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Successful treatment of 25 patients with Leriche syndrome with minilaparotomic approach is analyzed. This method promotes a decrease of postoperative complications and faster rehabilitation of patients compared with standard method. Mean time of surgery was 145+/-33,1 min, in one-stage carotid surgery - 182,1+/-27,4 min. Volume of infusion during surgery was 2500 ml, blood loss - 264,6+/-74,4 ml, time of aorta clamping - 24,6+/-5 min. There was no peripheral embolism after surgery. Postoperative lung ventilation lasted for 37,5+/-28,3 min. Mean stay in intensive care unit was 22,5+/-1,97 h. Patients could receive oral nutrition in 28,75+/-7,8 h. The proposed method may be used in the majority of cases as alternative to conventional surgery and doesn't require significant expenditures and expensive equipment.

Method of complex angiographic examination and treatment from translumbar approach (CTLA) in patients with diffuse occlusive lesions of arterial bed was developed. 529 patients (516 males and 13 females) aged from 20 to 80 years (53.1 +/- 1.6 years) were examined and operated with the use of translumbar approach: they underwent various angiographic examinations of peripheral, visceral and coronary arteries as well as interventions on arteries. The quality of contrasting of arterial bed in CTLA was higher in comparison with results of punction translumbar aortography and intravenous digital angiography, complications rate being minimal. Application of CTLA in practice made it possible to perform practically all kinds of angiography and many invasive procedures in patients with occlusions of peripheral arteries and after reconstructive operations on vessels.

Incidence, etiology and clinical course of chronic juxtarenal occlusion of the abdominal aorta have been studied. It was established that this type of lesion among other forms of occlusive disease of the aorto-ileal segment is encountered in 8.1% of patients. Inflammatory diseases of arteries prevailed as an etiologic factor. Diagnosis of this disease should be based on the use of complex up-to-date methods of examination. Roentgeno-contrast aortography in lateral position is of paramount importance in detection of upper level of thrombus spreading in the aorta. Original method of operative procedure used in 20 patients, has been developed with due regards for location of the occlusion, character of lesion of aortic walls and prophylaxis of intraoperative embolic complications. Restoration of blood flow in lower extremities without any intraoperative complications was obtained in all operated patients. In all suffering from symptomatic hypertension normalization of arterial pressure was obtained after the operation. Postoperative mortality rate made up 4.4%. The results obtained confirm high effectiveness of the above surgical treatment of patients with juxtarenal occlusion of the abdominal aorta.

Duplex scanning (DS) is the only available method for visualization of the internal aperture and arteries walls, to evaluate hemodynamic significance of stenosis. DS was used in 41 patients with aorto-femoral occlusions. The vessels diameter parallel with the specific features of the walls lesions and parameters of doppler frequency spectrum have been examined. In all patients the results of DS were compared with the results of paracentetic translumbal or i.v. digital angiography, equally with intraoperative evaluation. The classification of iliac arteries stenosis based on ultrasound examination has been proposed. In cases of stenosis less than 80% the results of DS appeared to be more accurate than results of angiography. In critical stenosis the results of DS coincided with the results of angiography. The use of DS in 11 patients without clinical and angiographical signs of stenosis made it possible to reveal the lesion and take the decision for bifurcation by-pass surgery. In 98% the results of DS coincided with the results of intraoperative evaluation. DS must be used in patients with Leriche syndrome.

Reconstructive operations were carried out in the clinic on 437 patients with Leriche's syndrome in the recent 8 years. In 25 of them successive shunting of the vessels of the femoro-popliteal segment became necessary later because of inadequacy of the blood flow immediately after the first operation (15 patients) or consequent thrombosis of the femoral artery (10 patients). Trophic changes in the distal parts of the extremity, pain at rest or intermittent claudication occurring after 20-25 minutes of walking were the indications for resorting to successive shunting in the femoro-popliteal segment despite the maintained functioning of the shunt in the aortoiliac position. The deep femoral artery was used as the donor vessel in 12 operations among the 25 successive operations on patients with the Leriche's syndrome. It is noted that with the use of this vessel the successive operation becomes simpler technically and the length of the shunt can be reduced. Adequate restoration of blood flow in the extremity was attained in all patients after successive shunting of vessels in the femoral segment with the use of the deep femoral artery, and persisted for 6 to 12 months.

In a group of 182 patients who underwent surgical treatment for aortoiliac occlusions 172 had to be subjected to intraoperative distal angiography. The operative tactics in this case was determined by the degree of affection of the peripheral vessels and the character of collateral circulation, which were appraised from the findings of the operative angiograms. According to this, all patients were divided into 4 groups. Two patients developed complications linked with faulty appraisal of the drainage paths.