Improving transcatheter bioprostheses and systems of their delivery, gaining surgical experience, as well as optimizing patient selection made it possible to achieve high levels of efficacy and safety of the procedure of transcatheter implantation of the aortic valve (AV). Nevertheless, complications of this technique with a negative influence on both short- and long-term outcomes are still encountered in many patients. Despite the fact that transcatheter implantation of the AV has historically been associated with lower incidence of hemorrhagic events than traditional surgery, bleeding occurring during this operation is fraught with a worse prognosis. Complications of the vascular access still remain the main cause of hemorrhage. To assess the incidence, predictors and prognostic significance of major vascular complications associated with the transfemoral vascular access for transcatheter implantation of the aortic valve. This retrospective study initially enrolled a total of 628 patients who underwent transcatheter implantation of the AV from March 2015 to October 2024. After exclusion of patients with other than transfemoral vascular approach, as well as with unsatisfactory quality of preoperative multislice computed tomography not allowing for the assessment of vascular anatomy, the final analysis included 548 patients. The primary endpoint of the study was defined as predictors of major vascular complications of the transfemoral approach after transcatheter implantation of the AV, with the secondary endpoint being long-term survival and freedom from cardiovascular death in patients having endured nonfatal major vascular complications of the access site at the in-hospital stage after transcatheter implantation of the AV. There were a total of 32 major vascular complications. Of these, 3 (0.6%) resulted in a lethal outcome, with 29 (5.3%) accompanied by BARC type 3a and 3b bleeding. Puncture percutaneous vascular access was used in 94.9% of patients. The most frequently applied method of vascular access closure was a combination of two ProGlide devices (70.9%). The group of patients with major vascular complications of the transfemoral access was found to have a higher frequency of puncture of the left common femoral artery (21.9% vs 10.5%, p=0.04), as well as a longer length of hospital stay (13.3±8.3 vs 9.4±5.8, p=001). The only independent predictor of major vascular complications was the left side of the vascular access (odds ratio 8.85; 95% confidence interval 1.58-69.40, p=0.02). With an average follow-up period of 2.1±2.2 years, the log-rank test revealed no statistically significant differences in freedom from all-cause mortality (log-rank p=0.11) and freedom from cardiovascular death (log-rank p=0.30) in patients with and without non-fatal major vascular complications of the access site after implantation of the AV. The incidence of major vascular complications of the access site after the procedure of transcatheter implantation of the aortic valve amounted to 5.9%. The only independent predictor of major vascular complications was the left side of the vascular access. The development of major nonfatal vascular complications at the in-hospital stage influenced neither survival nor freedom from cardiovascular death in the remote period.
Surgery of arterial aneurysms in the Russian Empire began in St. Petersburg in the 1806--1810s at the Medical and Surgical Academy under the leadership of I.F. Bush (Glossev S.P., Kryukov Yu.Yu., 2022). The further development of this area of surgery until the middle of the XIX century was described by Yu.Yu. Kryukov (2023) according to monographs and dissertations of that time. However, we believe that the periodical medical press, in particular, the medical newspaper 'Friend of Health', which was published from 1833 to 1869, played an important role in spreading knowledge about achievements in this field of surgery. However, there are very few studies on the history of the development of vascular surgery in this period based on the materials of the periodical press, and according to the newspaper 'Friend of Health' there is not at all. The purpose - to recreate and analyze the development of arterial aneurysm surgery in Russia in the XIX century. based on publications in the medical newspaper 'Friend of Health'. From 1833 to 1869, the medical newspaper 'Friend of Health' published 197 articles by foreign authors and 15 reports by Russian surgeons concerning surgery of arterial aneurysm. the analysis of publications on aneurysms was carried out using historical, evolutionary-chronological and comparative methods. A content analysis of the following publications was carried out: N.S. Alexandrovsky (1855) 'On hypertrophy of the right ventricle of the heart (Apeigisma activum Corvisar)'; I.V. Buyalsky 'On ligation of the unnamed artery (Ligatura arteriae innominatae)' (1833), 'On the first successful operations for ligation of popliteal aneurysms, conducted in St. Petersburg' (1850), 'On ligation of the unnamed artery' (1854) and 'Popliteal aneurysm, ruptured (Anevrisma poplitaeum ruptum), cured by ligation of the femoral artery' (1864); I.F. Geifelder 'On the case of an aneurysm of the mandibular artery' (1856); H.J. Hubbenet 'On the operation of a false aneurysm in the ulnar fold' (1855); K.I. Groom 'On three ligations of unnamed arteries made in Russia in 1827 and 1833' (1834); 'On the ligation of the artery in anevrysma arteriae Abrachialis spurium' (1836) and 'On the speech of P.A. Naranovich with an anatomical analysis of the aneurysm of the superior ascending artery that burst into the right ventricle of the heart' (1842); V. Donetskiy 'Popliteal aneurysm (Anevrisma poplitaeum), cured by injection)' (1843), K.I. Groom 'Review of the work of Dr. I.F. Hildebrand 'On the recognition and treatment of aneurysms and on the operation of ligation of arteries' (1843); N.I. Pirogov 'On the possibility of ligature on the abdominal aorta' (1839) and 'On ligation of the left common iliac artery due to traumatic aneurysm arteriae gluteae' (1852); I.V. Rklitsky 'On ligation of the external iliac artery in the case of femoral artery aneurysm' (1852). Arterial aneurysm in Russia in the nineteenth century was diagnosed quite successfully, but operations with this vascular lesion were isolated. Only 15 (2%) out of 197 reports were devoted to the description of clinical observations and surgical treatment of this disease in the newspaper 'Friend of Health', which may indicate both the difficulties of diagnosis and the high risk of aneurysm surgery. During these years, for the first time in Russia, an aneurysm of the unnamed artery was described (I.V. Buyalsky, 1833, 1834) and an aneurysm of the ascending aorta (K.I. Groom, 1842), a method of ligation of the abdominal aorta in an aneurysm of the iliac artery in an experiment (N.I. Pirogov, 1839). Operations for aneurysms performed after the discovery of anesthesia (1847) and before the introduction of antiseptics (1867) included ligation of arteries according to the methods of Antill, Filagrius, P. Brazdor, J. Gunther.
The aim of our study was to estimate initial and long-term outcomes of ascending aortic and root replacement with either xenograft or allograft in patients with chronic aortic aneurysm. Forty-five patients were enrolled in the study from January 2017 to May 2023. In 23 patients a Medtronic Freestyle xenograft was applied, while 22 patients underwent allograft implantation. Early safety, clinical efficacy were analyzed using VARC-3 and ICHOM criteria at exact time points using non-parametric statistics. Time-to-event survival analysis was performed using log-rank test and Kaplan-Meier curves. Patients from both groups demonstrated excellent early results with zero 30-day mortality. There were no incidence of myocardial infarction, deep sternal wound infection and pacemaker implantation. One patient after xenograft implantation was complicated with ischemic stroke. Resternotomy for bleeding was required in one patient from both groups. Patients with either allograft or xenograft demonstrated 100% freedom from structural deterioration, redo surgery, endocarditis and pacemaker implantation during the whole follow-up period. Allograft implantation was associated with significantly better survival compared with xenograft (100 vs 78.3%, OR 10.53; 95% CI 0.0128-0.3839; р=0,036) and better quality of life (95% CI -22.76, -2.244; р<0.05) two years after surgery. The number of patients with left ventricle hypertrophy was significantly higher after xenograft implantation regardless the overall reduction in left ventricle hypertrophy in both groups compared with preoperative variables (р=0.03). The maximum and average pressure gradient at the aortic root after surgery and one year after surgery was statistically significantly lower after allograft implantation [16.0 (11.8-21.0) and 7.0 (5.0-10.0) vs 7.0 (6.0-10.0) and 3.0 (3.0-5.0); 95% CI (4.326-13.67) and 95% CI (1,844-6,156); p<0.05]. The analysis of survival to the endpoints was carried out in 6-, 12-, 18-, 24-, 36-, 48- the monthly period after surgery. Expected survival in the allograft group through 6, 12, 18, 24, 36, 48 for a month and beyond, it was 100%. Survival rate in the xenograft group over the same time periods - 82,6; 82,6; 82,6; 77,7; 77,7; 77.7% (log-rank test, p=0.02). Ascending aortic and root replacement with either xenograft or allograft demonstrated excellent early results with zero 30-day mortality and lower rate of complications in selected patients. Clinical efficacy, quality of life and time-to-event analysis may justify in favor of allograft ascending and root replacement, although it should be studied further. Allograft aortic replacement showed better hemodynamic profile with regard to significantly lower number of patients with LV hypertrophy and lower peak and mean pressure gradients on aortic root.
Currently, for extensive occlusive lesions of the superficial femoral artery, the treatment of choice is femoropopliteal bypass grafting above the knee joint space. In the absence of a suitable autogenous vein or xenograft, synthetic grafts are used. One of the causes of thrombosis in the reconstruction zone after using synthetic grafts for femoropopliteal bypass grafting is the high incidence of restenosis in the anastomotic zone of arterial reconstruction due to endothelial dysfunction. One agent that normalizes endothelial function is a complex of bovine vascular regulatory polypeptides. To evaluate the effectiveness of using a complex of regulatory polypeptides of bovine vessels after femoropopliteal bypass above the knee joint space with a synthetic prosthesis. The study included 60 patients with stage III-IV lower extremity arterial atherosclerosis according to the Fontaine-Pokrovsky classification. They were divided into two groups of 30 patients each. All patients underwent surgery: femoropopliteal bypass grafting above the knee joint space using a synthetic prosthesis made of polytetrafluoroethylene diameter 8 мм. After surgery, patients in Group I, in addition to standard therapy, received one course of a drug based on a complex of bovine vascular regulatory polypeptides according to the instructions for use of Slavinorm® (intramuscular injections of the drug twice a week for 5 weeks, No. 10). Patients in Group II received only standard therapy according to clinical guidelines. To evaluate the effectiveness of treatment of patients, the following were used: measurement of the ankle-brachial index (ABI), ultrasound examination of the zones of the proximal and distal anastomoses of the femoropopliteal bypass, as well as measurement of the pain-free walking distance (PFWD) on the first day, 1, 3, 6, 9, 12 months after surgery. In groups I and II, the average ABI value before treatment was 0.46 and 0.44; 1 month after surgery 0.76 and 0.74; 3 months 0.77 and 0.71; 6 months 0.78 and 0.7; 9 months 0.785 and 0.7; 12 months 0.8 and 0.65, respectively. In groups I and II, the average DBH value before treatment was 31.5 m and 23 m; 1 month after surgery 118.5 m and 88 m; 3 months 128.5 m and 87 m; 6 months 128 m and 84 m; 9 months 134 m and 71 m; 12 months 138 m and 66 m, respectively. Changes in ABI and DBH in both groups throughout the entire follow-up period were statistically significant (p<0.001). Twelve months after surgery, the incidence of restenosis in Group I was 7 (11.6%) cases, while in Group II it was 15 (50%) cases. Postoperatively, at various follow-up periods, cases of BPS thrombosis were recorded: 1 (3.3%) case in Group I and 4 cases in Group II (13.3%). According to logistic regression data, in Group II patients who did not receive the bovine vascular polypeptide-based drug, the odds of developing restenosis in the arterial reconstruction zone were 3.25 times higher (OR 0.325, 95% CI 0.108-0.976, p=0.045) than in Group I patients. The use of regulatory polypeptides of bovine vessels after femoropopliteal bypass grafting above the knee joint space using a synthetic prosthesis reduced the incidence of restenosis of arterial reconstruction anastomosis zones by 3.25 times and, as a consequence, reduced the incidence of thrombosis of femoropopliteal bypass grafts.
To compare endovascular treatment (kissing stenting, KS) with traditional open aortobifemoral bypass grafting (ABBG) in management of patients with lesions of the abdominal aorta bifurcation and iliac arteries. We performed a single-center analysis of patients subjected to endovascular treatment with bare-metal stents by means of kissing stenting or ABBG for TASCII C/D lesions of the aortoiliac segment (AIS) from 2012 to 2021. We assessed the parameters of the perioperative risk scale (American Society of Anesthesiologists, ASA and Society for Vascular Surgery, SVS), frequency of hospital complications, early 30-day mortality and long-tern patency. The obtained results were analyzed by means of the Kaplan-Meyer curves, with the Cox regression used to determine predictors influencing patency parameters. The study included 57 patients with KS and 86 patients with ABBG. The KS group had a higher perioperative risk: ASA (ACP=0.06), SVS (ACP=0.08) and less frequent lesions of the AIS (TASC D lesions 26.3% vs 46.5%, ACP=0.202). After propensity score matching, the study comprised a total of 80 patients (40 with KS and 40 with ABBG), thus forming well balanced groups in terms of demographic data, risk factors, lower limb ischemia degree, perioperative risk: ASA (ACP=0.006), SVS (ACP=0.003) and AIS lesion anatomy (TASC D - 40%, ACP=0.000). 36-month mortality amounted to 5% after KS vs 2.5% in the ABBG group. The length of hospital stay in the KS group was significantly shorter than in the ABBG group (3.9±1.6 days vs 9.1±1.9 days, p<0.001), as well as that of ICU stay (0 days vs 2.1±0.4 days, p=0.001). The rate of early postoperative complications was comparable (7.5% vs 15%, p=0.47). Three-year primary patency was similar between the KS and ABBG groups (87.5% vs 95%, p=0.24); multivariate analysis showed that critical limb ischemia and hemodynamically significant lesions of the efferent arteries were risk factors for developing restenosis/reocclusion (6.65 [1.29; 34.37], p=0.02 and 6.4 [0.72; 50.22], p=0.04, respectively). Endovascular treatment of lesions of the aortic bifurcation and iliac arteries with bare-metal stents demonstrated primary patency comparable with that of ABBG over the 3-year follow-up period. The incidence of early postoperative complications was comparable. Thus, endovascular reconstruction of the aortoiliac segment for TASC C, D lesions by means of kissing stenting can be considered as an alternative to ABBG.
The problem of atherosclerotic lesions of lower limb arteries and chronic critical ischemia is currently important, requiring the development and implementation into clinical practice of modern, safe and accurate methods of examination, thus making it possible to more precisely plan and evaluate the outcomes of the operations performed. This study sought to determine the possibility of using the technique of ultrasound examination (duplex scanning) of the pedal arteries, measuring dopplerographic parameters of quantitative assessment of blood flow in the angiosomes of the foot in patients with chronic critical lower limb ischemia, depending on severity, and alterations therein following revascularization. We examined 31 patients with atherosclerotic occlusive lesions of lower extremity arteries. Of these, 3 patients had III stage chronic limb ischemia according to the Fontaine-Pokrovsky classification and 28 had IV stage ischemia. Twelve patients were diagnosed as having type 2 diabetes mellitus. The patients' age ranged from 56 to 93 years, with a male-to-female ratio of 26:5. The main dopplerographic parameters assessed were as follows: pulse waveform, ante- or retrograde blood flow in the artery examined, peak systolic blood flow velocity, maximal systolic acceleration, and acceleration time. We consider that the main advantage of using duplex scanning of the pedal arteries with measuring the maximal blood-flow acceleration is a possibility to assess namely the severity of foot ischemia. A strong inverse correlation was found between the maximum acceleration measured in pedal arteries and the severity of lower limb ischemia, as assessed according to the modified Rutherford scoring scheme (R2=0.78). It was shown that the proposed method of diagnosis is accurate and non-invasive, making it possible without additional devices and preparations to assess the result of revascularization in the operating room immediately after surgery. This pilot study allows us to conclude that duplex scanning of the pedal arteries with the measurement of the maximum blood flow acceleration is a promising rapid alternative method of diagnosing peripheral artery disease and assessing efficacy of revascularization performed, especially in patients with uninformative values of the ankle-brachial index and impossibility to measure the finger pressure index.
Currently, only one method of spinal cord protection-cerebrospinal fluid (CSF) drainage - has been rated as level 1 evidence in international guidelines for thoracoabdominal aortic aneurysm surgery. However, in recent years, there has been increased attention to complications of CSF drainage, such as intracranial hemorrhage. The aim determination of the frequency and risk factors of complications of CSF drainage during operations for thoracoabdominal aortic aneurysms. A search of publications in the PubMed (Medline), Google Scholar, and Russian Science Citation Index (eLibrary) databases was conducted according to the PRISMA criteria. The ROBINS1 and ROBINS2 scales were used to assess the methodological quality of the studies. The pooled complication rate was calculated using a random-effects model (DerSimonian-Laird). Univariate (subgroup analysis) and meta-regression analyses were performed to assess the influence of the following parameters on the complication rate of CSF drainage: study type, article publication date, surgical approach, target CSF threshold pressure, CSF drainage rate, and CSF drainage method. The final analysis included 71 articles (10.798 patients) published from 1991 to 2024. In general, the methodological quality of the studies was acceptable, the risk of systematic error remained moderate. According to the meta-analysis, the incidence of all complications of CSF drainage was 11.9% (95% CI 9.7-14.1), the incidence of severe complications was 1.7% (95% CI 1.3-2.0), intracranial symptomatic hemorrhage was 1.3% (95% CI 1.0-1.7), and associated mortality was 1.1% (95% CI 0.1-3.1). High heterogeneity of studies and the absence of significant publication bias were noted. A significant increase in the incidence of complications was revealed in later publications. No differences were found in the incidence of CSF drainage complications depending on the type of publication, type of procedure, CSF pressure threshold used, drainage rate, and drainage technique. Due to the high complication rate, a careful assessment of the benefits and risks of CSF drainage is necessary. This study highlights the limitations of the available data, the high prevalence of complications associated with CSF drainage, and the need for further research to determine the true complication rate and evaluate various CSF drainage protocols.
The authors herein share their experience with surgical treatment of arteriovenous fistulas (AVF), describing standard diagnostic measures and possible methods of management of this pathology, as well as analyzing the known methods of treatment of post-traumatic AVFs in a specialized vascular hospital. To determine the most effective method of surgical treatment of patients with posttraumatic AVFs in the early period of wound disease. From 2021 to 2023, a total of 58 patients with posttraumatic AVFs of the extremities were treated in the vascular centers of the National Medical Research Center of Surgery named after A.V. Vishnevsky and National Medical Research Center of High Medical Technologies - Central Military Clinical Hospital named after A.A. Vishnevsky'. Of these, 51 (88%) patients were diagnosed as having lower-limb vascular pathology and 7 (12%) had upper-limb pathology. 29 (50%) patients underwent X-ray endovascular methods of treatment, 26 (44.8%) patients were subjected to open surgical intervention, and 3 (5.2%) victims were found to have spontaneous closure of the AVF. Endovascular methods of treatment included: implantation of stent grafts in 20 (34.5%) patients, embolization with microcoils in 7 (12%) cases, and 'multilayer' stenting of the AVF zone in 2 (3.4%). Open surgical methods of treatment were as follows: arterial prosthetic repair in 20 (34.5%) patients, ligation of the arteriovenous fistula itself in 3 (5.1%) patients, autovenous plastic surgery of the arterial defect in 1 (1.7%) case, fistula disconnection with single-suture closure of the venous wall in 1 (1.7%), and resection of the damaged segment of the popliteal artery with an end-to-end anastomosis in 1 (1.7%). During the postoperative follow-up period, 3 complications developed in each study group. After endovascular treatment, these were 'local' complications in the form of thrombosis and implant dislocation in 2 patients and a recurrence of the functioning AVF in 1 case. After open surgery: wound suppuration in 1 patient, arrosive bleeding in 1 patient (with the resulting limb amputation), and a relapse of the AVF in 1 case. Each case of posttraumatic arteriovenous fistula has an individual approach to treatment. Surgical decision-making depends on such factors as the duration of AVF, diameter, localization, level of arterialization of venous blood flow, severity of changes in the walls of the affected arteries and veins. All posttraumatic arteriovenous fistulas should be treated surgically in a specialized vascular center with all modern technologies.
In Russia and the world, there is an increase in the number of cancer patients with localization on the head and neck. According to the Global Cancer Observatory (GLOBOCAN), 890.000 new cases of head and neck cancer and 450.000 deaths were registered in 2018, with a forecast of a 30% increase in the incidence by 2030. Carotid chemodectomas (CC) account for 0.5% of all head and neck tumors. The frequency of occurrence is estimated as 1 per 30000-100000 people. CCS in most patients are benign, but 10% may be malignant. The aim to determine the rational surgical tactics in patients with carotid hemodectomas, from the standpoint of the radicality, effectiveness and safety of the operation. a retrospective, multicenter study. An analysis was conducted of the medical records of 80 patients with CBTs who underwent treatment in the vascular surgery departments of Regional Clinical Hospital No. 3, City Clinical Hospital No. 8, Chelyabinsk Regional Clinical Hospital and Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in Chelyabinsk from 1985 to 2025. In particular, the results of instrumental research methods were assessed and a histological analysis of the obtained biopsy materials was performed. The literature search, as well as the systematization and analysis of information, was conducted from scientific literature sources located in the PubMed, Web of Science, and Elibrary databases. When writing the work, a literature search was conducted, as well as an analysis of the most significant clinical observations of patients with CС, including those with signs of malignancy, bilateral lesion, hereditary history, as well as a combination of tumors with atherosclerotic lesions of the internal carotid artery and the development of critical stenosis. To ensure the radicality, efficacy, and safety of carotid body tumor removal, the following principles should be considered: for type III tumors according to the Shamblin classification, as well as for tumors with malignant properties, en bloc resection followed by internal carotid artery reconstruction is advisable. The sequence of tumor removal in bilateral cases is determined by their size, Shamblin classification, and the presence of symptoms. Simultaneous bilateral tumor removal should not be performed due to the risk of fatal complications. Lymph node dissection should be performed in cases of enlarged lymph nodes in the surgical area, tumor recurrence, and aggressive or malignant tumor forms. Preoperative embolization of branches of the external carotid artery prior to surgical tumor removal has not proven its effectiveness. Patients with carotid body tumors, especially those with a family history or multiple tumors, are recommended to undergo genetic testing.
Abdominal aortic aneurysms (AAA) occupy the first place by the incidence amongst all aortic aneurysms and are found in 0.1-1.6% of all autopsies. The natural outcome of the AAA course is rupture occurring, according to literature data, in 50-80% of patients Amongst AAAs, there are forms posing great challenges in diagnosis and surgical management due to rarity of the disease and diversity of clinical manifestations. The purpose of this study was to determine the leading clinical signs of rare forms of AAA rupture and develop optimal surgical tactics of treating them. At the Department of Vascular Surgery of the 'Institute of Emergency and Restorative Surgery named after V.K. Gusak', we operated on a total of 633 patients with AAAs, of these, 285 (45%) for a ruptured aneurysm. Amongst the latter, there were 22 (7.7%) patients presenting with rare forms of rupture defined as: chronic contained rupture in 7 (2.5%) patients, aneurysmal rupture into the gastrointestinal tract with the formation of an aortoenteric fistula in 6 (2.1%) patients, rupture into the inferior vena cava with the formation of an aortocaval fistula in 6 (2.1%) patients, and a combination of AAA rupture with abdominal aortic dissection in 3 (1%) cases. The main methods of examination included duplex and triplex scanning, Doppler ultrasonography, and in insufficient information, spiral computed tomography (SCT) and SCT-angiography. All 22 patients were operated on. Of these, 9 (40.9%) patients died. The diagnostic peculiarities were as follows: 1. Chronic contained rupture turned out to be difficult to differentiate from a retroperitoneal tumor, both before and during surgery. Two-phase nature of clinical manifestations was characteristic of the clinical course of this variant of rupture. 2. Aortoenteric fistulas were characterized by symptoms of a pulsatile mass in the abdominal cavity, relapsing gastrointestinal bleeding, with negative results of fibrogastroduodenoscopy. 3. Aortocaval fistulas were characterized by systolic-diastolic murmur above the aneurysm and acute right ventricular cardiovascular insufficiency. Diagnosis of rare forms of AAA rupture is a difficult task, the clinical course of the disease is characterized by a wide variety of symptoms, thus leading to delayed rendering of emergency specialized care. Surgical tactics in rare forms of abdominal aneurysm rupture has not yet been standardized and solving this problem requires further accumulation of experience.
Arterial disease of the lower extremities is a common form of atherosclerosis associated with an increased risk of cardiovascular disease and mortality. Arterial disease of the lower extremities tends to progress from asymptomatic forms to intermittent claudication and critical ischemia. Sulodexide therapy in patients with PH allows for increased pain-free walking distance. At the same time, the scientific literature has not fully documented how long-term sulodexide therapy affects the quality of life of patients with arterial disease of the lower extremities. The aim of the study was to evaluate the effect of sulodexide on the quality of life of patients with arterial disease of the lower extremities. The multicenter prospective observational study of ANDANTE included patients with PH stage IIa-IIb according to the classification of A.V. Pokrovsky receiving sulodexide therapy. During the 6-month follow-up, 4 visits were conducted, during which the quality of life was analyzed based on a subjective assessment of physical and mental health using the SF-36 questionnaire. Pain-free walking distance, ankle-shoulder index, self-assessment of erection retention, WELCH walking ability scale scores, and Hasegawa dementia scale scores were also evaluated for men. In this article, we have considered only the dynamics of patients' quality of life in terms of physical and mental health on the SF-36 scale as the primary endpoint of the study. In the future, data on other criteria for the treatment of patients will be presented. The study included 229 patients aged 37 to 90 years (on average, 65.0±9.9 years). Men prevailed among the patients - 159 (69.4%) patients. There were 118 (51.5%) smokers and 111 (48.5%) non-smokers. The average duration of the disease from the moment of diagnosis of arterial disease of the lower extremities to inclusion in the study was 6.0±6.3 years. In addition to OCD, 72.5% of patients were diagnosed with hypertension, 28.4% with cerebrovascular disease, 26.6% with coronary heart disease, 25.3% with diabetes mellitus, and 19.7% with erectile dysfunction. At the time of inclusion in the study, 61.6% of patients were taking antiplatelet agents, 10.9% were taking direct oral anticoagulants, and 46.3% of patients were taking lipid-lowering therapy. At the time of inclusion in the study, 147 (64.2%) patients followed the recommendations on physical activity. Revascularization before inclusion in the study was performed in 19.2%, and 80.8% were treated conservatively. The study did not record any adverse events during sulodexide therapy. Compliance with therapy was high and averaged 4.6 points on a 5-point scale. The indicators of the physical aspect of the quality of life on the SF-36 scale significantly increased (p<0.01) after 6 months of treatment with sulodexide from 35.7±8.3 points on the first visit, to 44.6±7.2 points on the fourth. At the same time, the indicator increased by 8.9 (24.9%) points. The mental aspect of the quality of life during treatment also significantly improved from 45.4±9.9 to 51.6±6.7 points, an increase of 6.2 (13.6%) points. ANDANTE's study showed an improvement in subjective physical by 24.9% and mental by 13.6% aspects of quality of life on the background of sulodexide therapy in patients with ZANK.
Varicose vein disease of the lower extremities is a common vascular disorder associated with endothelial dysfunction, chronic inflammation, and venous wall remodeling. A promising therapeutic approach is pharmacotherapy aimed at modulating vein-specific biomarkers, including E-selectin, MCP- 1, VEGF, MMP-2, and MMP-9. To evaluate the effects of micronized purified flavonoid fraction (MPFF), sulodexide, and their combination on key biomarker levels and quality of life in patients with VVDLE, depending on the clinical stage (C2-C6). This prospective comparative study included 198 patients (68.2% female; mean age 43.0±8.72 years; BMI 22.0±2.9 kg/m ), allocated into four groups: compression therapy, MPFF 1000 mg/day, sulodexide 250 LSU twice daily, and MPFF plus sulodexide. Treatment duration was 2 months, with a follow-up period of 12 months. Biomarkers were assessed using the enzyme-linked immunosorbent assay method at visits V0, V2, and V3; quality of life was evaluated using the CIVIQ-20 and SF-36 questionnaires. In C2-C3 patients, MPFF showed the greatest efficacy, with sustained reductions in E-selectin ( 25.4%), MCP-1 (-24.5%), and VEGF (-20.8%) (p<0.001), accompanied by quality-of-life improvement. In C4-C6, sulodexide achieved pronounced and prolonged MMP-9 reduction (-53.8% at 2 months; -24.9% at 12 months) and quality-of-life enhancement. The combination therapy in C4-C6 patients reduced all biomarkers by month 1 and maintained decreases in MMP-2 (-18.2%) and MMP-9 (-24.3%) at 12 months, with persistent CIVIQ-20 and SF-36 improvement. In C2-C3, combination therapy provided no additional benefit and was associated with a higher adverse event rate (28%). Pharmacotherapy efficacy depends on the stage of VVDLE: MPFF is optimal at early stages, while sulodexide or its combination with MPFF is preferable for advanced disease. A personalized treatment approach enables maximal clinical and biochemical benefits with a comparable safety profile.
Carotid endarterectomy is the gold standard for stroke prevention. Although it is one of the most common procedures in vascular surgery, its technique has not been fully standardized. In particular, there is no consensus on the optimal approach for dissection of the carotid bifurcation. Data suggest differences in the safety and efficacy of the retrojugular and/or antejugular approaches, primarily regarding local wound complications and the incidence of cranial nerve injuries, which occur in 1.4-31% of cases and significantly impair patients' quality of life. To compare the safety and efficacy of the antejugular and retrojugular approaches to the carotid bifurcation within a prospective randomized study. The study enrolled 280 patients (140 retrojugular, 140 antejugular). internal carotid artery (ICA) stenosis >70% (asymptomatic) or >50% (symptomatic). primary - pre-existing neurological deficits, reoperations. secondary - perioperative stroke, wound hematomas, early reinterventions. Prospective randomized study. Common complications: perioperative acute cerebral circulatory disorders/transient ischemic attacks - 2.14%/1.43% with antejugular access, 1.43%/0.71% with retrojugular access (p=0.658/0.566); hematomas - 0.7%/2.1%, respectively (p=0.63). Local neurological symptoms: on day 1 - 33.8% (dysphonia - 33.1%, vocal fold paresis - 1.9%), on day 3 - 22.9%, after 3 months - complete regression in all patients. After applying the secondary exclusion criteria, 134 patients with retrojugular access and 132 patients with antejugular access were included in the comparative analysis. The frequency of cranial nerve damage, dysphonia, and dysphagia did not differ depending on the type of access (p>0.05). The surgery time was 76.1±1.8 min (antejugular) vs 74.2±2.4 min (retrojugular, p=0.51). The retrojugular approach facilitates internal carotid artery exposure and obviates venous ligation but does not reduce local neurological complications or operative duration compared to the antejugular approach. Both techniques demonstrate comparable safety profiles, with approach selection contingent on surgeon preference and patient-specific anatomy.
The aim of this study was to develop an algorithm for the prevention and treatment of venous thromboembolic complications (VTEC) during staged surgical interventions in wounded patients with gunshot fractures of the lower extremities (LE). The treatment outcomes for VTEC were retrospectively assessed in 149 wounded patients with gunshot fractures of LE who were treated in a Level 5 military medical facility (MMF). All wounded were male, with an average age of 38.4 ± 8.8 years. Instrumental examination included ultrasound angioscanning of LE and computed tomography (as indicated). By localization, gunshot fractures were: femur in 80 (53.7%) wounded, tibia - in 33 (22.1%), fibula - in 1 (0.7%), femur and tibia - in 7 (4.7%), tibia and fibula - in 26 (17.4%), femur and fibula - in 1 (0.7%), femur, tibia and fibula - in 1 (0.7%). Deep vein thrombosis (DVT) of LE was detected in all the wounded. By the segments of damage, patients with DVT were distributed as follows: the iliofemoral segment was affected in 6 (4%) wounded, the femoropopliteal segment - in 53 (36%), the popliteal-tibial segment - in 67 (45%), and the distal segment - in 23 (15%). Short-term treatment outcomes were assessed based on mortality rates, secondary amputation rates, recurrence and/or progression of venous thromboembolism, and hemorrhagic complications. Indications for lower musculoskeletal surgery were delayed in most patients (123, 82.5%). The median duration of preoperative anticoagulant therapy (ACT) with low-molecular-weight heparins was 7 days (Q1 - 5, Q3 - 11). A total of 247 (53.2%) interventions were performed with a high risk of hemorrhagic complications, while 217 (46.8%) had a low risk of bleeding. A postoperative break from ACT of up to 24 hours was most often used (353 interventions, 76.1%). A 24-48 hours break in ACT was performed after 97 (20.9%) operations, while a 48-72 hour break was performed only after 14 (3%) operations. Surgical prophylaxis of massive PE was performed in 24 (16.1%) patients, with the most common procedure being superficial femoral vein ligation (21 wounded) performed during the previous stages of medical evacuation. The median hospital stay in a MMF was 8 days (Q1 - 6, Q3 - 15). There were no fatal outcomes. Secondary LE amputations were performed in 12 (8%) wounded. DVT progression was noted in 9 (6%) patients. Development of massive PE and major bleeding were not noted. Performing femoral vein ligation before one or more high-risk interventions in wounded patients with gunshot fractures of LE was not associated with lower complication rates compared with isolated anticoagulant therapy with low-molecular-weight heparins in the perioperative period. A rational combination of perioperative anticoagulant therapy with short-term withdrawal before and immediately after surgery, as well as its resumption in most patients within 24 hours after surgery, with or without surgical pulmonary embolism prophylaxis, helps prevent both massive venous thromboembolic and hemorrhagic complications.
One of the main success factors in the treatment of patients with acute mesenteric ischemia is the timely diagnosis and the earliest possible start of treatment. The aim is to evaluate the diagnostic accuracy and specificity of computed tomography (CT) with intravenous contrast and X-ray contrast angiography in the diagnosis of acute mesenteric circulatory disorders. The work was carried out on the basis of two multidisciplinary hospitals of the third level, which include departments of general surgery and cardiovascular surgery. The study included 93 patients with suspected acute abdominal ischemia. CT angiography was performed in 68 of them, X-ray contrast angiography was performed in 14 of them, X-ray CT preceded endovascular intervention in 8 patients, and acute mesenteric ischemia was detected only intraoperatively after laparotomy in 28 patients after preliminary X-ray contrast examination. The sensitivity of CT angiography was 72.6%, and the specificity was 80.2%. Due to the accuracy and the possibility of detailed visualization of the distal parts of the mesenteric bed, the sensitivity of endovascular interventions was 94.6%, and the specificity was 100%. The use of X-ray contrast angiography is preferable in patients in stable condition with suspected acute mesenteric ischemia, regardless of the severity of changes in the intestinal wall. CT angiography is an accessible and non-invasive research method, it is the primary diagnostic method in patients in order to identify complications of acute mesenteric ischemia, as well as the only method applicable in the absence of endovascular diagnostic methods in the clinic.
Cyanoacrylate adhesive сlosure (САС) of subcutaneous veins is a modern method of treating varicose veins of the lower extremities, demonstrating a number of advantages over traditional surgical and thermal ablation techniques. Unlike endovenous thermal сlosure, tumescent anesthesia is not performed in САС, which significantly reduces pain and impact on perivenous tissues, especially for patients with trophic skin disorders. In addition, postoperative compression is not required, which is contraindicated in the presence of obliterating atherosclerosis of the lower extremities. Given the relative novelty of the methodology, the number of studies with long-term results is limited. The aim is to evaluate the long-term outcomes of the use of САС in the treatment of patients with IBD. A retrospective analysis of electronic medical records of patients with IBD has been carried out since the integration of the considered technique into the work of the Phlebology Center of the Multidisciplinary Medical Holding SM-Clinic from 2019 to 2024. The study included patients with varicose-transformed tributaries of the main subcutaneous veins, corresponding to classes C2-C6 according to CEAP, with terminal valve dysfunction with axial reflux (>0.5 s, diameter of the trunk of the subcutaneous vein - 0.6 cm and higher). САС was performed using the VenaSeal Closure System (Medtronic) according to a standard protocol. In the course of the work, demographic and clinical data, key preoperative characteristics (diameter of the target subcutaneous vein, number of venous basins) were evaluated, which were analyzed using descriptive statistics methods. A visual analog scale (VAS) was used to assess the intensity of pain directly during surgery. Postoperative follow-up of patients, including ultrasound duplex scanning, was performed on the 3rd day, then 1, 3, 6 and 12 months after surgery, and thereafter annually. The criterion for the effectiveness of САС was the occlusion of the trunk of the target vein. The safety criterion is the frequency of postoperative adverse events and complications. Evaluation of long-term results with a follow-up period of 5 years was performed in 39 patients who underwent CT in the second half of 2019. 52 lower extremities and 53 venous basins corresponded to this number of patients. There were 24 women (61.5%) and 15 men (38.5%). The average age of the patients was 58.3±16.2 years. 19 (48.7%) patients were elderly and senile. The distribution of patients according to the CEAP classification: C2 - 21 (53.8%), C3 - 15 (38.5%), C4 - 3 (7.7%). The average diameter of the large saphenous vein was 10.8±4.1 mm, the small saphenous vein was 6.7±2.3 mm. In 25 (64.1%) patients, CT was performed on the 1st venous basin, in the remaining 14 (39.5%) - simultaneously on the 2nd venous artery. The average duration of the intervention was 35±25.7 minutes. In 26 patients, САС was performed as an isolated procedure, without intervention on the tributaries and did not require the use of postoperative compression. Simultaneous interventions on tributaries were performed in 13 (33.3%) patients: foam sclerotherapy in 9 (23.1%), miniflebectomy in 4 (10.2%). Intraoperative VAS pain was estimated at less than 3 points in 36 (92.3%) patients. The average VAS score was 2.9±0.7. Immediate technical and anatomical success was achieved in all 39 (100%) patients at the first 2 follow-up examinations (3 days and 1 month after the procedure). In subsequent controls, recanalization was registered in 3 (7.7%) patients. Glue-induced thrombosis was noted in 1 (2.6%) patient. 5 (12.8%) patients had a phlebitic skin reaction (delayed type) that occurred from 1 week to 1 year after surgery. This complication was eliminated by conservative treatment. Tributary thrombophlebitis was recorded in 2 (5.1%) patients. In 1 (2.6%) case, an abscessed soft tissue granuloma was diagnosed at the vein puncture site 5.5 months after the CT scan. Ecchymosis was observed in 4 (10.2%) patients. There were no postoperative neurological complications, pulmonary embolism, or deep vein thrombosis in this group of patients. The incidence of target vein occlusion at 3 months, 6 months, and 3 years after the intervention was 97.5%, 94.9%, and 92.3%, respectively. The last indicator remained until the 5-year observation period. The САС technique demonstrates a high level of efficacy and safety in the treatment of patients with varicose veins of the lower extremities, with a 92.3% occlusion rate of target veins within 5 years after сlosure.
Endovascular thermal ablation techniques, such as endovascular laser or radiofrequency ablation (RFA), have become the standard of care for treating varicose veins. However, some patients may experience unpleasant sensations, such as a 'tourniquet' or 'string', in the area where the subcutaneous artery is obliterated. One way to reduce these adverse events is through the use of topical treatments, such as sodium heparin gel (1000 IU) and a combined preparation containing escin, heparin, and essential phospholipids. The aim of this study was to evaluate the clinical symptoms, frequency, and severity of the 'string' sensation in patients with varicose veins who underwent large saphenous vein ablation (LSVA), and to assess whether sodium heparin (1000 UI) or the combined preparation could alleviate these symptoms. An open, randomized, prospective cohort study was conducted on 180 female patients aged 18-72 years (mean age 41.2±7.5 years) diagnosed with varicose veins of the lower extremities. The patients were divided into three groups: Group 1 underwent IVF without any additional conservative therapy; Group 2 received topical heparin (1000 IU) applied twice daily for two weeks after endovenous thermal ablation (EPR); and Group 3 received a topical medication containing escin, heparin, and essential phospholipids applied twice daily after EPO for two weeks. In the initial class of chronic venous disease, grade 3 according to the CEAR classification, a decrease in edema was recorded at the end of treatment in group 1 in 72.7% of cases, in group 2 - in 76.9% of cases and in group 3 - 91.7%, respectively. The differences between groups 3 (patients receiving a combination topical agent) and the other two were statistically significant (p<0.05). For grade 4 chronic venous diseases, a reduction in dermatitis symptoms was noted in group 3 in 83.3% patients compared to 50% and 57.1%, respectively, for groups 1 and 2. A decrease in induration of tissue was observed in 66.7% of patients in group three compared to 40%, in both group 1 and group 2. Healed ulcerative defects were noted in 60% of group 3 patients versus 33% and 25% in groups 1 and 2, respectively. Using a combination of topical agents, the number of 'string' symptoms decreased from 50.6% to 93.5%. The symptom of 'string' after acute renal failure may occur 2 months after surgery in about 3-4% of patients on average. The use of topical agents containing a combination of venoactive drugs (escin), heparin, and essential phospholipids can help reduce the severity of this symptom.
Methods of endovascular treatment of patients with arterial lesions expand the possibilities for limb salvage. However, one of the main reasons for the reduced long-term effectiveness of these surgical interventions is restenosis. Endothelial-mesenchymal transition is considered one of the reasons for the development of restenosis. The aim was to study the possibilities of predicting the development of restenosis after endovascular interventions on the main arteries of the lower extremities in patients with atherosclerotic peripheral artery disease (PAD) by assessing the levels of endothelial-to-mesenchymal transition biomarkers. The study included 50 patients divided into groups depending on treatment (operative or conservative). The mean age of the patients in the surgical group was 66.1±8.83 years and that in the conservative group 70±8.62 years. The groups were comparable in terms of gender, stage of the disease, side of the lesion, concomitant diseases and baseline values of the ankle-brachial index (ABI). The control group additionally comprised 10 apparently healthy volunteers with neither PAD nor other identified diseases. Peripheral venous blood was collected to assess the level of EndMT markers (endothelial markers - PECAM-1, vWF, mesenchymal markers - vimentin, alpha-Anti-Actin Alpha 2 - antiACTIN, and integral EndMT marker - TGF-b1) in the apparently healthy subjects, as well as patients with stage IIb-IV PAD according to the classification of A.V. Pokrovsky-Fontaine before and after endovascular reconstructive interventions on the arteries of the lower extremities. All patients underwent duplex ultrasonography to assess restenosis at the site of the endovascular interventions performed, with the ABI also determined. Decreased values of the ABI in the post-operative period were associated with elevated levels of vimentin (VIM). Vimentin concentration above 2.98 ng/ml was associated with the development of restenosis 3 months after endovascular surgery. At this stage of the study, it is only possible to assess the role of the mesenchymal parameter vimentin as a potential marker for predicting the development of restenosis after endovascular interventions on lower extremity arteries.
Atherosclerosis of the brachiocephalic arteries is one of the leading causes of ischemic cerebrovascular disorders, which is based on a complex, multi-stage process regulated by epigenetic mechanisms. The latter, in particular, include changes in the expression of molecules such as microRNAs - small (on average, 22 nucleotides) non-coding RNA sequences that are heavily involved in most physiological and pathological processes. The aim of the study was to evaluate the expression of miR-126-5p/-3p, miR-21-5p/-3p, miR-33a-5p/-3p, miR-29a-5p/-3p in relation to association with clinical cerebrovascular events and to identify differences in the expression pattern depending on the performed transluminal balloon angioplasty with carotid artery stenting for hemodynamically significant carotid stenosis. Our prospective study included 80 patients [average age - 66 years, men - 44 (55%)] with cerebral atherosclerosis of varying severity who were admitted to the vascular departments of the 'Research Center of Neurology' (Moscow). Transluminal balloon angioplasty with stenting (TBAS) of the carotid artery was performed in 33 patients [in 14 (42%) patients - for symptomatic stenosis]. All patients underwent thorough clinical and neurological examination, laboratory and instrumental research methods, including isolation and analysis of microRNA expression (miR-126-5p/-3p, miR-21-5p/-3p, miR-33a-5p/-3p, miR-29a-5p/-3p). The microRNA expression pattern was significantly different in the patients who underwent TBAS: the levels of miR-126-5p/-3p and miR-29a-5p were statistically significantly lower, and those of miR-33a-5p/-3p higher compared with the patients who did not undergo angiosurgery. A multivariate linear regression model that included the expression of all the microRNAs studied identified miR-126-5p and miR-21-5p as statistically significant independent predictors of the degree of carotid artery stenosis. The expression of a number of atherogenic microRNAs in patients who underwent transluminal angioplasty with carotid artery stenting appeared to be of a differentiated nature. The most significant biomarker was the expression level of miR-126-5p, which is associated, among other things, with the degree of carotid stenosis.
According to WHO, the number of people suffering from atherosclerotic lesions of the brachiocephalic arteries in different age groups is 20-50%. The development of ischemic stroke with existing chronic occlusion of the internal carotid artery (ICA) occurs with a frequency of 6-15%, and the annual risk of developing acute ischemic disorders in the ipsilateral basin, despite adequate drug treatment, ranges from 6 to 20%. The aim is to evaluate the efficacy and safety of endovascular recanalization in chronic ICA occlusion. The analysis of the first results of intravascular treatment of 12 patients with chronic ICA occlusion on the basis of the vascular neurosurgical department of the Russian Research Neurosurgical Institute named after Professor A.L. Polenov. The age range is from 42 to 75 years (the average age is 57 years). There were 11 men (91.6%) and 1 woman (8.4%). Depending on the type of chronic occlusion, according to the D. Hasan scale (2018), the distribution of patients was as follows: type A (the presence of a proximal ICA stump of the 'candle' type + retrograde filling of the ICA to the stony/cavernous segments) - 4 patients; type B (the presence of a blindly ending proximal ICA stump without the formation of a 'candle' + retrograde filling of the ICA to the rocky/cavernous segments) - 3 patients; type C (occlusion of the ICA from the mouth + retrograde filling of the ICA to the rocky/cavernous segments) - 2 patients; type D (occlusion of the ICA from the mouth with the absence of retrograde filling of the stony/cavernous segments of the ICA) - 3 patients. In 8 (66.6%) of the 12 patients, the ICA lumen was completely restored. According to the D. Hasan scale, type A was noted in 4 patients, type B in 3 patients, and type C in 1 patient. In 4 (33.3%) patients, technical success was not achieved, of which according to the D. Hasan scale: type D was observed in 3 patients, type C in 1 patient. Of the 8 patients with successful ICA recanalization, all underwent remote monitoring by computed tomographic angiography or digital subtraction angiography. No data confirming restenosis were obtained in 6 patients. There were no episodes of recurrent ischemic disorders. In 1 patient, thrombosis of stented ICA was detected against the background of the patient's self-withdrawal of double disaggregant therapy. Unsuccessful recanalization (4 patients), in our opinion, is associated with convolution of the ICA and severe scarring in the lumen of the occluded artery. Intravascular recanalization of chronic ICA occlusion is a promising method that can be effectively used to restore the full-fledged lost artery lumen and normalize brain perfusion to reduce the risks of recurrent ischemic cerebral events.