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ABSTRACT: 65 patients with the aortic dissection type B were operated on in the period 1995-2010. The proximal local aortic prosthetics proved to be the method of choice in treatment of such patients. The method allowed the reduction of the hospital lethality on 5,7 ± 3,9% and considerably decrease the overall hospital stay.
Khirurgiia 01/2011;
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ABSTRACT: Treatment approaches of patients with thoracoabdominal aneurysms and aortic dissections type B should be individual. Risk ratio of surgery itself and progression of non-operated disease, such as aneurysm rupture, is the determining factor in defining pro et contra surgical treatment.
Khirurgiia 01/2010;
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ABSTRACT: Short- and long-term follow-up results of intima-preserving exoprosthetics of ascending aortic aneurism in 50 patients were studied. The group of control consisted of 54 patients, whom traditional linear prosthetics of ascending aortic aneurism had been performed. Time of artificial circulation and myocardial ischemia was significantly shorter in first group: 60,3±2,6 min and 21±1,7min, respectively. Patients of both groups showed no significant aortic distension postoperatively (34,5±0,7 - 36,6±0,8 mm). Thus, a dosed resection of the ascending aortic aneurism with intima-preserving exoprosthetics proved to be relatively simple and promising technique.
Khirurgiia 01/2010;
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ABSTRACT: Long-term treatment results of 53 patients operated on thoracoabdominal aortic aneurisms and 7 patients, treated conservatively, were analyzed. Efficacy and choicelessness of operative treatment are demonstrated. 5-year general survival and complication free period for the operated patients were 0.59+/-0.09 and 0,67+/-0,1, correspondingly. 10-year survival and complication free period was 0.51+/-0.1 and 0,34+/-0,14. Unfavourable outcomes are cased by rupture or dissection of non-operated parts of aorta (40%); progressive coronary and carotid arteries occlusion (33,3%); septic complications (13,3%). Possibilities of long-term outcomes improvement after operative treatment of thoracoabdominal aortic aneurisms are proposed.
Khirurgiia 01/2009;
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ABSTRACT: Presented herein is own experience in successful management of a female patient diagnosed with a primary aortoesophageal fistula secondary to a rupture of a chronic posttraumatic dissecting aneurysm of the descending thoracic aorta into the oesophagus. The contained herein review of the literature deals with the problems concerning surgical policy of and indications for different variants of reconstructive operations on the aorta and oesophagus.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2008; 14(2):133-40.
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ABSTRACT: The problem of protecting the spinal cord and visceral organs in surgery of distal aortic dissections becomes increasingly important today because of a comparatively high incidence rate of complications. Paraparesis in type 3 dissecting aortic aneurysm (DAA) is noted to occur in ischaemia of the spinal cord lasting more than 56.5+/-12 min and the inclusion into the blood flow of less than two responsible intercostal arteries. Multiple-organ insufficiency in type 3 DAA is observed in ischaemia of the visceral organs lasting more than 36.4+/-6.9 min. While using profound hypothermia and circulatory arrest, fatal haemorrhage appears when the duration of the hypothermic arrest is more than 48+/-13.5 min. The used methods aimed at protecting the spinal cord and visceral organs (perfusion-free technique with cerebrospinal fluid drainage, left artio-femoral bypass, circulation arrest with deep hypothermia), optimization of the scope and technique of the operation, shortened duration of ischaemia, inclusion of the maximum number of the spinal arteries into the blood flow, the use of the system of collection and return of blood make it possible to expect a decreased number of complications.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2008; 14(1):100-4.
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Khirurgiia 02/2008;
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ABSTRACT: Overall 13 patients with aorta aneurysm disease underwent staging operations with 2 weeks - 12 years interval. Surgical treatment of aneurismal lesion of the whole of aorta is very difficult due to severity of the disease and non-typical surgical technique, and characterized by high complications rate and lethality. Individual approach to each patients and staging surgery permitted to achieve the positive results of surgical treatment with 10% lethality.
Khirurgiia 02/2008;
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ABSTRACT: Neurological complications after descending and thoracoabdominal aortic aneurysm (TAAA) correction procedures remain a serious challenge. Their prevention implies proactive approach to manageable risk factors: diagnosis and preoperative correction of latent renal failure [odds ratio (OR)=4.72; p=0.08] and minimization the cross-clamp time (OR=7.0; p=0.03). Extended TAAAs, especially type 1 and 2, (OR=8.5; p=0.03) must be operated only in facilities with sufficient experience in such reconstructions. Prognostic model was suggested to calculate precisely the risk of paraparesis. TAAA correction is accompanied by 1.45-fold higher risk of neurological complications then after procedures that are accomplished under protection.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 01/2008; 14(2):103-7.
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ABSTRACT: The paper presents the method of local repair of distal aortic dissections. Local aortic grafting for surgical correction of type B dissecting aortic aneurysms helped to decrease hospital mortality up to 15.4%, the rate of paraparesis and multiorgan failure - up to 11.5%.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2007; 13(4):138-43.
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ABSTRACT: The article deals with a clinical case report of a successful surgical treatment of a patient presenting with type III thoracoabdominal aortic aneurysm according to Crawford, using the technique of separate implantation of all the four visceral branches of the aorta into the side of the prosthesis due to impossibility of implanting them on a single platform.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2007; 13(1):139-42.
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ABSTRACT: Quality of life at the patients with dissecting aortic aneurysm type B and aneurysms of descending aorta were studied with SF-36 questionnaire before and after surgical treatment. Quality of patients life before and after surgical treatment is lower compared with health population. Reconstructive operation takes beneficial effect on life quality at long-term postoperative period.
Khirurgiia 02/2007;
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ABSTRACT: The surgical approaches for aneurysms of thoracoabdominal aorta are analyzed. Both thoracoretroperitoneal and thoracolaparotomic approaches are appropriate; they are up to quality of visualization and manipulation on low-thoracic part, visceral branches and bifurcation of aorta that is verified by experimental studies (wound depth 11-15 cm, angle of surgical action 100-110 degrees, angle of surgical action axis 80-90 degrees). The level of thoracotomy and type of approach depends on variant of lesion and planned reconstruction. Modified thoracophrenopararectal approach (wound depth 11.4+/-0.2 cm, angle of surgical action 97.0+/-3.7 degrees, angle of surgical action axis 88.0+/-2.0 degrees) is optimal for manipulations on aortic isthmus.
Khirurgiia 02/2007;
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ABSTRACT: Simultaneous surgical interventions on the aorta and valvular system of the heart were performed in four patients presenting with aortic dissections and aneurysms conditioned by Marfan's syndrome. The following reconstructive operations were carried out: 1) prosthetic repair of the aortic valve and the ascending portion of the aorta by means of a valve-containing conduit with replantation of the openings of the coronary arteries into the side of the prosthesis according to the Benthall - De Bono technique, annuloplasty of the tricuspid valve according to the De Vega technique, valvuloplasty of the mitral valve by the Alferi technique; 2) grafting of the aortic valve and the ascending portion of the aorta by means of a valve-containing conduit with replantation of the openings of the coronary arteries according to the Kabrol's technique, plasty of the tricuspid valve by the De Vega technique; 3) prosthetic repair of the aortic arch with distal wedge-like excision of the membrane of the dissection and directing the blood flow along the both channels, plasty of the mitral valve, plasty of the aortic valve and the ascending portion of the aorta with a valve-containing conduit, accompanied by replantation of the openings of the coronary arteries into the side of the graft according to the Benthall - De Bono technique; (4) plasty of the mitral valve with a disk graft through the fibrous ring of the aortic valve, prosthetic repair of the aortic valve and the ascending portion of the aorta with a valve-containing conduit, accompanied by replantation of the openings of the coronary arteries into the side according to the Benthall-De Bono technique.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2007; 13(4):126-31.
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Khirurgiia 02/2006;
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ABSTRACT: Primary results of albumin surgical glue application during surgical grafting of thoracic aorta are analyzed. It is demonstrated that the glue is an effective method of hemostasis, permits the surgeon to decrease time of surgery, intra- and postoperative hemorrhage.
Khirurgiia 02/2006;
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Khirurgiia 02/2006;
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ABSTRACT: Traumatic injuries to the thoracic aorta consequent on closed chest traumas present an extremely severe and unfavourable condition as regards natural history. One of the specific disease variants lies in the formation of false post-traumatic aortic aneurysm with an arteriovenous fistula. In the presence of post-traumatic aneurysm of the thoracic aorta with an arteriovenous fistula, the disease course may be complicated by the phenomena of circulatory decompensation. Taking into account certain features of the morphology and pathogenesis of the given disease, surgical interventions require strict adherence to a number of the rules which make it possible to avoid intraoperative aneurysmal rupture. The present paper describes a case of successful surgical treatment of acute false post-traumatic aneurysm of the aortic arch with an arteriovenous fistula under profound hypothermia and circulatory arrest. Presented herein is also a review of the literature concerned with the topic.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2006; 12(2):127-31.
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ABSTRACT: Presented herein are a rare clinical case and the results of successful staged surgical treatment of a patient with vasorenal hypertension, who had undergone repair of the thoracoabdominal aorta from the isthmus to the bifurcation with replantation of the intercostal, visceral and renal arteries according to Crawford. In the long-term period, the patient developed bilateral stenosis of two left and then of the right renal arteries. Correction of vasorenal hypertension required a special approach. In view of infeasibility of the use of the aorta for proximal anastomosis establishment (commissural process, deranged wall and graft) staged bypass grafting of two left and right renal arteries was performed.
Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2006; 12(3):127-31.
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ABSTRACT: Over 5-years, 167 reconstructive surgeries for stenosis of internal carotid arteries (ICA) were performed in 124 patients. Mean age of the patients was 63.5 years. One hundred and twenty-nine carotid endarterectomies (CEAE) in 86 patients and 38 reconstructive operations of ICA in 38 patients were performed. There were no lethal outcomes in short- and long-term postoperative period. In short-term period after prosthesis of ICA restenosis was revealed in 3% patients, after eversion CEAE in 3% patients the embolism was seen, after standard CEAE restenosis were diagnosed in 8% patients and thrombosis -- in 3%. In long-term period after grafting of ICA the strokes were seen in 3%, stenosis -- in 6% patients, after eversion endarterectomy -- in 0 and 3% patients, and after standard CEAE -- in 3 and 24% patients, respectively. It is concluded that grafting of ICA is adequate surgical method of reconstruction and stroke prevention in specific variants of carotid atherosclerosis.
Khirurgiia 02/2005;
