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Analysed in the article are the results of ultrasonographic examination of patency of venous stents implanted in 86 patients with obstructive lesions of the iliofemoral segment of deep veins. The authors proposed an algorithm of triplex scanning, making it possible to optimize ultrasonographic examination, as well as increasing the accuracy of assessing the state of the stent and patency of the stented segments of veins. The first stage was to examine the state of the stented venous segment in the mode of grey-scale scanning (B-mode), for which purpose the study was performed in the longitudinal and transverse projections. This made it possible to determine the qualitative state of the stent as either presence or absence of its migration and deformation, completeness of expansion, extravasal compression. The second stage was to locate the venous stent in the mode of colour Doppler mapping (CD-mode), thus making it possible to assess stent patency. The third stage was examination in the spectral Doppler mode with the use of the distal compression test. Ultrasonographically detected phasic, respiration-synchronized blood flow with an increase of its linear velocity proximal to the stent in distal compression (positive compression test) is suggestive of no obstructive alterations in the stent's lumen. Determination of the blood flow velocity makes it possible to evaluate the stent patency or stenotic alterations. Monophasic low-velocity blood flow in the ipsilateral common femoral artery may also be indirectly indicative of impaired stent patency (pronounced stenosis, thrombosis, occlusion). The proposed algorithm of ultrasonographic triplex study of patency of venous stents may be used in out-patient conditions repeatedly and safely for the patient.В статье анализируются результаты ультразвукового исследования проходимости венозных стентов, имплантированных у 86 пациентов с обструктивными поражениями илиофеморального сегмента глубоких вен. Авторами предложен алгоритм триплексного сканирования, позволяющий оптимизировать ультразвуковое исследование и повышающий точность оценки состояния стента и проходимости стентированных сегментов вен. Первым этапом предлагается исследовать состояние стентированного венозного сегмента в режиме серошкального сканирования (В-режим). Для этого проводили исследование в продольной и поперечной проекциях. Это позволяет определить качественное состояние стента в виде наличия либо отсутствия его миграции и деформации, полноты раскрытия, экстравазальной компрессии. Вторым этапом следует выполнять локацию венозного стента в режиме цветового допплеровского кодирования (CD-режим), что дает возможность оценить его проходимость. Третьим этапом осуществляется исследование в спектральном допплеровском режиме с применением дистальной компрессионной пробы. Наличие фазного, синхронизированного с дыханием кровотока на допплерограмме с усилением его линейной скорости проксимальнее стента при дистальной компрессии (положительная компрессионная проба) свидетельствует об отсутствии обструктивных изменений в просвете стента. Определение скорости кровотока позволяет судить о его проходимости либо изменениях стенотического характера. Монофазный низкоскоростной кровоток в ипсилатеральной общей бедренной вене также может косвенно указывать на нарушения проходимости стента (выраженный стеноз, тромбоз, окклюзия). Предложенный алгоритм ультразвукового триплексного исследования проходимости венозных стентов может применяться в амбулаторных условиях многократно и безопасно для пациента.

Presented in the article is a prospective study of endovascular embolization of ovarian veins in female patients suffering from primary pelvic varicose veins, with the assessment of the immediate and remote results, as well as a 1-year follow up.The aim of our investigation was a comprehensive clinical and instrumental assessment of efficacy of endovascular embolization in women with pelvic varicose veins.Our single-centre study included a total of 29 female patients presenting with pelvic varicose veins and undergoing embolization of ovarian veins using microcoils, in 5 cases the procedure was supplemented with injecting a foam sclerosant.The technical success of endovascular occlusion of ovarian veins amounted to 100%. Two women immediately after the operation were subjected to a redo intervention: in one case - resection of the ovarian vein and in the second case - repositioning of the microcoils. In the remote period, one patient due to recurrent relapses underwent repeat embolization followed by retroperitoneal resection of the ovarian vein. The findings of the clinical methods of examination demonstrated a decrease in the intensity of manifestations of pelvic varicose veins according to the pelvic venous clinical severity score and visual analogue scale, as well as improvement of the women's quality of life.Endovascular occlusion of ovarian veins is a highly effective, minimally invasive, and safe method of treatment of female patients with incompetent ovarian veins. Endovascular treatment may be regarded as a method of choice in management of the primary form of pelvic varicose veins.В статье представлено проспективное исследование эндоваскулярной эмболизации яичниковых вен у пациенток с первичной варикозной болезнью таза с оценкой ближайших и отдаленных результатов, а также годового наблюдения. Цель – комплексная клиническая и инструментальная оценка эффективности эндоваскулярной эмболизации у пациенток с варикозной болезнью таза. Материалы и методы. В одноцентровое исследование включено 29 пациенток с варикозной болезнью таза, которым была выполнена эмболизация яичниковых вен микроспиралями, в 5 случаях процедура дополнялась введением пенного склерозанта. Результаты. Технический успех эндоваскулярной окклюзии яичниковых вен составил 100%. В двух случаях непосредственно после операции осуществлено повторное вмешательство: в одном – резекция яичниковой вены, во втором – повторное позиционирование микроспиралей. В отдаленном периоде одной из пациенток вследствие повторных рецидивов проведены операции повторной эмболизации, а затем забрюшинной резекции яичниковой вены. При оценке клинических методов исследования отмечали снижение интенсивности проявлений варикозной болезни таза по шкале тяжести и визуально-аналоговой шкале, а также улучшение качества жизни пациенток. Выводы. Эндоваскулярная окклюзия яичниковых вен является высокоэффективным, миниинвазивным и безопасным методом лечения пациенток с несостоятельностью яичниковых вен. Эндоваскулярные методы лечения могут считаться методом выбора в лечении первичной формы варикозной болезни таза.

This article is a review of the literature related to the possibilities and perspectives of reconstructive operations on deep veins for post-thrombotic disease (with the data retrieved from such databases as the PubMed, Scopus, Medline and EMBASE). The most optimal variants of performing reconstructive operations on deep veins are described, accompanied and followed by analysing their outcomes with the discussion of approaches to determining the indications for these interventions. Also considered are the perspectives of bettering the results of reconstructive operations at the expense of modernizing the technologies of diagnosis and surgical treatment.В статье приводится обзор литературы по возможностям и перспективам реконструктивных операций на глубоких венах при посттромботической болезни (использованы базы данных Pub Med, Scopus, Medline и EMBASE). Описываются наиболее оптимальные варианты исполнения реконструктивных операций на глубоких венах. Анализируются их результаты с обсуждением подходов к определению показаний к этим вмешательствам. Рассматриваются перспективы улучшения результатов реконструктивных операций за счет модернизации технологий диагностики и хирургического лечения.

Aim. Assessment of the function of veno-venous bypass operations in postthrombotic disease with the use of ultrasound duplex scanning. Methods. The results of veno-venous bypass procedures are presented including crossover autovenous bypass for unilateral postthrombotic iliac vein obstructions (during short-term postoperative period in 56 patients, during long-term period - in 68) and saphenopopliteal bypass for femoral vein obstruction (in 12 patients). Results. Functional tests making ultrasound duplex scanning more informative in assessment of the function of bypass operations were developed. It was determined that most of crossover grafts (70.6%) have a propensity to equal «physiological» dilation leading to the requisite venous drainage from an affected extremity. Some grafts (23.6%) undergo pathological transformations like local and diffused deformed dilation, сicatricial stenosis that diminish venous drainage and require reintervention on the graft. Venous hemodynamic studies of the affected extremity with the graft being open and cross-clamped showed that in 73% of the patients the major role in the maintenance of venous return is played by crossover bypass. Long-term outcomes in 56 patients after 15 years proved patency of crossover grafts in 43 patients (79.6%). In 11 out of 12 patients (91.7%) examined during long-term postoperative period saphenopopliteal grafts were patent. It was demonstrated that they are capable of prolonged functioning without pathological dilation. Long-term outcomes of the procedure proved reliable function of the grafts and improvement of regional venous hemodynamics. Conclusion. Ultrasound duplex scanning is the optimal method of the assessment of short-term and long-term outcomes of reconstructive bypass operations due to their noninvasiveness, safety, and high resolving power and the possibility of repetitive qualitative and quantitative studies of venous system including those in community setting.

Presented herein is an original method of preparing a bypass graft (a non-reversed autovein for femoropopliteal and femorotibial bypass grafting) and assessment of quality of valvulotomy using a thermal imager. The study included a total of 31 patients. All patients subdivided into 2 groups were subjected to bypass grafting operations with the use of a non-reversed autovein. In group 1 (n=16) prior to applying a bypass graft we assessed its patency with the use of an original method by means of a thermal imaging camera. In group 2 (n=15) assessment of graft patency after destruction of valves was not performed. In group 1 there were no bypass graft thromboses in the postoperative period, whereas three (20%) patients in group 2 developed bypass graft thrombosis within the first 24 postoperative hours, requiring repeat operation. Bypass graft thrombosis was caused in all cases by insufficiently destroyed valves of the venous transplant. There were no lethal outcomes within 1 year postoperatively. Control ultrasonographic examination after 1 year revealed bypass graft thrombosis in two (13.3%) patients in group 2, leading to the development of critical ischaemia and gangrene in one (6.6%) of these patients and later on requiring limb amputation at the level of the femur. A conclusion drawn is that thermal imaging makes it possible to intraoperatively assess quality of valvulotomy in using a non-reversed autovein as a bypass graft and to improve the results of surgical treatment.Представлен оригинальный способ подготовки шунта (нереверсированной аутовены для операции бедренно-подколенного и бедренно-берцового шунтирования) и оценки качества вальвулотомии с использованием тепловизора. В исследование включен 31 больной. Всем больным, разделенным на 2 группы, проводились шунтирующие операции с использованием нереверсированной аутовены. В 1 группе (n=16) перед наложением шунта оценивалась его проходимость с использованием оригинального способа с помощью тепловизора. Во 2 группе (n=15) оценка проходимости шунта после разрушения клапанов не проводилась. В послеоперационном периоде в 1 группе тромбозов шунта отмечено не было, тогда как во 2 группе тромбоз шунта в первые сутки после операции возник у 3 (20%) больных, что потребовало выполнения повторной операции. Причиной тромбоза шунта во всех случаях были недоразрушенные клапаны венозного трансплантата. В сроки до 1 года после операции летальных исходов не было. При проведении контрольного ультразвукового исследования через 1 год у 2 (13,3%) больных во 2 группе выявлен тромбоз шунта, что привело к развитию критической ишемии и гангрены у 1 (6,6%) из этих пациентов и в дальнейшем потребовало выполнения ампутации конечности на уровне бедра. Сделан вывод, что тепловизионное исследование позволяет интраоперационно оценить качество вальвулотомии при использовании в качестве шунта нереверсированной аутовены и улучшить результаты хирургического лечения.

We describe herein a case of surgical treatment of a 32-year-old female patient presenting with multilevel post-thrombotic occlusion of deep veins of the left lower limb. Laboratory study revealed high-risk hereditary thrombophilia (homozygous mutation of PAI-1, MTR, heterozygous mutation of MTHFR, MTRR, ITGA2). The first stage included endovenectomy from the common femoral vein with creation of an arteriovenous fistula between femoral vessels. An attempt of endovascular stenting of iliac veins was initially unsuccessful. After 3 months, the woman was rehospitalized to undergo successful endovascular operation with stenting of the iliac veins and common femoral artery on the background of the functioning arteriovenous fistula. The clinical outcome of the operation was good. Follow-up ultrasonographic examinations (ultrasound duplex scanning) were performed at 3, 6, 10 and 13 months after the second operation. The findings of ultrasound duplex scanning at 13 months showed that the stented segments of deep veins were freely patent, with the arteriovenous fistula functioning well. There were no signs of impairments of central haemodynamics, with significant regression of clinical symptoms. The total score by the Villalta scale as compared with the baseline values decreased from 13 to 5. Given the pattern of deep vein lesions, complexity of open and endovascular operations, and the presence of thrombophilia, we decided to abstain from disuniting the arteriovenous fistula. This case report demonstrates possibility, efficacy and safety of long functioning of an artificial arteriovenous fistula in a particular patient cohort.В статье описан случай оперативного лечения пациентки 32 лет с многоуровневой посттромботической окклюзией глубоких вен левой нижней конечности. При лабораторном исследовании у больной выявлена наследственная тромбофилия высокого риска (гомозиготная мутация PAI-1, MTR, гетерозиготная мутация MTHFR, MTRR, ITGA2). Первым этапом выполнена эндовенэктомия из общей бедренной вены с наложением артериовенозной фистулы между бедренными сосудами. Попытка эндоваскулярного стентирования подвздошных вен первоначально была безуспешной. Через 3 мес. больная повторно госпитализирована и ей успешно проведена эндоваскулярная операция со стентированием подвздошных вен и общей бедренной вены на фоне функционирующей артериовенозной фистулы. Клинический результат операции был хорошим. Контрольные ультразвуковые исследования (ультразвуковое дуплексное сканирование) осуществлялись в сроки 3, 6, 10, 13 мес. с момента второй операции. По данным ультразвукового дуплексного сканирования через 13 мес. стентированные сегменты глубоких вен свободно проходимы, артериовенозная фистула функционировала хорошо. Признаков нарушения центральной гемодинамики не наблюдалось. Отмечался значительный регресс клинических симптомов. Значение суммы баллов по шкале Villalta по сравнению с исходным уменьшилось с 13 до 5. С учетом характера поражения глубоких вен, сложности открытой и эндоваскулярной операций и наличия тромбофилии от разобщения артериовенозной фистулы решено воздержаться. Данное наблюдение демонстрирует возможность, эффективность и безопасность длительного функционирования искусственной артериовенозной фистулы у определенной когорты пациентов.

The problem of chronic venous insufficiency in women during pregnancy is of current concern. A total of 115 pregnant women in the first, second and third trimesters of gestation were examined in a stage-wise manner. During the first stage we conducted a comprehensive clinical study with the obligatory consultation by the obstetrician-gynaecologist. At the second stage, all women were subjected to ultrasonographic examination of the venous system of both lower extremities and the small pelvis. Studying the diameters of the deep veins of the right and left lower limbs, as well as the paired veins of the small pelvis demonstrated no statistically significant differences, which made it possible to evaluate these parameters as a whole. In all pregnant women, the lumen of the examined vessels was uniform, with the veins being patent, compliant, stained on colour Doppler mapping. Respiration-synchronized, phasic blood flow was registered. In the course of the study it was revealed that the diameter of the veins of the lower limbs and small pelvis increased as gestation proceeded. The findings of ultrasonographic angioscanning showed that by the third trimester of pregnancy the diameter of the femoral vein was 1.5-fold larger and that of the popliteal vein was 1.4-fold larger. The diameter of the veins of the pampiniform plexus of the ovaries during gestation was noted to have increased 1.13-fold. This was accompanied and followed by deterioration of tonic-and-elastic properties of the venous wall and the development by the third trimester of valvular insufficiency with the emergence of venous congestion. Seventeen (16%) women were found to have varicose syndrome. The above mentioned alterations of venous haemodynamics appeared to lead to impairment of blood flow in the affected veins and to the emergence of thrombogenic zones in the valvular sinuses. Of the 115 women examined, 77 (67%) were found to have degree 1 sludge and 36 (31.3%) had degree 2 sludge, with the D-dimer level in these women having increased to 773.3±37.5 ng/ml. Degree 3 sludge was observed in 2 (1.7%) women previously operated on for acute venous thrombosis. Their D-dimer level amounted to 954.3±43.2 ng/ml. It was demonstrated that studying the valvular sinuses for detection of sludge during examination of pregnant women allowed obstetricians-gynaecologists and physicians of ultrasonographic diagnosis to form risk groups for the development of deep vein thrombosis and to timely take appropriate measures aimed at prevention of the pathology concerned.

The purpose of the study was to assess the immediate and remote results of endovascular treatment of obstructive lesions of the veins of the iliofemoral segment.We performed balloon angioplasty and stenting for iliofemoral venous thrombosis in a total of 75 patients. Of these, 60 patients were subjected to stenting of post-thrombotic obstructions and 15 patients underwent stenting of non-thrombotic obstructive lesions of the iliac veins (for May-Thurner syndrome - in 11, for extravasal tumour-induced compression and cicatricial stenosis - in 4). Stenting was performed using self-expanding stents Wallstent (Boston Scientific, n=84) or S.M.A.R.T. (Cordis, JohnsonJohnson, n=16). The stent diameter varied from 12 to 18 mm depending on the venous segment to be stented. The average number of the implanted stents amounted to 1.3 per patient. Efficacy of endovascular intervention was evaluated by measuring the pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS).Technical success of endovascular intervention amounted to 92%. Stent thrombosis in the immediate postoperative period occurred in 7 (9.3%) patients. Of these, three patients were subjected to catheter-directed thrombolysis with restoration of patency of the stented venous segment of the limb. Stent occlusion within 48 postoperative months was diagnosed in 4 cases. Two patients underwent successful repeat angioplasty and stenting. Stent restenosis of not less than 50% at 36 months of follow up was observed in 5 (16%) patients. Repeat stenting was performed in 1 case. Dynamic control of stent patency was carried out by means of ultrasonographic duplex scanning. Also performed were control multispiral computed tomography-phlebography and roentgen contrast-enhanced phlebography. Cumulative primary and secondary patency at 60 months in post-thrombotic lesions amounted to 72 and 81%, respectively, in non-thrombotic lesions to 85% (primary patency). The VCSS values demonstrated a significant decrease in manifestations of chronic venous insufficiency. The mean value of the composite parameter decreased from 14.2±4.2 to 7.5±2.6 (p0.001), the malleolar circumference decreased from 272.3±6.7 to 250.6±6.1 mm (p0.01). Permanent healing of trophic ulcers was noted in 5 (71%) patients.The method of endovascular angioplasty and stenting for obstructive lesions of the veins of the iliofemoral segment is a minimally invasive, safe, and highly effective therapeutic modality, which is confirmed by significant improvement of the limb's condition and good remote results of patency of the venous segments restored. Endovascular methods should be wider implemented into the clinical practice.

Presented herein are the outcomes of conservative treatment of patients suffering from post-thrombotic disease and chronic venous insufficiency of the lower extremities. Our open prospective randomized study included a total of eighty patients divided into two groups, each consisting of 40 people. All patients were subjected to standard comprehensive conservative treatment, with Group Two patients additionally prescribed Venarus. Efficacy of treatment for post-thrombotic disease was assessed with the use of the Villalta scale. The obtained findings demonstrated clinically significant improvement of the main clinical symptoms in Group Two patients, thus suggesting efficacy of the drug as soon as after a short period of administration. Treatment with Venarus in patients with distal forms of involvement of deep veins of the lower limbs was accompanied and followed by improvement of the tonicoelastic properties of the intact common femoral vein. Healing of small trophic ulcers was conditioned by efficacy of the drug at the level of the microcirculatory bed.

Haemostatic disorders play an important role in the pathogenesis of acute venous thrombosis. One of the least studied reactions of blood coagulation and thrombogenesis is spontaneous contraction of blood clots, which takes place at the expense of the contractility apparatus of activated blood platelets adhered to fibrin fibres. The work was aimed at studying the parameters of contraction of blood clots, formed in vitro, in blood of 41 patients with acute venous thromboses as compared with the same parameters in apparently healthy donors. We used a new instrumental method making it possible to determine the time from initiation to the beginning of contraction, as well as the degree and velocity of clot contraction. It was revealed that in patients with venous thrombosis the ability of clots to shrink was significantly reduced as compared with the control. We detected a statistically significant retardation of and decrease in of blood clot concentration in patients with venous thrombosis complicated by pulmonary artery thromboembolism as compared with contraction in patients with isolated deep vein thrombosis, witch may be important for early diagnosis and determination of the risk of thromboembolism. Besides, we revealed a statistically significant retardation of contraction in patients with proximal thrombosis as compared with contraction in patients with distal thrombosis, with similar values of the degree of contraction. Contraction was statistically significantly reduced in acute thrombosis (less than 21 days), whereas in subacute thrombosis (more than 21 days) the parameters of contraction were closer to normal values. The obtained findings suggest that reduction of blood clot contraction may be a new, hitherto unstudied pathogenetic mechanism deteriorating the course and outcome of venous thrombosis. The clinical significance of contraction and its impairments, as well as the diagnostic and prognostic value of the laboratory test for blood clot contraction would merit further study.

The purpose of the study was to work out a method of preventive diagnosis of venous thromboses by means of ultrasonographic duplex scanning (USDS).A total of 306 people were examined. Of these, 146 patients presented with acute venous thrombosis, 108 subjects suffered from varicose veins, and 52 were apparently healthy people composing the control group. All those enrolled into the study were examined by means of USDS, with the D-dimer level determined.The obtained findings made it possible to discover and duly describe an ultrasonographic phenomenon of the presence of echo-positive inclusions in the zone of valvular sinuses, which was called the phenomenon of spontaneous echo contrast (SEC). This was followed by working out a classification of this phenomenon, describing two degrees thereof. Degree 1 SEC reflects the fact that the area of valvular sinuses is the most thrombogenic zone. Degree 2 SEC is characterised as a pathological, being simultaneously pre-thrombotic, condition and may serve as one of the earliest predictors of the development of venous thrombosis. A close correlation was established between the degree 2 SEC phenomenon, the presence of venous thrombosis and the values of the D-dimer level (r=0.89, p0.01).Ultrasonographic examination of valvular sinuses is a simple, readily available and reproducible method of screening and may thus be used for preventive diagnosis of acute venous thromboses. The findings of this study make it possible to form risk groups by the development of deep vein thrombosis, as well as to initiate timely measures on prevention of the pathology concerned.Цель исследования – разработать метод превентивной диагностики венозных тромбозов с помощью ультразвукового дуплексного сканирования (УЗДС). Материалы и методы. Обследовано 306 человек, из которых 146 – с острым венозным тромбозом, 108 – с варикозной болезнью и 52 – практически здоровые лица, составившие контрольную группу. Всех пациентов обследовали с помощью УЗДС и определяли уровень D-димера. Результаты. В результате проведенного исследования описан ультразвуковой феномен наличия эхопозитивных включений в области клапанных синусов, названный как феномен спонтанного контрастирования (СК). Разработана классификация этого феномена, описаны две степени СК. СК 1 степени отражает тот факт, что область клапанных синусов – это наиболее тромбогенная зона. СК 2 степени характеризуется как патологическое, являющееся предтромботическим, состояние и может служить одним из наиболее ранних предикторов развития венозного тромбоза. Установлена тесная корреляция между феноменом СК 2 степени, наличием венозного тромбоза и показателями уровня D-димера (r=0,89, p0,01). Заключение. Ультразвуковое исследование клапанных синусов является простым, доступным и воспроизводимым методом скрининга и может применяться для превентивной диагностики острых венозных тромбозов. Результаты этого исследования позволяют формировать группы риска по развитию тромбоза глубоких вен и проводить своевременную профилактику данной патологии.

The article contains a review of the literature concerning the use of the Tachocomb haemostatic sponge in cardiovascular surgery. This is followed by enumerating the pharmacological properties of the agent, mechanism of its action, and methods of application. Also shown herein is a high haemostatic effect of the sponge, exceeding that of other means of topical haemostasis. Both safety and a hypoallergenic nature make it possible to widely use Tachocomb in surgical practice.В статье представлен обзор литературы о применении гемостатической губки Тахокомб в сердечно-сосудистой хирургии. Перечислены фармакологические свойства препарата, механизм его действия и способы применения. Показан высокий гемостатический эффект губки, превосходящий другие средства местного гемостаза. Безопасность и гипоаллергенность позволяют широко использовать Тахокомб в хирургической практике.

The study was aimed at assessing efficacy of open thrombectomy in acute iliofemoral venous thrombosis.From January 2012 to December 2016, a total of 37 patients underwent transfemoral thrombectomy for acute iliofemoral venous thrombosis. The Control Group consisted of 24 patients receiving standard anticoagulant therapy. Six patients were subjected to a hybrid operation consisting in thrombectomy supplemented with stenting of the residual compression stenosis of the left common iliac vein (CIV). The outcomes of the operations were controlled by means of duplex scanning. Clinical efficacy of the operations was evaluated with the help of the Venous Clinical Severity Score (VCSS) and CEAP classification.Patency of the iliofemoral segment at 6 months of follow up after thrombectomy was observed in 92% of patients. At the same time, in patients receiving anticoagulant therapy recanalization of the iliofemoral segment was observed in only 21% (5/24; χ2=31, p0.01) of cases. Recanalization of the femoropopliteal segment 6 months after thrombectomy was noted to occur in 70% (23/33) of patients. The median of the composite index by the VCSS after 6 months decreased from 7 to 2 (p=0.002). The cumulative patency of the iliofemoral segment 36 months after surgery amounted to 86%. Clinical assessment of the remote results of thrombectomy according to the CEAP classification demonstrated that 90% (19/21) of patients were either free from or had weakly pronounced symptoms of post-thrombotic syndrome.Performing thrombectomy for iliofemoral thrombosis by selective indications using modern methods of restoring patency of deep veins significantly increases efficacy of treating patients presenting with this severe pathology and prevents the development of pronounced manifestations of post-thrombotic syndrome.Цель исследования. Оценка эффективности открытой тромбэктомии при остром подвздошно-бедренном венозном тромбозе. Материалы и методы. С января 2012 по декабрь 2016 гг. у 37 пациентов выполнена трансфеморальная тромбэктомия при остром подвздошно-бедренном венозном тромбозе. Контрольная группа была представлена 24 больными, получавшими стандартную антикоагулянтную терапию. У 6 пациентов проведена гибридная операция – тромбэктомия, дополненная стентированием резидуального компрессионного стеноза левой общей подвздошной вены (ОПВ). Контроль результатов операции осуществлялся с помощью дуплексного сканирования. Оценка клинической эффективности операций проводилась с помощью шкалы VCSS (Venous Clinical Severity Score) и классификации CEAP. Результаты. Проходимость подвздошно-бедренного сегмента через 6 месяцев наблюдения после тромбэктомии отмечена у 92% пациентов. В то же время у больных, получавших антикоагулянтную терапию, реканализация илиофеморального сегмента зафиксирована лишь в 21% (5/24; c2=31, p0,01) случаев. Реканализация бедренно-подколенного сегмента через 6 месяцев после тромбэктомии наступила у 70% (23/33) больных. Медиана суммарного показателя по шкале VCSS через 6 месяцев уменьшилась с 7 до 2 (P=0,002). Кумулятивная проходимость подвздошно-бедренного сегмента через 36 месяцев составила 86%. Согласно клинической оценке отдаленных результатов тромбэктомии по классификации CEAP, у 90% (19/21) больных после тромбэктомии симптомы ПТБ отсутствовали либо были слабо выраженными. Заключение. Выполнение тромбэктомии при илиофеморальном тромбозе по селективным показаниям с использованием современных методов восстановления проходимости глубоких вен существенно повышает эффективность лечения пациентов с этой тяжелой патологией и предотвращает развитие выраженных проявлений посттромботической болезни.

Presented herein is a review of the literature concerning mechanisms of calcification of atherosclerotic plaques (ASP), showing molecular mechanisms of interaction of processes of calcification with the factors inducing instability of ASPs (anti-inflammatory cytokines, neoangiogenesis, increased level of matrix metalloproteinases, etc.), also describing the effect of the value of volume of scope of calcification on stability of ASPs, followed by discussing the problems related to the role of biominerals (hydroxyapatite calcium phosphate) and Mn2+ in calcification of ASPs and their impact upon stability of the plaque.Представлен обзор литературы по механизмам кальцификации атеросклеротических бляшек (АСБ). Показаны молекулярные механизмы взаимодействия процессов кальцификации с факторами, вызывающими нестабильность АСБ (провоспалительные цитокины, неоангиогенез, повышение уровня матриксных металлопротеиназ и др.), описано влияние значения объема кальцификации на стабильность АСБ. Рассмотрены вопросы роли биоминералов (гидроксиапатита фосфата кальция) и Mn2+ в кальцификации АСБ и их воздействия на стабильность бляшки.

Described in the article is a clinical case report regarding diagnosis and treatment of pelvic varicose veins in a 34-year-old male patient presenting with compressive stenosis of the left common iliac vein (May-Thurner syndrome). The man had developed clinical symptoms of the disease as varicocele when he was 17 years old. Multiple surgical interventions on the veins of the spermatic cord failed to result in significant success. The diagnosis was verified by means of ultrasound examination and contrast X-ray phlebography. The patient was subjected to balloon angioplasty and stenting of the compressive stenosis of the left common iliac vein. The endovascular treatment performed was followed by the patient's improved condition, confirmed by methods of instrumental diagnosis, as well as by regression of clinical symptomatology.В статье описан случай диагностики и лечения варикозной болезни таза у 34-летнего пациента с компрессионным стенозом левой общей подвздошной вены (синдром Мея-Тернера). Клинические признаки заболевания проявились в 17-летнем возрасте в виде варикоцеле. Неоднократные хирургические вмешательства на венах семенного канатика не привели к значительному успеху. Диагноз был верифицирован ультразвуковыми методами исследования и рентгеноконтрастной флебографией. Больному выполнена баллонная ангиопластика и стентирование компрессионного стеноза левой общей подвздошной вены. На фоне проведенного эндоваскулярного лечения отмечено улучшение состояния пациента, подтвержденное методами инструментальной диагностики, а также регрессом клинической симптоматики.

Presented herein is a clinical case report regarding treatment of a patient after endovascular prosthetic repair of an abdominal aortic aneurysm, complicated by ischaemic necrosis of the sigmoid colon. This is followed by analysing the causes of the development of the complication, as well as by a brief review of the literature concerning this problem.Представлен клинический случай лечения больного после эндоваскулярного протезирования аневризмы брюшной аорты, осложненного ишемическим некрозом сигмовидной кишки. Анализируются причины развития осложнения. Приводится краткий обзор литературы по данной проблеме.

The present study was aimed at assessing initial results of hybrid operations in obstructive lesions of the iliac-femoral veins in patients with post-thrombotic disease (PTD). Hybrid operations [open endovenectomy from the common femoral vein (CFV) with creation of an arteriovenous fistula + stenting of iliac veins] were performed carried out in a total of eleven patients with PTD. Of these, there were 7 men and 4 women aged from 34 to 52 years (mean age - 42.8±7 years). All patients had severe-degree chronic venous insufficiency (CVI). The distribution of patients according to the CEAP classification was as follows: C4a - 2 patients, C4b - 4 patients, C5 - 4 subjects, C6 - 1 patient. The time having elapsed since a newly onset episode of acute iliac-femoral venous thrombosis varied from 2 to 12 years (averagely - 7.1±3.3 years). The degree of manifestation of PTD was determined by means of the Villalta-Pradoni scale before and 6 months after the operation. Instrumental methods of study included ultrasound duplex scanning (USDS), magnetic resonance and/or multispiral computed venography, and contrast-enhanced X-ray venography. The technical success of the procedure amounted to 91%. In one patient with occlusion of the common and external iliac veins we failed to perform recanalization and stenting. A further one patient developed in-stent and CFV thrombosis on the second postoperative day. An attempt of catheter thrombolysis turned out unsuccessful. There were no wound complications in the postoperative period. Neither was pulmonary artery thromboembolism registered. The dynamic control was carried out by means of USDS before discharge from hospital and at 1, 3 and 6 months after the intervention. The outcomes of hybrid operations after 6 months were followed up in five patients. Secondary patency rate of the stented iliac veins amounted to 100%. No relapses of trophic ulcers were observed. According to the Villalta-Prandoni scale the value of the median of the composite index decreased from 15 to 7 (p=0.012). The first experience with hybrid operations for obstructive lesions of veins of the iliac-femoral segment demonstrated their high efficacy and safety. Efficiency of the operation was confirmed by significant clinical improvement and good results of patency of the restored-repaired segments of veins.

The present study was aimed at analyzing the remote results of the operation of cross-over autovenous bypass at terms varying from 2 to 28 years in a total of 68 patients presenting with unilateral post-thrombotic occlusive lesions of iliac veins and in 12 patients operated on for obstruction of the femoral vein (saphenopopliteal bypass grafting). The obtained findings showed that a decisive factor of successful cross-over bypass grafting was a sufficient diameter of the autovenous transplant (not less than 7-8 mm). It was determined that in 70.6% of patients the cross-over bypass grafts become dilated with time and thus provide adequate outflow of blood from the affected extremity. Studies of the phlebodynamics in the diseased limb under the conditions of an open and cross-clamped shunt demonstrated that in 72% of patients the main function on carrying out venous return is performed by a cross-over shunt. Some shunts (20.7%) undergo pathological transformation in the form of deforming ectasias and cicatricial stenosis, which in many cases deteriorates the conditions of the outflow of blood and requires secondary surgical correction of the shunts. These operations were successfully performed in patients in the remote terms. Patency of the grafts at 15 years of follow up amounted to 79.6%. There was significant improvement of the outcomes of the bypassing operation observed in application of distal arteriovenous fistulas. A permanent clinical effect was achieved in 74.4% of patients with the functioning shunts. Patency of the saphenopopliteal shunts within the follow-up terms up to 12 years amounted to 91.7%. The remote results showed their reliable function and improvement of the regional phlebodynamics. It was determined that the shunts could function for a long time, not undergoing pathological ectasia. Forty-eight patients during dynamic follow up were subjected to operations on superficial and perforant veins with predominant application of minimally invasive technologies.В настоящем исследовании приводится анализ отдаленных результатов операции перекрестного аутовенозного шунтирования в сроки от 2 до 28 лет у 68 пациентов с односторонними посттромботическими окклюзирующими поражениями подвздошных вен и 12 больных, оперированных по поводу обструкции бедренной вены (сафенопоплитеальное шунтирование). Показано, что решающим фактором успеха перекрестного шунтирования является достаточный диаметр аутовенозного трансплантата (не менее 7–8 мм). Установлено, что у 70,6% пациентов перекрестные шунты со временем расширяются и обеспечивают адекватный отток крови из пораженной конечности. Исследования флебогемодинамики в больной конечности в условиях открытого и пережатого шунта показали, что у 72% пациентов основную функцию по осуществлению венозного возврата выполняет перекрестный шунт. Часть шунтов (20,7%) претерпевает патологическую трансформацию в виде деформирующих эктазий и рубцового стеноза, что во многих случаях ухудшает условия оттока крови и требует повторной хирургической коррекции шунтов. Эти операции успешно выполнены у пациентов в отдаленные сроки. Проходимость шунтов в сроки наблюдения через 15 лет составила 79,6%. Отмечено существенное улучшение результатов шунтирующей операции при применении дистальных артериовенозных фистул. Стойкий клинический эффект достигнут у 74,4% пациентов с функционирующими шунтами. Проходимость сафенопоплитеальных шунтов в сроки наблюдения до 12 лет составила 91,7%. Отдаленные результаты показали их надежную функцию и улучшение регионарной флебогемодинамики. Установлено, что шунты могут длительно функционировать, не подвергаясь патологической эктазии. У 48 больных в процессе динамического наблюдения выполнены операции на поверхностных и перфорантных венах с преимущественным применением миниинвазивных технологий.

The study was aimed at improving the results of carotid endarterectomy (CEA) by means of improving technical methods of performing reconstruction of the carotid bifurcation.From January 2012 to December 2014 at the Department of Vascular Surgery we performed a total of 703 CEA operations, including 183 (26%) according to the classical technique and 520 (74%) according to the eversion technique. The average age of patients amounted to 61.8±9.5 years. Operations were performed in patients with more than 70% stenoses of the internal carotid artery (ICA). 673 reconstructions were performed under general anaesthesia and 30 under the regional one. The preoperative examination included ultrasound duplex scanning (USDS), transcranial dopplerography, transcranial duplex scanning, magnetic resonance tomography (angiography). The technical result of the operation was assessed by means of intraoperative USDS. 62 (9%) patients underwent eversion CEA with prolongation of the cut on the ICA and external carotid artery (ECA) with the formation of an "extended" anastomosis between them. 28 (4%) patients were subjected to the classical CEA with the use of the technique of formation of a new bifurcation of the carotid artery by means of Y-shaped arteriotomy of the common carotid artery, ICA and ECA. In order to prevent flotation of the proximal portion of the atherosclerotic plaque cut in the common carotid artery it was fixed by II-shaped sutures. The remote results of eversion CEA with the creation of the "extended" anastomosis were followed up in 42 (68%) patients within the terms of 21±8 months. There were neither lethal outcomes nor strokes. Significant stenosis (more than 70% of the ICA lumen) was revealed in one patient. After CEA with the formation of a new bifurcation in the immediate postoperative period there were no cerebral circulation impairments. 18 (64%) patients were examined in the remote terms (21±9 months). There were neither lethal outcomes nor strokes. The check USDS revealed no significant restenoses of carotid arteries. Conclusion were drawn that preliminary marking of the carotid bifurcation with the help of USDS made it possible to optimize the length of the approach during CEA. The routine application of intraoperative USDS gives a possibility to reveal floating portions of the intima, thrombotic masses and to timely take measures aimed at removing these defects. The method of forming a new bifurcation of the carotid artery may be used in prolonged stenotic lesions of carotid arteries. This makes it possible to avoid the use of a synthetic patch with possible unfavourable aftermaths, thus considerably shortening the duration of the main stage of reconstruction.Цель исследования – улучшить результаты каротидной эндартерэктомии (КЭАЭ) путем совершенствования технических приемов выполнения реконструкции каротидной бифуркации. Материалы и методы: с января 2012 по декабрь 2014 гг. в отделении сосудистой хирургии выполнено 703 операции КЭАЭ, в т.ч. 183 (26%) по классической методике и 520 (74%) по эверсионной. Средний возраст больных составил 61,8±9,5 лет. Операции выполнялись пациентам со стенозами внутренней сонной артерии (ВСА) более 70%. Под общей анестезией выполнены 673 реконструкции, под регионарной – 30. Предоперационное обследование включало ультразвуковое дуплексное сканирование (УЗДС), транскраниальную допплерографию, транскраниальное дуплексное сканирование, магнитно-резонансную томографию (ангиографию). Технический результат операции оценивался с помощью интраоперационного УЗДС. У 62 (9%) пациентов применялся метод эверсионной КЭАЭ с пролонгацией разреза на ВСА и наружную сонную артерию (НСА) с формированием «продленного» анастомоза между ними. У 28 (4%) больных использовалась классическая КЭАЭ с применением техники формирования новой бифуркации сонной артерии путем Y-образной артериотомии общей сонной артерии, ВСА и НСА. Для предупреждения флотации проксимального отрезка пересеченной в общей сонной артерии атеросклеротической бляшки проводилась ее фиксация П-образными швами. Отдаленные результаты эверсионной КЭАЭ с созданием «продленного» анастомоза прослежены у 42 (68%) больных в сроки 21±8 месяцев. Летальных исходов и инсультов не было. Значимый рестеноз (более 70% просвета ВСА) был выявлен у одного пациента. После КЭАЭ с формированием новой бифуркации в ближайшем послеоперационном периоде нарушений мозгового кровообращения не было. В отдаленные сроки (21±9 месяцев) обследованы 18 (64%) больных. Летальных исходов и инсультов не наблюдалось. При контрольном УЗДС значимых рестенозов сонных артерий не выявлено. Сделаны выводы, что предварительная разметка каротидной бифуркации с помощью УЗДС позволяет оптимизировать протяженность доступа при КЭАЭ. Рутинное применение интраоперационного УЗДС дает возможность выявить флотирующие участки интимы, тромботические массы и своевременно принять меры к устранению этих дефектов. Метод формирования новой бифуркации сонной артерии может применяться при пролонгированных стенотических поражениях сонных артерий. Он позволяет избежать применения синтетической заплаты с возможными неблагоприятными последствиями. При этом существенно сокращается продолжительность основного этапа реконструкции.

Post-thrombotic iliac vein lesion is one of the causes of secondary pelvic varicose veins (PVV) in women. Endovascular treatment of this cohort of patients requires further studies.The study was undertaken to investigate the aspects of endovascular treatment of female patients diagnosed as having PVV secondary to post-thrombotic alterations of the iliac veins.Presented herein are the results of diagnosis and treatment of nine women suffering from PVV in obstructive lesion of the iliac veins. All patients underwent phlebography with stenting of the iliac veins, followed by clinical and instrumental assessment of efficacy of treatment.The technical success rate of stenting amounted to 100%. In the early postoperative period thrombotic complications developed in two women and in the remote period in one. The operation was followed by a decrease in the intensity of PVV manifestations, as well as chronic venous insufficiency of the lower limbs, which was confirmed by clinical and instrumental methods of objectification and visualization. The composite index of quality of life was noted to decrease from 47±5.3 to 27.8±3.3 points (p0.05). The median of the composite value of the Pelvic Venous Clinical Severity Score decreased by 8.6±1.8 points (p0.05). The average value of the composite index of the Venous Clinical Severity Score (VCSS) diminished by 6.8±1.4 points (p0.05) and that of the Villalta score by 8.3±1.6 points (p0.05).Pelvic varicose veins appear to develop in two of three women after endured thrombosis. The experience with stenting of the iliac veins demonstrated good efficacy and safety. Efficiency of the intervention was determined by improved quality of life of the patients and positive dynamics of the clinical course of the disease.Посттромботическое поражение подвздошных вен является одной из причин возникновения вторичной варикозной болезни таза (ВБТ) у женщин. Эндоваскулярное лечение этих пациенток требует дальнейших исследований. Цель - изучение аспектов эндоваскулярного лечения пациенток с вторичной ВБТ, обусловленной посттромботическими изменениями подвздошных вен. Материалы и методы. Приведены результаты диагностики и лечения девяти пациенток с ВБТ при обструктивном поражении подвздошных вен. Всем пациенткам выполнена флебография со стентированием подвздошных вен с последующей клинической и инструментальной оценкой эффективности лечения. Результаты. Технический успех стентирования составил 100%. В раннем послеоперационном периоде тромботические осложнения развились у двух пациенток, в отдаленном - у одной. После операции отмечали снижение интенсивности проявлений ВБТ, а также хронической венозной недостаточности нижних конечностей, доказанное клиническими и инструментальными методами объективизации и визуализации. Зарегистрировано уменьшение глобального индекса качества жизни ? с 47±5,3 до 27,8±3,3 балла (p0,05). Снижение медианы суммарного показателя клинической шкалы оценки тяжести ВБТ составило 8,6±1,8 балла (p0,05). Среднее значение суммарного показателя клинической шкалы оценки тяжести хронической венозной недостаточности нижних конечностей (Venous Clinical Severity Score - VCSS) снизилось на 6,8±1,4 балла (p0,05), по шкале Виллалта (Villaltа) - на 8,3±1,6 балла (p0,05). Заключение. Варикозная болезнь таза развивается у двух женщин из трех после перенесенного тромбоза. Опыт стентирования подвздошных вен показал хорошую результативность и безопасность. Эффективность вмешательства обусловлена улучшением качества жизни пациенток и положительной динамикой клинического течения заболевания.

The purpose of the study was to determine the criteria for instability of atherosclerotic plaques in carotid arteries with the use of improved and new diagnostic techniques. The study enrolled a total of 92 patients examined with the help of instrumental methods of diagnosis, including ultrasound triplex scanning, magnetic resonance imaging and multislice computed tomography. All patients were subjected to the operation of carotid endarterectomy in various standard modifications. The specimens of atherosclerotic plaques taken intraoperatively were examined with the help of morphological, immunofluorescent methods, electron paramagnetic resonance, electron microscopy. A multivariate logistic regression analysis demonstrated that the plaques with an area over 90 mm2 (OR 4.05; 95% CI 1.32-13.2; p=0.006), a volume of more than 0.6 cm3 (OR 2.72; 95% CI 1.05-9.58; p=0.04), and the JBA value of not less than 8 mm2 (OR 2.82; 95% CI 1.22-6.23; p=0.02) were statistically significant independent predictors of histologically verified unstable plaques. The results were compared to the findings of histological methods. In patients with the above mentioned ultrasonographic parameters, unstable plaques were encountered in 94% of cases. Immunofluorescent assay demonstrated a significant increase in the number of inflammatory markers (CD68+, CD36+ cells), as well as CD31+ cells as markers of neovasculogenesis in unstable plaques. According to the findings of electron paramagnetic resonance, bivalent manganese is a marker of plaque instability. Further studies will help reveal the mechanisms of plaque calcification. A decrease in the content of manganese correlated with an increase in the degree of plaque calcification (r =-0.69, p0.01). This serves as indirect evidence of a destabilizing effect of calcification on plaque stability. It was demonstrated that ultrasound elastography makes it possible to significantly extend the capabilities of standard ultrasound examination in detecting instability of atherosclerotic plaques in carotid arteries.Целью исследования явилось определение критериев нестабильности атеросклеротических бляшек сонных артерий с применением усовершенствованных и новых технологий диагностики. В исследование включены 92 больных, обследованных с помощью инструментальных методов диагностики, включающих ультразвуковое триплексное сканирование, магнитно-резонансную и мультиспиральную компьютерную томографию. Всем пациентам проведена операция каротидной эндартерэктомии в различных стандартных модификациях. Образцы атеросклеротических бляшек, взятых во время операции, исследованы с помощью морфологических, иммунофлюоресцентных методов, электронного парамагнитного резонанса, электронной микроскопии. Мультивариантный логистический регрессионный анализ показал, что бляшки площадью более 90 мм2 (ОШ 4,05; 95%-й ДИ 1,32-13,2; p=0,006), индексом объема более 0,6 см3 (ОШ 2,72; 95%-й ДИ 1,05–9,58; p=0,04), значением JBA не менее 8 мм2 (ОШ 2,82; 95%-й ДИ 1,22–6,23; p=0,02) являются статистически значимыми независимыми предикторами гистологически верифицированных нестабильных бляшек. Результаты сравнивались с данными гистологических методов. У пациентов с приведенными выше ультразвуковыми показателями нестабильные бляшки встречались в 94% случаев. Иммунофлюорецентный анализ продемонстрировал существенное повышение количества маркеров воспаления (CD68+, CD36+ клеток), а также CD31+ клеток как маркеров неоваскулогенеза в нестабильных бляшках. По данным электронного парамагнитного резонанса двухвалентный марганец является маркером нестабильности бляшки. Дальнейшие исследования помогут выявить механизмы ее кальцификации. Уменьшение содержания марганца коррелирует с увеличением степени кальцификации бляшки (r=-0,69, p0,01). Это служит косвенным свидетельством дестабилизирующего влияния кальциноза на стабильность бляшки. Показано, что ультразвуковая эластография позволяет существенно расширить возможности стандартного ультразвукового исследования в выявлении нестабильности атеросклеротических бляшек сонных артерий.

Analysed herein are the results of examining and treating a total of 290 patients presenting with relapses of varicose disease, including 198 women and 92 men. The patients' age averaged 51.6 ± 8.7 years, with the mean term of the appearance of relapses after surgery amounting to 4.8 ± 1.4 years and that of reoperation - 11.1 ± 7.5 years. According to the CEAP classification, the patients were subdivided as follows: C2 - 36 (12.4 %), С3 - 117 (40.4 %), С4 - 103 (35.5 %), С5 - 20 (6.9 %), С6 - 14 (4.8 %). All patients underwent ultrasound duplex scanning. Relapses in the basin of the great saphenous vein were revealed in 205 (70.63 %) patients, in the basin of the small saphenous vein in 65 (22.4 %) subjects. Neoangiogenesis was observed in 62 (21.3 %) cases, pathological reflux from pelvic veins as a cause of relapses - in 31 (10.7 %) patients, varicosity-altered tributaries of the great and small saphenous veins, not connected with the pathological stump or unremoved trunk - in 52 (17.9 %) cases. Based on the results of diagnosis, treatment was carried out in 241 patients. 179 patients underwent various types of interventions, of these, 94 with the use of minimally invasive therapeutic technologies. 76 patients were subjected to different methods of phlebosclerosing treatment, of these 62 in outpatient conditions. The study showed negative influence of axial reflux along through deep veins on the appearance and course of varicose veins relapses. The remote results of treatment at terms from one year to 9 years (mean 4.9 ± 2.6 years) were studied in 76 patients. Good results were noted in 52 (68.5 %) patients, satisfactory outcomes were observed in 22 (28.9 %), and unsatisfactory results - in 2 (2.6 %) patients.

The article reviews the materials of the 29th International Conference of the Russian Association of Angiologists and Vascular Surgeons "New trends and remote results of open endovascular interventions in treatment of vascular patients". Presented herein are the main results of scientific research in carotid surgery (carotid endarterectomy in the acute period of stroke, stenting), reconstructive, endovascular interventions in Leriche syndrome, pathology of lower-limb arteries, present-day technologies of treatment of aortic aneurysms (hybrid operations, endovascular prosthetic repair).

The article deals with is a case report of successful endovascular treatment of a patient with a saccular aneurysm of the infrarenal portion of the abdominal aorta complicated by its rupture into the inferior vena cava with formation of an aortocaval fistula. The patient underwent endoprosthetic repair of the abdominal aorta with the unilateral stent graft Endurant II 32x14-117 mm ("Medtronic") and cross-over femorofemoral bypass. The postoperative period was complicated by acute cardiac insufficiency and pulmonary oedema. After the appropriate intensive therapy lung oedema subsided, the events of cardiac insufficiency disappeared, and haemodynamics stabilized. According to the findings of the control multispiral computed tomography, the fistula does not function, there are no signs of the stent graft's dislocation or endoleak, with the cross-over femorofemoral bypass patent. The patient was discharged in a satisfactory condition.

The present work was based on analysing the results of a complex examination and surgical treatment of 16-to-78-year-old patients presenting with varicose disease during the period from 2006 to 2010. A total of 1,095 limbs were examined and operated on in 1,070 patients. Of these, 298 (29.6 %) were men, and 709 (70.4 %) women. The distribution of the patients according to the CEAP clinical classification was as follows: C1 - 3 patients, C2 - 215, C3 - 566, C4 - 203, C5 - 29, and C6 - 79 subjects. All patients underwent ultrasonic duplex scanning, with retrograde phlebography performed in 21 cases. 51.2% of patients were diagnosed as having pathological deep venous reflux. In the group of patients with valvular insufficiency of deep veins, a total of 93 operations aimed at correcting deep reflux were performed, including 12 interventions for congenital avalvulation of veins. The indications for restorative operations on the valvular apparatus of deep veins were determined in severe forms of chronic venous insufficiency combined with axial reflux along deep veins in cases of inefficiency of conventional methods of surgical and conservative treatment. The long-term outcomes of surgery were assessed after 18-48 months. The results were evaluated by means of clinical and instrumental methods of examination: the disease severity scale, patients quality of life questionnaire, ultrasonographic and roentgen contrast methods of examination, and legometry. The operations aimed at restoring the valvular function of the femoral veins turned out to be effective methods of correcting venous reflux and made it possible to restore the valvular function in 84% of cases. In the remote postoperative period valvular competence was observed in 74.6% of patients. Carrying out such operations significantly improve the course of the disease due to decreasing the malleolar volume (p0.001), manifestations of symptoms of chronic venous insufficiency (p0.001), and improving quality of life (p0.001).

Atherosclerotic occlusions of the abdominal aorta and arteries of the lower limbs are the commonest pathology of the arterial system. General growth of primary reconstructive operations on the abdominal aorta and peripheral arteries is accompanied and followed by the increased number of patients presenting with various postoperative complications of a specific character, such as early and late re-occlusions of the postoperative segments. Besides, currently important remains the problem concerning effective and safe management of acute occlusions of peripheral arteries not subjected to reconstruction. One of the promising methods of treatment for acute arterial occlusion is thrombolytic therapy. Presented herein is a review of the literature concerning the state of the art of thrombolytic therapy in acute occlusions of peripheral arteries.

The author herein gives a comprehensive review of the materials of the Annual Congress "Controversies and Updates in Vascular Surgery" held on January 17-19, 2013 in Paris, thoroughly analysing the most important reports concerning achievements and results of scientific studies in the area of modern technologies pertaining to management of aortic aneurysms, endovascular surgery of carotid and peripheral arteries, also covering various aspects of progress in diagnosis and treatment of venous pathology.

The article deals with a case report of successful hybrid surgical treatment of a patient presenting with a posttraumatic large false saccular aneurysm of the aortic arch with mediastinal displacement and compression of the left recurrent laryngeal nerve and trachea. The patient was subjected to a hybrid operation, i. e., bypass grafting of the brachiocephalic trunk and the left common carotid artery with a bifurcation prosthesis from the ascending aorta through sternotomy, carotid-vertebral and carotid-subclavian bypass grafting on the left in a combination with endoprosthetic repair of the aortic arch with the stent graft Valiant Thoracic 40 × 224 mm (VAMF 4040c200TE) manufactured by the Medtronic Company. The postoperative period was uneventful followed by rather rapid rehabilitation of the patient. One month after the operation, the clinical state improved considerably. His voice restored virtually completely, and breathlessness disappeared. According to the findings of MSCT angiography, the aneurysmatic cavity is thrombosed, with the stent graft showing no evidence of either dislocation or endoleak. The bifurcation bypass graft is functioning. According to the data of duplex scanning, the anastomoses established on the neck are patent.

The study was aimed at determining the prevalence of carotid artery stenoses while carrying out a screening population examination and at specifying the indications for endarterectomy in symptom-free patients. We carried out a screening examination by means of duplex scanning of 624 people (495 men and 129 women) aged over 50 years old and having no transient or persistent neurological symptoms or a history of an endured ischaemic stroke. The patients' average age amounted to 58.8±8.7 years. The examined patients were subdivided into two groups. Group One was composed of 485 patients presenting with various risk factors for the development of stroke: arterial hypertension, CAD, diabetes mellitus, hereditary predisposition. Group Two consisted of 139 subjects with no evident manifesting signs of cardiovascular diseases. The frequency of revealing ICA stenoses50% in the group comprising patients with risk factors (14.8%) was significantly higher (p = 0.002) than that (4.5%) in the group of apparently healthy people. From 2009 to 2011 the operation of carotid endarterectomy (CEA) was performed in 89 (15.9% of the total number of CEA) patients with asymptomatic stenoses of carotid arteries (ASCA), ICA stenting was performed in 15 patients. CEA in patients with asymptomatic lesions was carried out in ICA stenoses from 70 to 99%, and in a series of patients with unstable and ulcerated plaques with a high degree of embolization according to the findings of TCDG in stenoses from 60% and more. There were neither strokes nor lethal outcomes after the operations. Also given is a brief review of the literature covering contemporary problems concerning ASCA.

Presented herein is a clinical case report concerning surgical treatment of arterial insufficiency of the upper limb having developed on the background of thrombosis in an 85-year-old male patient. The cope of the operation was subclavian-brachial bypass grafting. Cephalic vein (v. cephlalica) was used as a graft in "in situ" position. The patient was examined 11 months after the operation, with the shunt functioning well.

Presented herein is a clinical case report of successful surgical treatment (open and endovascular operation) of a patient with DeBakey type III B chronic aortic dissection. The diagnosis was verified by contrast-enhanced multispiral computed tomography (MSCT). The first stage consisted in operation of carotid-subclavian bypass grafting and aortomy with dissection of the internal membrane of the abdominal aorta, dividing the false and true channels. The second stage included endovascular prosthetic repair of the thoracic aorta with the Relay stent graft. The course of the postoperative period was uneventful. According to the MSCT findings 2 months after the intervention, the endograft was patent, with neither shift nor endoleack. The false channel along the descending thoracic aorta is thrombosed. The maximal diameter of the abdominal aorta does not exceed 4 cm. According to the findings of duplex scanning, the carotid-subclavian bypass is functioning. The patient's condition is satisfactory.

The study was based on the findings of examination and treatment of fifty-four 19-to-55- year-old female patients (mean age 35.3 ± 7.3 years) presenting with varicosity of small pelvis veins. Of these, seventeen women with stenosis of the left renal vein were subjected to the following reconstructive operations on small pelvis veins: creating proximal ovarian-iliac anastomoses - 10 procedures, establishment of sapheno-ovarian anastomoses - 5 operations, one procedure of prosthetic repair of the left renal vein and one operation of transposition of the left renal vein. All interventions were completed with resection of the distal segments of the ovarian vein. A further 19 women with idiopathic reflux along the ovarian veins underwent uni- or bilateral embolization thereof, with multi-stage embolization of the branches of the internal iliac vein performed in one patient. The remaining eighteen endured the following interventions: unilateral resection of the left ovarian vein performed in twelve cases (3 endoscopic operations), bilateral resection in four cases (3 endoscopic resections). In seven cases the operations were supplemented with microphlebectomy of the varicosely altered perineal veins. Two patients underwent operations of crossectomy and resection of the pathologically altered internal pudendal vein. Five-year follow up showed that good-to-satisfactory results were obtained in 45 (83.3%) cases, with a disease relapse revealed in seven cases.

The present study was aimed at specifying the indications for operations performed on carotid arteries in an acute period of ischaemic stroke and assessing the results thus obtained. Between January 2008 and July 2010, we carried out a total of 372 operations on carotid arteries in three hundred and sixty patients. Of these, thirty-two subjects were operated on in an acute period of stroke. Neurovisualization was performed by means of magnetic resonance imaging (MRI) and computed tomography (CT). The condition of the carotid arteries was assessed by means of duplex scanning (DS). The operations performed on the carotid arteries were as follows: thrombembolectomy (n=4), carotid thrombendarterectomy (n 5), carotid endarterectomy (CEAE, n=21), and stent grafting of the internal carotid arteries (1СA, n 2). Five CEAE operations were carried out after thrombolysis. The interventions on the carotid arteries were performed within 6 hours to 12 days from the onset of the first symptoms of ischaemic stroke. Neurologists were actively engaged in both determining the indications for the operations and monitoring of neurological functions. There were no perioperative complications encountered. Regression of the neurological deficit during 7 days of in-hospital follow up occurred in sixteen patients (50%) (neurological deficit scoring 1-2 by the Rankin scale). One patient (3%) developed ischaemic stroke on postoperative day 3 after CEAE. Two patients were diagnosed as having transitory ischaemic attacks. Stenting turned out successful in the both patients. The remote results at terms ranging from 12 months to 2 years were followed up in fifteen patients. Of these, twelve patients (80%) showed complete restoration of neurological functions (Rankin scale scoring 0). Neither lethal outcomes nor relapsing strokes were observed over the follow-up period. The obtained outcomes strongly suggest certain advantages and advisability of active surgical policy of treating patients presenting in an acute stage of ischaemic stroke, with appropriate observance of the strict indications for the intervention.

The authors share herein their first experience gained in stenting for stenosing and occlusive lesions of the iliac-femoral segment veins, reporting the outcomes of treating a total of thirteen patients subjected to balloon angioplasty and stenting of iliac veins for chronic venous obstruction. While treating non-thrombotic venous lesions, stenting was successfully performed in 100% of the patients concerned. Inpost-thrombotic lesions therapeutic outcomes were successful in 9 (75%) patients. No immediate postoperative complications were observed. The remote results were followed up in eleven out of the 13 patients. Patency within the terms up to 16 months amounted to 81.1%. Clinical improvement was noted in 12 (92.3%) patients. According to the VCSS scale, there was a reliable decrease in the intensity of chronic venous insufficiency manifestations along all parameters. The integral index decreased from 6.56+/-0.71 to 4.45+/-0.65 (t=3.82, p0.002). The malleolar volume decreased from 275.3+/-6.7 to 241.6+/-6.1mm (t=12.3, p0.001). Hence, angioplasty and stent-grafting of iliofemoral veins turned out to be a minimally invasive, safe, and highly efficient therapeutic modality. The efficacy of the procedure was confirmed by a considerable improvement of the limb's condition and good remote results concerning patency of the reconstructed segments of the venous bed. Endovascular methods may be considered as a promising modality of treatment for this patient cohort.

The authors analysed a total of 152 surgical interventions on the brachiocephalic arteries (BCAs) performed in 142 patients. All the patients were subjected to intraoperative monitoring of cerebral haemodynamics by means of transcranial Doppler (TCD) ultrasonography simultaneously accompanied by electroencephalography (EEG). Additionally, the state of the reconstructed carotid arteries was controlled by means of ultrasonographic duplex scanning (USDS). Comparing the findings of the TCD recording and EEG made it possible to single out 5 groups of the operated patients. The EEG technique turned out to have more informative value as compared with TCD ultrasonography in determining the degree of cerebral ischaemia during clamping of the carotid arteries (CAs). Nine (5.9%) patients demonstrated lower tolerance of the brain to ischaemia, and the operation on the BCA was performed with the use of a temporal intraluminal bypass graft. Microembolic signals (MES) were registered in 54.6% of cases. Single MES were detected in six patients, sporadic MES--in 53, and multiple MES--in 24. Mention should be made that the--MES associated with the placement of the bypass graft appeared to be multiple and were registered in all the operated patients. Diffusion-weighted magnetic resonance tomography revealed fresh foci of lacunar cerebral infarctions in 14 (25%) of the 56 patients thus examined. Intraoperative USDS of the reconstructed carotid arteries revealed floatation of the residual remnants of the intima in two patients, which was the cause of a repeat intervention. Combined monitoring of cerebral haemodynamics makes it possible to timely prevent cerebral ischaemia, to narrow the indications for placement of an intraluminal bypass graft, and to dramatically decrease the rate of postoperative complications.

Presented herein is a clinical case report concerning surgical management of a rare-localization arteriovenous fistula, i.e., between the superior mesenteric artery and vein (the system of the portal vein) complicated by portal hypertension and ascites in a 67-year-old male patient. The check examination performed one month after the operation revealed no signs of either portal hypertension or ascites.

The article deals with a new method of diagnosis of venous thromboses, which is based on ultrasonographic scanning of the area of the valvular sinuses of the femoral vein. The authors examined a total of two hundred and forty-nine people; of these, 100 patients were diagnosed as having varicose disease, 99 subjects had acute venous thrombosis, and 50 people constituted the control group. All the patients were examined by means of ultrasonographic angioscanning, and also had the D-dimer level measured in them. The carried out study resulted in a description of an ultrasonographic phenomenon consisting in the presence of echo-positive inclusions within the area of the valvular sinuses, which was called the sludge phenomenon. The authors developed a classification of this phenomenon, describing three degrees of sludge. Degree 1 sludge is a physiological one and reflects the fact that the area of the valvular sinuses is the most thrombogenic zone. Degree 2 sludge is characterized as a pathological one, being indicative of the presence of a prethrombotic condition and may serve as one of the earliest prognostic factors for the development of venous thrombosis. Degree 3 sludge reflects thrombosis of the valvular sinus. The carried out studies made it possible to reveal a correlation between the presence of a sludge, its degree, the presence of a venous thrombosis, and the values of the D-dimer level.

In order to work out the indications for surgical and endovascular treatment of floating thromboses in the system of the inferior vena cava (IVC) and to evaluate the therapeutic outcomes obtained we examined a total of one hundred and forty-five 17-to-85-year-old patients presenting with acute thrombosis in the system of the IVC. Of these, floating thromboses were revealed in ninety-five patients. The most frequently encountered localization of the floating thrombus was the common femoral vein (CFV). In 77 patients, thrombosis originatedfrom the femoral vein (FV), and in 12 instances -from the saphenofemoral junction. The signs of pulmonary thromboembolism (PTE) were diagnosed in 22 cases. Instrumental studies included ultrasonographic duplex scanning (USDS), roentgenopaque and computer-assisted phlebography, and perfusion-mediated scintigraphy of the lungs. Thrombectomy from the common iliac vein (CIV), external iliac vein (EIV) and common femoral vein (CFV) with resection of the femoral vein was performed in forty-seven patients; of these, the procedure was combined with establishing a temporal proximal arteriovenous fistula (AVF) in sixteen subjects. The femoral vein was resected in nineteen instances. Thrombectomy form the IVC with the help of the "TREKS" device was carried out in six patients. Cava filters were implanted in a total of eighty-four patients. Of these, ten devices were intended and had to be 3 left for permanent implantation, with the remaining seventy-four patients having received retrievable ones. Rethromboses in the early postoperative period were observed to occur in four patients. The patients with the AVFs applied had no thromboses. PTE occurred in four patients, with one lethal outcome. Another patient died due to myocardial infarction. Temporary cava filters were successfully retrieved in sixty-eight patients within the terms from 10 to 56 postoperative days long-term results up to 2 years were followed up for thirty-eight patients, with good outcomes noted in twenty-six cases, satisfactory in ten, and poor results seen in two patients. An active therapeutic policy pursued in management of floating embolus-hazardous thromboses is the only efficient measure making it possible to reliably prevent the development of both PTE and post-thrombotic disease.

The purpose of this study was to assess the outcomes of using a mini-approach in surgery of carotid arteries. From September 2006 to December 2007, one hundred and twenty-nine patients (with a total of 139 operations sustained) underwent interventions on the carotid bifurcation for atherosclerotic lesions and pathological tortuosity of the carotid arteries. The patients were subdivided into two groups. Group A consisted of those operated on from the standard access to the carotid arteries, with Group B comprising the patients undergoing interventions on the carotid bifurcation from a mini-approach (a cutaneous incision less than 5 cm long, averaging 4.7 +/- 0.3 cm). The control Group C was composed of forty-two patients having endured operations on the carotid arteries from the conventional access performed at other specialised departments. In the patient groups referred to above, we compared the incidence rate of perioperative complications (stroke/death), lesions of the cranial and cervical nerves, as well as wound complications. In Group A patients, there were two patients with stroke, one of whom had eventually died. Neuropathies of the cranial and cervical nerves in this group of patients were observed to have developed in eight (6.2%) and ninety-two (71.3%) cases, respectively, and in Group C patients--in eleven (28.0%) cases. Cervical haematoma was observed in fourteen (10.9%) subjects. The average duration of the postoperative hospital stay amounted to 6.8 +/- 1.1 days. Amongst the Group B patients, cervical haematoma was noted in two (3.2%, P0.0001) cases only. A lesion of the cranial nerves (that of the superior laryngeal nerve) took place in two patients (P0.0001), and that of the cervical nerves--in four patients (P0.0001). No cheloid cicatrices were observed. The patients reported excellent and aesthetically pleasing surgical outcomes. The average duration of the postoperative hospital stay amounted to 2.8 +/- 0.69 days (P = 0.002). Hence, operations on the carotid bifurcation may be successfully performed from a mini-approach, with thus discomfort kept at a minimum and rapid rehabilitation of patients.

The object of the research was to identify role of functional nervous asymmetry in formation of pathology in experimental animals. The role of functional asymmetry of the brain hemispheres in development of ectromelia and melanoma at (CBAxC57BL/6)F1 mice was investigated. It has been established, that mice with domination of motor functions in the left hemisphere ("right-handed") are more resistant against infection with ectromelia virus, and melanoma B-16 grows more slowly in these mice as compated with animals with domination of motor functions of the right hemisphere ("left-handed"). Hence, for the first time the role of functional nervous asymmetry in pathogenesis of ectromelia and melanoma (B-16) in mice (CBAxC57BL/6)F1 is established.

The authors carried out carotid angioplasty and stenting (CAS) in forty-six patients (with a total of 48 interventions performed). Of these, forty-two (91.3%) patients were found to belong to a high-surgical-risk group; The patients years (mean age - 62.1 +/- 8.2 years). Thirty-six patients were found to have symptomatic lesions of the internal carotid arteries (ICAs)70%, and ten had asymptomatic stenoses80%. Twenty-three (50%) patients were diagnosed with grade II cerebrovascular insufficiency (CVI) (transitory ischaemic attacks). Amongst the most frequently encountered accompanying pathologies were various-severity CADs in forty (95.2%) patients, and arterial hypertension in thirty-eight (90.4%). The cerebral blood flow state during CAS interventions was controlled by means of transcranial Doppler ultrasonography in sixteen patients. In twelve patients, the main stage of the intervention was performed under control of ultrasonographic duplex scanning (USDS). The technical success of the operation was achieved in forty-four (95.7%) cases. Failures were primarily caused by impossibility of passing the guidewire catheter in type 3 aortic arch in two patients. Twenty-six (56.5%) patients developed bradycardia and hypotension after CAS. No haemodynamically significant restenoses following CAS within the follow-up terms from 2 to 12 months were observed in twenty-two patients. The article also contains a brief comparative analysis of multicenter randomized studies on the CAS-related problem. In conclusion, the authors note safety and high efficiency of CAS, considering this intervention an alternative to carotid endarterectomy in patients with elevated surgical risk. A USDS-controlled operation significantly broadens the possibilities of the method concerned.

The article describes a case report of successful surgical management of a 58-year-old male patient presenting with a pseudoaneurysm of the proximal anastomosis of the aorto-bifemoral bypass graft complicated by necrosis of the sigmoid colon wall. The patient was operated on 11 months after the first reconstructive operation, i.e. aorto-bifemoral bypass grafting and femoropopliteal bypass grafting for Leriche's syndrome. Clinical manifestations of a false aneurysm of the proximal anastomosis (abdominal pain, presence of a pulsating tumour-like formation) appeared one month after surgery. The diagnosis was verified by ultrasonography, angiography, and CT-angiography. During the repeat operation, it was determined that a large false aneurysm of the abdominal aorta had been caused by a complete cutting through of the anastomosis's sutures more than by half of the semicircle. Intraoperative findings included both a coarse commissural process in the abdominal cavity and 3 x 3 cm "decubital" necrosis of the dolichosigmoid's wall participating in the formation of the wall of the false aneurysm. The surgical procedure consisted in an operation of aneurysmal resection, aorto-bifemoral prosthetic repair, and resection of the dolichosigmoid with the establishment of an interintestinal end-to-side anastomosis and single-barrel preventive sigmoidostoma. After 3 months, the patient was subjected to the operation of intraperitoneal closure of the sigmoidostoma followed by complete recovery.

The purpose of the work was to assess the diagnostic significance of combined bolus magnetic resonance angiography (MRA) and two-dimensional time-of-flight MRA of lower limb arteries as compared to radioangiography in patients with occlusive diseases of lower limb arteries.Twenty-six patients with the symptoms of lower limb ischemia of varying severity were provided bolus MRA with prolonged manual injection of contrast substance and transposition of the MR-tomograph table. Additionally, all the patients underwent two-dimensional time-of-flight (2D TOF) MRA of the leg arteries.The statistic processing of bolus MSA for visualization of the pelvic segment has demonstrated its high sensitivity and specificity (97.74% and 92.31% respectively). On visualization of the femoral artery segment the sensitivity of this modality accounted for 97.57%, the specificity for 94.57%. In patients with severe ischemia, visualization of the leg arteries was difficult. Consequently, the specificity of the modality accounted for 44.58%. However, when this technique was combined with two-dimensional time-of-flight MRA of the leg arteries, the sensitivity and specificity of the modality reached 96.38% and 91.92% respectively.Bolus MRA of lower limb arteries is marked by the high sensitivity and specificity for visualization of the arteries of the iliac and femoral segments. To visualize the leg arteries in patients with severe forms of lower limb ischemia, this modality should be supplemented by two-dimensional time-of-flight MRA.

Combined atherosclerotic involvement of the brachiocephalic arteries (BCA) and lower limb arteries has been analysed in 107 patients (56 females and 51 males) with a verified diagnosis of ischemic heart disease (IHD). BCA atherosclerosis was detected in 83.9% females and 93.1% males. 75.8% examinees had no murmur. It is suggested that arterial hypertension and obesity in females with IHD may be risk factors of BCA kinking. Frequency of combined affection of extracranial arteries and lower limb arteries reached 23.2% females and 96% males. Therefore, it is necessary to screen these arteries for atherosclerosis in all IHD patients.

The aim of the present work was to study the causes of post-operative recurrences of varicosity and to define approaches to their optimal correction. Duplex scanning (DS) with Color Doppler Imaging of the blood flow was used to examine 126 patients (136 extremities) with recurrences of varicosity. The patients were distributed according to the CEAP clinical classification. Altogether 76 patients (78) extremities with recurrences of varicosity were operated on. 27 persons received different variants of sclerotherapy including echoscleroobliteration. According to the DS data, the most frequently obtained finding in patients with recurrences of varicosity was identification of the perforating veins with valvular insufficiency, namely in 120 (or in 88.2%) extremities. The long stump of the greater saphenous vein (CSV) was discovered in 86 (63.2%) extremities, the long stump of the lesser saphenous vein (LSV) in 6 (4.4%), ectasia of LSV trunk was recognised in 20 (14.5%), incompetence of the valves of the sural veins in 12 (8.8%) extremities. Incompetence of the valves of the deep veins was present in 73 (53.6%) patients. No sources of pathological veno-venous runoff were identified in 12 (8.1%) cases. A good agreement was established between the incidence of valvular incompetence of the deep veins and the disease severity. The indications for surgical correction of valvular insufficiency were worked out. It has been demonstrated that sclero-obliteration is the method of choice in the treatment of the recurrences of varices. The long-term results of operations for recurrences of varicosity were followed up in 62 patients over the period of one to 15 years. Good and satisfactory results were obtained in 60 (96.8%) cases. The authors believe that the majority of varicosity recurrences arise from an inadequate assessment of the status of lower extremity venous bed as well as from technical and methodological faults of the operating surgeon. DS in an indispensable component of preoperative examination of patients with varicosity recurrences.