The present work was aimed at comparative assessment of efficacy and risk factors of carotid endarterectomy and carotid stenting in patients suffering from symptomatic stenoses of the internal carotid arteries, with due regard for the degree of the accompanying cardiac pathology, the presence of contralateral occlusion, and severity of chronic cerebrovascular insufficiency. We examined and treated a total of 142 patients diagnosed with stenoses of the internal carotid arteries and symptoms of chronic cerebrovascular insufficiency. In the cohort of those subjected to carotid endarterectomy we performed a total of 76 operations in 73 patients, and in the group of carotid stenting 71 operations of stenting of the internal carotid artery with cerebral protection in 69 patients. Postoperatively we assessed the following parameters: «stroke+lethality», incidence of transitory ischaemi? attacks, incidence rate of cerebrovascular neuropathy, and acute myocardial infarction. In the carotid endarterectomy group, we revealed increased risk for the development of neuropathy of the craniocerebral nerves (OR=0.0564, 95% CI 0.9953, P=0.049). In the group of stenting, we revealed increased risk for the development of transitory ischaemia.
Incidence rate of arterial aneurysms is 3.4-4.6% of that of vascular diseases and has a tendency towards further increase. In National Research Center of Surgery, RAMS, 410 patients with arterial aneurysms of various localization were treated. The majority of the patients were men--221 (65.4%). Surgical procedures were performed in 338 (82.4%) patients. Reconstruction surgeries were performed in 273 (80.8%) patients, ligature surgeries--in 65 (19.2%) patients. In early postoperative period good results (recovery and improvement) were seen more often (p 10 years) were also better after reconstruction than after ligature surgeries.
The study included a total of 110 patients presenting with stenoses of the first portion of the subclavian artery (SCA). Group One comprised 55 (50%) patients subjected to carotid-subclavian bypass grafting. The degree of stenosis varied from 65 to 95% (p>0.05), occlusion of the SCA was found in 28 (p0.05) patients. Concomitant cardiac pathology was observed in 30 (55%) patients, with one (2%) patient having a history of stroke. Group Two was composed of 55 (50%) patients undergoing endovascular interventions. The degree of stenosis varied from 65 to 95%, with eight patients having occlusion of the SCA. Permanent steal syndrome was observed in 36 patients. Accompanying cardiac pathology was noted in 28 (51%) patients, with eight (15%) patients having a history of stroke (p
The authors analysed immediate and remote results of primary "open" reconstructive operations and arterial reconstructions performed after previous stenting of lower-limb arteries. The study comprised a total of 93 patients presenting with lower-limb critical ischaemia. Group One consisted of 46 patients with localization of the lesion of lower-limb arteries above the inguinal ligament. Group Two was composed of 47 patients with localization of lower-limb arteries lesions below the inguinal ligament. Each group was subdivided into two subgroups: subgroups Ia and IIa included patients with previously endured stenting of arteries of the respective segment (23 and 22 patients, respectively), subgroups Ib and IIb included patients previously not subjected to either endovascular or surgical treatment (23 and 25 patients, respectively). All patients underwent "open" reconstructive vascular operations. The outcomes of intervention were assessed at the hospital stage, as well as at 6, 12 and 36 months of consecutive follow up. After 8 months of follow up patency of the shunts in all patients amounted to 100%, with the lower-limb salvage rate of 100%. After 1 year, despite differences between subgroups in each group, they were not statistically significant (p>0.05). After 3 years differences in shunts' patency and lower limb salvage rate in subgroups IIa and IIb were statistically significant (p
It was analyzed the results of surgical treatment of 60 patients with internal carotid artery kinking operated in the department of vascular surgery of acad. B.V. Petrovsky Russian Scientific Center of Surgery of RAN. Indications for surgery included symptoms of cerebrovascular insufficiency (CVI) and instrumentally confirmed hemodynamically significant kinking of ICA. Criteria for surgical treatment were linear flow velocity gradient more than 2 and turbulent blood flow in the kinking segment diagnosed by ultrasonic scanning. All patients were divided into 2 groups depending on methods of surgery. The first group included 36 (60%) patients who underwent resection of ICA with orifice bringing down. The second group included 8 (13%) patients after ICA replacement and 16 (27%) cases with eversion endarterectomy, resection of ICA and orifice bringing down. The analysis of immediate surgery results did not reveal significant differences in dynamics of CVI and velocity parameters in reconstructed ICA (p>0.05). The index "stroke+mortality from stroke" was higher in the second group (p
The authors analyse their experience in surgical management of 325 patients diagnosed with lower limb critical ischaemia (LLCI) secondary to lesions of infrainguinal arteries. Of these, 216 (66.5%) patients (Group 1) were subjected to isolated bypass grafting operations defined as either "reconstructive", or "direct revascularisations". A further 35 (10.8%) patients (Group 2) underwent concomitant revascularizations accompanied simultaneously or in a stagewise manner (but within the time frame of one hospitalization) by reconstructive and palliative operations (e. g., femoropopliteal bypass grafting and lumbar sympathectomy), and 74 (22.7%) patients (Group 3) were subjected to only palliative operations alone (lumbar sympathectomy and revascularizing osteotrephination), i.e., "indirect revascularizations". The remote outcomes of surgical management were followed up within the terms of up to 5 years in 306 (94.2%) of the 325 patients operated on for LLCI. Of these: in 205 (94.9%) of the 216 Group 1 patients, in 33 (94.3%) of the 35 Group 2 patients, and in 68 of the 74 (91.9%) Group 3 patients. Amongst the Group 1 patients (n = 205) over the 5-year follow-up period we had performed a total of 70 (34.1%) amputations of the postoperative extremity and encountered 121 (59.0%) cases of thromboses of the bypass grafts. Of the Group 2 patients (n = 33), over the 5 year follow-up, the postoperative extremities were amputated in 7 (21.2%) patients. Thromboses of the bypass grafts over the same time period were noted to have developed in 11(33.3%) patients. Amongst Group 3 patients (n - 68) the postoperative extremities were saved in 37, with the limb salvage rate thus amounting to 54.4%.
It was estimated an efficiency of surgical and conservative treatment of patients with atherosclerotic carotid arteries stenosis and chronic ischemic optical neuropathy. The first group included 30 patients after carotid endarterectomy. The second group included 20 patients who underwent conservative treatment. The methods of investigation included determination of visual acuity, autorefractometry, direct and inverse ophthalmoscopy under mydriasis, computer static perimetry, assessment of functional status of optic nerve by using of threshold of electric sensitivity and lability, ultrasonic scanning of eyes arteries and carotid arteries. Follow-up terms were baseline, in one month and in one year after surgery or conservative treatment. Improvement of visual acuity on 0.1 and more in 1st/2nd groups was 9/2 (p=0.1629), in one year - 12/1 (p=0.0075). Improvement of field of vision: in 1 month in 1st/2nd groups it was 12/3 (p=0.0692), in 1 year - 17/1 (p=0.0002). The dynamics of neurological status: there was equal ratio of asymptomatic/symptomatic patients at baseline in subgroups. In the 1st group it was 19/11 vs. 16/4 in the 2nd group (p=0.3451). In 1 year after two kinds of treatment significant changes were revealed. There was 26/4 in the 1st group vs. 13/7 in the 2nd group (p=0.0902) with improvement only after carotid endarterectomy - 19/11 at baseline vs. 26/4 in 1 year (p=0.0716). Insignificant deterioration was diagnosed after conservative treatment - 16/4 vs. 13/7 (p=0.4801).