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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.

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.

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.

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.

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 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).

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 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 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.

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.

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 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 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.