Backgound. The number of patients with Leriche’s syndrome has increased dramatically. Despite the compensatory development of collaterals, this condition most often leads to symptoms of intermittent claudication and can result in critical ischemia and amputations. TASC II guidelines recommend reconstructive surgery, but this approach is associated with high perioperative mortality. So far, only few studies reported the results of endovascular correction of the atherogenic process in the infrarenal aorta.Objective. To present a clinical case of hybrid revascularization of the aortofemoral segment in a patient with ischemic heart disease.Design and methods. A 68-year-old patient with Leriche’s syndrome underwent ultrasound of the brachiocephalic arteries, coronary angiography, and multispiral computed tomography with angiography. Subsequently, hybrid surgery was performed.Results. Given the critical ischemia of the lower extremities and comorbidities, a hybrid surgical intervention was performed: endarterectomy from the femoral arteries and endovascular recanalization of the occlusion of the aortoiliac segment using the “kissing stents” technique.Conclusions. The requirements for equipment and experience of the surgical team limit the widespread use of hybrid correction of an occlusive lesion of the infrarenal aorta. The lack of randomized trials creates uncertainty in the choice of revascularization tactics. In the framework of this clinical case, the effectiveness of hybrid surgery in the treatment of a patient with multifocal atherosclerosis has been proven.
Splenic artery aneurysm is a rather rare abnormality, and its treatment is a pressing issue due to high morbidity and mortality in case of its rupture.Our aim is to show the advantages of the laparoscopy for splenic artery aneurysms.Patient P., 81 years old, was admitted for surgical treatment of the splenic artery aneurysm. Angiography revealed the tortuosity of the splenic artery with a 28-mm distal aneurysm. Laparoscopic treatment of the aneurysm was performed using a stapler. No complications were observed during the postoperative period, so the patient was discharged on day 5.The laparoscopic treatment is a method of choice in patients with a tortuos splenic artery and a distal aneurysm to spare a spleen. Received 20 December 2021. Revised 13 April 2022. Accepted 26 April 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: A.G. Vanyurkin, Yu.A. KudaevDrafting the article: N.S. Odintsov, Yu.K. BelovaCritical revision of the article: A.E. Neimark, M.A. ChernyavskiySurgical treatment: A.E. NeimarkFinal approval of the version to be published: N.S. Odintsov, Yu.K. Belova, A.G. Vanyurkin, Yu.A. Kudaev, A.E. Neimark, M.A. Chernyavskiy
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