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Discussed in the article is the literature data on the background, causes, and mechanisms of the development of degenerative aneurysmatic transformation of the afferent artery in a long-functioning arteriovenous fistula. This is followed by presenting two own clinical case reports concerning the development of pronounced dilatation of arteries during 13 and 25 years of the existence of posttraumatic arteriovenous anastomoses, with a detailed description of the variants of surgical treatment of these patients.

The article deals with the literature data on history of and modern attitude to lumbar sympathectomy in treatment for occlusive lesions of lower-limb peripheral arteries. This is followed by analysing the experience of 1,764 operations both independent and those combined with vascular reconstructions over more than a 45-year period. A conclusion is drawn that lumbar sympathectomy remains an operation associated with minimal traumaticity and a low complication rate, thus for long years improving the quality of life and destiny of patients.В статье приводятся литературные данные об истории и современном отношении к поясничной симпатэктомии в лечении окклюзирующих поражений периферических артерий нижних конечностей. Анализируется опыт 1 764 самостоятельных и сочетанных с сосудистыми реконструкциями операций за более чем 45 летний период. Делается вывод, что поясничная симпатэктомия остается операцией с минимальной травматичностью, с низким уровнем осложнений, которая на многие годы улучшает качество жизни и судьбу больных.

review in the article are opinions and experience of outstanding academic military surgeons, participants of the Great Patriotic war: Burdenko N N., Kupriyanov P.A., Akhutin M.N., Banaitis A.I., Elansky N.N, Petrovsky B.V., and others. The methods they worked out and practically implemented made it possible to substantially improve the outcomes of gunshot wounds and vascular lesions.

Presented in the article are the results of examination and treatment of 65 patients with infectious wound complications of the sternotomic injury after open heart surgery. The main risk factors for their development in our patients were as follows: obesity, chronic obstructive pulmonary disease, diabetes mellitus, severe heart failure, prolonged operation, sternal instability. The leading pathogenic microorganisms were Gram positive staphylococci. Treatment varied from prolonged antibiotic therapy with surgical debridement of the wound to subtotal resection of the sternum with various plastic reconstructive interventions. The scope of treatment was determined by the type and severity of infectious wound complications. Due to lack of standardized approaches in diagnosis, treatment and prevention this problem remains to be of current importance.

Treatment results of 48 patients with mediastinitis after the open cardiac surgery were analyzed. The main mediastinitis risk factors were: the chronic obstructive lung desease, diabetes mekkitus, severe cardiac insufficiency, prolonged operation, the use of artificial blood circulation and sterna instsbility. Major infective agents of mediastinitis were the Gram-positive cocci. The treatment options varied from the prolonged antibiotic therapy to plastic reconstructive surgery, which were determined by the severity of mediastinitis.

110 years since the birth of a famous scientist, Professor Lieutenant General Medical Service Arcadiy Alekseevich Bocharov (23.09.1901-2707.1970). In 1961 he was deputy chief surgeon of the Department of Defense and the chief surgeon of the Central Hospital n. a. P.V. Mandryka. In 1967 A.A. Bocharov became chief surgeon of the Central Military Clinical Hospital n.a. A.A. Vishnevsky. He owns more than 80 scientific publications section of multi-volume work "The experience of Soviet medicine in the Great Patriotic War of 1941-1945".

The study includes data of 139 patients with chronic abdominal ischemia, due to hemodynamically significant occlusion of impaired visceral aortic branches. The diagnosis was confirmed by aortography, computed tomoangiography and duplex color angioscanning. Immediate and long-term results of 49 reconstructive and conditionally reconstructive operations, 11 transcutaneous endovascular angioplasty, as well as postoperative complications, were analyzed.

Presented herein are the findings of examination of sixty-two patients with clinical manifestations of chronic abdominal ischaemia predominantly induced by stenosis of the celiac trunk. The authors carried out a comparative analysis of efficacy of instrumental methods of diagnosis of chronic abdominal ischaemia syndrome, having also investigated the lesions of the visceral branches by the findings of angiography. Also presented herein are the outcomes of various methods of surgical correction: 47 reconstructive and conditionally reconstructive operations, 10 transcutaneous endovascular angioplasties, also considering complications of the immediate postoperative period as well as short- and long-term outcomes of surgical treatment.

During the Great Patriotic War, military medicine gained a wide and versatile experience in organization of rendering medical care for and treatment of millions of the wounded in exceptionally complicated circumstances. The most important mission encountered by the medical service, i. e., salvation and treatment of soldiers was accomplished with honour: more than 72.3% of the wounded and 90.6% of diseased soldiers and officers were returned to the ranks by the Russian medical profession. Soviet surgeons contributed significantly to solving problems of field surgery as a whole and vascular surgery in particular.

There was congested a wide experience of organization and management of scientific work in the 3rd CMCH by Vishnevsky A.A. for a term of more than 40 years. This experience is subjected to generalization, analyze for the purpose of determination of it's priority orientations of improvement. Scientific-methods work in hospital is rated as a complex of measures, organisationaly-planed and coordinated by purpose and reinforcement of scientific schools of the 3rd CMCH by Vishnevsky A.A., as a basis of effective delivery of specialized medical aid. The vector of scientific researches is directed, generally, to solving questions of military and field medicine.

During the First World War wounds of vessels took 0,3-1,5% of all wounds, and lethality - 10-22%. Experience of vascular treatment, get by military-field surgeons during this war, was great. They have demonstrated advantage of vascular seam of bandage of vessels in conditions of their damages. Russian surgeons-participants of the First World War have formed the base, on which russian vascular surgery was advancing not only during wars, but also during peace-time.

The proffered paper provides the information about rendering surgical care for the wounded presenting with vascular injuries inflicted and sustained during wars Russia was engaged in, to be followed by a detailed description of the haemorrhage-arresting methods and techniques used in N. I. Pirogov's time, during World War I, the Great Patriotic War, as well as in local military conflicts and combat operations. Also depicted herein is the role surgeons of Russia have played in the development of vascular surgery, and, finally, due coverage is given to the statistical data concerning the methods of rendering care for those having suffered firearm wounds and injuries involving vascular lesions.

The problem of effectuating of a specialized aid to the patients with damages of vessels, enlargement of the patients with cardio- and vessel-diseases, a high lethality and invalidization formed a need for organization of specialized units. The first staff unit of vessel-surgery in the Armed Forces was created in 1968 in CMCH of Vishnevsky A.A. Since 1981 hospital became the main base of preparing vessel-surgeons. The author showed the role of prime specialists in elaborating and development of a new direction in treatment of the patients with cardio- and vessel-damages.

Nineteen patients with aneurysms of the popliteal artery have been operated. Indications and type of surgery were determined on the basis of the clinical picture, angiography and duplex scanning data. There were 19 surgeries: ligation of afferent and efferent vessels of aneurysm with auto-venous grafting (8), resection of aneurysm with auto-venous grafting (5), dissection of aneurysm with auto-venous grafting and coverage with duplication from aneurysmatic walls (3), endovascular grafting of aneurysm (2), ligation of afferent vessel of aneurysm (1). In early postoperative period after open surgical revascularizations thrombosis was seen in 4 (25%) patients. One patient died on day 20 after surgery due to decompensation of severe concomitant disease. The patient who has undergone ligation of afferent vessel without revascularization has discharged after compensation of acute ischemia.

Presented herein is a case report concerning successful treatment of the post-traumatic pathological anastomosis between the left external iliac artery and iliac vein using the stent-graft Jostent-graft. The anastomosis emerged after gunshot injury to the abdominal cavity.

The paper analyses vazaprostan administration to 88 patients with lower limb arteriosclerosis obliterans. Effectiveness of the drug is assessed in concordance with initial grade of ischemia.

In the elderly and old patients with atherosclerosis of lower limb arteries, ultrasonic dopplerography assisted study of hemodynamics in foot with use of Valsalva and corinfar tests was carried out. It is revealed that these patients retain high reaction to sympathetic influences. The obtained data were the base for use of lumbar sympathectomy in 419 patients over 65 years as an independent method of surgical treatment and in combination with reconstructive operations on major arteries. Good results were obtained in 70.1% operated patients, satisfactory results--in 22.7%. There were no significant differences in the results of lumbar sympathectomy between this age group and younger patients.

The lumbar sympathectomy was conducted for the grade II (according to Fontaine) obliterating atherosclerosis of the lower extremities arteries in 309 cases as the main method of surgery, and in 426--in concurrence with reconstructive intervention on the main vessels. The indications for and the efficacy of the desympathization in various levels of the main arterial bed affection are discussed.

The article summarizes the experience of the vascular surgery unit of the Vishnevskiĭ Central Military Hospital on treatment of 128 patients with chronic ischemia, namely atherosclerotic affection of aortofemorotibial segment. The authors show the important significance of the use of modern methods in studying the blood magistral and microcirculation. It is recommended to combine surgical and conservative treatment in order to preserve the affected limb. The article also contains determination and classification of chronic critical ischemia.

The work analyses the causes of early postoperative thromboses which occurred after reconstructive operations on the femoro-popliteal segment in 293 patients. Early postoperative thromboses are a frequent complication in reconstructive operations on the vessels and develop in 27% of cases mostly in the first days after the operation. The most frequent causes of early thromboses were deficient distal arterial blood circulation, technical and tactical errors of the intervention, and insufficiently corrected postoperative therapy. It is pointed out that combination of reconstructive operations on the main vessels with lumbar gangliectomy has a favorable effect on the results of treatment and prevention of early thromboses. The use of microsurgical techniques reduces the probability of the development of early postoperative thromboses. In the absence of an effect of repeated operative interventions, in increase of ischemia and intoxication the limb must be amputated before gangrene develops.

The authors summarize the experience of treatment of 178 patients with distal type of obliterated atherosclerosis of arteries of lower limbs. The 2nd stage of this malady was diagnosed in 91 (51.1%) patients; the 3rd stage--in 50 (28.1%); the 4th stage--in 37 (20.8%). 79 (44.4%) patients have received only conservative method of treatment, in 66 (37.1%) patients this method was accompanied by lumbar sympathectomy. Reconstructive operations with connection of one of the shin arteries to bloodstream were conducted in 33 (18.5%) patients. With the aim of improvement of distal artery channel visualization it is necessary to apply the digital subtraction angiography with the help of non-ionic roentgen-contrast preparations after the advanced application of spasmolytics.

A 10-year experience in the analysis of stationary examination and treatment of 163 patients with post-thrombotic disease of lower extremities is given in this article. Surgical treatment was conducted in 102 cases, medical treatment was applied for 61 patients. There is a classification of diseases which defines medical tactics. On the basis of the data obtained during these studies the authors make a conclusion that in cases of varicose, indurative of indurative-ulcerated forms of this disease surgical treatment is indicated in the accordance with the character of vein affection. Otherwise, it is more preferable to apply medical treatment in cases of eodemata.

In 72 patients with obliterative atherosclerosis of the arteries of the lower extremities and diabetes mellitus, the lumbar sympathectomy was performed. A good result was noted in 35 of them, amputation of the extremity was performed in 8 patients. Lumbar sympathectomy is indicated to the patients in initial stages of the disease.