The study generalized the 15-year experience of classical carotid endarterectomy performance with application of a temporary carotid shunt and an autovenous path in 325 patients. There were analyzed the more frequent complications in standard groups. Advantages of given method were determined and it was specified the ways, which facilitated to reduction of intraoperative risks and increase of technical quality realization of different stages of surgery.
Цель исследования-оценка итогов различных методов реваскуляризации у пациентов с MPAD. Материал и методы. Проанализированы результаты послеоперационного периода у 222 пациентов с мультифокальным поражением. Пациенты были разделены на три группы по типу выполняемой реконструкции артериального русла: 129 пациентам проведены открытые операции, 63-эндоваскулярные способы реваскуляризации, 30-гибридные вмешательства. Результаты. Больше больных с высоким периоперационным риском (III-IV ASA) было зарегистрировано среди пациентов эндовазальной и гибридных групп (p<0,05). Все гибридные вмешательства были выполнены симультанно, что сказалось на экономической эффективности вмешательства и первичной проходимости оперированного сегмента в 30-дневный срок. Среди пациентов, которым были выполнены эндоваскулярные и гибридные операции, не зафиксировано потери конечностей в 30-дневный срок; в группе открытых операций данный показатель составил 4,9%. Выводы. Гибридные вмешательства минимизируют риск развития негативных последствий, что позволяет использовать их у пациентов, которым невозможно выполнение многоуровневых открытых реконструкций. Ключевые слова: многоуровневое поражение, периферический атеросклероз, гибридные операции.
OBJECTIVE. The authors would like to consider the possibility and feasibility of simultaneous revascularization of two arterial segments in patients with lower extremity arterial occlusive disease by method of semiclosed loop endarterectomy. MATERIALS AND METHODS. The research included 143 patients. Revascularization of aortofemoral segment was performed on 67 patients. The simultaneous revascularization of aortofemoral and femoropopliteal segments was carried out for 76 patients. The follow-up period was 5 years. RESULTS. There was revealed that the long-term results of multilevel reconstruction were worse that single-level reconstruction. This method requires an individual approach. The best results of simultaneous interventions were obtained in patients aged 60 and older with the III stage of chronic limb ischemia and 2 or 3 working shin arteries. The worst results were observed in patients younger than 50 year old with IV stage of critical limb ischemia and significant lesions of shin arteries.
The case of surgical treatment for lipoblastomatosis extended into soft tissues of the neck, mediastinum, and spinal canal in a two-year-old child is presented. The child previously underwent three non-radical surgeries. The treatment success was determined by combined work of the multidisciplinary surgical team including general, spinal, thoracic and vascular surgeons, and neurosurgeons.
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