A N Vachev

Samara State Medical University, Kuibyshev, Samara, Russia

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Publications (23)19.01 Total impact

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    ABSTRACT: Presented herein is a clinical case report of successful stagewise surgical treatment of a patient with atherosclerotic occlusion of the main trunk of the renal artery of the single kidney. Clinically, the patient had signs of ischaemic renal disease in the form of pronounced azotemia being characteristic of the terminal stage of renal insufficiency, as well as malignant arterial hypertension. Besides, the patient had previously endured ischaemic stroke in the vertebrobaslar basin. The patient was subjected to stagewise surgical intervention, i.e., stenting of the upper-pole renal artery followed by open operation--prosthetic repair of the left renal artery with a synthetic prosthesis. Three months thereafter, the patient underwent carotid endarterectomy and operation of transposition of the subclavian artery. The postoperative period turned out uneventful. Currently, no progression of azotemia is observed, neither are there any indications for carrying out restorative therapy of the renal function.
    No preview · Article · Jun 2015 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery
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    Preview · Article · May 2015
  • A N Vachev · V K Koryttsev · I V Antropov
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    ABSTRACT: Treatment results of 59 patients with the complicated ulcer disease were analyzed. Authors prove, that in cases of perforative duodenal ulcer, the operation should aim the treatment of all the complications. The use of 2/3 gaster resection in combination with Jadd pyloroplasty and trunk vagotomy led to the decrease of the lethality rate on 21%.
    No preview · Article · Dec 2013 · Khirurgiia
  • E.A. Surkova · O.V. Tereshina · A.N. Vachev

    No preview · Article · Sep 2013 · Artery Research
  • O. V. Tereshina · Elena A. Surkova · A. N. Vachev

    No preview · Article · Sep 2013 · Artery Research
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    ABSTRACT: Introduction: A coronary-subclavian steal phenomenon was described in patients who have undergone prior bypass surgery using the left internal mammary artery (LIMA). Case report description: A 74-year-old male with a prior 3-vessel coronary artery bypass grafting (CABG) in 2005 was admitted to the hospital with the deteriorating condition over the last four months. He had complaints of exertional chest pain which was usually gone upon taking nitroglycerin. He had a history of carotid-subclavian bypass in 1995. His prior CABG included LIMA graft to the left anterior descending artery (LAD), saphenous vein graft (SVG) to the obtuse marginal (OM), and SVG to posterior descending artery (PDA). On admission, right arm blood pressure (BP) was 130/80 mm Hg, left arm BP was 80/60 mm Hg. Initial echocardiogram showed left ventricle (LV) ejection fraction of 53%. Stress-echocardiography was positive and demonstrated wall motion abnormalities in septal, antero-septal and anterior segments of LV. Duplex ultrasound revealed bilateral carotid stenosis of 55%, left subclavian artery subocclusion and stenosis of carotid-subclavian graft with maximal linear flow velocity up to 3.5 m/sec. Nevertheless both vertebral arteries had antegrade flow. Using cardiac catheterization severe 3-vessel coronary artery disease was diagnosed but PDA and OM SVG grafts and LIMA graft were patent. Angiography showed a severe stenosis of 95% of proximal left subclavian artery, stenosis of 59% of carotid-subclavian graft. LIMA graft had retrograde flow to the left subclavian artery and the first segment of left vertebral artery. The patient underwent PTA and stent placement of the left subclavian artery. During one-year follow-up period, he was symptom free, ultrasound showed normal flow in left subclavian artery, and regional wall motion of LV appeared to be normal. Discussion: Clinical manifestation of a coronary-subclavian steal in this patient was unusual with the severe angina but without any symptoms of cerebral ischemia probably due to partly functioning carotid-subclavian graft. Percutaneous revascularization of the subclavian artery was the reasonable treatment option. That lesion was more significant than stenosis of carotid-subclavian graft, more favorable for PTA due to minimal calcification and relatively short stenosis. Conclusions: Coronary-subclavian steal syndrome is a diagnosis that should not be overlooked, especially in patients with known peripheral atherosclerosis. Percutaneous interventions due to their efficacy and low complication rates constitute the first choice treatment in patients with high surgical risk.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: 299 patients with spontaneous pneumothorax were treated. All patients were divided in two groups. Patients of the first group (n=182) received thoracic puncture and/or drainage. The second group (n=117) has surgery, directed at liquidation of the source of pneumothorax, i.e., they received either atypical lung resection or subtotal parietal pleurectomy. The recurrent pneumothorax was registered in 24 (13.2%) patients of the first group and in 4 (3.4%) patients of the second. Authors state that radical surgical procedure for the spontaneous pneumothorax is an atypical lung resection with parietal pleurectomy. The use of active surgical tactics allows to decrease the number of recurrencies on 9.8%.
    No preview · Article · Jul 2013 · Khirurgiia
  • A N Vachev · D A Chernovalov · M S Mikhailov
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    ABSTRACT: Assessed herein are the results of treating a total of 119 patients presenting with chronic critical ischaemia of the lower extremities accompanied by necrosis of distal portions of the foot. All patients underwent various successful operations of lower-limb revascularization, followed by evaluating the terms of healing of the wounds on the foot after necrectomy and minor amputations. A conclusion was made that after successful limb revascularization for critical ischaemia in patients with atherosclerosis accompanied by coagulative necrosis, performing minor amputations and necrectomies should be delayed.
    No preview · Article · Aug 2012 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery
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    ABSTRACT: The article deals with outcomes of managing a total of twenty-nine patients of high operational risk with TASK II type С and D lesions of the aortoiliac segment. All patients were subjected to single-stage hybrid operations: open reconstructive interventions on the infrainguinal zone and stenting of iliac arteries. High risk of coronary complications these patients were running was confirmed in accordance with the European guidelines on perioperative assessment of the patients being elected for extracardiac operative treatment. Critical ischaemia was in all cases reliably relieved. Two patients during predilatation developed haemorrhage due to iliac artery rupture which was the cause of changing over to open operation. No lethal outcomes were observed.
    No preview · Article · Jul 2012 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery
  • A N Vachev · E V Frolova · N A Smolina
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    ABSTRACT: The article deals with surgical treatment of patients presenting with resistant arterial hypertension and detected pathology in the adrenal glands. The authors analysed the outcomes of surgical management of 97 patients with resistant arterial hypertension, also determining the factors contributing to prediction of the antihypertensive effect of adrenalectomy depending on morphological damage to the adrenal glands.
    No preview · Article · Jan 2011 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery
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    ABSTRACT: The experience of 34 operations of omental implantation to the patients with the critical lower limb ischemia due to the obliterative thrombangiitis was analyzed. 5 patients had the procedure on the both limbs simultaneously. The operative technique had been thoroughly described in the article. The procedure, being accomplished according to the certain standards, proved to be extremely effective.
    No preview · Article · Jan 2011 · Khirurgiia
  • A N Vachev · V V Sukhorukov · E V Frolova
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    ABSTRACT: Presented herein is a successful outcome of stagewise surgical management of a young adult suffering from nonspecific aortoarteritis accompanied renal artery lesions. The patient was subjected to a stagewise intervention consisting of stenting of the renal arteries and an open operation, i.e. bilateral aortorenal bypass grafting performed with the synthetic stent B-Braun.
    No preview · Article · Jan 2011 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery
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    ABSTRACT: 102 tissue samples, resected during treatment of the perforated duodenal ulcers. The most pronounced fibroplastic and acute inflammatory tissue changes were registered in the immediate perforation zone and 0,5 sm above. At a distance of 1,0 sm these changes become less evident. Therefore, in patients with the perforated duodenal ulcer and palpable surrounding infiltrate less than 3,0 sm in diameter, the resection line should be no shorter than 1,0 sm away from the perforation.
    No preview · Article · Jan 2011 · Khirurgiia
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    ABSTRACT: A retrospective analysis of 365 completed patient records received by the duty surgical hospital with perforated gastric ulcer and duodenal ulcer. All the patients were operated on urgently. Diagnosis of purulent peritonitis was set 17% of patients, "serous"--47.4%, "seroplastic"- 35.6%. 75.3%, perform suturing of perforated openings, regardless of the form of peritonitis. The remaining 24.7%--interventions that address as a perforation, and the impact on the pathogenesis of peptic ulcer. When radical surgery, which were performed in selected patients even with purulent peritonitis, deaths were reported. And when suturing the ulcer defect lethality was 14.5%. In this group of patients were comparable in age and severity of general condition. It is concluded that that the operations of suturing perforated ulcers were used unnecessarily broad, and the majority of patients admitted to hospital with a perforated stomach ulcer and duodenum may increase the volume of surgical benefit for radical treatment of complications as well as most of peptic ulcer.
    No preview · Article · Jan 2010 · Ėksperimental'nai͡a i klinicheskai͡a gastroėnterologii͡a = Experimental & clinical gastroenterology
  • A N Vachev · V K Koryttsev · T V Larina
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    ABSTRACT: Treatment tactics of patients with duodenal ulcer bleeding were analyzed. Criteria of recurrent ulcer bleeding were defined. The importance of consideration of thrombocyte hemostasis component in treatment of such conditions was studied.
    No preview · Article · Jan 2010 · Khirurgiia
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    ABSTRACT: Presented herein are favourable outcomes of surgical management in six patients suffering from thromboangiitis obliterans (TO) with accompanying critical ischaemia of either the both lower extremities (5 subjects) or the both upper limbs (1 patient). They were all treated by means of a surgical intervention with simultaneous transplantation of the greater omentum on a vascular pedicle onto the both limbs. A total of 12 revascularizing procedures were performed. With an overall of the 12 extremities eventually spared, the remote limb-salvage rate amounted to 100%. A detailed description of the procedural technique is followed by analysing long-term therapeutic outcomes having proved encouraging. The obtained results confirmed a possibility of reliably relieving critical ischaemia inpatients with TO by means of transplanting the greater omentum on a vascular pedicle simultaneously onto the both limbs.
    No preview · Article · Jan 2010 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery
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    ABSTRACT: Aim of the study was to assess effect of therapy with b-adrenoblockers and If-inhibitors on the rate of development of coronary complications of carotid endarterectomy. Patients (n=111, mean age 61 +/- 4 years) subjected to carotid endarterectomy in 2006 - 2007 were divided into 3 groups according to therapy in pre-, intra-, and postoperative period. Group 1 consisted of 48 patients treated with metoprolol. Group 2 comprised 33 patients with contraindications to b-adrenoblockers who were treated with If-inhibitor ivabradine. Patients of control group 3 (n=30) received neither b-adrenoblocker nor If-inhibitor. There were no significant differences between groups in sex, age, concomitant pathology, and degree of stenosis of operated carotid artery. We assessed rate of development of ischemia and myocardial infarction during operation and in first 24 hours after surgery. In group 1 mean 24 hour heart rate according to Holter ECG monitoring after 7 days of therapy decreased by 14 +/- 3,7 beats/min, episodes of ischemia after surgery were registered in 4 patients (8%). In group 2 mean 24 hour heart rate decreased by 10 +/- 2,5 beats/min, 4 patients (12%) had signs of myocardial ischemia during first 24 hours after surgery. There were no myocardial infarctions in groups 1 and 2. In control group mean 24 hour heart rate did not significantly change. Significantly higher number of postoperative coronary complications was revealed among patients of this group: 2 (6%) developed myocardial infarctions, in 5 (17%) appeared signs of myocardial ischemia. Administration of b-adrenoblocker metoprolol and If-inhibitor ivabradine significantly lowers rate of development of coronary complications after carotid endarterectomy. Ivabradine is indicated to patients with contra indications to b-adrenoblockers.
    No preview · Article · Feb 2008 · Kardiologiia
  • YV Shchukin · AN Vachev · EA Surkova

    No preview · Article · May 2006 · European Journal of Cardiovascular Prevention and Rehabilitation
  • A N Vachev · V K Koryttsev
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    ABSTRACT: Results of treatment of 308 patients under 60 years of age with verified stopped ulcer duodenal bleeding were analyzed retrospectively. The number of recurrent bleedings among 85 women was less than among 223 men with similar location of ulcer, severity of blood loss and methods of treatment. Basing on the results of treatment of 99 patients who received no transfusions of blood components it was demonstrated that the velocity of erythrocytes and hemoglobin natural recovery after blood loss was significantly higher among women than among men.
    No preview · Article · Feb 2006 · Khirurgiia
  • A N Vachev · Iu V Shchukin · E A Surkova
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    ABSTRACT: The aim of the study was to decrease the risk of ischemia and myocardial infarction (MI) in intraoperative and early postoperative period after carotid endarterectomy (CEA). 295 patients underwent CEA from 2001 till May 2005 in the Clinics of faculty surgery, Samarsky state medical university. Besides clinical investigation, patients underwent Doppler ultrasonography of brachiocephalic arteries, transcranial Doppler, brain CT (if appropriate), echocardiography, repeated ECG and intraoperative ECG monitoring. Patients were divided into 3 groups. The first group (n=78, 26.4%) did not receive any special preoperative cardiological care. Among them MI developed in 8 patients (10.2%) on the first postoperative day. The second group (n=131, 44.4%) received nitrates, desaggregants, calcium antagonists, ACE and metabolic drugs preoperatively. In this group there were 6 cases (4.6%) of MI in early postoperative period. The third group (n=86, 29.2%) received cardioselective lipophilic beta-blockers (Atenolol, Metoprolol), in addition to drugs that were given for the second group. No cases of MI in early postoperative period were registered in the third group. Differences were statistically significant (p<0.05). Inclusion of beta-blockers into preoperative medical care before CEA procedure significantly decreases the risk of myocardial ischemia and infarction in early postoperative period (24 hours).
    No preview · Article · Feb 2006 · Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery