of patients. Four patients died after the operation. Comparative evaluation of the late-term results was carried out by the actuarial method. The authors believe a stage-by-stage character of the intervention to be expedient, except for cases of one-stage critical ischemia carried out simultaneously in two arterial channels and the possibility of simultaneous reconstruction of the sternotomy approach.     

Detection of carotid occlusive disease by ultrasonic imaging and pulsed Doppler spectrum analysis.

Ultrasonic imaging of the cervical carotid arteries by ultrasonic arteriography and duplex scanning combined with pulsed Doppler spectrum analysis were investigated in a series of patients undergoing arteriography. By using the ultrasonic image as a guide for precise placement of the pulsed Doppler sample volume, the characteristics of blood flow at points of interest in the carotid arteries could be determined. Audible analysis of the Doppler signal permitted correct diagnosis of 23 of 26 (88%) high-grade stenoses or occlusions with ultrasonic arteriography and 24 of 26 (92%) with duplex scanning. Spectrum analysis of Doppler signals obtained with the duplex scanner detected all of the 22 high-grade stenoses. Spectral abnormalities of a lesser degree also were detected in 18 of 23 vessels (78%) with atherosclerotic plaques which should not have reduced cerebral blood flow. These techniques permit the accurate detection of and the distinction between high-grade stenoses and occlusion, as well as the identification of many plaques which are not large enough to affect intracranial hemodynamics.     

Surgical treatment of occlusive diseases of the brachiocephalic arteries

Experience of the department of vascular surgery of the Novgorod Regional Hospital from 1985 is analysed. The department has the standard sets of instruments, equipment, and roentgenodiagnostic apparatus which allow catheter, selective, and puncture angiography to be carried out. Thirty-six operations were performed on 28 patients. All were conducted under endotracheal anesthesia with medicamentous protection of the brain. One patients died from reflex cardiac arrest. No complications occurred in the other operations and their results were positive. It is concluded that reconstructive operations on the brachiocephalic trunks can be successfully performed in angiosurgical departments of regional and city hospitals with a personnel skilled in diagnosis and a trained angiosurgeon and anesthesiologist on the staff.     

Doppler ultrasonic diagnosis for arterial occlusive disease in the lower limbs

Measurement of segmental arterial pressure by Doppler ultrasonography and Doppler arterial tracing in the lower extremity has become a widely used noninvasive diagnostic technique for arterial occlusive diseases. One hundred and twelve limbs with arterial occlusive disease (aortoiliac 45, superficial femoral 13, popliteal 11, aorto-iliac-femoro-popliteal 35, and tibiofibular arterial segments 8) were evaluated by both angiographic and Doppler ultrasonic techniques, Angiographic findings showed that ultrasonic diagnosis was accurate in 86% of aorto-iliac-femoro-popliteal arterial lesions, in 92% of superficial femoral arterial lesions, and in 100% of the remaining lesions. We believe that the diagnostic accuracy of Doppler ultrasonography could be further improved with the help of segmental arterial pressure measurement using 4 separated narrow cuffs and blood stream tracing technique.     

Doppler ultrasound procedures in the diagnosis of occlusive processes of the supra-aortic arteries

Reported in this paper is experience obtained from application of Doppler sonography to more than 2,000 examinations of patients with suspicion of cerebrovascular insufficiency. Indications for Doppler-type investigation are described together with criteria of Doppler sonography for positive detection of occlusive processes in greater brain-feeding arteries and for adequate assessment of results obtained from vascular surgery. The sensitivity of Doppler sonography amounted to 88.8 per cent and its specificity to 92.9 per cent, as recorded from 117 patients who had been angiographically followed up. Doppler ultrasonography for its high productivity in terms of wide-ranging diagnostic information was found to be the optional method for non-invasive diagnosis of occlusion in supra-aortic arteries, provided absence of contraindications.     

The noninvasive diagnosis of occlusive lesions of the internal carotid arteries

Thirty patients with atherosclerotic occlusive alterations of the internal carotid artery were examined with an ultrasonic apparatus with nonattenuating waves. The method allowed to exactly diagnose occlusions of the internal carotid arteries and hemodynamically reliable stenoses of the carotid arteries.     

Ultrasonic angiography in the diagnosis of occlusive diseases of major arteries of the legs

A positive feature of non-invasive ultrasonic angiography is thought by the authors to be its high informative value. A generalized experience with 657 examinations performed in 285 patients is presented.     

Surgical tactics in combined occlusive diseases of the brachiocephalic arteries and terminal segment of the aorta

An associated pathology of brachycephalic arteries and aortofemoral segment was found in 37.7% of cases. Operations on brachycephalic arteries (1st stage of the treatment) were performed on 29 patients, on the aorto-femoral segment (2nd stage)--on 26 patients. An interval between the stages was from 2-3 weeks up to 1-1.5 months and depended on the degree of occlusive injury of the aorto-femoral segment. All the patients showed clinical improvement confirmed by control rheovasography.     

Treatment of combined lesions of brachiocephalic and lower limb arteries

Treatment results of 364 patients with multifocal lesions of brachiocephalic and lower limb arteries are analyzed. Indications for surgical treatment were based on priority principle. Staged surgical policy results in 5-year survival of 88-93% patients, improves life quality and saved limbs in 90-93% patients compared with conservative treatment. One-stage surgical interventions are associated with high lethality and should be performed with strong indications only. Conservative treatment cannot be regarded as alternative to surgical procedures.     

Comparison of digital subtraction angiography, CT angiography, and ultrasonic Doppler examination in the evaluation of penile arterial lesions]

BACKGROUND: CT angiography reconstructed by a multidetector-row helical CT scanner is a newly developed form of imaging. We compared CT angiography and ultrasonic Doppler examination with digital subtraction angiography (DSA) in the diagnosis of arterial lesion. METHOD: Eighteen patients with arteriogenic erectile dysfunction (ED) underwent color Doppler study, DSA, and CT angiography after providing informed consent. The CT angiography images were obtained by a multidetector-row helical CT scanner, Asteion TSX021A (TOSHIBA). We injected prostaglandin E1 into the penile cavernous body, and then rapidly infused nonionic contrast medium into the antecubital vein. DSA and CT angiography images of the bilateral internal pudendal arteries and cavernous arteries were examined for stenotic lesions or occlusion. We also compared the peak systolic blood flow velocity in the cavernous artery measured by color Doppler ultrasound with CT angiography and DSA. RESULTS: The CT angiography and color Doppler studies were performed on an outpatient basis, but DSA required hospitalization. In the 36 internal pudendal arteries, DSA represented 22 normal arteries and 14 stenosis or occlusions. CT angiography showed 15 normal arteries and 21 occlusions. For the diagnosis of stenosis or occlusion in the internal pudendal artery, the CT angiography image had a good agreement, with a sensitivity of 1.00, specificity of 0.68, and accuracy of 0.81. For diagnosis in the cavernous artery, CT angiography image also showed a good agreement with DSA; however, the quality of the images of fine arteries was better in the DSA images. The inferior view and internal view of the pelvis in CT angiography were helpful for visualizing the internal pudendal artery, especially at the pubic bone. There was insufficient correlation between peak systolic blood flow velocity and DSA findings. There were no serious complications involved in either examination. CONCLUSIONS: CT angiography has not yet reached the same level as DSA in the evaluation of fine arteries. However, CT angiography can produced images sufficient for the diagnosis of arteriogenic ED with some advantages. We believe that with improvement, CT angiography will become an adequate replacement for DSA in the diagnosis of penile arterisl lesion.     

Asymptomatic occlusive lesions of cerebral arteries in Japanese hemodialysis patients

While cerebrovascular diseases (CVD) are very common in hemodialysis (HD) patients, the prevalence and risk factors of asymptomatic occlusive lesions (AOL) of cerebral arteries in HD patients have not yet been elucidated. We performed cerebral magnetic resonance angiography (MRA) on 123 HD patients without symptomatic cerebrovascular disease and on 52 control subjects. On the basis of these images, we investigated the prevalence and risk factors of AOL. Stenosis greater than 25% narrowing of the cerebral arteries was found in 27 HD patients. The prevalence of AOL of cerebral arteries in HD patients was significantly higher than in the control group [27 (22.0%) versus 4 patients (7.7%), chi.2=4.2, p=0.0411]. Multiple logistic regression analysis showed that independent risk factors of AOL of cerebral arteries were uremic state, dyslipidemia, and age in all subjects and dyslipidemia and age in HD patients (R.2=0.162, p=0.0004; R.2 =0.138, p=0.0145, respectively). Our findings suggest that chronic renal failure maintained by hemodialysis increases the prevalence of AOL, and that age and dyslipidemia are also significantly associated with AOL in HD patients.     

Consideration on the treatment of chronic occlusive lesions of the iliac arteries

This study addresses the problem of the best treatment for chronic unilateral obstructive lesions of the aorto-iliac arterial axis. After making a review of the literature, some considerations are made. In recent years this disease has increasingly been treated by endovascular methods with dilation (angioplasty) and stents. However, the classic indications (short stenotic obstruction), supported by national and international guidelines, are being continually widened by operators acquiring growing skills with this method. Nevertheless, no long term studies have demonstrated a clear superiority, in severe cases, of endovascular methods over traditional surgical methods (by-pass), as regards either long term results or costs. Among the traditional methods, many surgeons prefer the femoro-femoral by-pass to the orthopic aorto-femoral by-pass, particularly because of its lesser invasiveness. However, it should be noted that comparisons of the two methods have yielded results in favour of the orthotopic procedure, above all about long term results.